{"text": "###Input :My daughter ( F, 18 y/o, 5'5', 165lbs) has been feeling poorly for a 6-8 months. She had COVID a couple of months ago and symptoms have are much worse in the last month or so. Symptoms seem POTS-like. She feels light headed, breathless, dizzy, HR goes from ~65 lying down to ~155-160 on standing. Today she tells me HR has been around 170 all day and she feels really lousy. (She using an OTC pulse ox to measure.) She has a cardiology appt but not until March and a PCP appt but not until April since she's at school and it's a new provider. What to do? Is this a on call nurse sort of issue? Or a trip to the ED? Or wait till tomorrow and try for an early appt? Try a couple of Valsalvas? Wait it out until her cardio appt? Or? She's away at school if Boston, what to do? Thank you ###Output :If she actually has a HR of 170 that is accurate, ongoing and persistent, she needs to be seen in the ED immediately."}
{"text": "###Input :Im a 37 y.o. transgender man with pre-diabetes and high cholesterol/triglycerides. I had chest pain and dizziness several months ago and went to cardiology for tests. Stress echo was normal, though the symptoms were still made worse with the exercise. I was sent for a CT scan with contrast. No blockages or abnormalities. They did find a small hiatal hernia. I asked if that could cause chest pain and they reluctantly admitted that it could. I say reluctantly because despite my results being normal, she wanted to put me on a stronger statin. Ive been on statins for years and it has impaired my glucose tolerance. Rather than go on Metformin, I opted to go on strict low carb diet, monitor my glucose and lots of walking. Ive done that for two years and Im almost back in to anormal A1C. Ive worked very hard. I also switched from Simvastatin to Pravastatin. The latter has some preliminary findings suggesting it doesn't effect glucose tolerance as strongly. One of the worst statins for this...is Crestor. The cardiac nurse is convinced that I need to be on it. So I tried it for a month and surprise - my glucose is impaired again. (Morning was usually 160 at worst, two days ago it was 300. My diet has not changed.) I said no thanks to the Crestor and asked to be put back on Pravastatin. Nurse was really pushing back saying its still worth the risk because my cholesterol was too high on the Pravastin. I agreed to double my dose of it until we sort out this dispute. I get a call today from the cardiologist resident who was approached by the RN about my refusal to take Crestor. I get the same spiel about how its worth the risk. I explain patiently that A) I show no signs of heart disease. B)that my chest pain was very likely the hiatal hernia (which will be addressed separately)C) That although I understand their logic, I have worked very hard to keep my Diabetes controlled without Metformin. The common side effects of which (fecal incontinence and nausea) Ive seen with my sister and would very much like to avoid. Cardio Resident says she will \"consult Endocrinology but they will likely say the same thing\". Add to this that Im on Testosterone Cypionate , which she says can cause the triglycerides to read high. I told her to make sure she mentions this when she talks to the Endo. I feel like I am being forced onto a medication that I dont consent to. Here are my questions: 1) could Testosterone cypionate cause a false high reading of triglycerides on a blood test? 2) Am I being foolish in my refusal of the more aggressive statin? 3)Are there other options I am not seeing? ###Output :How high is your cholesterol? Since youre only 37 and they are pushing statins pretty hard, I would assume that your cholesterol sucks and you almost certainly should be on atorvastatin or rosuvastatin if it is being recommended by two cardiology providers. Small hiatal hernias do not generally cause chest pain, and for sure do not cause dizziness. If your chest pain was worse with exercise, its concerning for micro vascular disease, with a normal CT.Overall while statins do increase glucose intolerance, they overall have a net benefit in decreasing risk of heart attack and stroke. While your glucose numbers may change, its less about the glucose numbers and more about reducing downstream effects.It is kind of silly frankly to avoid metformin without knowing if youll have GI side effects or not. You likely will unfortunately need metformin in the future, statin or not, and if you dont tolerate metformin there are other alternatives out there such as GLP-1 agonists and SGLT-2 inhibitors that also help with cardiovascular risk."}
{"text": "###Input :Male 35 physically active no issues before non smokerRecently my entire body swelled up like edema was in the hospital CK level super high but leveled out and started attacking itself over the last year I've gone to every doctor possible. My body is losing skeletal muscle mass and spams for the last year with no clear answers. I'm swimming in all my clothes and no matter what I do nothing helps. Excessive exhaustion and sweating as well.Went to cardiologist but she was vague on my test and scheduled a ct was wondering if anyone had suggestions after echo and ekg were negativeI've been to go a rheumatologist, neurologist, etc and no one has answers for what's going onThis is the latest from my cardiologist but if anyone else has ideas pleaseRAC sign is present, suggestive of anomalous coronary circulation with retroaortic course. ###Output :Wish you the best,, really with this the only way anybody could provide any sort of advice would be a review of complete medical records and all lab findings"}
{"text": "###Input :Appreciate it al labs have come back completely negative only thing that's been consistently elevated but wasn't that much of a concern was CK levels everything else you could think of from any type of test normal ###Output :again, really need complete work up and medical notes to provide any insight here"}
{"text": "###Input :32F, 130-140lbs, have asthma and history of postpartum preeclampsia. Former cigarette smoker, currently vapes nicotine.ECG in comments.Ive been feeling huge thumps in my chest, several times a minute. Called 911 a few days ago because I wasnt sure if I was going to keel over, have never felt this before, and was scared. EMT thought I was in AFIB. ER doctor says no, just PVCs and to reduce my stress, stop vaping and limit caffeine. That these are harmless and I dont need to worry.Sometimes I feel lightly dizzy when it happens. I notice them when Im falling asleep. I notice them just sitting here, and the last few minutes, Ive been feeling big thumps pretty much every 15-20 seconds. Theres no way thats normal right?Can someone tell me if I need to ask my PCP for a referral to cardiology? Or tell me what youre seeing? This is truthfully scary to me and so uncomfortable. ###Output :Normal sinus rhythm with a PVC. Not concerning."}
{"text": "###Input :33F 144lb 55 ex-smoker x13yrs quit 2018 non-drinker Dx GPA with kidney/sinus/joint/skin involvement 2002, CKD2, chronic migraine with aura, SVT ablation 2017 dual AV node, sepsis 2018 from PID due to improperly placed IUD, dysautonomia (dx recently from tilt table test), Sjogrens, hospitalized in November for hypoglycaemia (glucose 2.7) still being worked up by endo but symptoms resolved after Rituxan so they are thinking autoimmune hypoglycaemia  Im not going to list everything because its just depressing and not relevant. Basically a big mix of autoimmune disorders and premature degenerative conditions related to treatment for GPA Currently taking ..Rituxan infusions every 6 months, next one in a couple of weeksPlaquenilLipitorZoloftWellbutrinGabapentinCyclobenzabrineEltroxinVyvanseZopicloneDomperidoneZofranTopiramateOxycodoneTriptans for migrainesSome PRNs Im forgettingSo I just want to know if this ECG is normal. Ive never gotten any alerts for Afib on my Apple Watch before and today during a particularly brutal migraine with lots of dry heaving, I got a few alerts (this ecg isnt of the Afib ones). If you move the sensor, you can get different lead ECG readings (according to my cardiology nurse). I placed the sensor over V2 (I had to look that up) to get this reading and the big dip after the QRS complex (also had to look that up) looks off to me when I compare it to the normal image on Google. Is this something I should be concerned about? Migraine has started to abate but I feel weird. Heart was pounding in throat the whole time, especially when on my side. Some shortness of breath. Mostly feeling better now.Thanks for your time, help (hopefully) putting my mind at ease and teaching me something in the process :)Edit - also, not sure if relevant but I got my 5th COVID vaccine (the bivalent Pfizer one) on Mondayhttps://i.imgur.com/mA1T0Vz.jpg ###Output :EKG interpretation requires a very comprehensive understanding of cardiac electrophysiology, anatomy, and pathological processes, including the mechanisms that various arrhythmias, ischemia, and, in your particular case, previous procedures/ablations have on these functions. Without attempting to delve into the \"why's and how's\" of what these very complex squiggles mean, the short answer to your question is yes: inverted T waves in lead V2 can be completely normal in many individuals (that \"dip\" you're referring to after the QRS is the T-wave, and inverted just means that it's flipped upside down)."}
{"text": "###Input :Thank you so much for the education :) ###Output :Did you place the back of the watch on your chest (in the V2 lead position) and then touch the crown with your finger to get this? If so, then the inverted T wave you are concerned about would not be a valid finding. The voltages in the precordial (V) leads in a 12 lead EKG are measured in relation to the average of the 4 limb leads, not just one arm which the watch is doing. EKG tracings from Apple Watches are good for determining heart rhythms but not much else."}
{"text": "###Input :Thats exactly what I did. I was told you could use it on that area and even on the ankle to replicate different ECG (EKG?) leads. Thank you for the info!! Phew! ###Output :It would be theoretically possible to get a tracing with accurate wave morphology between 2 limbs with an Apple Watch, but it could be inverted if the polarity is switched. Please dont try this though, it can only serve to stress you out more. As long as the watch says sinus rhythm, you are probably good. Ask your physician for a standard EKG is you are concerned."}
{"text": "###Input :I appreciate you geeking out with me explaining the technology moreI find all of this stuff so fascinating. I got 6 Afib alerts today but I read there are a lot of false positives, especially with younger people. Will go get a full 12 lead to make sure. Thanks again! ###Output :Did the watch say an EKG tracing you performed showed afib or was it from monitoring from the heart rate sensor?"}
{"text": "###Input :An EKG I performed while having palpitations showed Afib, which is why I started trying to get different lead readings  was trying to see if it was a fluke or not and get as much info for cardio if necessary (Holters suck). Didnt happen consistently when performing recordings back to backsome would say it detected Afib and others sinus. ###Output :Thats a bit concerning. Be sure to show those EKG tracings to your cardiologist.Many of the medications you list can can affect heart rhythm and interact with each other. The Vyvanse particularly would not be good to take if there is a question of atrial fibrillation."}
{"text": "###Input :I think its long QT? Something QT? Pharmacist mentioned that I was on a lot that increased that risk so Ive been careful with the domperidone and zofran but I had to take both today. In your opinion, are there any meds you would cut? Other than the Oxycodone - I have a plan for that. I know you dont know my full medical history but I would love to eliminate some of these meds. Are there any redundant ones? Ones that work against another one? I wont take what you say as medical advice and discontinue meds or anything - just curious what another doctor would say. Appreciate it!Edit - and stopping Vyvanse for now until I talk to cardio is probably the best. I dont take it every day anyways ###Output :No way I can address something this complex and nuanced in this forum. Please discuss this with your personal physician."}
{"text": "###Input :Thank you for the advice! We havent thought about pheochromocytoma. It does seem to line up. How does that get diagnosed? The website I was reading just a minute ago said a 24-hour urine test which she did when her GI doctor wanted to test for carcinoid syndrome/neuroendocrine tumors with a 5-HIAA urine test. I think they were only testing 5-HIAA though and not anything else so not sure if thats what they test for when checking for pheochromocytoma. Shes also had a kidney ultrasound and two abdominal (including kidneys) CT scans with contrast. Would they have shown up on those or is it one of those things they have to be specifically looking for?Shes reached out for therapy. She actually is a counselor herself so we tend to think she had the proper coping skills herself but as time has gone on with this, she has reached out to former colleagues, specifically to try to schedule EMDR therapy which has been very helpful for her in the past.The tricky part with it being related to anything COVID-related is she's never actually tested positive for COVID. So we don't know that she's had it even though when she searches for others dealing with her symptoms on reddit, it often takes her to posts in the covid longhaulers subreddit. ###Output :5-HIAA testing is for carcinoid syndrome, not pheo"}
{"text": "###Input :I would test Seum Copper levels and Zinc. Copper deficiency can cause peripheral neuropathy, histamine intolerance (copper is a cofactor of DAO), dysautonomia (copper is a cofactor of DBH, required to convert dopamine to norepinephrine), EKG abnormalities.Copper deficiency can be caused by zinc toxicity, and zinc has become a very popular supplement \"to prevent\" COVID. Too much zinc supplementation without Copper can lead to copper deficiency.We havent looked into that. She doesnt take any zinc supplements so were not sure what would cause her to have copper deficiency or zinc toxicity. Well write it down to mention to her PCP at her next appointment.She has been checked for carcinoid syndrome. Her GI doctor suggested it and she had both the CgA blood test and 24-hour urine 5-HIAA test that luckily both came back in normal range. ###Output :I agree with another poster - she needs to have a PCP that can consolidate her information and testing to help you guide where to go next. I think you keeping this list is fantastic to help you advocate for yourselves.There are a few things here:The white plaques found on the colonoscopy Spring 2021 is of very high interest especially given that the cause was not determined. Was it ever biopsied? It may be worth another repeat C-scope because it sounds like the most recent direct visualization was an EGD. Low grade colitis from inflammatory bowel disease doesnt always show up on a CT scan.I also think her autoimmune workup is incomplete from the blood work listed. In addition to this, viral illnesses (such as the one she had in 2019 that may or may not have been COVID) often can trigger the beginning of an autoimmune condition. The blood work ANA and RF is by no means comprehensive. Why was an RF checked? Was she having joint pain as well? With a family history, autoimmune conditions are very high on my listnose symptoms, lung symptoms, microscopic hematuria, peripheral nervous system issues beings up differentials including: GPA (granulomatosis with polyangitis previously known as Wegeners Granulomatosis) and Anti-GBM (Goodpasture) Disease which are autoimmune vasculitisI would recommend checking for vasculitis: ESR, CRP, C3/4, ANCA, Anti-GBM, cryoglobulinsOther autoimmune conditions can manifest with GI issues too - there is a lot of overlap. Whether she has joint pain or not, I would check CCP, HLA B27, Sjogren panelSystemic scleroderma is a possibility too which would include Anti-Scl70 labsIf she has joint pain, a synovial ultrasound of the hands / feet may find active joint or tendon inflammation which would support an inflammatory condition as well.I hope this information can help bring your wife some answers and hopefully treatment"}
{"text": "###Input :I greatly appreciate this response as its extremely informative!The white plaques were never followed up on unfortunately. Her blood in her stool cleared up shortly after so she let it go.I definitely agree with you on the autoimmune thoughts. I had no idea there were so much more to test for. What kind of specialist would she see who would run those kinds of tests and how does she approach it with that doctor? Just tell them she wants to be tested for everything? ###Output :A lot of those blood tests I mentioned any primary can order as well as the synovial ultrasound.Its hard to approach an MD about specific tests but I think its worth asking. It just depends on how you think your doctor is. I have patients ask me for specific tests pretty often and we just make a joint decision on if its worth it in shared decision making.As for which specialty? rheumatology and GI would be the ones in my opinion."}
{"text": "###Input :Hey. I am male 24 Height 5:10 and weigh 87 kg. I don't drink or smoke. For a few months i have been suffering from left sided chest pain that radiates to my left arm and back. I also suffer from shortness of breath at times. I decided to get my lipid profile done and my cholesterol levels came back very high. I then decided to get Echo Cardiogram and Exercise Tolerance Test and some other blood work. Can you take a look at my reports. Thankshttps://imgur.com/a/SiBOG1Phttps://imgur.com/a/yKBhqsFhttps://imgur.com/a/aK6RuWchttps://imgur.com/a/IWwMi1vhttps://imgur.com/a/UaEOvP2 ###Output :The point of getting testing like this done is to go over it with a medical professional who can then make recommendations. The echo and stress test are normal, your cholesterol is too high. I'd suggest that you find a primary care doctor."}
{"text": "###Input :I did. Was recommended to start statins but i am yet to start those. I wan't to see if the levels could be brought down by lifestyle and diet changes first. I just can't figure out why im experiencing the chest pain. ###Output :That's a good thing to talk to your PCP about. GERD is a common cause of non-cardiac chest pain."}
{"text": "###Input :35 yo female 5'7\" (170 cm) 180lbs (81.6kg) Caucasian and Native American I have previously had high blood pressure, but as of the last year or so my blood pressure has become very LOW for undetermined reasons, with my most recent reading being 101/60Primary symptoms: Decreasing general health for the past ~3 years, primarily presenting as severe fatigue, syncope + nausea when overheated or standing up too quickly, needing a minimum of 10-12 hours of sleep every night to feel rested, general malaise.I have asthma, ADD, MDD. Drink occasionally; previous occasional smoker but quit ~5 years ago. Same for recreational drugs -- on occasion when I was younger, but none for at least 5 years. I had previously been diagnosed with Rheumatic Fever in 2015, which seems VERY relevant here, but every doctor I've tried to discuss it with brushes it off when I mention it.So, last month I finally got a referral to a cardiologist, after years of trying to get one, and I was given a heart monitor to wear at home for two weeks, and then on Dec 23rd I had an echocardiogram ultrasound done. After trying and failing to get ahold of them by phone, Friday I FINALLY received a letter in the mail with my results. The front page of that letter states that all my tests were normal, and no follow-up is needed.THEN, that same letter goes on to detail in the next few pages that I have a small left ventricle, sinus tachycardia with an average heartbeat ranging from 90-150 bpm, paradoxical septal motion, mild pulmonary valve regurgitation, a thickened mitral valve, mild mitral valve regurgitation, trivial tricuspid valve regurgitation, and then it states that my \"right ventricular systolic pressure could not be estimated due to inability to detect peak tricuspid regurgitation\" and that my pulmonary valve stats were also inconclusive due to \"poor visualization\".The \"inconclusives\" I suppose could go either way, and I don't know if those are something I should try to get more testing for to clear up or not. But the rest definitely does not sound \"normal\" to me, and based on a quick Google search most of those things seem to be more common in someone who has had previous cardiac surgery, which I have not, and/or they usually go hand-in-hand with severe pulmonary hypertension, and as previously mentioned, my blood pressure has been consistently LOW, to the point of being almost abnormally so, for at least the past year.So, is there anyone who can confirm that all those abnormalities could be found, while still falling within the \"normal\" range of test results? Am I just reading too much into this, or am I right in thinking that my cardiologist didn't do his job properly, and a second opinion is needed?Update: Wow this really took off way more than I expected! I went to bed early last night, was busy with other stuff this morning, and then I'm American, so I have been thoroughly distracted by the absolute shitshow going on in DC ever since..., so I haven't logged on to Reddit to check back on responses until just now. Thank you to everyone for what looks like some very educated replies; I'm working my way through them and will try to respond more thoroughly tomorrow after a good night's (hopefully) sleep! ###Output :Nearly all of the things youve described are seen on essentially every echo report. Trivial and trace and mild regurgitation are seen in one or more valves of (what I estimate to be) the vast majority of healthy people. The regurgitation is only really abnormal if its significant (moderate or severe). Its important to mention any at all, though, so the previous report can be compared to any future ones (among other reasons). The reason theres a lot of could not assess...poor visualization all over the report is because this was a transthoracic echo. If they need better visualization of those structures, they would need to do a transesophageal echo which is a really not-fun procedure which requires you to be sedated, and is usually reserved for people with high suspicion for infective endocarditis or severe cardiac disease involving the poorly visualized structures.The rest of the findings could be related to pulmonary arterial HTN, which youve already mentioned. PAH is not the same as hypertension in general. The lung circulation is separate from the systemic circulation (though obviously the two are connected) and PAH is usually due to changes in the lung structure or function. For example, COPD, pulmonary fibrosis (scarring in the lungs), or - my attendings personal favorite underdog in the world of heart/lung issues - sleep apnea.The full report of any diagnostic study, like an echo, is always going to have something that doesnt sound completely normal in it - the wonderful world of incidental findings. Thats why its important to go by what the cardiologist or other ordering physician interprets from the echo. Its also why every diagnostic report has a disclaimer along the lines of correlate with clinical findings. In the context of your presentation, the echo that you had done was essentially normal. Its what my own echo report said despite results that could have been used to diagnose someone with heart failure with reduced ejection fraction had they been a 68 year old with blood pressure of 155/100 for the past 25 years, extra heart sounds, and shortness of breath.Your echo was done, I presume, to look for rheumatic heart disease in the context of your clinical findings (which could be consistent with that, though its rare to get this from only having rheumatic fever once). These findings arent really consistent with RHD. The mitral valve is slightly thickened, which may be the result of the rheumatic fever, but the report does not show mitral stenosis (the expected consequence of RHD).What Id recommend doing is writing down the findings youve seen on the report, including your concerns about what they could mean, and other good questions youve asked in your post here (like about pulmonary artery hypertension, and the poor visualization of certain structures on the echo and how important these inconclusive findings would be to a diagnosis) and take them with you to the next appointment. Because your cardiologist has a more complete picture of your clinical presentation and other health info, they are the best person to help guide you through the report, why they do not feel this echo has shown the underlying problem, and the next steps to take.Best of luck to you, and thank you for the question! Echo reports are always confusing and concerning to many who arent aware that many of the abnormal findings are often normal variants, so this is a great post to discuss that with."}
{"text": "###Input :Sorry for such a late reply, but the past few days have been a bit busy for me. Thank you for such a detailed response!So, the echo actually wasn't done specifically to look for Rheumatic heart disease -- that's just something I thought might be relevant or related to the problems I've been having. It was primarily done because I've been having these periodic attacks of such severe fatigue I can barely get out of bed, and when I do manage to get myself upright, I get out of breath and heart-poundy with even the slightest exertion, and am just generally extremely weak and disoriented -- I can't lift my arm over my head for more than a couple seconds, can't stay standing very long without sitting or leaning heavily on something, etc... and if I try to fight it and actually KEEP myself upright and moving around for more than a minute or two -- ie, to take a shower -- it quickly progresses to my heart feeling like it's gonna pound out of my chest, then nausea + room violently spinning, very rapidly followed by syncope. I'm not sure if it's full or partial syncope because I'm not sure if only being \"out\" for a few seconds or so qualifies as full syncope or just partial -- but I definitely black out briefly and collapse, and then spend awhile feeling violently sick and dizzy and shaky (and cold-sweaty) after I come back to. These \"attacks\" (episodes? Not really sure what to call them) come and go, but when they happen, they generally last about a week (roughly 3-4 days of being really bad, then another 3-4 days of recovery before I'm relatively back to normal again.) I've figured out that my Adderall prescription seemed to be a primary trigger for these attacks, so I've recently quit taking that altogether, and I'm hoping that will drastically reduce the attacks... but they've definitely happened at other times even without any triggers that I've been able to pinpoint, so it's not the Adderall that was CAUSING it (also it didn't happen every time I took the Adderall, which is why it took awhile to pinpoint that being a huge trigger) -- there's something underlying that's going on, and the Adderall just seemed to trigger whatever that \"something\" is. But I'm not sure what it is that triggers them other times.So, my cardiology workup was primarily to try to figure out what the hell is going on with me as far as all that. I was honestly really hoping the answers here would be along the lines of \"yes, something DEFINITELY got overlooked or mixed up, you need to call and insist on a follow-up appointment and let your doctor know he effed up and x, y, and z needs to be immediately looked into further\". I mean I'm not looking for a malpractice suit or anything, I understand mistakes can happen... but I just really wanted to hear that it WAS a mistake, because I'm SO. FED. UP. with these goddamn symptoms.I have been in and out of doctor appointments CONSTANTLY for three years now. And I haven't been able to work for those three years because jobs just fire me for having to call in too often. And despite three years of endless appointments and efforts, I feel like I'm still no closer to having any answers... so I was REALLY hoping this would finally provide some. I would rather have an upsetting diagnosis at this point, than continue having NO diagnosis at all. Knowing what IS wrong would be so much more useful than just knowing one more thing that isn't -- once I know what IS wrong, I can actually get a treatment plan going for it, and maybe I can finally start getting my life back on track. I used to be super active -- worked full-time in a restaurant, on my feet running around 40 hours a week; spent my free time riding bikes, hiking, and gardening, as much as possible... and now I can barely do any of that. Very short hikes, small amounts of gardening... but none of the rest. I want my life back.Or worst case scenario, with a diagnosis I could at least apply for disability, if getting my life back isn't an option, and have some meager bit of income again, anyway. I could start processing the fact that getting my life back close to where it was before just isn't gonna happen, and deal with that, instead of holding out some hope of being able to be \"fixed\" -- at least somewhat -- once I finally know what's wrong. With answers, I could at least do SOMETHING. With no answers, my life just stays in this shitty limbo indefinitely. And I really, really thought this was going to be what finally gave me some answers. It 100% FEELS like it's my heart that's the root of my problems... and I was even about 2/3rds through one of the attack weeks when I had the echo done, so I thought for sure it would show something while I was right in the midst of it, especially. So I just can't wrap my head around how everything could be \"basically normal.\"I suppose that all wasn't exactly clear in my \"symptoms\" summary -- I was just trying to rush through and get to the echo results, and didn't really feel like typing out the whole story -- so I just figured \"fatigue/syncope/malaise\" would cover the gist of it.I do really appreciate your response, though... I just wish it was what I actually wanted to hear. I just don't know how much more I can take of hearing \"nothing seems to be wrong\" when something is so obviously, seriously wrong. I know it's not psychosomatic; any doctor who tried to tell me it's \"anxiety and/or depression\" would probably find themself in possession of a brand new, shiny, second asshole by the time I was done with them... but this never-ending lack of answers does sometimes make me wonder if I'm going crazy. It feels like I'm being gaslit -- but by medical science, not by a person. ###Output :Hello. I'm not a native English speaker so the terms \"mild\" or \"moderate\" got me a little confused at first. The medical student and the cardiologist gave a very good explanation as to why those are really normal findings, those are normal findings in my country as well. Still heart rate isn't normal, and symptoms persist so there is still a problem. Now we now it isn't in the heart. I also think that the rheumatoid fever isn't something to be worried of there was only one event, the echocardiogram findings demonstrate mitral valve thicken but not an stenosis, I agree with the rest and think that is not a problem. There are not-doctors that are thinking about POTS/dysautonomy, I came here to tell them they are not crazy, I also suspect that. However dysautonomy is diagnosed by discarding other illnesses, and with only the findings of an echocardiogram it cannot be diagnosed. I would ask with internal medicine for a second opinion and more tests, first you have to discard hypothyroidism (not likely), adrenal dysfunction and endocrine dysfunctions. The recommendations to better your symptoms are drinking more water, change positions slowly: if you are in crouch position stand up as slowly as you can, from laying down sit before you stand up. Try doing some non impact exercise (not a good idea: weight lifting, running, crossfit). Hope you get better and find some answers. Stay safe"}
{"text": "###Input :48 year old female 54 normal weight female. Went to the ER for chest pains on the left side that were consistent for about two months and have since subsided in the ER had a normal chest CAT scan with contrast. Low anion Gap. I was just looking back at bloodwork from ER visit in December and noticed Anion Gap was 1/mol/L but Albumin was normal 3.9 and total protein normal 7.2. The Dr didn't mention this to me. And just saw this now. So worried about Multiple Myeloma now. My sodium was low 131 and SGPT (ALT) was low 12. The only thing they mentioned was elevated Hgb 15.5 and Het 46.3% but said nothing to worry about. Can anyone give their opinion. Ive also been to the gastroenterologist and cardiologist, upper endoscopy and colonoscopy normal and all cardiology tests were clear just showed some palpitations upon exertion. ###Output :Multiple myeloma usually has high calcium, kidney disease, anemia (low blood count) and bone disease. You mentioned none of those. Low anion gap is hardly used in the emergency setting, and usually will need retesting if blood to see if it was a one time occurrence."}
{"text": "###Input :Thank you for the response. Several months ago I did have elevated calcium but have been retested two times and calcium was normal. I was taking a lot of gas x and alka seltzer for the chest pain that I had gone in for.Also had bloodwork three weeks prior and anion gap and albumin and globulin were normal. Would that change so fast? ###Output :Anion gap is calculated by (sodium + potassium) - (bicarbonate and chloride). Most of the time when it is reported as low it is because there is slight variation in these factors from any random blood sample leading it to be falsely low. This is why they usually repeat it, and usually it normalizes."}
{"text": "###Input :8F, 78lbs, no medication. She was in the hospital for a long time but they discharged her. She is still in pain, please help. I attached the notes of her discharge.The patient is an 8-year-old white female with five weeks of fever, rash, arthralgias. Last month, the patient noted foot pain involving both left and right feet, as well as a blotchy pink rash on the leg that proceeded to spread to the trunk and then arms and then face during that week. The patient had low-grade fevers with temps to a max of 101. This has progressed to the week prior to admission higher fevers with T-max of 103.5. The patient has endorsed muscle pain, particularly in the right leg and arm, and PMD had seen the patient this week noted right knee and right index finger swelling. There is no noted weight change over this time period. No noted diarrhea or swollen nodes. The rash the patient described the week prior had an acute abrupt onset and 5-10 minutes later would dissipate.Rheumatology was consulted on the patient from admission. Lab studies were sent to rule-out an infectious etiology for rash. Strep culture was negative. EKG was also performed to rule-out a prolonged PR interval. EKG was within normal limits. A DNase B antibody was 547 and an ASO titer was 300. While results were elevated, the patient did no meet clinical criteria for rheumatic fever and diagnosis that was most likely entertained was systemic JIA. Further lab work included an ANA which was negative, rheumatoid factor which was negative, a CRP on admission was 8.6 mg/dL with an ESR about 80. CK and aldolase were within normal limits. Ferritin was elevated at 663. LDH was within normal limits. CBC was reassuring with normal white counts, hemoglobin and platelets; findings nonsuggestive of leukemia. Hepatic panel within normal limits. A chest x-ray was done to rule-out mediastinal mass, and that was negative. From an infectious standpoint, Parvo, CMV, EBV were all negative. Clinically the patient was noted to have a salmon-colored transient rash that would come and go throughout the hospitalization lasting a matter of minutes. No definite arthritis on examination. Oncology was consulted given the history of arthritis and fevers. It was felt in the setting of normal cell lines in evaluating a smear, which revealed no blasts, no indication of hepatomegaly or splenomegaly and uric acid and LDH within normal limits and x-ray that was normal, they felt that further oncologic evaluation was not indicated and a bone marrow was not indicated at that time. Cardiology was also officially consulted because the patient had a 2/6 ejection murmur on the exam. Cardiology felt the murmur was a flow murmur and evaluated the EKG, which they read as within normal limits, and decided an echo was not indicated to rule-out valvular disease in the setting of the rash and arthritis in an attempt to workup acute rheumatic fever. ###Output :Internal medicine doc here but in my differential is Adult Onset Stills Disease which can still present in children and Rocky Mountain Spotted Fever. The salmon colored rash lasting a few minutes is textbook for Adult Onset Stills Disease.I'm assuming she had blood cultures done at one or multiple points during her admission. Did she have a procalcitonin tested? Did she receive any antibiotics? Any steroids like solumedrol, prednisone etc? Does she still have joint pain? Does this rash show up only during febrile episodes? Any auto immune conditions in the family like lupus, rheumatoid arthritis, hashimotos?"}
{"text": "###Input :NAD. My son has Adult onset stills disease, also considered SJIA when in a child under 16. His symptoms were rash (with fever) that could disappear when the fever went down. Muscle aches, joint pain. Enlarged spleen, liver. Elevated CRP, ESR, ASO, and Ferritin. Liver enzymes elevated from the swelling. He is on high dose prednisone and biologic injections. Hospitalized for 3 weeks.Its rare op, but your sisters case seems so similar. It needs aggressive treatment early on for the best chance of success/possible remission ###Output :Yes, the evanescent nature of the rash in this context twigged me to Still's as well. There is a known juvenile onset form that falls under \"SoJIA\" (Systemic-onset Juvenile Idiopathic Arthritis), considered a version of Still's.OP, this sounds exactly like a form of arthritis to a clinician who takes care of children. I agree that what comes to mind for your mother as \"arthritis\" is likely too limited, and that definition might need to be expanded in her mind. Could you look at this, and maybe share it with her? https://www.arthritis.org/diseases/systemic-juvenile-idiopathic-arthritisAbout a third of the way down that page is the SYMPTOMS section, with subsections on Fever, Rash, and Joint Pain. Please read it and see if it rings a bell. Best wishes."}
{"text": "###Input :27, female, 5ft 8, 190lbs, folic acid & vitamin D supplement medications.I am 16 weeks pregnant and have Wolff Parkinson White syndrome. I was diagnosed in 2012 but have been asymptomatic for around 8 years now. Today I was at maternity and was checked by cardiology where WPW presented itself again on my ECG. I had an 2 ablation attempts in 2012 & 2013 where they werent able to get the extra pathway.How will this affect my pregnancy and delivery options? ###Output :It depends on if you have arrhythmias. Have you ever had atrial fibrillation? Did they ever do an exercise stress test?Most of the time it won't effect pregnancy but if you have ever had atrial fibrillation the risk of degrading to a ventricular arrhythmia will be increased in pregnancy.Talk with your cardiologist, it may be beneficial to start a beta blocker depending on your history."}
{"text": "###Input :I'm not sure what details are most important here, so I'll try to sum things up clearly. I need to determine if I should pay for a private autopsy, the problem is money is tight. However, if it's likely someone messed up, I want to take action. This hospital has something of a reputation when it comes to problems with infections, and previously they messed up on a friend of mine, their mistake nearly led to the amputation of her arm. Luckily that time they caught their mistake, and the $250,000 medical bill wasn't placed on my friend.Male665'10\"215 lbhad been on 5mg oxycontin for a bruised rib, took something like 30mg total a dayRough timeline:Day 1 he went to the ER for an infected toe. They referred him to another ER because the infection had spread to the bone and they needed to amputate. His GP said he had no diabetes. He may have had a case of bronchitis.Day 2 he's dealing with bad conditions at the hospital where his surgery will take place due to overcrowding in the non-covid section of the hospital while they give him antibiotics prior to surgery.Day 3 surgery takes place, surgeon reports everything went quickly and smoothly. Dad texts me after, saying everything went well. I talked with him and he sounded tired, but didn't seem out of the ordinary post-op.~14 hours later, a nurse says he was talking with my dad, he was joking with the nurse and the nurse \"got his pain level down\" and continued his rounds. An hour after this, my dad starts to gasp for breath, starts coding and they move him to the cardiology section where he passed.Some possible weirdness:The surgeon led me to believe there would be an autopsy, though he never directly stated there would be one, as he said my dad was relatively young and the surgeon didn't know what could have gone wrong. However, the surgeon had either already signed off on no-autopsy or did shortly thereafter. Going back to our conversation, the surgeon never said \"there will be an autopsy\" he just said \"the coroner will have to tell us what happened\" or something along those lines.I waited for a couple of days to hear back the results, but the hospital then lost my dad and the stuff he had brought in with him, they lost him for something like 4 or 5 days, with us calling every day after the 2nd day after his passing trying to find him and his phone so we could get his contacts and notify people. We still don't have his phone, so we haven't been able to notify all of his friends as the majority of their contact info is in his phone and we don't have it yet. ###Output :First off, let me say I am very sorry for your loss.All the following assumes you live in the US:I believe the specifics varies by state/county, but any unexpected death (with or without surgery) is by default a coroner's case. This means, someone at the hospital (doctor or nurse) is legally obligated to call the county coroner and report the death. The coroner has the discretion to order an autopsy, i.e. say yes or no they believe one should be done. In this situation, I would think they definitely would, and the body would be transferred to the coroner's office to do it. Even if the coroner says no, they don't require one, the attending doc of the patient can request an autopsy (to be done by the hospital.)I guess in your shoes I would do the following:Contact the surgeon and ask if the case was reported to the coroner. If not, why not. If they did call, what did they say about an autopsy.Then ask how you go about arranging a private autopsy. The surgeon might not know, but should be able to get you in contact with people in the hospital who can help you find out.Any respectable surgeon would want to know what happened just as much as you do. If you find him being evasive on the subject or refusing to return your calls, contact the hospital administration. Admins know medical legal risk and this is absolutely a red flag in that regard."}
{"text": "###Input :I have had an experience in a hospital like this, as the mom of a patient. The procedure was absolutely botched and we did not find out til later from a nurse who didnt realize they hadnt told us the entire truth. It changed the procedure for pyxis picks in our local hospital, because they picked the wrong medication and it went through two nurses and a pediatrician and was administered to my newborn, premature son.Every business is going to protect its own interests, and I consider doctors a business entity as well as the practices and hospitals. Mistakes are understandable but for a mistake to make it through 3 medical professionals and not be caught til hours after the fact is inexcusable.All this to say, mistakes happen and even on a big scale. I wouldnt think it uncommon for this sort of thing to happen. ###Output :Interesting assuming your flair is correct and you are not in medicine it seems more likely there was a miscommunication. I've seen bad outcomes but i have never seen or been involved in a \"coverup.\" In PACU Im on the phone with the family/proxy immediately informing them of even relatively mild complications like blood loss requiring transfusion (1-2 units not MTP).At least in general surgery, the patient/their PCP will see what was done on post-op imaging. You can't hide from radiology!"}
{"text": "###Input :irst off, I know the pain of losing a parent and Im terribly sorry.Second, NAD, but my field of work happens to be in medical malpractice, specifically investigating licensed medical professionals.Malpractice is generally defined as medical negligence, but this comes in many forms.What I would do is request any and all medical records IF you can legally. Or whoever can, they need to and are allowed under HIPAA. The records we see from doctors are very general, they are required to log and note just about everything and a lot of detailed notes youll never see unless requested.It appears if any negligence happened it was after his passing. The fact that they lost him is NOT ok.Id also be curious to see what medication he received after surgery or in the hours before his passing. Incorrect dosage or medication is a lot more common than people think.Anyway a malpractice attorney may not be the best route yetThey would have a coroner examine the body and can sometimes determine cause of death without an autopsy hasnt a cause of death been given to your family yet?If they cannot determine cause an autopsy would be performed and the family has to consent.The family also has every right to request one, but you may have to pay for it.I would gather that information for sure and any and all medical records ###Output :This very sudden event does not sound like a surgical complication. It sounds more like a pulmonary embolus or heart attack, possibly an acute allergic reaction. WITHOUT RECORDS I CANNOT CLAIM THIS AS FACT. Edit: I just noticed you mentioned they moved him to the cardiology floor. A cardiac event seems more likely.You can request a copy of his medical records if you want to know more.Pulmonary embolism was my first thought as well, but of course its my first thought regardless of the situation because, well, gotta CT somethin.Sorry for your loss OP. I hope you are able to find peace within all of this."}
{"text": "###Input :In my hospital, the surgeon has no decision making in a coroners case. A mandatory coroners case is if a patient dies within 24 hours of admission. Furthermore, if any patient dies in my hospital, the charge RN or patients RN calls 1) the coroners office. 2) organ donation. 3). The family, and 4) the funeral home or cremation. The surgeon has nothing to do with the decision of a coroners case, the coroner decides. If the coroner decides no autopsy is warranted, the family may have there own independent autopsy completed at their own expense. Your fathers surgeon signed off because your father was no longer his patient. I hope this helps, and I am truly sorry about your father. ###Output :Saying that hospital staff killed your dad is a bit of a stretch, but you do deserve an autopsy like you asked for.Reaching out to get records from the hospital and getting a lawyer could help. You could also reach out to the medical examiners office and see if theyre even aware of this case, if they havent heard of it, or if they rejected it."}
{"text": "###Input :Is there a way to get a coroner to do it? The county coroner said they won't since the surgeon signed off on it, so as far as I'm aware I need to get a private autopsy done, which is a pretty large financial burden at around $7,000. I'll absolutely pay for it if it's at all likely that they messed up. I can't stand the thought that they could face no repercussions for any mistakes they made. ###Output :Its really hard to connect a sudden event like this to a relatively benign surgery i.e. toe amputation. I cant envision a scenario where the surgery was a direct cause of his death. If it was a PE and he wasnt getting SQ heparin in the hospital, maybe you have a case, but even that might be a stretch. The vast majority of deaths in the hospital were beyond anyones control, but of course there are exceptions. Despite popular belief, its hard to kill people.I think it's most likely that they didn't make any mistake that caused this death, especially with just an amp of a digit, but I would think this definitely would deserve an autopsy. He probably had a PE, STEMI, something catastrophic either unrelated to the surgery or a very unfortunate complication of the surgery, and was in a part of the hospital for very non-acute patients that don't really need much monitoring when it happened."}
{"text": "###Input :Im a 32 year old male, smoked tobacco from 18-22 and switched to vaping, regular use of marijuana and no other drug use since age 22, I used to abuse cocaine. Went to the ER twice, once for a short lived but stabbing center chest pain, other visit I was sitting watching videos and my heart started pounding out of my chest and reach 150-160bpm, but absent of pain, both times EKG and X-ray were explained as unremarkable and was given an ER diagnosis of palpitations/anxiety. I went to my PCP yesterday and he asked if any of the ER staff mentioned a incomplete RBBB. I told him they did not, I reached out to ER doctor and he said the computer read out printed an incomplete RBBB on the paper but upon human examination it wasnt the case and was likely caused by me being underweight. My PCP said this is highly unlikely and ordered a chemical stress test and a cardiology appointment for May 5th, I trust my PCP but hes new to me so I dont know him very well. Can an EKG false read a RBBB or is my PCP correct to be suspicious? If I do have an Incomplete RBBB what does that mean for someone my age? Waiting on the next appointment is giving me anxiety and just want to understand more about whats happening. Thank you in advance for your help! I have a family history of stroke but not cardiac failure. ###Output :An incomplete RBBB is generally a benign and incidental finding. I would not worry about it at all. I often dont mention it to patients if I see it on their EKG because it doesnt really meaningfully increase risk of anything nor does it typically indicate underlying cardiac disease. Think if it as simply just being the way your heart is wired."}
{"text": "###Input :34F, Canada, Cushings Disease with associated type 2 diabetes, hypertension, etc.One week ago I underwent a transsphenoidal pituitary adenoma resection. Midway through the surgery my heart stopped and they had to give me CPR. Not sure how long I was out for (the doctor said I was back before he had time to get the life-saving medications). My heart stopped again right at the end of the surgery. I woke up from anesthesia having my chest x-rayed and being asked a bunch of questions to see if I had any neurological damage.X-ray showed no fractures and ECGs were normal. The cardiology team didnt really know what happened and just said something about a vasovagal response with asystole. They discharged me from their care. I ended up developing diabetes insipidus so I spent 5 days in hospital.My chest still hurts something fierce. The headaches, fatigue and the hormonal rollercoaster from the tumour being removed is a walk in the park in comparison.Is the pain just muscular if the X-rays were clear? How long can I expect this to last? I feel like I cant take deep breaths or move my arms without pain. I complain but Im very grateful to the doctors who saved me!Should I be cautious going under general anesthesia in the future or was this just a freak thing?Thank you! ###Output :That certainly sounds like a challenging case.You should review what happened with the anesthesiologist as they can provide the necessary context and course of events to what happened. Having the anesthetic record available will also be invaluable.Also, brain surgery carries additional risks, with significant pauses in heart rate being due to several different mechanisms. Most likely, this will not be an issue in other surgeries. However, it is impossible to know without more information.As for your chest pain, while broken ribs can happen, there can also be pain in the joints as well as muscles and other tissues. The soreness should eventually get better in the next week or so."}
{"text": "###Input :Thank you! Yes all the doctors seem a bit mystified by it. I have follow-ups with the surgeons in a couple weeks so I will get more details. I admit to feeling a bit freaked out by the experience. And the chest pain has been killer. ###Output :Broken ribs are notoriously hard to see on X-rays  were looking more for breaks that are also very out of place, or a collapsed lung from the fracture. So you could very well have a broken rib that wasnt seen."}
{"text": "###Input :26F. 510, 150lbs. Non smoker, exercise 2x per week.I had an episode a few weeks ago where I felt lightheaded for about 15 minutes. I also had heart palpitations and feel very anxious (heart palpitations started after light headedness). This improved with deep breaths. I havent had an episode like this previously but have in the past felt heart palpitations when stressed.I spoke to a doctor at the time who sent me to the ER. I had blood tests, 2 ECGs, blood pressure tests and an X-ray which were all normal, but was sent to cardiology as a follow up.I have also since spoke with a GP who said they likely think my symptoms were a panic attack as I do suffer from anxiety and health anxiety. That said, I still have to see a cardiologist to confirm.I have my appointment tomorrow and Im very anxious about it. What will happen? Whats the likeliness of needing further tests and what would they be? Im worried about having to do a lot of follow up tests as Im travelling soon and need to be fit to travel ###Output :They might just talk to you about your symptoms and what happened. Family heart disease history. Might have you wear a heart monitor to catch any arrhythmias that might happen if/when you feel lightheaded etc. or do an echocardiogram but I say might given that you only had one episode and all blood work / ekg are normal."}
{"text": "###Input :Gender: Male. Age: 21. Weight: 160. Diagnosed with asthma.Some months ago, I went into the emergency room for heart palpitations. I am prone to heart palpitations during anxiety, but those are caused by tachycardia. They feel like a fluttering in my chest. These heart palpitations feel like my heart stops and then THUDS into my chest. When I went into the emergency room, they were relatively infrequent. I was referred to a cardiologist.During my cardiology appointment, the doctor told me that I had a heart murmur. He ordered an echocardiogram, an MCOT monitor and a stress test. The echocardiogram came back negative for any abnormalities and I have four days left on my MCOT monitor (which is like a monitor that sits on a patch above my heart and monitors my heart rhythm 24/7). I never had the stress test done.Since that appointment, I've had these beats relatively infrequently. Maybe four times a night tops.Starting last night, I began to have them much more frequently. Much more frequently. And it is only one PM and it's happening maybe two or three times already. My question iswhen are these skipped beats concerning? When should I be worried about dying? Should I go to an emergency room? ###Output :There honestly isn't any indication to go into the ER if you're wearing the MCOT monitor. While you have it on, detection of an arrhythmia is automatically transmitted to a central surveillance station for further analysis and possible intervention. If something concerning or life threatening was going on, someone would call you about it immediately."}
{"text": "###Input :Wellthe people monitoring the data have made it clear that MCOT isn't an emergency service and that all of the information from the monitor is being sent to my cardiologistwho isn't at work until tomorrow. So my thoughts are that he hasn't even seen any of my data since this has started. I just had another skipped beat. They're happening very frequently.The site says that they will only contact me if specifically requested by my physician, who isn't working weekends. I'm quite scared because these beats are happening much more frequently than normal. ###Output :Are you having any other symptoms with the skipped beats? Like chest pain, shortness of breath, lightheadedness/dizziness, vision changes, or numbness/weakness/tingling anywhere, that's any different from your baseline? If so, then those would be indications to present to an ER."}
{"text": "###Input :Whenever I have the skipped beat sensations, there's like an anxious feeling in my chest and sort of a feeling like my body is heavy. It is the same sensation that I get during panic attacks but much less severe. The sensation never lasts. It goes away immediately after the beat. I'm terrified these fuckers are going to kill me. I have no idea why all of a sudden these are happening so frequently. ###Output :It sounds like PVCs (premature ventricular contractions) which feel weird but arent life threatening."}
{"text": "###Input :Thank you so much! I was told I had a blockage of some kind? I cant remember exactly what its called now. Essentially the 2 parts of my heart arent in sync with each other. Thats why I got the heart monitor. Is that something to worry about? ###Output :CMS/HCC is just a designation for billing stuff (CMS = Center for Medicare/Medicaid Services).\"Ambulatory referral\" - referral to an outpatient cardiologist (not being sent to see them urgently in the hospital)Syncope is the medical term for fainting, or becoming unconscious.The optic disc is a spot in the back of your eye where we can see the nerve that gets information from your eye and brings it to the brain. \"Anomaly\" just means that something looks funny (since they don't say anything else here, I can't say how it looks funny).In short, for your passing out or possible seizures, they're sending you to see a cardiologist to make sure it isn't your heart. For the funny thing they saw in the back of your eye, they're having you see an ophthalmologist. Sounds like all of this is a very reasonable workup for your issues.Hard to say with that general explanation - it'd be more helpful if you have the medical name of the condition."}
{"text": "###Input :I believe its a first degree atrioventricular block. ###Output :Based on his username the original respondent is the best to answer this question though."}
{"text": "###Input :27F. 213 pounds.Preexisting conditions: pcos, endometriosis, factor V, anxiety, depression, and under active thyroid Medications: propanol 40mg, levothyroxineLast year I started having random heart palpitations. I went to the ER. I had an ekg. In the ER they determined I was normal so they gave me a referral to cardiology. Since then Ive had a 30 day heart monitor, echo, and a stress test. Im told that all the results read normal and Its probably anxiety playing a part.On Friday I had a weird sensation happen. Its happened a handful of times and I mainly feel it at nighttime while laying down. It is in the middle of my chest and its a cross between a flutter and a spasm. Like it gets tight for a second. It makes me cough and I breathe in to get it to stop. I can also slightly feel them in my lower neck beating. I also woke up this morning a little weak in that area. It freaks me out.I have some slight occasional pinching just like I do with the other palpitations (Im told that can be normal ) but Im not in pain. I dont have a headache. My blood sugar is normal. My bpm is normal. My blood pressure is a little lower than where it usually sits but its still in the range.Im seeing a NP on Monday but I wanted to ask if anyone has experienced this or knows what it might be before I get told its just anxiety again.Disclaimer: Im not saying it cant be anxiety but every time I go to the doctor EVERYTHING under the sun is anxiety and its hard to get past that diagnoses when you feel like something is off ###Output :The workup youve had is incredibly thorough and it couldnt find anything pathological. Short of a heart attack (which is almost impossible at your age) there wouldnt be any significant changes to your cardiac physiology since that battery of tests was done.Anxiety is by far the most likely cause.From the sounds of it, it is probably anxiety."}
{"text": "###Input :I (24F) had an ekg done yesterday to investigate consistently high blood pressure (around 140/85 or higher) and both high (122bpm) and low (53bpm) heart rates. The ekg showed that I have a heart block and they explained that my heart is skipping beats and part of it is beating slower? They seemed pretty concerned and asked if I had any chest pain or dizziness, which I said no - but that I am almost constantly nauseated and tired.I have a lifelong history with nausea and fainting that Ive learned to control by avoiding triggers like heat, cardio, or becoming overwhelmed emotionally. They said since Ive been experiencing symptoms for so long, its probably not immediately life threatening and sent me home. But they insisted that I go to the ER if I feel like Im going to faint at any point and I was given an urgent referral to cardiology. How concerned should I be?Stats: 24F; very rarely drink, no cigarettes, no vaping, daily weed; Diagnosed with bipolar, adhd, and anxiety; Currently taking Trileptal 675mg and lexapro 10mg ###Output :There are many types of heart block of various degrees of seriousness. It's not possible to say from this info what you have"}
{"text": "###Input :Depends on the type of block you have. Is it a first or second degree, Mobitz or Wenkebach?For a third degree, you'd've had to stay in the hospital, I guess. ###Output :Or bundle branch or fascicular."}
{"text": "###Input :I'm a 19 female, no drinks no drugs no smoke, \"loose ligament syndrome\"(modern day gHSD and hEDS, basically hypermobility spectrum disorders) runs down the matrilineal line. I couldn't inherit the diagnosis because diagnostic process changed, but same symptoms. Because of that, I'm very sedentary- chronic pain and bad joints makes even walking difficult to do for any extended period of time.Because of the loose ligament syndrome thing, I was supposed to have seen a cardiologist a while ago(if it's hEDS, increased risk of aortal dilation). On top of that, just learned maternal grandmother is also medicated for high cholesterol and bp, and had a heart murmur.I just scheduled a doctor's appointment for the 18th of February- just with my gp for a physical, and I'll go from there. Scheduled it after I went to an urgent care for something unrelated and they took my bpm three times(137, then 111 laying down, then 102 as they had me meditate for a minute). I have tons of symptoms that I just attributed to an autonomic condition like pots or something, and didn't bother treating because \"it's not fatal\"- common mentality in my family. However, these symptoms all also apply to cardiac issues. Things like chest pain spreading to shoulder blades + neck, feeling like a lump in my neck during hot shower + palpitations, blood pooling in my feet, breathlessness, dizziness, cold hands and feet, etc etc. I'm also wearing a Fitbit to help give general metrics(I know Fitbits aren't concise) to the gp.Anyways, because of these symptoms, I'm concerned that my gp will hear this and send me to the er (the gp office is connected to a hospital), rather than referring me to cardiology. These are all symptoms I've dealt with for months if not years. Not entirely afraid of that, I just like knowing what to expect and am trying to mentally map out possibilities.I'm curious to know at what point a doctor decides to refer a patient vs send them to the er? Especially if it's something the patient has been dealing with for a while(like in my case), vs something brand new?Update: nevermind had a heart event and I'm at the er now. So, fun reminder to go to the er when the internet tells you to, rather than waiting it out. ###Output :As an ER doc, I can hopefully help map out the in's and out's of what \"should\" dictate a referral to a specialist vs. what constitutes the need for a recommendation to go to the ER.The answer is...you ready for this?...If the presentation is...an emergency. Poof. Mind blown...\"You condescending asshole!\" I hear you saying to yourself. But, no, seriously, this is power to you. IF your PCP, for some odd and unnecessary reason, says, \"Based on your symptoms, you need to go to the ER. NOW!\" Calmly tell him, or her, \"But, I thought that dark and scary soul-sucking hell-hole was only for emergencies. Yet, I've had these symptoms for months. Why is this suddenly so emergent? Please just refer me to a cardiologist who can help me with my chronic cardiac issues.\" Then, feel free to bat your eyelashes, if you so choose, as they sit in the cesspool of being completely and totally wrecked by reason."}
{"text": "###Input :Yeah I put an update at the bottom, I'm at the ER after a cardiac event ###Output :Ahhh dang. At the very least, I hope you get feeling better soon!"}
{"text": "###Input :My mother has undergone an MRI brain without contract as she was suffering from double vision, major headaches, fatigue, imbalance, and frequent of coordination. The MRI scan consequently showed a small 7x4 mm nonspecific focal area of white matter high signal change seen on T2 and FLAIR sequences in the left centrum semiovale. The neurologist then advised to undergo a CT contrast scan alongside a lipid panel test to infer on the MRI findings.As per the CT scan, below were the findings:Atherosclerotic changesOcclusion of the right vertebral artery at the origin, partial visualization of the cervical segment, retrograde filling of the distal V4 segment and PICASignificant narrowing of the left PCA distal P2 and P3 segmentMild narrowing of the proximal right ICA about 40%.Right A1 segment is congenitally absent, the rest of the right ACA is hypoplasticThe lipid panel test showed the following:Lipid panel-LDL 3.34, total cholesterol 5.61Momentarily, the neurologist has requested a HBA1C and liver function exam, in addition to the echocardiogram and a 24-hour blood pressure monitoring from cardiology standpoint. He has concluded that the previous MRI reported a lesion suggestive of old ischemic infarct.I am looking for advice regarding the next viable steps as the healthcare from the country I am currently in is not up to par/adequate. I am extremely distressed and worried about this case as my father has suffered from a hemorrhagic brain stroke 12 years ago and cannot lose another parent as a result of a medical condition. I am the sole carer of both my parents who works 10 hours a day. Please advise me. ###Output :It is not uncommon to have small, old infarcts as people get older.The important thing to do if these are seen is secondary prevention, meaning modifying risk factors to prevent future infarcts. This sounds like it is already taking place through the measurement of her HbA1c and lipid profile.As to whether anything is done about the existing vessel narrowing will depend on her particular case and where in the world you are and should be discussed with her team."}
{"text": "###Input :Thank you for your reply. Greatly appreciated. Could I just ask in regards to the occlusion of the right vertebral artery and the 40% narrowing of the ICA - how dangerous/worrisome are those findings and should we opt for any surgical intervention?The neurologist has suggested to get her on Lipitor 20mg daily for 3 months and an anti platelet treatment (although she took aspirin before and had a huge drop in ferritin levels equating to 2.7 and edema, which led to her having to get iron infusions). The neurologist hence recommended plavix as an alternative. ###Output :This will again depend on local practice and your mothers wider medical history and functional status.As an example, in my region we wouldnt consider it unless stenosis was greater than 50% and even then, the vertebral arteries are very difficult to access safely and generally only consider thrombectomy of small vessels in the acute phase."}
{"text": "###Input :In regards to medical history, my mother has been extremely healthy, no smoking or drinking, and no other medical issues. However, it is essential to note that her father and sibling have passed away from a heart attack, and two others have undergone open heart surgery.So, from my understanding, operating on the vertebral artery is extremely dangerous, and for any other stent operations regarding intracranial and extra cranial arteries, the stenosis should be larger than 50%? But what is the likelihood of her ICA percentage growing to 50% and in how long? Considering she suffered from an transient ischemic attack recently reflecting in the MRI, how would you assess this case? ###Output :The number of 50% is an example of what we would use in my local practice - it does not necessarily represent the targets in your area/situation. That is a much more nuanced question that can only be answered by your team."}
{"text": "###Input :Hello, Im posting on behalf of my 76 year old father. He had double bypass surgery back in 1995. Other chronic conditions include Afib, medically managed cholesterol, and he is a regular drinker (mainly beer and wine). His medications include Metoprolol 50 mg, Xaralto, Lipitor 40 mg, Lavazo 4000 mg, baby Aspirin, Coq10, and D3. He has dealt with very swollen feet for years and always has a dry cough. He is not short of breath or wheezy at all. In fact he is quite active, he walks about 3-4x a week, lifts with a personal trainer 2x a week, does Pilates reformer once a week, and yoga/stretching lesson once a week. He has gone to Cleveland Clinic for a full physical every year and they feel that everything is managed from a cardiology perspective. They cannot treat his Afib via electric shock for whatever physiological reason, and he doesnt want to undergo a major surgery. According to his Apple Watch, his resting heart rate is 45 for the past 13 weeks. He had a vascular doppler of his lower extremities and they found that his veins are larger than normal but no blockages. His lab work has not shown signs of kidney problems. What is most concerning to me, is that no one ever seems to be concerned about his cough. My dad is convinced its allergies but he wont take an allergy pill because it makes him tired and wont see an allergist. I would love an opinion about his very swollen feet (picture below in comment) and persistent cough. I feel like it is abnormal and we shouldnt be taking everythings fine and managed for an acceptable answer. I think that it is a symptom of something else happening in his body. What do you think it could be and do you think he should go get a second opinion? If so, where? ###Output :Sounds like congestive heart failure. He should see a doctor asap."}
{"text": "###Input :Left Ventricle: The ventricular size is normal. There is no left ventricular hypertrophy. Global LV systolic function is normal. The left ventricular ejection fraction is 70 %. LV diastolic filling parameters are c/w normal diastolic function.Right Ventricle: The right ventricular size is normal. Global RV systolic function is normal.Left Atrium: The left atrium is normal in size.Summary and Conclusions:No previous studies for comparison.Normal LV size and systolic function. LVEF= 70%. Normal LV filling pressures.Normal RV size and systolic function.Normal biatrial size.MEASUREMENTS AND CALCULATIONS:Left Ventricle: Normal Aorta/Left Atrium: Normal IVSd: 0.6 cm (0.7-1.1) LV FS: 40 % (>25%) RA Area A4C: 11.8 cm2 (<18) LV EF (Biplane) 70 %. (54-74) Right Ventricle: LV Mass 66 g (67-162) RVd A4C: 2.8 cm (2.5-4.2) LV RWT 0.40 (<0.43) TAPSE: 15 mm (>16) LV EDV 2D: 44.5 (56-155) IVC Diameter: 1.8 cm LV ESV 2D: 13.4 (19-58) LV EDV index: 31 ml/m2 (35-75) LV ESV index: 9 ml/m2 (12-30) ###Output :Cardiologists take a broad approach to reading an echocardiogram, not just looking to see what measurements fall within a range. Your cardiologist is the best person to tell you if your echo is normal or not.This is a normal study"}
{"text": "###Input :Please can I have some help identifying exactly what material has caused a nasty skin reaction in my 5 yr old? (Female, Caucasian, no health issues but has had other topical reactions in past)She had a tonsillectomy a few days ago and her skin has reacted to the sponge backing on the electrodes they stuck to her chest during surgery. (I know it's only the sponges, as the welts are in perfect circles)I've identified the electrodes as Ambu WhiteSensor 4535M https://www.ambu.co.uk/cardiology/ecg-electrodes/product/ambu-whitesensor-4535mThe data sheet says the sponge is material is \"polyester polyurethane reticulated\". Google tells me these are two different materials? Is there a common name for this stuff that doctors use, and is it a common medical material that I need to look out for in future? ###Output :Acrylate allergy is most likely followed by nickel next."}
{"text": "###Input :65M, 5'9\", 140lbs, Asian / Chinese, NYC, no medications <-- My Dad's InfoI'm in a stressful medical situation right now, and need some help / advise. My dad had an emergency aortic valve and ascending aorta replacement 5 days ago due to aortic dissection 7 days ago. He was in the OR for ~11 hours because they first attempted to repair a part of the ascending aorta, took him off bypass, saw that things weren't going well, then put him back on bypass again to do a more aggressive procedure of replacing the aortic valve and the ascending aorta including the arch, so it was a very long amt of time on bypass.Yesterday he was moved from the Cardiothoracic ICU and into a normal hospital wing due to a bed shortage in the ICU. I've noticed since he came out of surgery that he has a facial muscular abnormality on his left side (his left mouth is slanted up) and is having difficulty speaking/writing (he is slow to utter syllables, is misspelling very easy English and Chinese words, can't pronounce English and Mandarin words to the point where it is not possible to have a conversation with him without both my mom and I guessing while he attempts to partially speak / write). The cardiology team told me yesterday that they don't think they need to bring neurology in to examine him because it may all be normal effects of the bypass. I am really worried there may be signs of a stroke (he can't read/write properly and his mouth is crooked) and I am wondering why nobody at my dad's hospital is concerned with a neuro eval. What do you think - should I push back more for a neuro eval or is this normal? ###Output :I'm a neurosurgeon so I'm kinda talking out of turn but....I did rotate thru CT surgery as an intern long ago, so maybe it's still valid.Have they done a CT or MRI of his brain? If yes and it's normal, rest easy. A negative imaging study (especially MRI) rules out a stroke, which means there's little for neurology to do, other than diagnose \"encephalopathy after surgery/bypass.\" However, if they've done no imaging, I'd consider that odd. My ICU has a low threshold to get a neurology consult and imaging, and someone having language issues and a facial droop for 5 days after heart surgery would certainly trigger it."}
{"text": "###Input :No, they have not done imaging of the brain yet. If this were your family member, would you advocate for CT or MRI? Thank you so much for replying to me so quckly. ###Output :I think a CT is a reasonable step. Quick look to rule out something concerning like a bleed or a stroke."}
{"text": "###Input :Thank you so much for your help. Using info and confidence from this thread, I was able to push/advocate with the hospital over the last few days to have the surgeon finally order a CT scan and....blood clot in the frontal lobe. A stroke team then confirmed an embolic stroke immediately. He will need to have another procedure to remove fluid around the heart.It suprises me that if I had not pushed for brain imaging, my father would have been discharged as if nothing was wrong. I can see why having family/children may sometimes be the difference between good care and terrible care. It feels good to have a baseline data point and it sounds like aspirin + therapy are the only treatment that we can seek after his condition hopefully stabilizes (low blood oxygen levels, fluid in heart and lungs is in hard to reach places, etc.).The power of Reddit continues to shine. I am grateful for this community. ###Output :Glad you pushed and got some answers. Heart surgery puts people at risk of both bleeding strokes (because the blood is thinned during surgery) and well as embolic strokes (because things can flick off arteries, valves, and even repair devices like aortic repair grafts). It's important to differentiate between the two, since a bleeding stroke is a contraindication to many/most post op blood thinners.I hope your dad's recovery goes smoothly. He might ultimately be a candidate for inpatient rehab, which can definitely accelerate recovery after a stroke. It's usually done at a different facility than where the surgery was done. The physical, occupational and speech therapists that work with him now will let you and the surgeon know if he's an appropriate candidate for it."}
{"text": "###Input :Female 35 / 55 / 195 poundsI attended my physical today and my doctor said that I have a heart murmur. This hasnt ever happened to me. She told me not to worry but now I have a cardiology appointment. I have severe health anxiety. She said its likely from anxiety or a small leak? - she said since I dont get out of breath its unlikely its serous? ###Output :Everyone here will tell you the same thing your doctor told you.Take a deep breath, Relax and wait for the next appointment. No one can tell you any different without examining you."}
{"text": "###Input :Sex - FemaleLocation - EnglandPre-existing conditions - Chiari Malformation with Syrinx, IIHSurgeries in previous 12 months - Stents fitted to transverse sinus & ICP monitorMedications - Aspirin, Antenolol, Acetazolamide and progesterone only pill (to stop cycles, I am sterilised so not used as birth control).Issue - Hi. I am currently waiting an appointment with cardiology following a trip to A&E with tightening pains in the chest when experiencing a double heart beat. This was evident on the ECG the hospital took and appeared similar to the ones taken with my Apple Watch. It has been queried if it may be bigeminy(?). Ive attached an image in the comments from today. The episodes are becoming more frequent and happening for longer periods. I dont want to bother our already busy hospitals when these happen just to have an ECG and be sent away to wait the referral. Can anyone suggest anything I can try to stop this happening? I dont drink given my pre-existing conditions, have never smoked and Ive cut out caffeine already with no results. Thank youETA - Ive taken blood pressure when these are happening and readings are totally normal, reading with picture in comments was 114/66 ###Output :Looks like classic premature atrial contractions (PAC). Can happen in times of high stress. Usually benign, sometimes in the setting of new arrhythmia. Beta blockers can reduce occurrence so maybe cardiology might want to discuss atenolol dose.Sounds like you might getting into a cycle that precedes panic attacks which makes people feel like they are having a heart attack eg short of breath, chest pain. Then fear of a similar episode happening again causes stress and then you cycle right back into stress induced PACs. Breathing exercises are golden when you feel youre about to enter one of these cycles. In through the nose 4 seconds, out through the mouth for 6 seconds. Do this at least 4 times and focus on breathing.See what cardiology has to say. Very unlikely anything serious."}
{"text": "###Input :22F. 115lbs. 5'2. History of gallbladder removal. History of lupus. I take aderall for ADHD and hydroxychloroquine for my lupus, as well as birth control.EDIT: Heres the full reportI saw a cardiologist a month ago and wore a heart monitor for 2 weeks and had an echo done. I went in because I have a consistently high heart. The heart monitor didn't show anything concerning according to cardiology and I was diagnosed with inappropriate sinus tachycardia. Well, I got my report back.Everything was normal besides two things that I read on the report:Trace mitral valve regurgitation.IVC is dilated at 2.5 cm.This freaks me out a bit because my doctor didn't mention any of this to me and he won't respond. On the 2D measurements, the only abnormal measurement was my LA which was 2.8 (reference range 3.0-4.0 cm).The reports from the mitral valve stated:Regurgitation: TracePeak E: 0.9 (0.6-1.3 m/s)Peak A: 0.5 (<0.7 m/s)E/A Ratio: 1.8 (0.75-1.5)The only other measurements that were high were my Pulmonic Valve:Peak Vel: 1.1 (0.6-0.9 m/s)Peak Grad: 4.5 (<=3 mmHg)I am really freaking out. How concerning is this? Is the dilation, regurgitation, and high values concerning? ###Output :A lot of good answers here, I'll just confirm what the others have said. Pretty much all the answers I read are correct. It's not uncommon for our heart valves to have a tiny bit of leak (regurgitation), it's nothing to worry about. As far as the IVC. It's a touch on the large side but it could just be a normal variant. It could also mean that you are very well hydrated and there just happens to be a lot of fluid in your veins making it look nice and plump."}
{"text": "###Input :Thank you so very much for this. It is very much appreciated. I had assumed that my doctor wouldve told me if it was concerning but I just wanted to double check. I do have very plump veins which makes blood work easy for me lol.The hydration would make sense as I hound down so much water throughout the day (close to 90 oz). I was over hydrating too much and ended up depleting my electrolytes so now I add electrolyte drops to my water.Again, thank you so much for taking the time to respond and fantastic username. ###Output :I'd interpret this as basically not concerning. IVC of 2.5cm by itself can be normal in adults as long as there's good compressibility and respirophasic variation (not commented on, but given lack of tricuspid regurgitation and normal right heart function, would highly doubt any abnormalities). Most likely, this just means you were well hydrated at the time of the study.Regarding the mitral regurgitation, trace amounts of regurgitation across the mitral and tricuspid valves can occur in otherwise healthy adults without any significant pathology or cause for concern. Given that the rest of the report shows normal systolic and diastolic function, I'd be really surprised if the regurgitation they describe is significant or would cause any symptoms."}
{"text": "###Input :My (74F) mom will likely be diagnosed with Alzheimer's later this month by the neurologist when we go for a follow-up after an inpatient stay for delirium. She is currently in a memory care facility. She has DM, OSA, and CHF with an implanted defibrillator. As I step in to manage her appointments I was wondering if she needs to see all her various specialists still. She will be seen by a Geriatrician for primary care, and I assume Cardiology would still be needed due to the defibrillator. But would she still need endocrinology and a dietician for the DM? What about Neurology and Psychiatry after the diagnosis? I got the impression from the Hospitalist that no treatment would be coming for Alzheimer's. Her DM and OSA have always been poorly controlled due to her non-compliance. I don't want her to get worse, but I'm also wanting to be as efficient as possible with the appointments since I'm on my own. ###Output :When quality of life starts to decline, it is important to look at quality vs. quantity of life. If you want her to live as long as possible then yes she needs to continue to see her specialists unless they say it isn't necessary.If her goals are just peace, dignity and comfort rather than trying to extend life then focus on this instead. Her geriatrician can help with this."}
{"text": "###Input :I have pasted the findings of my regular echo below (The tricuspid regurgitation is new) I apologize for the formatting. It wouldnt allow photos.I am a 31 y/o female and just had my yearly follow-up with cardiology. Suddenly my doctor says she is very concerned about my MVP due to my age, and scheduled the esophageal echo.Naturally, I am terrified. I have a four year old, and Im supposed to be getting married. I have issues with anesthesia and Ive been a mess at work all day at the thought of having heart surgery - or possibly not waking up.How serious DOES this sound? I believe a doctor when they say theyre concerned. But Im freaking out right now. Normal left ventricular size and systolic function with an estimated EF 55%. Mild left atrial enlargement. The mitral valve is thickened and the anterior mitral valve leaflet is elongated. There is bileaflet mitral valve prolapse and an associated eccentric jet of moderate mitral insufficiency. There is mild tricuspid valve regurgitation. Dilated IVC without respiratory variation consistent with elevated right atrial pressure 15 mmHg. Estimated PA systolic pressure at the upper limits of normal 34 mmHg. Given decline in LV systolic function (previously 65%) and technically difficult images with difficult to view mitral insufficiency, will discuss with the patient moving forward with a TEE.-Left ventricle cavity size appears normal. Left ventricular systolic function is normal with an ejection fraction of 55%.-Left atrium cavity size is mildly dilated.-Right ventricle cavity size appears normal. -Systolic function is normal.-Right atrium cavity size is normal.-The aortic valve is probably tricuspid. The leaflets exhibit normal excursion. There is no regurgitation.-The mitral valve is thickened and the anterior mitral valve leaflet is elongated. There is bileaflet mitral valve prolapse and an associated eccentric jet of moderate mitral insufficiency.-There is mild tricuspid regurgitation. RVSP is 34 mmHg.-The pulmonic valve was not well visualized.-The aortic root at the Sinuses of Valsalva appears normal in size.-The inferior vena cava demonstrates a diameter of >21 mm and collapses <50%; therefore, the right atrial pressure is estimated at 15 mmHg.-There is no pericardial effusion ###Output :Sounds like the initial problem here is that they can't get good enough images of your mitral valve, so that's why the doctor is suggesting the TEE (trans-esophageal echocardiogram). This will require sedation (usually moderate sedation, like getting your wisdom teeth out). This is a very safe procedure, so I'd suggest it as a good next step to get all the important information your doctor needs."}
{"text": "###Input :3f 3ft tall 34lbs No medications Medical history: Uncomplicated pregnancy and no complications during delivery (vaginal) VSD and heart murmur present at birth but resolved on its own and was cleared by cardiology at age 2 She does have sensory issues and possibly autism were awaiting evaluation.We play doctor a lot because going to the Dr has always been something shes had a hard time with and when I was checking her mouth I noticed she had some red dots on the inside of her cheeks. While I dont believe it to be anything worrisome I wanted to just check. I got the best pictures I could of the red dots I saw. Theres a single one on one side and about 6 on the other side. I tried asking her if anything hurt like her mouth or throat but she didnt respond and is not always able to communicate clearlyI just noticed it today, so I am unsure about the duration and how long its actually been there. ###Output :Likely from normal trauma"}
{"text": "###Input :42F, obese, hypertensive but controlled on meds, normal cholesterol but low HDL, arthritis, recent ankle reconstruction (July and October), seasonal allergies, depression/anxiety.Following a bout of awful GI issues for a week in December, I developed noticeable PVCs. They have progressively gotten more frequent, so I saw my PCP in January. She referred me to cardiology following a normal CBC and MBP.I had a two-day chemical stress test and echocardiogram yesterday and today. I finished around 0900 today and by 1330 I was scheduled for an emergency heart cath tomorrow.I never spoke to the cardiologist, only his nurse. She said he was incredibly concerned about the results of my tests, but didnt elaborate. I was in shock and didnt even think to ask why he was concerned.The results were uploaded to the My Chart app and I tried to read them, but its all foreign to me.Lexiscan reportEcho reportWould anyone be willing to help me understand this? ###Output :The reversible defect on the \"lexiscan report\" is showing that after injection of a drug to simulate the effects of exercise on your heart, there is an area of the heart that doesn't appear to be getting enough blood flow. The concern would be that there is a narrowed coronary artery in this area.These findings are not always accurate but warrant a coronary angiogram, where a small thin tube is threaded up into an artery usually in the wrist, to get a better look at the blood vessels and find if there is narrowing. If there is coronary artery disease, the options would be medical management, a cardiac stent, or recommendations for surgery.I'm reassured that you seem to have normal heart function and currently have no symptoms, and don't have diabetes which can cause some difficult-to-treat coronary lesions. \"Incredibly concerned\" is an unfortunate word choice, positive stress tests are a very frequent occurrence and you are stable. Don't get ahead of yourself you will know more after the cath about whether there is a problem and what to do about it."}
{"text": "###Input :31M,169cm,95kgI want to ask. previously I had taken aspirin and clopidogrel as instructed by the cardiology clinic. at the same time I had an appointment with a gastroenterologist because of a stomach acid problem and the gastro doctor told me to stop Clopidogrel. When I take Aspirin and Clopidogrel Blood test like Red blood cell Hemoglobin Haematocrit is high and it was abnormal last month. My question, If I stop clopidogrel on the instructions of the gastro doctor will it cause 3 types of blood readings to increase more in the future ###Output :Clopidogrel and aspirin do not affect your red blood cell or hematocrit that being said you should speak with your cardiologist before stopping those medications"}
{"text": "###Input :40/F 5'7 175 lbs: gerd, anxiety, bile reflux, asthma, allergies. Cardiology concerns- calcium score of 149, ldl 191, total cholesterol 281, family history of heart disease at a young age.My cardiologist just prescribed Rosuvastatin 40mg. The bottle says not to take within 2 hours of magnesium or aluminum antacids. Does that include esomeprazole magnesium? I usually take all my morning medications (esomeprazole, zyrtec, fluoxetine, vitamins) together- do I need to wait 2 hrs to take the statin? ###Output :No your esomeprazole should be fine"}
{"text": "###Input :My father was in his late 40s and went on a walk. He was 160 lbs and 54 and vegetarian, didnt drink or smoke, and exercised pretty regularly. He called my mom and told her he couldnt breathe. She drove to him and got there within two minutes (he wasnt too far from our house). When she got there he was unresponsive and another passerby had started cpr and called 911. He revived before the paramedics got there and was able to talk to my mom. He even called her on the way to the hospital in the ambulance and told her he got there. As soon as he got there he lost his pulse. They did cpr on him and tried to revive him for an hour before they called his death. Im very lost. How could he have been revived on the sidewalk but not in the hospital. I thought cardiac events were treatable if they were caught within the first few minutes. He had calcium deposits on his heart and had tested positive for covid two weeks prior. Any insight would be greatly appreciated as Im looking for some understanding and closure.Edit: thank you all for your comments. Ive read all of them and really appreciate the insights you all have given into what could have happened. Im talking to a doctor about getting a cardiology consult for my siblings and I to make sure there arent genetic/other issues. Im also making sure my family will get the updated covid booster shots. My dad was pretty religious and we therefore cremated him as soon as possible, because thats what he would have wanted, and tbh I value fulfilling his last wishes more than an autopsy at this time. Ive also gotten my mom and siblings into grief counseling and am looking into options myself. Thank you again for all your kind words. ###Output :Hi. I am very sorry for your loss.Some cardiac arrest cases do happen in healthier individuals and can be fatal. Not all cardiac arrest cases are treatable even in an emergency.It's normal to feel lost right now, but you will get through this. Grief counseling may be helpful in your situation for closure."}
{"text": "###Input :OP, Im NAD but my dad passed suddenly and unexpectedly from cardiac arrest 10 months ago as well. He was 66, and had received a clean bill of health from his doctor 2 weeks prior. I just want to say, I am so incredibly sorry for your loss. I know how youre feeling. Grief is such an incredibly tough journey, one that Im still in. The first few months are the hardest, I got into grief counseling immediately and talking about my dad to someone really helped me. Just know that everything youre feeling is ok, and its good to ask questions. My thoughts are with you and your family.sacca:OP, I'm NAD, but as a hospice volunteer, many hospice organizations offer grief counseling services even if the person was not involved in their hospice program. These sorts of orgainzations might be a place to start for grief counseling.Grief is different for everyone, and for many it's like a roller coaster that eventually levels out, but the ride is uncomparable to anyone elses - give yourself time and space especailly now. I lost both my parents a little suddenly (they were in their 80s, but not much warning) and for me, years later, the roller coaster has become much flatter, with more tender memories than anything else.Another person: Adding to the story chain for OP.When I was 27, I had a massive widow maker heart attack in my larger artery (LAD). I was only 27.I didn't know I had a blood clot in my heart, because I didn't know I had a clotting disorder. The LAD was 98% clotted. Sometimes there's more silent things happening in our bodies.I'm really sorry for your loss OP. ###Output :Im sorry for your loss. Without an autopsy or knowing your family history its impossible to know. He could have had a pulmonary embolism or myocarditis leading to ventricular arrhythmia as a result of his COVID. He could have a genetic syndrome such as Brugada or ARVC or the like. He could have suffered a massive heart attack though thats probably least likely."}
{"text": "###Input :Cardiac incidents are complicated. You mention that he had plaque (calsium deposit) in his heart, which can cause heart attacks, he might have been revived at first and then suffered another attack later causing him to pass away. Having plaques in the arteries of the heart is one of the main causes of heart attacks, and if a piece of this build up breaks off a blood cloth might form around it, blocking the blood flow to the heart starving it for oxygen which is a potentially life threatening condition.That's a question better fit for a Cardiologist, as an EMT it's a little outside my job description to know the fine details about the tests. I know they use duplex ultrasonography which is an imaging tool that uses sound waves to check the flow of blood in the veins. It can detect blood clots and blockages in the deep veins. But I'm not sure how much/little build up there has to be for it to detect it. They also use a blood screening called \"D-dimer\" which is a substance that is released when a blood clot breaks up. Again, I'm not sure how sensitive the test is. ###Output :Im sorry this happened to you. My father died In A similar manner, playing tennis. He was in great health, it was a terrible shock to our family and left me fatherless at a young age. Your father likely had a cardiac arrhythmia, it could be related to the Covid virus as it can settle on your heart. If there is no cause of death found at the autopsy it will fall under the category of sudden cardiac death. Resuscitation is not like in the movies and has a low likelihood of good outcomes especially in the field (outside of the hospital). Sometimes despite everyones best efforts people still pass, do not blame yourself or anyone else as these are just acts of nature or God."}
{"text": "###Input :I (22F) found out I have a pulmonary embolism on november 2nd. It is in the posterior basilar segmental pulmonary artery of the right lower lobe. Its acute (d-dimer at 1,170), I wasnt really concerned honestly. I have been in and out of hospitals my whole life (Im not very lucky when it comes to my health) and ive gotten to the point that I dont stress out whenever I get diagnosed with something new. The ER doctor suspects it was caused by my BCP (combined) along with post-covid stuff (I had covid in july/august of this year).I work as a phlebotomist and recently added an MA type position to my job role at a preventive cardiology office. So I am in the medical field but I dont know a lot about medical stuff - moreso just what I learn from patient situations and what I hear around the office.The first day back at work, a lot of co-workers were extremely concerned and worried about me, some said things like im so glad youre alive!. I appreciated all of the kind words from everyone but it got me a little nervous about how serious this is??Should I take this more seriously? And be more aware of my symptoms? I can take my vitals daily at work and do little things like that. I am so lucky that this happened while working at a cardiology office as the doctors there are keeping an eye on me and basically just told me to monitor my d-dimer at the office and refill my own prescription for eliquis etc etc. Obviously giving them the blood work results if there is anything concerning.The only thing I have changed in my life is that Im constantly wearing a mask in public as I really dont want to risk getting sick right now. When I started eliquis while I was in the 2 weeks of 10mg twice daily, I sneezed and got a nose bleed (I havent had a nose bleed in a good 10+ years so thats not normal for me), so I really dont want to be constantly coughing or sneezing. I used to try to wear a mask out in public whenever I remembered to bring a mask with me and I avoided large crowds as I am immunocompromised anyway, but I wasnt extremely strict with it. Ive also been wearing compression socks since I started this recent BCP.Should I be more careful in other places? Is this something I should be really worried about? I feel like Im doing enough but the comments I get whenever I mention my PE to someone kind of scare me.Medical info : 22 Female 5ft8 ~155lbs White. Diagnosed with psoriatic arthritis at age 2 (arthritis, psoriasis, and uveitis). PCOS, endometriosis, and a septate uterus (the main reason Im on BC). Hypermobility (probable EDS). Frequent concussions (recently got a referral to see a neurologist for this). Guillan-barr episode in October 2020 due to an insect bite on my neck. Paralyzed from the neck down, was in the ICU for a week for precautionary reasons but never needed a ventilator. GB isnt reoccurring and not on any medications for it. ADHD (along with depression and anxiety) and PTSD.Humira bi-weekly for uveitis. Eliquis 5mg twice daily. Falmina (BCP). Prazosin for PTSD (nightmares). Cymbalta for depression. Vyvanse for ADHD (not taking currently due to concussion and PE. Vyvanse makes me extremely tired and Im already tired from my PE so I dont want to make myself even more tired). Pred-forte eye drops for uveitis (SIG changes constantly, currently on twice daily in both eyes).Extremely light drinker (last drink I had was sometime in September). Occasional marijuana use for humira side effects and pain (~4 nights a month). ###Output :PEs are like car wrecks. Some are horrible and kill you instantly, more often they are a semi big deal, and a lot of the time they happen and are lame but you werent really at risk of dying on the spot. But regardless, if you tell someone youre in a wreck theyll gasp and ask if you were ok.Sounds like you had a small subsegmental PE which as you said couldve been provoked by your medication. Take your eliquis which will prevent new clot formation and your old clot will dissolve with time"}
{"text": "###Input :male/ 37 years old/ 230lbs/ 6 feet tall/ non-smokerI've had chest pain since my late-20s. For about 12 years, I've had high cholesterol due to a rather poor diet. My total cholesterol is \"borderline\" high according to the ranges, at around 230 mg/dL, my LDL is usually around 160 mg/dL and my HDL is around 50 mg/dL. My blood pressure is always pretty good at around 115/78.Due to the chest pain not going away, I was sent to a cardiologist who did a whole cardiology workout: echocardiogram, loop monitor, EKG and a calcium CT scoring test. Everything came back fine and my calcium score then was \"Zero\" , which the cardiologist said is a perfect exam.Since then, I've been diagnosed with a hiatal hernia and anxiety. I've started Zoloft, which has made my chest pain 85% better. I still get it at times, and my doctors are convinced it's my hiatal hernia creating pressure in my chest and/or pushing on my vagus nerve.Fast forward 6-7 years to today, I just really started getting my diet in gear about 2 weeks ago but just at that time before I started, I wanted to get a baseline blood work to compare. My cholesterol was the same as it usually was for the last 12 years but my primary care physician said my C Reactive Protein is 5.5 mg/L , whereas when I had it drawn years ago , it was around 3.0 mg/L. He said \"you really need to focus on lowering your cholesterol. That CRP could be due to your arteries starting to narrow and atherosclerosis starting to happen.\". Would the calcium score test from 6 years ago change that much in that time?I am not \"fat\" and have really wide shoulders so I carry my weight differently but I know I should definitely lose weight and eat better, which I definitely have been. Hearing that my CRP is now high, I am worried that there is now narrowing in my heart. Should I go back to my cardiologist and see if I can have a repeat calcium scoring test or even a CTCA? ###Output :More than anything you need treatment for your cholesterol. Are you on a statin? Poor diet does not by itself lead to an LDL of 160 in a 37 year old."}
{"text": "###Input :thank you. I am not on a statin. My doctor said given the fact that I got my LDL down to 118 a few years ago when I tried eating more fish (salmon), he said I can do try the diet route again if I stick to it. He also knows I don't exercise much due to the pressure I feel from the hiatal hernia. ###Output :It is worth considering. While you are young your elevated lipids and hsCRP are enough to at least consider it"}
{"text": "###Input :79M approx.. 6 195 lbs. asthma (we have no idea what meds he is on or prescribed at ER)My FIL (79M) was taken via ambulance to a small local community hospital on Tuesday and diagnosed in the ER with having had a TIA due to Afib. Heart issues is something that was unknown to them previously so he was not previously on any meds for that. My husband got up there in time to interact with the doctor at discharge and specifically heard the doctor tell FIL and MIL that he needed to take the meds he was being prescribed and see cardiology and neurology as soon as possible. This was a small local community hospital outside of San Diego but they are in an area with a large senior population where they probably see this a lot. My husband felt the instructions were clear and relayed succinctly.Because my own father has a long and fantastic experience with both cardiology and neurology at the large very well respected university medical center my husband asked me if I could make appointments for his father there as we figured inlaws were overwhelmed among other issues. I was surprisingly able to secure him appointments for this Monday and Tuesday respectively (6 days post ER visit). Husband told MIL that evening that appointments were secured for FIL at the university hospital.Now today my husband learns that MIL took FIL to their GP yesterday (day after he was released and before specialist visits) to their GP (whom my husband refers to as Dr. Quack due to his negligent care of his aunt resulting in her subsequent death due to melanoma so we may be biased here and this is why we are asking) told him he didnt need coumadin that he was just stressed and he just needed some Xanax to relax. So FIL told my husband today that he stopped the meds that ER doc overprescribed and am just taking the Xanax. I FEEL GREAT! FTR we have no idea what the other meds were and now they wont tell us.MIL is exploding at my husband and accusing him of a lot of wildly ridiculous things and FIL is trying to keep the peace and just shutting down. As a bit of background there are A LOT of issues with MIL and her behavior and this is pretty standard. Husbands basic rule is that we just need to prevent her from harming others and just tune her out otherwise. So our question is will this change of meds harm FIL and husband needs to intervene more strongly or is this something standard? TIATLDR: is it medically acceptable for a GP to remove someone from blood thinner (Coumadin?) less than 48 hours after a TIA and replace with Xanax even before they have seen cardiology or neurology?Edited to clarify timing ###Output :Everything here is just odd. No way of knowing what's what without the hospital records. Please be sure to take them with you to the neurologist and cardiologist."}
{"text": "###Input :Thank you for responding. Right now they are saying he is not going to cardiology and neurology because GP told him he doesn't need it. (again husband and I do NOT trust this GP and believe the ER). Husband had me call the university and make sure the appointments cannot be cancelled unless they call my husband's number. Our question is will he be fine like this until Monday or should husband intervene with the nuclear option and go collect FIL when MIL is out and take him to urgent care? ###Output :Unless FIL is cognitively incompetent, they should be able to make their own decisions. They have all the information from the ER and GP to go on. This is a complicated situation and your question is not answerable without more detailed/nuanced information and discussion of pros/cons. Being on Coumadin is either a necessity or a huge liability (quite often both) depending on factors we do not know here on Reddit."}
{"text": "###Input :34 female 5'9\" 230lbsNon drinker, light smoker but almost completely quit since the heart problems started. Had covid 6 weeks ago with no complications. No history of heart problems or high BP.It started less than 2 weeks ago with drops and spikes ranging from 90/60 to 180/110Now it's sustained high BP and elevated HR. I did go to the ER Monday just to make sure it wasn't something acute as there is accompanying chest pain but the entire time I was at the ER my BP was very low as was my HR.I have a cardiology appointment next Friday but every day since Monday I've been waking up with systolic in the 150s. I feel physically panicked all the time and it's starting to affect my sleep. I've already doubled my propranolol from 40 to 80, I take klonopin and prazosin daily as well, and I've added clonidine and antihistamines to also try to keep it lowered. Even taking all of those at once it barely makes a difference.I have a good life right now i can't think of any stressors other than being in love, but I feel like I can't do anything or be there for anyone because my body is fucking panicking 24-7 nowI can't do this much longer. It's obviously not an emergency but I feel awful not at all being in control of my body. It's like something flipped the fight or flight switch and it's stuck on high. This does not reflect my mental state at all. ###Output :How regularly are you taking the clonidine? That frequently causes rebound hypertension."}
{"text": "###Input :Age: 8Height/weight: Average, not sure exactly but last i was told, she's within normal rangeFemaleCaucasian/ HispanicNo previous medical history, no prior surgeriesnon-smoking householdWe all had covid in December 26th. It was rough but we all recovered. Me and my husband were vaccinated. My kids weren't because their clinic wasn't providing the vaccines yet.I'm going to try to be thorough as possible because it's just so much going on with her and i don't know where to start and her symptoms are all over the place... Last summer she was in someone's house that had a rabbit. The rabbit was filthy and it scratched the top part of her hand. Her hand began looking infected because even though i washed it and put neosporin on it, kids are kids and she couldn't keep it clean and soon it began looking red. She got a fever roughly around that time and was complaining of headaches and that her \"throat feels tight\". I took her to her clinic and they drew blood to test her for \"rabbit scratch fever\" It came back negative..They figured she just caught a virus and nothing became of it. The scratch eventually healed with an ointment they gave her. That same summer she..again...being a kid, didn't listen to me and was rolling in grass in her grandmother's yard which we have found ticks in. She ended up with a tick in her head which by the time we noticed it amongst her hair was engorged. I pried it off her. My daughter again, began complaining of headaches and her body hurting, \"tight\" throat. I took her to the ER and had her get tested for lyme disease it came back negative..It's now almost a year later and her headaches \"tight throat\" and body pain just come and go sporadically. I would chalk it up to growing pains which is what everyone was telling me. Her doctor never seems concerned...But sometimes the headaches are so intense she will cry and lay down and ask for a cold towel for her head...she's 8. And now on top of it all she's got new symptoms. She came to me about a week ago saying her butt felt weird like it had \"dots\". I tell her to show me and all over her butt and upper thigh area she is covered in what look to be pimples. Its so odd. My mind automatically went to \"bed bugs!\" So i checked the beds from top to bottom but found nothing. She still has trouble sleeping some nights and comes to sleep on our bed so if it was bed bugs why is she the only one with the dots? I'm checking her daily and it's as if she's got a new \"pimple\" everyday...again, she's 8...wth..Another new symptom she has is she's been getting heart palpitations. One minute she's playing on the floor or on the sofa, and the next she will come to me saying her heart is beating rapidly. I put my head on her heart and i feel her heart beating quickly. It scares her and i have to scoop her up and hold her for a while. She has also started hypervenilating when she's upset. Something she's NEVER done in her life. We aren't strict with her and she's a happy child, why would she start doing that? She says she can't help it.I took her to her doctor roughly two-three weeks ago because i had enough, i told her doctor everything from the summer to now. From the body pain to the heart pain and showed him her butt pimples and asked him to please help because we are at our wits end. He checked her out and said her heart sounds fine to him. He also was dismissive towards her skin problem. He did however notice the lymph nodes around her neck were really swollen. He ordered her to get blood work done and it came back last week. She has covid anti-bodies in her blood. She tested negative again for lyme (im guessing he just wanted to double check in case the other one was a false negative) and showed what he thinks might be her in \"Recovering\" state of cat scratch fever? ...ok? We have cats so i guess that's possible. He sounded so unsure with himself. Sighing a lot and kept going \"eh...i don't really know what to tell you...\" and stumped with her blood work. He sent her a prescription for Azithromycin just to be safe. She has to take this every day after dinner.Thing is, she's still complaining about her various symptoms. And it's been days since she got the medicine and now she's more frequently telling me her hearts beating quickly. So im afraid to continue giving her the medicine in case that's whats causing the palpitations. I have sent various messages to her doctor two days ago but he isn't calling me back. I'm tired of waiting for him and already went ahead and made her an appointment for both pediatric cardiology and dermatology. I also found a new pediatrician because i've had it with this guy. Both appointments are next week. But until then i'm just a bundle of nerves. I hate when she comes to me saying her heart hurts or her head hurts. Can anyone here please tell me whats wrong with my baby girl?Edit: were at the ER now. She started complaining of heart pain and palpitations and Im done waiting. Will update depending on what they say ###Output :Time for a new doctor. Its not typical for 8 year olds to get heart palpitations"}
{"text": "###Input :Yes, but I was just told by a pediatric cardiologist that this is happening with children who had Covid and were t vaccinated. Im going through similar with my 8 year old.Edit: werent vaccinated, not were.The reason I stated what I did and kind of barged in here to comment was just to bring light to this issue.Theyre monitoring her for now. They had to her a holter monitor for a few days, then some testing. She was fainting and her lips were turning blue when she would have her palpitations. I also have them and get dizzy but never blue finger tips or blue lips.I hope all ends up okay. I know how scary this is for both of you. ###Output :How long does it last? If it lasts 15+ minutes, it might be worth your peace of mind to get her on a monitor in the ER. If its only a few minutes then she probably needs a holter monitor or evaluation with a pediatric cardiologist."}
{"text": "###Input :29F, non-smoker with history of NSVT. Diagnosed in 2011. NSVT was then changed to PSVT in patient records without my knowledge until recently.Diagnosis would present with palps, lightheadedness and tunnel vision. It occurs randomly with no clear trigger.I had a new holter applied for rapid pounding heart with dizziness and angina.Holter findings were reported normal with low burden PVC and sinus tachycardia. (sinus tachycardia is expected culprit for rapid heart and associated symptoms)However, VT was also noted?https://imgur.com/a/S2rMmmEThe comment states AIVR. And Im just curious if this is actually AIVR or PSVT? Or something else entirely.I do have an appointment with Cardiology in a few weeks. ###Output :Characterized as AIVR because rate is <110 with widened QRS.PSVT is usually in the setting of tachycardia so rate goes from normal to very high. Had a few more beats (like those shown) at a faster rate happened, it may have been called PSVT."}
{"text": "###Input :That makes sense, thank you!Do you know if PSVT and AIVR have a habit of appearing hand in hand? ###Output :Not typically. My best guess is this was a small run of soon to be PVST that corrected before becoming tachycardic."}
{"text": "###Input :29M 62 181lbs Hypertension (20mg olmesartan qd) and recently recovered from mild COVID infection, otherwise no significant medical hx. I do also take melatonin nightly and use an occasional ginger root supplement.I was on a beach trip over the weekend and we stopped to grab some brunch around 10am before my girlfriend and I drove back home. I drank a cup of coffee at brunch, and felt a skipped beat kind of feeling, so I took an Apple Watch ECG. To my surprise, I noticed that I was popping anywhere from 2-10 PVCs/minute, which I have no history of.I rode it out on the way home and tried to forget about it. I took a few more random Apple Watch ECGs, and the frequent PVCs have been consistent all day. Finally a little after we got home, I decided to go to urgent care just to get seen. They did an ECG, which didnt capture any PVCs on the 10 second strip of lead II. But the NP said she auscultated a few after they took the ECG. Confirmed on my Apple Watch theyre still happening.The NP basically told me shed give me a cardiology referral and to do nothing in the meantime, but to go to the ER immediately if I started having any chest pain or SOB. She basically said that there was nothing she could do in the urgent care setting and that I need a further cardiology work up.Is this solid advice? Am I safe? Or do I need to go to the ER? Besides the initial skipped beat feeling, I havent been symptomatic at all.I will also say, I had a good bit of alcohol this weekend, more so than usual. Could it be alcohol and caffeine?12 lead ECG from urgent careApple Watch strip with PVCs ###Output :Yup wait to follow up with cardiologist. ER if SOB or chest pain. Caffeine and alcohol can certainly contribute"}
{"text": "###Input :40M 5'8 160 pounds. As part of my team of doctors (3 cardiologists, primary care doc, endocrinologist, neurologist, etc.), we've been hunting down some autonomic issues that I have been having. I haven't had blood work in a couple of years because I have been pending Disability since last year and had a work injury the year before that. My autonomic issues worsened over that time.If TLDR, can a Cardiology office request the same type/amount of blood work as a primary care doc, for instance?I don't have a primary care doctor presently because I had a good one and he moved away back to his home state a while ago. Most primary care doctors are unfamiliar with specific autonomic dysfunction conditions, so my third cardiologist is the specialist in autonomic issues. They want to do blood work. Of course, I'm asking their office what kind of blood work they can do, as well. But since it may be days before they can get around to that general question, this is a two-part question:I'm wondering if any doc can explain the difference between which offices (primary care, cardiology, endocrinology, etc.) can do what types of blood work and if they are 'limited' in what types they can request.Also, is that that limitation solely based on the provider themselves being medically unable to request beyond specific blood work related to their specialty or is it just because they're not familiar with other blood values? For instance, I asked my neurologist one time about blood work values from a cardiology tilt table test and he said he \"didn't know how to read those blood gas levels\". So that told me that of course that's not his specialty, and I knew that, but he was the one who asked about blood work to begin with. ###Output :Any doctor can order any kind of blood work, but the limitation as you've found is the ability to properly interpret it."}
{"text": "###Input :Im 20F with a long standing family history of heart failure. Ive had intermittent chest pains due to chronic Tachycardia but last night it was unbearable and I went to the ER because I thought I might be having a heart attack. I waited approximately 2 hours after initial onset to leave work bc another manager needed to be present. My mistake but I eventually shut down the store out of fear and went. My ECG was flagged abnormal for nonspecific T wave abnormalities on the inferior leads. But thats always on my ECG. However the hr recorded was 72. My avg resting hr is 98. Could I have had a cardiac event that ended before I got to the hospital? negative D Dimer low average Lactase and high PT (12) and PTT (54) INR 1.1. Chest X Ray clear. Should I push for a cardiology referral given family history? or was it likely a fluke? ###Output :>Should I push for a cardiology referral given family history?No, they would probably decline the referral given your normal investigations.>Could I have had a cardiac event that ended before I got to the hospital?Incredibly unlikely.Also:>Ive had intermittent chest pains due to chronic TachycardiaI doubt these two things are related."}
{"text": "###Input :34, male, 5'9\", 260lbsnon-smoker, rarely consumes alcohol (1 or 2 a month, if at all), tried a friend's THC vape once, no other recreational drug use.medications: effexor 150mg, concerta 54mg, advair 2 puffs daily, albuterol rescue inhaler as neededhealth conditions: anxiety, depression, ADHD, moderate asthma (all very well controlled on current meds)medical history: knee surgery 2012, initial 2 COVID vaccines March and April 2021 + booster November 2012, had COVID February 2022.Background of Current IssueHad a mild case of COVID-19 in February. Main symptoms were swollen lymph nodes on the left side on my neck and armpit and frequent heart palpitations.Symptoms went away until April, when I started having sudden heart palpitations randomly throughout the day. When the palpitations end, my the same neck and armpit lymph nodes swell up painfully for several hours.Symptoms got bad enough that I thought I was dying and went to the ER. Not dying, just something that can happen post-covid. Minor abnormalities on ECG, Doctor explained why they weren't concerning in my case.After a couple months of reducing caffeine intake as much as possible ( about 2 cups of coffee before work, no more canned coffees or caffeinated tea at work), it seemed to have gone away.About two days ago, it came back. Didn't recognize the symptoms for what they were and went to the ER again. Slightly different abnormal but not concerning ECG. Blood pressure was high, went back down to normal by the time I was discharged. Negative COVID-19 test. Same left side lymph nodes painfully swollen.My Question for AskDocs:I plan to see a cardiologist about the heart palpitations since they have been so frequent after coming back.Is there any other specialty that might be able to help me? Or would making sure my heart is okay be enough? ###Output :Cardiology will handle the palpitations.Without seeing your ekgs I can't tell you much more. There are many causes of palpitations, if the ER discharged you then the palpitations we're probably due to PACs or PVCs which can be treated by your PCP or cardiologist to reduce your symptoms, but like I said, can't say much more without the ekgs or more info."}
{"text": "###Input :Age: 21. Weight: 160. Gender: male. Height: 5'7\". Diagnosed with asthma.I had a cardiology appointment today. I was told that I had a heart murmur and I had a bunch of tests scheduled..the soonest being A WEEK OUT. With my echo being months out. Seems like a heart murmur could easily kill me. What's up. ###Output :Many heart murmurs are caused by non-life threatening things. Unless you are having signs or symptoms of life threatening things (passing out, chest pain, severe shortness of breath, etc) doctors will investigate things in an outpatient setting. For example, most cancer work ups (arguably more life-threatening) are done in an outpatient setting."}
{"text": "###Input :Mandatory info: 30M, 6'3\", 185lbs, white, near syncope with heart pains for the past week, EKG abnormality. Don't smoke or use any recreational drugs, have used Ambien (5-10mg) to treat insomnia intermittently for the past 3 years. No preexisting conditions.Last week I had back-to-back instances of severe chest pain, followed by a hot flash / sweating and dizziness that persisted for about 60s. This occurred at the airport, and resulted in me getting transferred to the ED for evaluation. Paramedics conducted a few EKGs, and I heard them say there appeared something anomalous with \"B3\". At the ED, had an additional EKG, chest x-ray, and ultrasound with no acute findings. No bloodwork done. Cleared to fly, completed my work travel, returned home with a PCP appointment scheduled for this morning. The intermittent pain / palpitations / weakness / dizziness has persisted since the first episode.At PCP visit today, another EKG was done and compared to my past EKGs done at that office. My primary found an anomaly in Lead 3 (which I assume is what I misheard the medics identify), and ordered bloodwork (troponin and lipid panel, amongst others). Gave me an urgent referral for cardiology, wants me to get a Holter monitor and stress test at a minimum.My question for all you wonderful people: what is the pathophysiology that leads to an anomalous Lead 3 finding on an EKG? How worried should I be? ###Output :Impossible to say without seeing the ECG and exploring. Lead 3 (in conjunction with others) corresponds to the inferior portion of the heart. But there are many things that could be showing in this lead on your ECG."}
{"text": "###Input :F30. Ive had these transient episodes of PSVT for some years now, following an Epstein Barr infection when I was 22. Ive had a cardiology referral before, with a 3 day monitor. It caught nothing, so they diagnosed me with Anxiety and sent me away with a low dose of Propanolol if I wanted it.These heart episodes are making my life a living hell. They are destroying my relationships and my ability to function in my daily life. I used to work, but now I dont. Ive had to give up my job because I couldnt cope with the interrupted sleep (they specifically wake me up from a sound sleep, usually around 3am). This is obviously very frustrating for both myself and my partner.Went to ER with chest pain after the last episode, and the ER doc wanted to get me a 21 day heart monitor - which would definitely catch it as my episodes appear in clusters, a few times a month. There appears to be a hormonal component to it.Ive completely cut out caffeine but the effect that has had on it has been minimal.Now, the NHS is saying that they will refer me to cardiology when my anemia is sorted. But, its never sorted - at least, not without iron infusion therapy (I have IBS and dont tolerate oral tablets well).I did have an iron infusion months ago, which picked my Hb levels to no longer anemic - but didnt get the referral then either. On the contrary, I heard nothing from my GP, for months, and now Im back to being anemic again - its so hard to maintain my iron levels without routine IV iron, and the only time I get it is if Im in hospital for another reason (last time was Gynae related).Im beginning to lose hope that this will ever be resolved and worry that Im just going to drop dead of an unidentified cardiology issue.Is there any way I can get the cardiology appointment and have my cardiologist take me seriously instead of attributing it to anemia like last time, because my resting HR is 60bpm, these SVT episodes are a very distinct and immediate jump to a hr of about 170-200bpm, and they arent anxiety related at all. They also definitely arent anemia related because even when I am no longer anemic, I still get them. Twice monthly, around the times I ovulate and right before my period. Predictable as clockwork.I just want them to stop because they make me afraid to sleep at night and as a result I have developed pretty terrible insomnia, and depression due to the constant fear of wondering if something is severely wrong with me. ###Output :I dont understand why you had to give up your job if they only happen twice a month like you say? Do the beta blockers work?"}
{"text": "###Input :I was training as a student nurse, but the stress from this has been too much for me to cope with tbh.Im reluctant to take BB because my resting heart rate sits at 60bpm, and tbh theres nothing wrong with my resting hr. I would prefer to have an ablation than take daily unnecessary medication for the rest of my life? ###Output :Im sure the cardiologist assessed your pulse before giving you beta blockers, have you tried them?"}
{"text": "###Input :That was when I was 25, and Im 30 now, so its been a while since my last cardiology review (during which time these episodes have gotten more frequent and last longer) and the cardiologist hadnt ever actually seen an ecg tracing of this issue, which I think is a pretty important piece of diagnostic information. Id personally advocate for my patients that abnormal ecgs are reviewed, so why not mine?Ill ask my GP about trying a low dose BB, but I dont expect it to do a great deal other than lower my BP a smidgen. ###Output :Id be surprised if a cardiologist ordered a 3 day monitor without reviewing an ECG first.If I was you Id go back and take the beta blockers, give them a go. If they fail then go back and say I did what you said doc whats the next steps. The outcome will either be finding a treatment that works in primary care or youll be referred back to cardiology."}
{"text": "###Input :I have also been having infrequent runs of (possibly) SVT, which also seem to be hormone related, although Sods Law they have never appeared when hooked up to hospital machines, only a 6 lead home device.I also have a resting HR of 50-60 but have found beta blockers insanely useful. I take a super low dose of bisoprolol and it seems to be just enough to stop my heart going into these fast rhythms but not so much that my heart feels too slow. I was sceptical at first too, but Im glad I gave it a go. I drink a tin of coke each day and take stimulant medication and I will only get a brief run of SVT once in a blue moon. Whenever Ive stopped the beta blocker the issue has come back so it must be doing something.I hope you manage to get to the bottom of things and find a solution! ###Output :Meds are helpful as mentioned and usually pretty well-tolerated unless you have AV block or hypotension.Depending on frequency, length of the episodes and preference cardiologists generally use either chronic preventive therapy with a beta-blocker or calcium channel blocker, or pill-in-the-pocket with flecainide or beta-blocker. If you have a favorite vagal maneuver those can sometimes work too.These are very rarely life-threatening. Ablation is effective but can't help you negotiate the NHS system. Fixing the iron deficiency will also help. Our hematologists do have some patients with chronic iron deficiency anemia who can't catch up with oral supplements who have scheduled IV infusions, but only after every possible source of ongoing blood loss or iron malabsoprtion is addressed (celiac, heavy menses etc)."}
{"text": "###Input :40M 5'18 160 pounds. Over the past few years, some weird symptoms either developed or got worse. I was lightheaded back in 2018 and a neurologist found nothing wrong with me. Late December, symptoms sent me to the ER with elevated blood pressure, white blood cell counts at 14.5, stomach and intestinal pain, rapid heartbeat, etc. My heart rate and blood pressure rapidly fluctuate. My heart rate varies by at least 20 beats per minute from the base line. So I'm sitting and the base is 70, it will go 72, 75, 78, 80, 82, 85, 87, 90...88, 86, 84, 83, 0, 78, 75, 72, 70 and sometimes do that whole course twice in a minute. I am not known to have ever had Covid and I am presently fully vaccinated, as well.Over the past few years, I've been seen by primary care, neurology, gastroenterology, endocrinology, had head/abdominal scans with nothing noted, saw 3 cardiologists, wore 2 Holters for a month, had lots of blood work and such. Stress Echo via treadmill showed a healthy and strong heart.Diagnosis of Postural Orthostatic Tachycardia Syndrome by primary care, neurology and cardiology. Dysautonomia/autonomic dysfunction got thrown vaguely into the mix, as well. Tilt table test would have been negative for POTS. I didn't faint or have the rapid rise in heart rate. They gave my sublingual nitroglycerin and I fainted within a short time. BP went down to 97/56 and pulse to 40, possibly only because of the nitro. I am lightheaded 24/7. Even just lying on the bed at night, I feel little sharp \"zaps\" of lightheadedness. I'm familiar with BPPV and it's not that. The POTS no longer applies - I am rarely tachycardic. Also, my blood pressure is now more so low on a daily basis. For instance, earlier today it was 99/57 after a meal that was quite heavy in salt. I seem to always crave salt and can't seem to get enough of it. I am completely exhausted every day, have no energy and my entire body is hyperreflexic.I have hundreds of tiny little red bumps all over my upper and lower back and the backs of my arms. They do not itch. Back in 2020 an EGD showed an inflamed stomach lining with negative biospies. 6 months of Prisolec 40mg twice daily at that time didn't help. He put me back on the 40mg twice daily again. It was after that point that I ended up chasing the POTS/autonomic dysfunction stuff and had not seen the gastro doc since because I later lost my job due to a work injury. I just saw my gastro doc again recently. After reviewing my symptoms, he asked if I have ever seen an allergist. Then when I told him about the horrific lower colon pain that I get at times, constipation on average of 2-3 days at a time due to inflammation preventing a bowel movement, the feeling of inflammation and severe burning/clawing pain for hours even after a bowel movement and such...he feels that I may have something else going on in my colon. He brought up Crohn's and said it was sneaky sometimes. I showed him photos of my pie crust-like tongue that seems to swell at times and I get canker sores in various areas of the mouth and have for a long time. I showed him a photo that looked like I was pregnant - considerable lower colon swelling and abdominal bloating. Also, what makes me think some of my other symptoms like the low blood pressure and such may be related is because when I press on my lower colon area or rub it, my ears immediately ring and at times I get nauseous. There's no way that's a coincidence given how often it happens.I'm always hungry for big meals even after I just ate a big meal recently. I get considerable postprandial hypotension. I haven't worked in 2 years, pending Disability. Gastro doc requested CBC, Comprehensive Metabolic and Thyroid/TSH panels. All within normal range except the thyroid panel:T3 UPTAKE 24 Reference Range: 22-35 %T4 (THYROXINE), TOTAL 10.9 High Reference Range: 4.9-10.5 mcg/dLFREE T4 INDEX (T7) 2.6 Reference Range: 1.4-3.8TSH 2.25 Reference Range: 0.40-4.50 mIU/LThe only flag was the T4 Thyroxine and it's only 0.4mcg/dL higher than the highest normal reference range. All other blood work was fine. This reference range seems normal and also what is 'normal' seems to vary considerably depending on what source you compare it against.Severe burning/clawing sensation in the lower colon just below the navel. Worse at night, but moderate pain 24/7. Full-body malaise, jitteriness and rare spikes in blood pressure with full-body tremors as if freezing cold for 15-20 minutes. I get even more colon pain during this time and at times feel feverish. I have had unexplained blood pooling in my hands and feet since I was a teenager. Heavy nausea immediately after lightly pressing or lightly rubbing the lower colon area below the belly and middle abdomen. No vomiting. Frequent bright yellow or greenish stools with some worm-like mucus in them. No visible bleeding. Upper body jolt-like 'tics' that feel at times as if they are originating from the lower abdominal area and cause my upper body to jump randomly in certain movements. With the lightheadedness, it feels like even when I'm sitting or lying down an djust move one arm or leg, I get a brain \"zap\" of lightheadedness. What in the world could cause that?I'm trying to get a colonoscopy to see for sure. Due to low income, the Colorectal Cancer Alliance has me on a list for funding for a colonoscopy locally when it becomes available, quoting possibly in February when more programs open.What are my chances of Crohn's/IBD with the above issues going on? Could it also be the cause of my blood pressure and heart rate fluctuations? I'm puzzled at the normal white blood cell counts given that my lower colon was absolutely hurting/inflamed during the blood draw. ###Output :There's nothing here that suggests IBD, though that doesn't mean you can't have it.It's possible that you have IBD but your symptoms are pretty vague and not classically IBD"}
{"text": "###Input :28YO female, healthy and an avid lifter. Referred to cardiology for heart palpitations and fast heart rate. Placed on 7 day heart monitor. Was told that I am in ST majority of the day. There were some skipped beats as well. Placed on toporol for management. Cardiologist said borderline concerned, due to how high my HR is. Said if it gets worse, things would change. These strips are from the Holter monitor report. ###Output :ST = Sinus Tachycardia. It means the heart is working down the normal electrical system, but its going faster than normal. Often there is an underlying cause (and not a primary problem with the heart), but sometimes peoples hearts just go fast and we need to slow them down with medications like your toprol."}
{"text": "###Input :Age: 36 years old Gender: Female Height: 5'4\" Weight 160lbs Location: USA Smoking: Never Meds: xyzal 5 mg daily for chronic idiopathic urticaria and angioedema 200mg Zoloft (serteraline)I recently gave birth. I had pre-eclampsia with high blood pressure, protein in my urine, headache and chest pain. I was given an ECG, EKG, and chest x-ray while in the hospital. I was discharged a couple days later and they put a zio heart monitor on me for 2 weeks.This past Friday I had a follow up appointment with a cardiologist after my monitor results, the other tests, and one more ECG. The cardiologist told me (in a relatively relaxed and casual way) that I have a long QT interval and that can increase the risk of sudden cardiac death. She referred me to a geneticist who I'm waiting on for an appointment.At the time my brain stopped working when she said death but now I'm trying to gauge what is.me.being overly health anxious and what is justified worry. I am emailing the doctor but I suspect it willl take awhile for a response since it is the weekend.But given that I have no history of drinking, smoking, drugs, eating disorders, or any vitamin imbalances. How worried should I be?? Like should ainbe saying my goodbyes?! Or do I just ignore it and my life will be relatively normal??? I haven't had any fainting spells and I don't THINK either side of .y family has a history of SCD. But on both sides there is cardio history -- my maternal grandfather died of a heart attack and my maternal uncle has had a couple I think? My paternal uncle has had a heart attack and I think my paternal grandfather died from one as well? But that one I am really unsure about.Is this the sort of thing that everyone has and is NBD?? Or is this the sort of thing where I need to 100% commit to completely devoting myself to Cheerios and heart healthy choices if I want to live???I really appreciate any help or advice you can give. I really know SO LITTLE about cardiology it's like I don't even know what I don't know. ###Output :I'm sorry you're going through this. I don't think you need to say you're goodbyes at this point. There are varying degrees of prolonged QT intervals. Without actually knowing how prolonged it is it's hard to really guess. Depending on how prolonged it is it may be nothing to worry about but it sounds like you're in good hands with seeing a cardiologist and moving forward with workup."}
{"text": "###Input :Thank you for your reply.I feel so ignorant about how hearts work I feel like my brain can't even comprehend the risk or understand. I'm not a particularly stupid person but this is all just beyond my capacity. ###Output :Don't feel that way! It's a complex organ and no one would expect you to fully understand. You should reach out to your cardiologist and just see if they can explain it better to you, that may be helpful before seeing the geneticist and answer some of your questions."}
{"text": "###Input :F49, 55, 143 lbsI had a severe allergic reaction and I almost died on Tuesday. I got stung 2-3 times by a yellow jacket while cutting the grass. I came inside to get some Benadryl and saw all these black spots (probably 4 minutes later). Then I was profusely diaphoretic, dry heaves, had copious amount of phlegm from my mouth and nose, couldnt breathe, weakness and was blacking out. It was so so fast.My husband (hero #1) happened to be coming from the airport so he called 911 and My 13 year old gave me one of her epipens in the thigh (she is anaphylactic to shellfish and buckwheat). First responders came (maybe 4.5 minutes) and I couldnt open my eyes, they put me on a blood pressure monitor and then it was alarming, so they turned the alarm off. Then advanced life support I think or Ems literally picked me up and ran me out to the ambulance. I think I blacked out and woke up and I barely remember the ambulance ride with sirens and lights and them laying on the horn. I could hear them saying we got gotta get her pressure up, we got nothing here. I remember trying to talk to them and my tongue wouldn't work. When I was conscious and realized the lights and sirens were on, i saw the seriousness. When I heard them say ETA 3-5 and BP of 40/20 - I 'm like , that's not compatible with life. The paramedics worked on me the entire time. At hospital had me in a trauma room and called all staff over loudspeaker. Thankfully they got my pressure up and gave me another epipen and steroids and Benadryl. The epipen and lack of blood flow gave me some cardiac issues and Im following up with cardiology.That said, I dont feel right. Im weak. I keep waking up with nightmares about not being able to breathe and I keep replaying the incident in my head. I have little appetite. Do you think I would benefit from some counseling? Did I almost die? I feel like I certainly came close. Would I be a candidate for venom therapy? I feel like this if my only chance at a normal life.Is there any way I have some sort of Mast Cell Disorder for this to come on so suddenly? ###Output :Sounds like a pretty traumatic experience and I'm sorry you had to go through that. It is normal not to feel completely yourself this quickly after such an event, and it may take some time to feel back to normal again.Medically, it is good that you have recovered. I must emphasize you need to have an epi-pen with you at all times in the event you do have another sting at some point. The strength will come back. It's hard to tell how bad off you are, but can say a BP of 40/20 is pretty bad.Counseling is up to you. It sounds like you are having an acute stress reaction to a traumatic experience (think PTSD, but happening essentially immediately after). This may improve on its own, or may need some help to get through."}
{"text": "###Input :Sorry to hear about how much has happened to you in such quick progression  I can imagine it was and continues to be very jarringBased on your description and recollection of the events, you went into severe anaphylactic shock which likely would have been fatal had your husband/daughter/EMS not been around. Will reiterate what has been said already to keep an epipen on you at all times moving forwardOnly other thing Id add to whats been said is you likely may be a candidate for venom therapy. However, it sounds like theres still quite a few things going on so take it one day at a time. Once everything else has settled, you may want to consider connecting with an allergist to receive venom testing  in Canada the 5 main sting tests we do are on honeybees, wasps, yellow hornets, yellowjackets, and white faced hornets. If you test positive for a stinging insect, venom immunotherapy can be 98% effective for the rest of your lifetime. That being said, its not cheap, and it can take 3-5 years of injections at the very leastWishing you all the best in your recovery! ###Output :In reference to your last sentence - your mast cells must work normally for you to get anaphylactic shock in the first place, the issue is that your immune system is sensitised to the venom in the sting. Given that there is no definite way that you can guarantee avoidance of the same allergen in the future you should be referred to an immunologist for consideration of a desensitisation program"}
{"text": "###Input :Could a Physician clarify as to why Cardiology have told GP to omit Ramipril until blood tests and ECG have taken place.34 year old male BP 160/110 (Schizophrenia/Meds Olanzapine/Valproic Acid/Citalopram)GP prescribed Ramipril 1.25mg, he started to take though 6 days later a call from the surgery saying omit Ramipril until above has been done. Booked for 2 weeks time, but has left (my son) with no BP moderation. Very worried as seems so high! ###Output :Your doctor will likely be able to answer this question in much more detail, but often before starting an ACE inhibitor (which ramipril is one) it's important to make sure a patient has normal/stable kidney function and potassium. A blood pressure of 160/110 isn't imminently dangerous, no reason to make hasty decisions."}
{"text": "###Input :Im a 40(F), 410 and 113 pounds. I was diagnosed with hypertension in 2018, its been u fee control with Lisinopril HCTZ 20-12.5 with no issues. I was diagnosed with ADHD in December 2019 and put on methylphenidate 20 mg(2 in the morning and 1 at 1:00 pm). I always checked my blood pressure around lunch to make sure it was t too high, I never had an issue. I was diagnosed with Hashimotos last October and started seeing a functional medicine doctor last December. I was put on NP Thyroid 30 mg, moved up to 60, then doubled to 120 by June. I have had labs drawn every 3 months since December. I felt really good until around the beginning of August. My TSH was <.02 but T3 and T4 were in range so she reduced my medication to 105 mg a day.Since I was checking my BP for it being to high, I didnt realize it was going down. I happened to miss my afternoon dose of the methylphenidate and my nephrologist commented is was a little low. This was the last week of August. I had some scans done by my cardiologist the next week. I mentioned my fatigue and she suggested I stop the methylphenidate for a few days to see if that helped and to follow up with her in 2 weeks. The next few days my BP just completely went down, I ended up in the ER twice because of it. The did CT scans the first time I went and I had kidney stones. The second time I went, they though it was a kidney infection. I went back in the methylphenidate because it kept my BP up. I followed up with my cardiologist. She said everything was fine cardiology wise and to continue to take the methylphenidate without the lisinopril until I could find out the cause for the drop.At this point a reached out to my thyroid doctor to see if anything thyroid related could cause this and she said no because usually signs of over medication is high blood pressure. She said to let her know what the urologist and nephrologist said.I made an appointment with my urologist and he did a cystoscopy and ureteroscopy based off the CT from the ER visit but he found nothing wrong and no stones. The nephrologist also found nothing wrong.So last Wednesday, I finally get her to run my TSH, Free T3 and Free T4. I got the results back yesterday. My T4 is in range. TSH is <.01. T3 is 5.3. I ask about T3 thyrotoxicosis and again she says that would cause high BP. She wants me to not take my thyroid meds for 2 days then go down to 90 mg.This has been going on for 2 months. The constant up and down with my BP has me struggling. My vision is getting blurry. Im exhausted. Do I wait it out to see if what she says or should I go to the ER? ###Output :With hyperthyroidism, hypertension is definitely more common, but this is not always the case. In acute crises of hyperthyroidism, blood pressure can also be lowered, particularly diastolic. In general, I'm pretty sure the problem here is the interaction between the various medications you are taking. The thyroid medication is largely overdosed considering that TSH value, and has been increased quite randomly over the various months. Also, I am not a fan of NP thyroid, since adjusting the dosage is difficult with that medication. Until the TSH is in range, we can't be 100% sure thyroid is not responsible. Look for an endocrinologist."}
{"text": "###Input :Thank you. I was taking Jaimiess birth control until mid-July. The functional medicine doctor kept suggesting I get off of it to help get my hormone levels up since I was only on it to lighten my periods. From what I read, the estrogen acts as an inhibitor for the thyroid medicine, which would explain why the dosage needed to be increased so much before it started working. Then I went off the birth control and the thyroid meds just went wild. I asked her if that could possibly be a factor but she said no. I am now also wondering if my hypertension was caused by the birth control. Hypertension runs in my family so I just assumed that was the reason. I had no idea birth control could cause that. Im looking for an endocrinologist but the 6 Ive called, with good reviews, are at least 3 months out. Im debating if I should go back on the pill so I can get my BP back up for now, then come off of it under the supervision of an endocrinologist. My cardiologist said, shed rather it be high(obviously not too high) that can brought down with meds, than it be too low. I just know I cannot continue with the methylphenidate like I have. Again, thank you for your response. ###Output :Estrogen has an effect on thyroid function by altering the hormone-binding protein, but generally the problem is when you stop therapy or go through menopause. It is also true that the pill can increase blood pressure, but not so much that you go from hypertension to hypotension. The effect of the pill is modest. I think if therapies are the culprits, it depends more on the triad thyroid hormone-antihypertensive - ADHD meds . I don't think it's a good idea to start hormone therapy again just to control blood pressure, honestly."}
{"text": "###Input :My son 3 years old recently diagnosed with autism. He was sitting near me suddenly he started to cry but with very low energy. I looked at him and his face was blue. I quickly grabbed him and he fainted I put some cold water on his face and ran to the balcony to get some fresh air. Then his face turned to very white and he started to open his eyes then he fainted again, on my way out of the building he woke up and slowly got some energy back. I arrived at the ER Almost 30 minutes after this happened, they did blood gases tests and blood counts then after an hour they said all is good but I need to see a cardiology to make sure nothing is wrong with his heart. I took a look at the test results and I think there is something wrong and the tests were not ok. I uploaded a screenshot of the tests. TAM KAN SAYIMI = FULL BLOOD COUNT (Count or percentage) KAN GAZLERI = BLOOD GASES. What should I do now? TestsEdit: Now (after 7 hours in the ER) they gave him the 3rd \"fever shot\" in his serum. The heartbeat is now stable in 160s after being stable at 180s but it sky rocketed twice to 241 and 250 bpm and when he cries it goes to 200s until he comes doen. They say it may be a flu infection. ###Output :I believe one of those is chloride. It's a hair above reference range and is fine.The other two are oxygenated vs. deoxygenated hemoglobin. They appear to be applying arterial reference range values to a venous sample, making them look very aberrant. These are also fine.Lactate being slightly elevated is super common in kids also. Nursing often struggle to get good samples with limited tourniquet use, and the lactate is frequently a tad elevated."}
{"text": "###Input :Looking for clarification, are you recommending a tighter tourniquet to ensure a more accurate lactate level? I am a nurse... ###Output :No. Limiting tourniquet use as much a possible is best for lactate."}
{"text": "###Input :Okay thats traditionally been my understanding. I just wanted to make sure there wasnt some other thought process. Thank you. ###Output :No. Nothing in these labs is spooky.Has he had any gastrointestinal symptoms?\"Toddler doing weird shit and passing out\" is sometimes from intussusception, and we have a low threshold to do US looking for this."}
{"text": "###Input :37F, 5'7, 128lbs, Caucasian. Primary complaint is increased resting heart rate, palpitations at night that wake me as I'm trying to fall asleep and fatigue.Symptoms started 06/15/2022 with one severe episode of diarrhea. After that I was feeling very fatigued. On 06/22/2022 I was very dizzy and almost fainted, my heart rate was elevated (120-140) and I had tingling/numbness in my hands and feet. Went to the ED. Only thing they found was a Potassium of 2.6, they said my ECG was \"inline with my low Potassium\". They gave me IV Potassium, Magnesium and saline. Got my Potassium up to 3.8 and sent me home.Three days later I had a similar episode and went back to the ER (I thought maybe my Potassium was low again or that maybe it was my heart). They did another ECG and said my heart was fine. Potassium was fine. No other abnormalities. ER doc said maybe viral or Thyroid.In the weeks after my ER visit I was still feeling very weak and my heart rate was still elevated (80's laying, 90's sitting, 110 standing). I was still dizzy. My stomach was destroyed, I couldn't eat without getting severe reflux and I just wasn't hungry. I thought it could be POTS. My symptoms were worse in the morning and in the evenings I felt almost normal.Symptoms slowly started to improve as I started breathing/meditation exercises and started getting back into training and eating. (I lost almost 10 pounds during this because I just couldn't eat).I then started to experience adrenaline surges where my heart would race, I would feel very jittery, nauseous and I would have to pee many times. At first the surges happened only in the morning, but later started happening at night. Only one a day. The surges would leave me very tired. I had very poor exercise tolerance.I saw my PCP and we ran many tests, CBC, BMP, Full Thyroid Panel, T3 and antibodies, H.Pylori, AM cortisol, Catecholamines, PTH, Heavy metals, MTHFR, DHEA serum, ACTH plasma, celiac panel, Homocysteine, CRP, 25 hour Urine Catecholamines and Metanephrines, Folate RBC and serum and B12. The only \"abnormal\" tests are below:Alkaline Phosphatase low 32 (this has always been low for me).High epinephrine 67 (I was having a \"surge\" that morning, I am not afraid of blood draws).Heterozygous C665C MTHFRHigh am Cortisol 21.2 (I was having a \"surge\" that morning, I am not afraid of blood draws).DHEA 686 (she said it was normal but it seems high for me based on my age).24 hour urine Normetanephrine 122 lowFolate RBC 1248 (for context)Folate serum >20 (for context)B12 852 (for context)Background information: When this all started, my husband and I were trying to conceive and I had been taking 800mcg of Methylfolate to prevent neural tube defects since May. The day I ended up in the ER was the day I got my period. I thought that maybe, based on my MTHFR mutation, I had a bad reaction/poor tolerance to the Methylfolate so I stopped taking it 2 weeks ago. My symptoms seemed to align with too much Methylfolate, based on other peoples reports.My biggest complaint now is the palpitations at night. I keep getting jolted awake several times as I am falling asleep. This lasts an hour until I fall asleep until morning. Palpitations are felt when I am lying on my side and sometimes when I lie flat on my back. I have headaches off and on and still feel like something isn't right, like my body cannot relax. I also get this feeling of pressure in my head. I don't have any shortness of breath except for when I am jolted awake at night.I am not an anxious person thought I am certain these issues have caused worries. I am active (strength training three times a week, assault bike workouts and lots of walking/hiking/paddleboarding). I do Olympic lifting for fun but haven't gotten back to that yet. I eat paleo-ish, low carb, Weston A. Price though I am trying to incorporate more carbs into my diet. I take Magnesium Glycinate at night, probiotics, Vitamin D and Cod Liver Oil. I practice good sleep hygiene. I don't lead a stressful life. I have a cardiology appointment at the end of August.Any input would be greatly appreciated as I have already spent so much money on all this, I need to be efficient with my resources.Im thinking that something really messed me up, maybe the Methylfolate combined with a stomach bug? I had COVID in January, maybe that has something to do with it. Will this likely resolve on its own?Thanks in advance! ###Output :I dont think methyl folate has anything to do with your symptoms. My hypothesis is that the first occurrence sensitised you and made you more introspective. Fear of something can cause tachycardia and introspection can make you notice your heart beat, where you previously wouldnt have noticed it.Relaxation exercises, especially breathing exercises and a distraction from your own thoughts via audio book or podcast might be helpful. 24h ECG could objectify your symptoms, but Im not sure thats a good idea. Maybe try it for a week or so and get back to me, if it doesnt help? Cant promise Ill immediately respond, but I check up on Reddit regularly :)"}
{"text": "###Input :Fair enough. I am and have been meditating and doing breathwork. I will continue. Any hypothesis on why the first occurrence happened in the first place? ###Output :Hm, maybe its not really anything about your body changing, but your perception of it having changed. Concentrate on your belly button, for example. Normally, we dont really consciously feel the pulse there, but if you concentrate on it long enough, it will feel really strong. Its there all the time, but we only notice it, if we actively look for it."}
{"text": "###Input :I understand what you are saying, I just don't know that it's true. But, I will go with that theory and see what happens. Thank you for taking the time to reply to my post. ###Output :Neither of us know if its true. I only have your explanation of everything happening to you, there is no blood work, no images, no test results available to me here. Im trying to give you a direction to work in and my opinion based on the information given. There is a reason this isnt designed as an actual treatment or doctors visit, here :) That said, I hope you get well soon!"}
{"text": "###Input :Well, here's my week update. I am definitely continuing to feel better. I told myself that whatever seems to be happening to me is not something that I need to worry about. I am continuing to do my breathing/meditation exercises 1-3 times a day. I am exercising daily (strength training, pushing the sled and riding the assault bike, usually 10 minute TABATA). I drink water with liquid IV daily, am eating well and sleeping well. I sauna every other day. My resting heart rate is still consistently elevated, about 100 - 110 standing. I used to be around the 70 range standing. I've only had one adrenaline surge in the last week. I do think that changing my state of mind has helped me avoid any extra stress but I do still feel like im not my usual energetic self. Like my body is working harder. ###Output :First of all,thats great to hear. In addition to that, a physical stress response, where your body constantly readies for fight or flight will sap energy from you. Are your palpitations still there?Your cardiology appointment isnt far now, that will hopefully help with stress, too, or maybe allow for more specific advice."}
{"text": "###Input :I'm(M17) 176cm(5'9) and 48kg(105 lb), my BMI is 15.5 and I'm REALLY skinny, everytime somebody sees me they get either scared or concerned, and at the beginning i said i was fine but now I really feel like I need help. We contacted many different doctors in my city(I live in Italy) and nobody knows what my problem is.. we(my family and I) did many exams looking for problems with metabolism and we got nothing, we were thinking to get my self hospitalized (as you know, it's free in Italy xD) but they asked us a kind of \"hint\" of what medical department(like \"cardiology\" i don't know if it's correct in English) i should go in, and our doctor told us he'd inform himself but didn't tell us anything.So my questions are, what could be my problem, what department should I get hospitalized in and in general what should I do?Any answer is appreciated and I'll try to answer every question ###Output :\"You're not eating enough food\" is the answer about 98% of the time."}
{"text": "###Input :Add a couple of glasses of sustagen/ensure and a few spoonfuls of peanut butter to your daily intake (in addition to everything you already eat), if you still havent gained any weight after a few months then I would see a gastroenterologist to check for malabsorption.Well, I'm not the 98% I eat enought I'm quantity and i get all the nutrients i would need, yet i can't gain any weight nor muscle. We've been struggling with his problem for a while and it's getting always worse.. i grew 10cm in about 1 year and a half while not gaining any weight, i actually lost weight. I get it that many people jump to that conclusion, but I'm 100% sure it's not that ###Output :How many calories per day are you eating?What brand of food scale are you using?"}
{"text": "###Input :Don't know exactly, but I can estimate about 2.6k calories a day, altough some days it may be Less and some a lot more ###Output :Also, you can't say it's \"100% not that\" when you haven't ever measured your calorie intake.It's like saying your checking account is getting lower and lower and you don't know why, but you've also not looked at the math for your income vs. expenditures.\"You're not earning enough money for how much you spend.\"Nah, can't be that! I'm certain.\"Have you actually looked at you budget?\"Nope.Unless you have some malabsorption disorder where you can't absorb nutrients (these people have constant diarrhea, gas, belly pain, and even oil in their stool), you just aren't eating enough calories.That's not enough.Young men, especially active young men, typically need 3,000-4,000 kcal to gain weight.Anything in the low or mid 2,000s isn't going to cause weight gain.This isn't a medical mystery. Eat more food and workout. You need r/gainit, not an inpatient stay (assuming no eating disorder)."}
{"text": "###Input :Yes, but I don't think it should cause this much weight loss either, as well as the fast loss of muscle.I'll try eating even more as you told me.. even tho I'm still skeptical about it, as me and my brother eat pretty much the same things yet he's alright(skinny but not on the same level as me) ###Output :That's literally the only answer. If you've been evaluated for metabolic disorders, malignancy, etc, the only thing that will make you gain weight is eating more calories.Even moreTo clarify, mid 2,000s is not a lot of food for a teenage boy. If that's an accurate estimate at all, is not surprising you're not gaining weight. You're not eating a lot to start with.Eating the same amount of food won't make you gain weightEating less food won't make you gain weight.You must eat more food."}
{"text": "###Input :If I feel heart flutters about once a day, and cardiology tests come back normal, at what point do I need a medicine to prevent strokes? In other words, when, if ever, would it be time to go on Plavix or Eliquis?(Female, 55, no drugs, overweight, normal blood pressure, normal cholesterol) ###Output :The sensation of flutters versus having atrial flutter / fibrillation is different. Unless you actually were diagnosed with it, you do not need medicine for stroke prevention."}
{"text": "###Input :35F, 145lbs, 511 dont smoke, drink rarely. Generally consider myself healthy, however mid last year I underwent double jaw surgery and have since not taken part in any form of exercise and feel very unfit, but I still eat a well balance diet for the most part!After surgery however I lost over 20lbs in around 2 months and then gained it all back in the following 4 I had a hard time psychologically during recovery for a plethora of varied reasons and also unexpectedly became a carer for a relative who developed dementia whilst I was still recovering, this took a toll on mental health and I fell into a bit of a depression, I was prescribed Sertraline 50mg in late September 2022 however my mental health has VASTLY improved, it is my physical health that is bothersome.I also have a history of IBS and GERD (diagnosed over 10 years ago so is my normal but has slowly gotten a little worse over time).I reached out with no urgency to doctors for a health check as my generally sense of physical health felt at an all time low. I wanted to reassess IBS and GERD with focus on regular urgent diarrhoea (occasionally up to 6x a day), and regular nausea. Additionally I find myself easily very short of breath, dizzy and nauseous, and ultimately I feel weak. The disconcerting feeling this brings means I avoid any physical activity (historically I have enjoyed being more active). I noted that my heart rate has been falling lower and lower in the last 8 months since surgery and I am not physically fit at the moment. I feel slow. Maybe I am just getting old I was given a battery of tests and most of my bloods are generally fine, I have some deficiencies eg. Folate (which I queried as I dont drink and enjoy my greens) but was advised that some people are built different and need more vits or nutrients than others and I just need to take supplements  I assume this may cause some of my symptoms such as diarrhoea?I also had a 24hr Holter monitor and results came through yesterday. I havent seen them but doc noted 357 counts of bradycardia with lows of 37bpm. Coupled with my nausea and dizziness, I have an urgent referral to cardiology (although that still means in 3 months).However when I read up on Bradycardia, it doesnt seem to be a concerning issue? I dont have the full results but is it only the coupling of my nausea etc that makes it more concerning. Unsure if relevant, but despite low heart rate I often have slightly high blood pressure.Tldr: is bradycardia with nausea and dizziness worthy of urgent cardiology referral? Can heart issues cause additional symptoms such as regular diarrhoea?Also not sure if relevant, but I had a persistent rash and redness and deep itch in left breast for last 2 months, ultrasound shows I have lots of benign cysts and a fibroadenoma, they (radiologist and consultant) seemed unconcerned but did biopsy due to my age and I will get results soon, the lack of concern from consultant means I have little concern also (my mother has fibroadenomas that have never caused any issues), but thought I would add everything that ails me! Ha! In case there is some magical connection to it all.Thanks! ###Output :What is your normal heart rate? Was it sinus bradycardia? How long were these episodes in duration?. Also would be helpful to know any medications other than the SSRI and whether you have sleep apnea, have had Lyme or chagas disease or are hypothyroid.To he honest I would also be surprised if it is sinus bradycardia that it is causing your symptoms rather than vice versa. Nausea and bowel movements are an excellent way to temporarily lower your heart rate. Most often it is just a normal variant, and if it is sinus bradycardia almost never requires a pacemaker. Wouldnt get too overwrought.The downside is i there is no magical connection here to any issue other than maybe being a symptom of nausea, which isnt that magical."}
{"text": "###Input :Thanks for response! I take no other medication, however I did take antibiotics and omeprazole briefly post surgery last year. I cannot see the detailed results, ###Output :okay then what i said above i guess."}
{"text": "###Input :I have zero other health issue than those noted in my post, when I was very young I had migraines and I have always had dodgy joints (again Im getting older and runs in the family) and that is about it.I have never had any ailments you noted. When first diagnosed with IBS I was given lansoprazole in case I had an ulcer. But generally I have been in good health most of my life and taken little medication. Its just a bit cloudy all at once now I have reached my mid 30s  Blood tests historically are fine only regular things to note: I consistently have high bilirubin in liver blood tests but as the rest are fine this is usually noted as Gilberts syndrome? And again, not an issue. Cholesterol is teetering on high side but still currently in normal range. High but normal MCV in last few blood tests (~100)Im more concerned that I am not in need of an urgent referral and wasting time? But secondarily would like to know why I feel so rotten, and if it could relate to heart at all? It would be great if I could actually see the results and notes - I should call and ask for them and see if they will share! ###Output :I suspect that this is not cardiac related and it is incidental. But with your symptom of dizziness and bradycardia and your GP's concern followup is prudent and not a waste of time. \"urgent\" and \"three months\" don't seem to belong together.You certainly have symptomatic gastrointestinal disease, diagnosed IBS but some of the symptoms sounds like gastroparesis. I would continue to followup with gastroenterology for workup and treatment."}
{"text": "###Input :Hey guys,Today I had a pulmonary function test performed and results are mostly normal, which I expected. The only abnormal result is my FEF25-75%. The final value was 2.04, 64% of the expected reference value.I didn't have a bronchio dilator test performed due to palpitations, which I take beta-blockers for. Still being studied in cardiology.I didn't expect much to come out of this, because my GP suspects it might be exercise induced asthma. I wasn't feeling particularly bad when I had the test performed either.I experience chest tightness, wheezing, sob, air-way burning feeling and it hurts when I try to take a deep breathe. If I talk too much or laugh, I also get chest pain and cough.I have been prescribed Atrovent/Ipratropium bromide and it's so far the only thing that has helped me. It has taken me from barely being able to walk 40-50min, to walking 40-90min (usually 40-60) depending on the day without collapsing. ###Output :The FEF25-75 is the forced expiratory flow throughout the middle of your expiration. When we fully exhale our lungs are left with some air leftover (called residual volume, or RV on your PFT). This RV is there because as we exhale our small airways close down as the intrathoracic pressure rises above the intra-bronchiolar pressure -- it's a normal part of expiration. A lower FEF25-75 is thought to reflect early small airway closure, which could be a component of asthma (as asthma affects small airways).You'll notice I use a bunch of hedgy language (lots of \"could\" and \"thought to\"). PFT guidelines recommend against using FEF25-75 to diagnose or treat anything. The data just isn't very strong. The American Thoracic Society recommends not even putting the FEF25-75 on the PFT report. All that said, the FEF25-75 isn't entirely worthless, it just has to be interpreted with caution. If you have the right symptoms, a reduced FEF25-75, and a positive clinical response to bronchodilators it can be very reasonable to suspect asthma.If you have a great response to the inhaler, great, there's your answer. If not, it would be a reasonable time to seek an evaluation by a pulmonologist. Your goal should be feeling normal. All-too-often asthmatics will talk about having daily symptoms, which is a real shame. They either need more aggressive treatment or a different diagnosis altogether."}
{"text": "###Input :23F, 51 and 115 pounds, Asian. depression, anxiety, ptsd, adhd, taking 20mg adderall, 57.5mg paroxetine, 50mg welbutrin. i drank weekly in college but since ive left, i barely have. no weed either.I crashed my car a while back into a pole, but I have no idea how it happened - my memory is blank from me just driving on the road to me being in front of a pole, where i tried to break before i crashed. i dont know why theres a gap in the memory, but my pcp is suggesting i may have passed out or have had absence seizures, but she feels its neurological and not cardiological which is why Im seeing a neurologist in a week. i am just wondering if there are any ideas of what it could be / if i have any disorder. i know i didnt fall asleep as i have a pretty routine sleep schedule, but i just want any ideas of what could have happened to soothe my nerves. the car crash left me with a broken ankle and a friction burn, but nothing else. thank you in advance. ###Output :You need to be evaluated for potential seizures - that's why you're scheduled to see a neurologist. If nothing found there, probably worth getting some kind of cardiac workup."}
{"text": "###Input :Age: 28Sex: Non-binary/Female (she/they with a uterus)Height: 59Weight: 145Race: White/EuropeanDuration of complaint: N/A, 3-weeksLocation: New England USAAny existing relevant medical issues: Depression and anxietyCurrent medications: Wellbutrin (daily 150mg), Xanax (as needed, usually ~0.25mg/month)Hi Docs,This is a question about my spouse (she/they) in their late 20s and physically healthy. She has a panic disorder thats especially bad in medical settingse.g., took 0.5mg Xanax before their recent echocardiogram, but was still hyperventilating and crying throughout.Three weeks ago she was having some chest tightness, which we thought was from a workout we did the prior day, but wanted to go to urgent care just in case. Urgent care gave her an EKG (her first one), which had an inverted T wave in one lead (EditI think it was actually in two leads, EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.). Along with the tachycardia (which always happens in medical offices, but goes back down to ~70bpm after) and they sent us (in our car, not ambulance) to the ER.ER did blood panel CBC/diff, some hormones, D-dimer in case clot, etc, all looked normal except for neutrophils at 82% (reference 48-76), then checked for fluid in the heart cavity with an ultrasound. ER wasnt concerned and sent us home with a cardiology f/u.Cardiology NP was worried about potential inflammation (e.g. myocarditis, as Ive heard has been a more common than usual in young women lately from covid, which we dont think weve had yet) so did an echo and a few more blood tests, including a sediment test, all of which looked normal.No chest pain or tightness or swelling other complaints since the ER incident.I dont have the full EKG, but herere the values they released to us from one lead:PR interval: 123ms QRS: 78ms QT: 318ms QTC: 443ms P Axis: 65 degrees R Axis: 69 degrees T Axis: -4 axis (was -36 at previous visit)Cardiology NP is concerned about the inverted T wave and wanted a cardiac MRI after the echocardiogram, but to me the T wave seems like an unconcerning variation in the absence of other symptoms. If I was the patient Id be fine with the MRI but, given how psychologically difficult an MRI would be for my spouse, Im not sure its necessary and want to encourage her to talk to her primary care doctor about her options.Based on the (of course incomplete) picture Im giving here, does my interpretation sound reasonable, or am I missing something?Thank you! ###Output :Inverted T-waves in V1 and V2 are normal."}
{"text": "###Input :Thank you! Yeah I just went back into the ER notes to check. It looks like it was two leads, not sure which ones (Thinking back, I think they circled the top right cornerlead 4?)From the ER Chart: EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally. ###Output :Would need to be able to see the EKG to tell more info.Are they still having symptoms?Could provide more info with: Troponin lab value D dimer lab Echo report"}
{"text": "###Input :Thanks for the responseAh, that makes sensebummer that they dont provide the full EKG, I shouldve taken a picture. Ill update this post if I somehow get it.Theyre not having any symptoms anymore, aside from the anxiety.Troponin is <6 ng/L. D-dimer is <270 ng/mL.Echo summary: The left ventricular cavity size and wall thickness are normal. Left ventricular systolic function is normal. There are no segmental left ventricular wall motion abnormalities noted. The estimated ejection fraction is 60% The right ventricular size is normal. The right ventricular systolic function is normal. Normal valve structure and function.Reason for exam: eval in ED with CP x 4 days, EKG showed TWI inferolateral leads, trop <6, Dimer wnl, no history of Covid. Persistent tachycardia. Abnormal EKG Palpitations ###Output :Thank you. So labs and the echo are normal. TWI is not an indication for cardiac MRI. TWI in inferolateral leads can even be due to things like lead misplacement.I think it would be in your partners best interest to ask the ordering NP how the cardiac MRI would impact their care. If it's positive for myocarditis, what will they do to treat it? (The answer is probably nothing). If it is negative for myocarditis, what will they do to treat it? (Also nothing) Secondly, it could be in their best interest to discuss this test and their care with a physician.Gotta give you a disclaimer: My assessment and recommendations are based on the information provided and I have not seen the EKG, taken a history from the patient, or performed a physical exam. I don't want to sow mistrust and am not attempting to disagree with other medical personnel, since the ordering NP has performed all of these assessments."}
{"text": "###Input :40M, 5'10\", 210 lbs, Caucasian, California.5mg Bisoprolol for arrhythmia, 160mg fenofibrate for high trigs, 300mg gapapentin for chronic thoracic spinal painHello. I'll try to keep this as short as possible as I know you're all busy.TL:DR - https://imgur.com/a/m5lprmBWondering if anyone can offer an opinion on this ECG from my implanted loop recorder. The loop recorder was inserted 1.5 years ago to investigate a an episode of sustained arrhythmia + syncope. I have a history of AVRT (ablated in 2006, possibly WPW, but that wasn't made fully clear to me). It seems something didn't go quite right during the ablation and the AVRT was eliminated but I developed frequent PVCs that were not present before the procedure. I have some documented NSVT from holter monitors and 30 day loop recorders over the past 10 years.My loop recorder seems to not be programmed to detect much of anything on its own. I think I would have to literally be in v-fib for it to automatically flag an event for review. After about a year of it literally capturing nothing despite having symptoms, I requested a patient trigger device that I can use to force the device to record and upload an event. Since I have started using the trigger, I have been able to capture several episodes such as this: https://imgur.com/a/m5lprmBWhen I look at this, my untrained sees a salvo of PVCs, which I guess technically defines NSVT. I have asked my doctor for an opinion on these events and every time his response is basically \"Doesn't look like anything to me\".What he doesn't seem to understand or appreciate is I find these episodes to be physically very uncomfortable and honestly, highly distressing, like hand over heart, feeling like I'm going to die sort of vibes. I admit that's probably a bit dramatic and an overreaction, but my cardiac history and long road to a diagnosis has trained me to think this way. Additionally, I am dealing with Kaiser Permanente in California and unfortunately, they have a rather abysmal reputation for cardiology and electrophysiology is basically non-existent.I realize there's people out there that have PVCs and other palpitations and barely notice them, but for some reason when I experience them, its like I'm getting punched in the chest.My hope is that someone out there can give me a reason why I should NOT be worried about these events. My doctor seems to be very, very, unconcerned by them, and maybe he's right to think that, but an explanation would be nice and if there's a way to be less frightened by these episodes, I think that should be considered therapeutic and part of the plan for care in this situation.Thanks for reading. ###Output :So first things first I dont see clear P waves and you seem to be slightly irregular. Do you have a history of AFib? Secondly the beats that you point out are wide but also irregular. This makes it less likely that they are PVCs/NSVT and more likely to be AFib with aberrant conduction if you have AFib to begin with. Since you have AVRT and have had ablation, its not unusual to have some aberrancy when the rate changes since you have an abnormal electrical conduction system thats also been burned. While this isnt life threatening in any way, increasing your bisoprolol dose would probably help keep the rates better controlled and decrease your symptoms. You can also get a cardioversion/ablation if you are actually in AFib"}
{"text": "###Input :No history of AFib.I think the lack of visible p waves may have more to do with how the ecg is rendered with this recorder (very small), plus this is a screenshot of the report's summary, so maybe the actual report renders the morphology with better detail (I don't ever have access to that). For comparison, I have a 6 lead Kardia ecg device that is much clearer and shows clear p waves.This isn't the first time I've gotten a recommendation to increase the bisoprolol dosage but im a bit concerned about the long term side effects of that. I've already been on it for over a decade and I'm 40 now. However, after this recent episode, I think it's probably best for my sanity.Follow-up question. Does your opinion change knowing that I have never been diagnosed with afib, despite several doctors reviewing my strips in the past? ###Output :I think the answer no matter what is to increase bisoprolol."}
{"text": "###Input :Now I am off them in the past few weeks I have noticed mild chest pain and fluid retention in my legs. I have always carried weight in my legs but recently I have been needing to pee quickly after lying down at night. I can speed the process up by lying on the ground and putting my legs up against the wall to let it drain down them. I always get a lot of fluid when I pee when I do this, lots more that I should do. I know fluid retention can be dangerous with heart problems and Im getting quite concerned. I have a GP phone appointment next Friday but Im concerned Im not pushing for the right things fast enough.I also suffer from what I have always assumed was IBSI have been tested for Celiac, thyroid problems, absorption levels and all the standard things you would be tested for on the NHSI know that the heart problems could be caused by the low levels in my blood, but what is causing my levels to be low in the first place. Im really worried and really at a loss. Thanks ###Output :The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication."}
{"text": "###Input :The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication. ###Output :Often, but not always. Your physiology changes over time so sometimes you may start to see side effects that you previously didnt."}
{"text": "###Input :Cross from /AskCardiologyDetails to previously deleted post, dad had heart attack but refuses medical adviceI previously posted and deleted due to lack of details. My dad (56M) had a cardiac event two weeks ago that he refused to explain. Yesterday he invited me to dinner to explain his situation. He looks TERRIBLE, he is gray with the blackest bags under his eyes. He explained he was working out and suddenly had SVT bad enough to where he lost feeling in his body, his left arm turned blue and he collapsed (didnt lose consciousness) and couldnt get up for a couple hours. As a nurse, he 100% believes he had a heart attack. He stated he has been feeling ill for 6 months, had this event, and has not felt normal since. His cholesterol and triglycerides are insanely high and he knows he has hereditary atherosclerosis. He is very anti-doctor/pharmaceutical and is relying on a diet of nitrous oxide-rich foods and Willow bark to clear is arteries of plaque. He looks like a corpse and Im afraid he will die soon without medical attention. If he did have a heart attack, whats his outlook without treatment?Edit: he is not on any medications, works out twice a day, his father had triple bypass at 70. ###Output :Ok man, I'll be pretty straightforward - lack of attention to this could kill your father.The thing you worry about after a heart attack is that part of the heart muscle doesn't work well. You can get heart failure pretty easily when one wall of the heart isn't contracting. If he looks bad to you, keep gently encouraging him to get checked out. Use words like \"I'm worried about you\" and \"I don't want to lose you.\" Don't push. Encourage and focus on your concern for him.It isn't clear it was a heart attack, but something bad happened. An arrhythmia, exacerbation of undiagnosed heart failure, a heart attack, some other vascular event are all on the table and need proper testing to sort out."}
{"text": "###Input :hanks for your response, I did ask that he see a doctor but he is very stubborn and just accepts if its my time then oh well. So Im not expecting much here unfortunately. ###Output :Ugh. Im sorry. So hard to watch a parent do that. Be persistent. Enlist other family members. Avoidant behavior is very common. Especially for healthcare workers."}
{"text": "###Input :Im 34, female, 5 ft. And currently depending on the day between 209 and 223 lbs ( its weird, Ill get to that.)Day 1 Normal bp: 90/60. Weight 184 pounds 5/29/21.So back in June, I was working in a facility housing homeless individuals. During my shift, I smelled what I thought it was an electrical fire or fumes coming through or exhaust system. I discovered that folks were either cooking or smoking methamphetamine in the facility, but couldnt do more then create an incident report and narrow down where this happened.I coughed a bit, Had a headache, went outside to clear my head. Didnt think anything of it. By the end of my shift It felt weird to breathe. Like I was stuffed up. Within 48 hours I was wheezing coughing and very fatigued. COVID negative. Started azithromycin and prednisone 7 day taper.By day 4 post incident I could feel It wasnt helping. Went to the hospital. 02 was in the high 70s, I was coughing so hard. Confused. BP elevated for me 120/70s. Admitted for 4 days. 3 COVID tests (2 pcr, 1 rapid) negative. No fever this whole time. Nothing came up in sputum tests or blood work other than what they explained as inflammation.According to docs notes: patient was admitted to the hospital originally for suspicious of pneumonia based on the chest x-ray reading. In speaking to the patient, her symptom is more consistent with a asthma/COPD attack and lack the usual signs symptoms of infectious pneumonia including fever, productive cough, leukocytosis, and known sick contact. Instead, her symptom was brought about by inhaling smoke at her workplace. Patient has a history of childhood asthma for which she managed at home with rescue inhaler, patient did not have any asthma issues as an adult until exposure at her work.Therefore, after admission, she was treated for an asthma/COPD exacerbation. Antibiotics initiated on admission ( levaquin, azithromycin)to a more appropriate diagnosis. She responded well to bronchodilators, nebulizer, and oral steroid. So I finish the azithromycin, prednisone and have duoneb, and albuterol to help.CT scan showed glass opacities, right side of lungs was worse. 5th PCR test negative for COVID.06/13-I go back to the doctor 6/13. I feel worse. They tell me to give it time.06/24- return to work on light duty. No more than 4 hours a day of walking.07/03-7/23- doctors are still saying give it time. My lungs sound clear. I quit my job with the county to work from home.07/29- go into urgent care because I feel like I cant breathe. Exacerbation of symptoms. They talk about referral to pulmonologist but nothing yet. More prednisone dosepak7/30-8/15- using flutter, spirometer, albuterol and duoneb still as directed. Flutter/ spirometer every hour. Albuterol every 8 hours.Hospital admission 8/16-8/21 doctors notes*Called by nursing due to worsening hypoxia. Patient was admitted for presumed asthma exacerbation with high suspicion for COVID-19 infection. She was initially on room air with SPO2 of 90%. Since her admission, her oxygen needs has been gradually increasing. She is currently on 15 LPM oxygen mask with SPO2 95%. She is becoming more tachypneic with respiratory rate up to 36.Due to lactic acidosis of 3.9 on presentation, patient was started on normal saline at 125 mL/h. She was also started on dexamethasone for presumed asthma exacerbation with possible COVID-19 infection. She is on albuterol MDI inhaler every 4 hours and every 2 hours as needed.Vital signs: Temperature 98.7, pulse of 107, respiratory rate 36, blood pressure 114/74, SPO2 95% on oxymask.On physical exam, patient is alert and oriented. She shows signs of mild respiratory distress with increased work of breathing and tachypnea. She has decreased breath sounds with mild crackles expiratory right greater than the left. No active wheezing.Laboratory studies show white count of 18.3, hemoglobin 14.7, platelets 277. Chemistry panel within normal limits with potassium of 3.9. Magnesium low at 1.7. Lactic acid improving to 2.2 from 3.9. Procalcitonin less than 0.05. D-dimer 0.41.CTA with PE protocol per my review shows no filling defects consistent with pulmonary embolism. There are mild diffuse patchy interstitial bilaterally concerning for COVID-19 infection versus asthma related pneumonitis. No pleural effusions or focal consolidations.Acute hypoxemic respiratory failureLactic acidosisHigh suspicion for COVID-19 infection. Progressive worsening with administration of IV fluids. Improving lactic acid.Plan: -Discontinue IV fluids. -Furosemide 40 mg IV once. -Continue dexamethasone 6 mg by mouth daily for 10 days. -Continue albuterol scheduled and as needed. -Magnesium sulfate 4 g IV once to assist with treatment of possible asthma exacerbation. -Check ABG. -Continue levofloxacin. -Follow-up COVID-19 testing results. Continue precautions for now. -Escalate to high flow oxygen to decrease work of breathing.Patient is critically ill. The patient continues to have: Acute hypoxemic respiratory failure the vital organ system that is affected is the: Respiratory system If untreated there is a high chance of deterioration into: Respiratory failure, cardiac arrest, and eventually death. The critical care that I am providing today is: I performed an extensive data review and discussed care with patient. I have stopped IV fluids and started diuresis with furosemide 40 mg IV. I started magnesium sulfate IV for treatment of presumed asthma exacerbation. I have escalated oxygen needs to high flow oxygen.I get discharged from this hospital stay with 2L oxygen constantly. I get to see my doctor for follow up 9/8. They tell me again to get better first. Then well look at respiratory therapy and pulmonologist and physical therapy long term. I talk to them about my weight gain and my puffy face. They say its common with steroids. I can self monitor for oxygen use.9/17 develop vertigo, confusion, nausea and vomiting. Diagnosed with colitis. COVID negative. Urgent care visit. No longer on oxygen but still exhausted.9/25- diagnosis sinusitis, vertigo from left ear infection. Lungs clear. COVID negative10/5- vertigo doesnt go away. Given meclizine. COVID negative10/17- patient noted to have slightly elevated blood pressure likely circumstantial secondary to presenting complaint (152/90). Referred to primary care physician for further evaluation.Medical Decision Making: CT temporal bones show some fluid within the left mastoid. Slight elevation of white count. Patient also has an abnormal dilatation of the right lateral ventricle on CT of her head. This is concerning in light of her ongoing nausea vomiting and vertigo over the last several weeks. Discussed with pharmacy and placed on antibiotics to cover for possible mastoiditis and discussed with hospitalist for admission for further evaluation and treatment of this ongoing vertigo and abnormal CT head. Admitted in guarded condition.10/17- COVID positive. Test results received after discharge. 10/18. 10/21 tests negative for COVIDWeight gain from June to October 21 is from 184 pounds to 222.October 27- pcp follow up after quarantine. Currently 231 pounds. BP is 148/86.Doc notes History of Pneumonia, RecurrentRecurrent pneumonias with recurrent hospitalizations Exposure to methamphetamine at work at shelter - ended up with ground glass opacities on imaging. Tested multiple times for covid, negative at that time. Has had persistent fatigue, lightheadedness, loss of energy Positive for Covid 10 days agoWeight GainGained 30 pounds since September. Has had recurrent doses of steroids with recent infections. Orthopnea Has had decreased appetite and is not eating much at all. When she does eat a lot, feels need to vomit.HypoxiaDesaturations throughout hospitalizations, was discharged on home oxygen which she was able to wean down, but does still have hypoxia when she sleeps and exertion. Concerned for sleep apnea.VertigoRecurrent episodes of vertigo especially after recent illnesses Reports that she is occasionally awoken by vertigo and hot flash symptoms. Repeat evaluations for the same - does have history of CP, recent finding of R ventricle enlargement on MRI. Some benefit with Meclizine, but has had abnormal associated symptoms including confusion, word finding difficulty. Continued to say istory of pneumonia, recurrent Suspicion for initial covid infection with negative test causing initial ground glass opacities As these are consistent with many other etiologies and she has significant other symptoms (fatigue, weight gain, hair loss, vertigo with normal TSH) will consider other etiologies ANA, RF, anti-CCP for evaluationWeight gain TSH normal in the past, so has never reflexed to T4 and T3 - will measure these Autoimmune evaluation as elsewhereHypoxia Pulmonology evaluation,possible covid long-hauler symptoms, possible other causes of groundglass opacities Sleep study and general PFTsCurrently taking : Claritin albuterol Flonase every day. Meclizine as needed. I think they help.I KNOW THIS IS A LOT. I m sorry thank you for even reading this but I wanted to be thorough.How can I advocate for myself further? What can I ask about? Any additional testing you would suggest? I dont feel like a person anymore. If I eat, clean my kitchen and walk the kids to school it takes everything I have. ###Output :This is a hell of a history. From the right ventricular dilatation, hypoxia, and continued GGOs on CT scan Id say that the cause is probably the lungs. The pulmonologist is going to be your best friend here. PFTs are going to be helpful"}
{"text": "###Input :Ruptured calcaneofibular ligament and ?fracture of the anterior process of the calcaneus I am a little unsure of where that exactly is on the ankle after looking at multiple diagrams, doctors werent helpful enough in explaining it.- backstory if youre interested:Ill try and keep this short, history of ankle injuries in the past, never quite this bad on that ankle (other one has had reconstructive surgery).I am a 24yo Female who works in emergency as a critical care RN.Rolled the ankle after stepping on a hockey ball 2.5 weeks ago. First 3 days was horrendous, then the pain settled and all I needed was Panadol once a day.XR on day 1 said no fractures. Went home and played another game of hockey a week later (with some pain after of course).US at week 1 said fully ruptured ligament and small ossicle 2.8mm indicating a possible fracture. Recommended CT.CT at 2 weeks showed possible cortical fracture at anterior process of calcaneus.Now Ive had ligament damage in the past, on the other ankle, and this feels relatively minor in comparison.Im being told by an orthopaedic surgeon that I need to be in a moon boot. I am ambulating fine on flat ground with rigid strapping tape on to replace the broken ligament.Its relatively painless to poke around the ankle area. Im not sure I even understand exactly where this supposed fracture is.Im worried by going in a boot when Im coping so well, will hinder my recovery and extend the time itll take me to get back to sport.I can attach some paperwork in the comments.Whats your opinions? Is it possible theres no fracture? ###Output :Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.The anterior process of the calcaneus is deep inside the foot, and thus fractures do not always produce tenderness, as you cannot palpate it directly. I assume that when you say \"no bone pain\", this is what you are talking about.Fractures of the anterior process can be occult, not seen on plain x-ray due to the overlap of bones in the area, and sometimes CT or MRI are needed to confirm.I am a little surprised at you posting here, as you are a registered nurse who has access to emergency physicians and have already seen an orthopedic specialist for consultation. The opinion of your orthopedic specialist is that you have a fracture, and the treatment recommended is immobilization. No one who has neither examined you nor had access to your imaging studies will be able to give you better advice.The rationale behind immobilization of such fractures is simple: the foot has many bones that articulate (touch and move) with each other. Broken bones that do not heal well will cause permanent pain and debility due to interruption of the way the bones can move in relation to each other.If you want a second opinion, then see another foot specialist, bring them all of the imaging tests on DVD (reports are of limited use in these situations)."}
{"text": "###Input :Height: 1.8m (5' 11\")Weight: 64kg (141lbs)Race: CaucasianLocation: Seattle, WA, USA (German born, Berlin)Vices: occasional vaping with very weak nicotine content, no drinking, no illicit drugs, chronic pain patient (fentanyl patches, 50 microgram)Current physical conditions: pituitary macroadenoma, adrenal cortext carcinoma, and a ton of implants and artificial bones. I cannot afford treatment for either and my insurance, medicaid, will not pay for removal of either or even treatments since my treatment is HCG, which comes from only fertility clinic pharmacies, and medicaid doesn't cover and fertility treatments for menCurrent mental health conditions: PTSD, bipolar, BPD, ADHD, generalized anxiety, and recently depression. All are treated quite effectivelyMedications (total daily doses): 50microgram fentanyl patches, 6mg prazosin, 12mg tizanadine, 7.5mg mirtazipine, 2700mg gabapentin, 2mg clonidine, up to 150mg hydroxyzine, 80mg Latuda, 200mg Lamotrigine, 40mg viibryd, 10mg melatonin, 8mg ondansetronEmergency Usage Only Medications: Hospital only: 100mg dex, 20mg morphine, 4mg lorazepam all IV for cluster headaches; Personal use: 50mg IM dex for cluster headaches, epi-pen for food allergiesWARNING: This will be long. I deeply apologise, but I feel like I need to be very specific and include context to get an accurate answer, if one even exists.----------------------------------------------CONTEXT:I want to start this off by saying I don't particularly believe in homeopathy, certain Eastern medicine, religion (I'm agnostic, borderline atheist), or the paranormal. I do many things for work, taking whatever pays me, but I have spent the majority of my career as a data architect in medical research. I believe in what can be proven, but I also acknowledge we can't prove absolutely everything to be true or false and that the sciences are ever changing and ever growing. I would also note that my life have been a very challenging one and I seem to have the single worst luck of anyone I've ever personally met. I've been very stressed and it has gotten significantly worse of late, though I've been told that I'm handling it quite well. Of course, I also acknowledge that there's plenty of people who've lived much worse lives. I'm not trying to play the victim or be arrogant.----------------------------------------------IMPORTANT LEAD IN:I went to bed last night around 23:00. I woke up an hour or so later to the sounds of small booms outside the front of my house. I initially thought I'd imagined it, but I rolled over and say all 3 of my cats with their faces pressed against the window screen, ears perked up. The sounds actually happened. A few moments later, I heard out smartlock on the front door unlock followed by the door opening and closing. Aside from internal doors, the front door is the only \"normal\" door to the house. the others are sliding doors that were all locked and barred and sound completely different when opened and closed. My roommate was asleep in his room and had been for hours. Nobody else lives here. Once again, I thought I imagined it, but the cats had all left my room and run downstairs to the door, which is what they do when someone comes over or gets home from work, errands, or whatever. I then head a set of male and female voices coming from downstairs. I grabbed a replica Master Sword (from The Legend of Zelda game series my roommate gave me a few years back) and went to my roommate. I tried to wake him up repeatedly, but he just mumbled something inaudible and rolled away over and over. So I went downstairs quietly. I spent 15-20 minutes walking around the house, following the voices, but never found anything. One of my cats, Needles, kept running off towards the voices then coming back to yell at me to follow him to them, which is what he does whenever someone comes home and I don't instantly go see them, but I never could find them. He's an utter attention whore. After that, I gave up and went back upstairs. Within 5 minutes I heard the door open and close again and the voices stopped. I don't have the greatest hearing in the world and never got close enough to make out what they were saying. I checked my Nest doorbell camera and at no point did anyone walk past the door. It is always recording and saved online for 5 days and, with the way it's positioned, it couldn't possibly fail to see someone come in or leave. I checked my smart lock app to see how it was unlocked and it said it was unlocked using a key by a user named \"error\". To clarify, the account's username that opened it was not literally \"error\", but rather that the app produced an error trying to identify the user. There are no physical keys to our house. It's entirely electronic and only myself and my roommate have the access codes.I have no explanation for what happened. I was wide awake for it all. The cats saw it. My smartlock confirms it. It definitely happened.----------------------------------------------THE REAL ISSUE:After that all happened I went back to sleep. It generally takes me hours to fall asleep, however that's not what happened last night. I always fall asleep with the TV on for noise, but turned down. South Park is what I had on last night and throughout the course of the night, I could clearly identify the voices and episodes as they came and went, even during the \"dreams\" I'm about to talk about, but NOT during the dream at the end of my story. That's a VERY important thing to note. After maybe 30 minute I felt like I was asleep, but I wasn't. I could feel my sheets, feel my head and arms on the pillow, move around, and feel my cat against my leg. That said, I started \"dreaming\" as if I was asleep. I'd note now that I've only ever had 1 lucid dream before and it was right after my long-term secret fiance had left me. It was stressful cause I simply came home to an empty house one day. I hadn't heard a word from him all day and all that was left was a quit-claim, signed and notarized, leaving the house entirely to me and taking his name off it and a hand-written note saying \"I'll always love you. I'm sorry\". Never heard from him again. He was my world even though he wouldn't allow anyone to know we were together cause he desperately wanted to be \"straight\". I cried myself to sleep for quite literally years, though over time it became a silent cry. I've been told the stress caused the lucid dream. I have countless wonderful stories about him, but he did give me me a strong case of PTSD, which I already had to deal with from an extremely abusive father.Back to the story now. During this \"dream\" I found myself on a cement platform in a park with a table and two chairs in front of me, underneath a pavilion. There were lots of oak trees, azaleas, and camellias, like a park would look like where I grew up in New Orleans. A cup of my favourite tea was waiting for me. An middle-to-late aged woman was sitting at the table in a white pants-suit. She had blue eyes and gray hair. She introduced herself as \"death\" and asked me to sit and chat with her for a while. She discussed my life with me and asked me many questions. She knew things about me that I didn't even realize myself. My memory of it is hazy, however. The \"dream\" lasted 30-45 minutes. During the \"dream\" I was able to freely move my \"sleeping\" physical body. Movement would cause a strange type of interference with the dream that I cannot really describe, but as soon as I stopped moving it went back to being incredibly vivid. At one point I sat up entirely, walked to my desk, and scooped up one of my other cats, and brought him back to bed and wrapped my arms around him. I felt entirely real. I had fully control over my body and words through the entire \"dream\". At some point in the dream she asked me to stop moving around cause it made her \"presence\" more difficult and she insisted I trust her that it was real. Over the next 7 hours I had 7 more nearly identical \"dreams\". Each dream was roughly the same, but the scenery and other person changed. Each \"person\" I talked to presented themselves as some kind of aspect of life. The ones I remember were: Death, Joy, Lust, Love, Pain, and Plague. I'm struggling to recalled specifics about the conversations, but they all insisted it was real and that I was safe. Each discussion was different and revolved around the aspect of life they claimed to be.I woke up completely after that and was confused, scared, and for some reason, relieved. It felt like everything was going to be ok. I've only experienced that feeling one other time. In December 2016, I was run over, intentionally, by a woman in an SUV while I was crossing the road on my motorcycle. She ran her light with the goal of killing me cause she was enraged by the pride flag sticker on the back of my motorcycle. It's a long story that I've shared many times, but this is already long so I'll skip most of it. The force of the impact sent me flying 30 feet and I slammed into an oak tree and the majority of my body was either broken of entirely shattered and I damn well knew it. In relatively short order, I grew cold from my chest and it spread throughout my body and I knew what was happening. I was about to die. I suddenly felt this massive calming wave overtake me and felt like nothing could ever be wrong and everything is ok. I blacked out shortly later and when I woke up again, I was looking at EMTs and a nurse who'd been attempting to revive me. I had been dead for around 5 minutes and had been kept alive by the person who was driving behind me and just so happened to be an ER nurse heading to work at the hospital less than a mile away.Back to the story again, I was awake for around an hour after all those experiences and ended up falling back asleep. This time, however, I had a regular dream, technically a nightmare, which is normal for me. I suffer from night terrors that are truly horrible and take 6mg of prazosin at night to prevent them. I still get them from time to time, but the overwhelming majority of my dreams are standard issue nightmares. I rarely have any positive dreams.As a reminder, I'd mentioned earlier that I had South Park on throughout the night. During the bizarre \"dreams\", I could hear the voices and episode as they came and went and even laughed at a particularly funny scene and told the \"aspect\" I was currently talking to about it when it happened. In my last dream of the night, the standard-issue nightmare, I could NOT hear the TV, could NOT control my body, and was completely asleep. I'm not sure what that means overall, but I feel like it's a VERY important detail.----------------------------------------------THE QUESTION:Quite simply, what in the absolute hell happened to me last night?! I don't know what to make of any of it. As I said, I'm not spiritual or religious in any way, but this is causing extreme level of conflict and concern within me. Furthermore, I've been around a lot of dying people, I live with a doctor and dated him for the last 6 years (we broke up a few months back, but still live together), I've dated other doctors, I spend a ton of time at doc appointments and in hospitals, and I myself work as a data architect in medical research most of the time. I'm very aware that when people are nearing the end of their lives, most (60%, if I remember right) will hallucinate loved ones, angels, or even demons, and have long conversations with them over and over. In my experience, and to best of my knowledge, this usually happens within a few days preceding their death, but can happen as far as a few months in advance. Is that what I just experienced? I certainly have serious conditions, but I'm otherwise perfectly healthy. Other than my migraines, cluster headaches, and chronic pain I feel perfectly fine. I've had the migraines and clusters since I was a kid and the chronic pain since I was run over and nearly murdered. Nothing new has come up. I have been much more depressed and anxious about life lately as I've had awful dating experiences, am struggling horribly to land a new job, and the end of my lease is coming up soon and I will have nowhere to live, but I feel like I'm handling it well.I'm exceptionally worried about what happened last night. I want to see a doctor about it, but I have absolutely no clue who I'd go to. I know there's \"doctors\" who study dream analysis, but I talked to my ex about it, the doctor I live with, and we both feel like that's psuedo-science and doesn't carry any real validity. Because I'm currently laid off, aren't receiving unemployment, and am only earning money by doing freelance and contract work, I have to use medicaid for insurance. There's no available therapists or psychiatrists I can go to cause I can't afford their cash rates and the ones who accept medicaid are seriously booked up and have multi-year long wait lists. I'm on all of the wait lists, but I'm definitely not gonna hear back anytime soon. I can't afford cancer treatments either and medicaid won't pay for them.My mother insists all of it was a dream and I didn't wake up at any point through all of this. That's 100% false. I damn well know when I was awake and what I experienced. I have proof from the cats seeing and hearing what I did and the history on my door lock. I talked to a friend studying psych and he suggested I could be schizophrenic, but he's not a doctor or even a therapist and I was diagnosed as schizo year ago and treated for it, which worked, but when I moved to WA and found a much better psychiatrist, she vehemently disagreed, changed me to my current diagnosis and changed my medications which work far better, so I'm inclined to believe she was right. My psychiatrist in Louisiana was not on good terms with the board and was wildly aggressive with diagnosis and treatment for all her patients. Her results were remarkable, but her methods were HIGHLY questionable and she was quick to prescribe controlled meds. She had me on lorazepam and adderall while I was also on 50mg of Percoset daily from my neurologist. I absolutely never had any problems, complications, or side effects because of this and it was actually extremely helpful in helping me hold down a job and be a functional adult, but it's generally not appropriate to do. I desperately need my ADHD treated to hold down a job, but the state of WA will not allow you to be on more than 1 controlled medication at a time. I understand, but it makes life extremely difficult for me and I think it's completely unfair to make me choose between living in intense pain or being able to focus for more than 5 minutes at a time. Writing this post has taken me over 3 hours cause I keep walking away and doing other things.Anyway, any advice would be amazing. thank you for reading and I'm sorry for the length.TL;DRHad a series of \"dreams\" last night that didn't work like any dream I've ever had where I could freely move my physical body, which upset the \"people\" I was talking to in the \"dreams\". During the series of \"dreams\" I met personified aspects of life itself, like love, death, regret, plague, etc that held conversations with me about my life. A while after the series of \"dreams\" ended, I ended up going back to sleep and having a normal nightmare where I couldn't control my sleeping, physical body and things were normal. Now I'm wondering if that's my version of dying people hallucinating loved ones and I don't know what to do or what kind of doctor to see about it.That said, please, PLEASE read the full post. There's way more to this and the TLDR makes me sound like a lunatic. I spend a lot of time carefully writing it up and explaining everything, like the insanely critical context the TLDR is missing, please read it. ###Output :Sounds like lucid dreams. I dont want to Monday morning quarterback your doctors but thats a dizzying (literally) array of psychoactive medications you have all mixing together that probably played some role too."}
{"text": "###Input :Hi docs! Im currently in the neurology critical care unit with an aunt (78F) who was flown from our local hospital to this one. We knew that it was a smaller bleed, but not much else. Im the one that will be asking questions on behalf of her children (who are with me) so that we can fully understand whats going on. What are the questions that I should ask in order to get the most explanation all around? ###Output :I'm so sorry your family is going through this. I'm board-certified in both emergency medicine as well as critical care. Going to need a little more information in order to help tailor the appropriate questions to ask. What information have you received so far about your aunt's current situation, and what is her current condition (e.g. is she on a ventilator, acting appropriately, etc.)? Have the docs given any updates on her prognosis and/or next steps, medically?"}
{"text": "###Input :Thank you so much. No information other than that she was resting and that the bleed was small. They said that they would try their best, but wouldnt guarantee anything. Thats all the doctor told her son. :/ ###Output :Well, that's certainly not very helpful or enlightening at all :/ Idk your aunt's medical history, how the bleed occurred, or what intervention's her medical team has already performed so far. However, it's reassuring that the bleed is reportedly small. Important things that would be good to ask would be:-What interventions have been performed so far, and why? Also, which interventions/procedures can be expected in the future? -How severe is the bleed, and what deficits can be expected following recovery vs. what are the chances of a full recovery (note, they likely won't commit to a specific answer to this question, because there's no good way to predict patient outcome, but notifies the care team that you're actively involved in the patient's care and want to be kept in the loop)? -What does the recovery time/process look like if/when her bleed improves? -Are there any additional co-complications going on? -is there any specialized care that is going to be required following recovery? -How often can we expect patient updates from the doc in the future? -Does the providing physician have any specific concerns of their own that we should be aware of?Additionally, it's probably worth asking what support is provided by the hospital that's available for friends/family of the patient. If you have any additional information to share, please post here so that specific questions can be appropriately addressed."}
{"text": "###Input :I chose his CRNP because I was having chest pains and I already knew that I was hypertensive. I'm an advanced EMT and although my scope is nowhere near a CRNP, I can still diagnose myself for what is critical and what is not.This woman is under half of my age. I'm not comfortable with someone fresh out of medical school. She told me that I had to go to the ER. I paid $140 for an office visit for her to tell me that I had to go to the ER, after taking my blood pressure. I already knew that I was hypertensive and they told me over the phone to come in to get some kind of high blood pressure medicine.I told her that and she told me that I needed an EKG and a CBC workup. She told me they could do that at on-site, but without insurance, it would run me around $1,400... and it had to be paid, NOW. Words fail me here. All of this could have been told to me on the phone.I told her that I couldn't afford that out of pocket. She told me that I was going to be sent home... without any medicine. I said, \"Let's review here... It's such an emergency that I have to go to the ER or pay for tests now, but you can send me home without medicince???\" Unbelievable. I left, had to pay my $140, and went home with no medicine. I got home, at square one again, and was $140 poorer.The social worker called me later that day and she was also an EMT. I told her what I just typed. She emailed the doctor and a few hours later, I was prescribed some amlodipine that could be picked up immediately at my pharmacy.I received better care from a social worker that I paid nothing, than from a CRNP that I had to pay for... amazing. The CRNP obviously didn't even go to the doctor for consult. ###Output :I'm not comfortable with someone fresh out of medical school.NPs do not go to medical school. They are knowledgeable and can treat common illnesses, but they are not medical doctors.Are you located in the US? Do you not have insurance?"}
{"text": "###Input :What kind of school do they go to, then? I assumed that they went to some kind of medical school, since their scope is higher than a registered nurse.I am in the US and I just got insurance. ###Output :What exactly is your question? Any given decision to see an MD vs an APP is a balance of complexity and access."}
{"text": "###Input :31F, went to the ER due to stomach pain and uncontrollable shivering. She was admitted to the ICU and had extremely low blood sugar, hypothermia, hyperkalemia, blood in the stool, gram positive cocci in pairs and chains, anemia, and she had been previously diagnosed with endometriosis. They found cysts in the liver, hypodensity in the left side of the brain and have been taking several tests. ER gave her 3 blood transfusions for the anemia and she now has a swollen back, legs, hands, and feet. She is still anemic even after the 3 blood transfusions. She has undergone multiple MRI, ultrasounds, CAT scans, and blood works but they aren't sure what is causing everything.Her vitals at admission were:K 5.9Hgb 5.5Glucose 17Temp 94.5WBC 5700She started antibiotics yesterday morning and her second ecg was normal. She was taking oxycodone for pain but is now on morphine and lidocaine. Doctors said that she had a reaction to her 3rd blood transfusion and her heart rate went up and blood pressure went down. She is now on medication for that. She has not been allowed any food or water today after the reaction. An MRI found that she has lesions in her brain but the nuero surgery consultant said they were not going to do any procedure.Has anyone had experience with something similar and what was the diagnosis? ###Output :While I have lots of experience with patients like her, I dont think theres much that can be said over the internet to help. She has a severe critical illness with what sounds like septic shock. The best people to answer your questions is the team of doctor taking care of your sister."}
{"text": "###Input :Im 30 years old and after a very long and defeating search for a doctor willing to listen, I was finally diagnosed with Nutcracker Syndrome. I have surgery in 1 month, but I am in debilitating pain. Im a critical care nurse of 8 years and no stranger to the difficulties with pain management faced and felt by both physicians and patients. What I was baffled by was the extreme amount of gaslighting I faced as I tried to get this syndrome ruled in/out. Ive fought for months to NOT end up in this position (stuck in pain) by advocating for myself yet listening to each physicians advice, and trying to be a good patient and human being.I was in pain management but left the clinic because the doctor wasnt willing to work with me in any way. I was given Meloxicam, Gabapentin, and one 5mg Norco per day. Only the Norco would do much of anything. I had an appointment set up with a new clinic before I left, but its not till Dec. 12th and my pain has gotten MUCH worse even in the last week. I will also still have to wait the 2 weeks to actually get any medication (as far as i understand).My surgeon cannot prescribe me anything, and I see a PCP who uses holistic and traditional medicene (basically started me on tons of supplements) and really seemed to help me, its pricey but worth it as they are also more available. BUT, they cannot prescribe pain medication as they are a cash pay direct care practice. Ive called other pain clinics and they cant get me in until even later dates, Ive texted every doctor Ive worked with and their leads have fallen through. Meanwhile, the pain is so horrible I can hardly eat or move, and getting worse by the day. I went to the ED out of desperation a couple days ago and the doctor was kind and gave me 14 Norco 5s which help the pain a bit for about 2-3 hours. But I desperately need something stronger and more permanent (obviously).As far as options, My surgeon suggested going back to the ER for more pain meds (which was weird) or my PCP though he knows they cant prescribe those meds. The ER doctor suggested a new PCP which Im considering but Ive had good support with my current one and feel they are far more accessible, especially considering something new happens each week it seems like (strep B UTIs, hypothyroidism, gallbladder and liver issues, you name it). Plus idk if anyone would feel comfortable writing me opiates on a new patient visit.Is it even worth trying a new PCP? Would it be pointless to keep both my current PCP and see a new traditional PCP that could help with pain ? Or should I switch altogether? When my current pain meds run out I WILL have to go back to the ED because it gets that bad and Im no wimp. Its a solid 7-8/10 WITH the Norco on board. Would a second ED physician even consider writing Another script?Should I try and speak to the actual doctor I will be seeing Dec 12 about my hopeless situation or insist that the nurse tell him about it?Im really at a loss, Im in Indiana so medical marijuana isnt an option. I would appreciate any advice, leads, anything. I feel like Ive been failed for a year straight, and I was hoping I would be taken more seriously as someone whose also in healthcare, but its sadly not been the case. TIA ###Output :I'm sorry OP, this is awful. Not familiar with the health care system where you live and why your PCP can't prescribe opioids, but can you see them for help navigating how to have this addressed? I agree it looks bad if you start seeing a new PCP or go back to ED but perhaps letters from your current PCP explaining the situation would be helpful?"}
{"text": "###Input :Thats a good thought, I have asked them to call the pain management place I have an appointment at the attempt to get me in sooner. I will see if they will do that as well :) Nothing can hurt at this point. And thanks for the validation because honestly, Ive started questioning if its really all that bad (though I know it is).Its crazy what a year of being chronically ill can do to the mind, even someone familiar with the healthcare system (Im in the U.S.). A lot of doctors here would love to be able to help me out but legally cant, or if they can would have to fear for their license (presumably).The ED giving me the small script they did was even kinda going out on a limb. It all comes down to the fact that not many doctors arent familiar with nutcracker syndrome because its rare, and the extreme pain isnt a well known fact about it. So it makes me seem as if Im drug seeking, but one look at my background and its clear theres not history of anything whatsoever.I mean i worked in ICU for 8 years around every narcotic imaginable, and still could be if I wasnt this sick. And I was charge nurse of a high acuity unit. The doctors Ive worked with have helped me alot in this process but their hands are tied on the opiate thing. ###Output :I'm not familiar with the syndrome but it's not hard to look it up. It's very sad that because of the opioid abuse pandemic we've gone so far the other way that people can't get adequate pain relief for appropriate indications.Good luck, and I hope the surgery is effective!"}
{"text": "###Input :I had an awful IUD experience, involving vomiting and fainting as a result of the pain level. I would rate my IUD insertion worse than passing a kidney stone or breaking bones. Im not alone with this experience. If you search IUD on TikTok or other female-dominated subreddits, youll see an abundance of women/ teenage girls who have also described the IUD pain as the worst pain in their life. Ive noticed a trend of increased pain particularly among nulliparous women.The Intensity of pain doesnt seem to be acknowledged by many medical providers though, as many patients are told it will be a slight pinch and arent properly informed about the pain involved. As a result, many of us did not properly prepare for the persisting pain by arranging a ride home from the appointment, a day off from work/school, or mental preparation for pain. Many providers both seem to acknowledge that extreme reactions to the insertion are normal, but the pain isnt enough to warrant preparation or pain medicationsI played rugby, basketball, football, and softball. Ive had many broken bones and torn ACLs. Ive also passed kidney stone. The IUD insertion pain was by far worse and longer than any of the aforementioned pain events. If I was offered pain medicine for all those events, why is nothing given for IUD insertions to reduce the associated pain and discomfort? Is there a specific reason?Edit- I should mention Im directing this question to medical professionals in the US.Edit 2- Ill admit I havent looked into any of the studies about this. We had one doctor chime in that studies show that extreme pain is not the norm, but the trend Im seeing in person and across social media appears contradictory to those findings. Would any medical professionals be willing to share the specific studies that are being referenced for care? Im a PhD student in a different area of public health research, but I wouldnt mind doing some critical review of the publications while I have the time. Update: so far I've only found a few relevant articles in my Uni's database. Most are about a decade or older and have really small sample sizes, like n=40 or less. The more recent articles are recognizing the pain of insertion as an issue, but I'm not finding a lot of resources so far. If anyone has a specific research study they reference when learning, I'd be thrilled to look at it.Edit 3 -I started to search for articles. This is the first abstract I found:\"Concerns about pain during IUD insertion are a major barrier to use of IUDs among adolescent and young adult patients who may otherwise be interested in this method. Although few studies of pain control options have been conducted in this population, available data suggest that several pharmacologic interventions discussed in this chapter may be beneficial. Pre-procedure naproxen, ketorolac, or tramadol can help to reduce post-procedure discomfort. Paracervical nerve blockage with lidocaine-based anesthetics, topical lidocaine spray, or EMLA cream also appears to reduce pain with IUD insertion. Intravaginal 2% lidocaine gel may reduce pain with tenaculum and speculum placement. This chapter will discuss the complex nature of pain in gynecological procedures, including IUD placement, and the impact of anxiety and fear on pain perception. It will also review clinical guidelines to assist with pain control during procedures and describe evidence-based pharmacological pain control modalities that can be used during IUD procedures.\" Optimizing IUD Delivery for Adolescents and Young AdultsTho I don't have full access to the text, this abstract is making it apparent that pain management is a valid concern and there are options. Can doctors weigh in more on those options? If it is indeed a recognized problem in the medical community, why aren't these options considered?Update 4: I have 26 peer-reviewed articles to review. Slamming a coffee and Ill get you my quick-and-dirty lit review asap. ###Output :I don't do IUD insertions, but pain management should be discussed and offered.I don't care what the studies say. Sometimes you just need to be a human and empathize with other humans. Medicine is as much an art as it is science."}
{"text": "###Input :Im a 26F, 173lbs, 57 I have SLE Lupus, Ehlers Danlos Syndrome, and Idiopathic inter cranial hydrocephalus.I just had a CT W/O of the brain and neck yesterday. Reason for this was because Ive been having terrible headaches lately. I received a message today stating THIS REPORT CONTAINS FINDINGS THAT MAY BE CRITICAL TO PATIENT CARE.Impressions:Hyperdensity seen in the right frontal along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage. Sorry for the all caps I just copied and paste. What does this mean? Thank you for your help ###Output :Physician, Emergency Medicine | ModeratorAgree 100% with /u/sspwnage. Closing this thread as there is no other message that needs to be said other than call 911 or go immediately to the ER (and tell them your CT scan yesterday showed bleeding in the brain). I am a little surprised no physician called to tell you about this which I assume is just an oversight.PhysicianYou need to go to the emergency room ASAP. That CT is showing you are having bleeding in the brain. This is probably the cause of your headaches but they will need to run more tests. Seriously drop what you are doing and go, brain bleeds need to be monitored and seen by a neurosurgeon ASAP."}
{"text": "###Input :Hi there. Female, 20yo with Panic Disorder, GAD, MDD, BPD, the works. Hate it.Anyways, I've had psychiatrists keep me on Prozac 40mg most of my life and it's been the most comfortable. A numbing experience, but it did the job. Years ago, I tried Wellbutrin but at the time I had COVID (which actually amped my anxiety) and thought my anxiety getting worse was due to Wellbutrin, so I was taken off. Back to prozac for 2 more years. Recently, I got off it again and got on Wellbutrin 150mg due to sexual side effects and hoping it'd help my anxiety.It did not. In fact, it made anxiety worse and I've had awful panic attacks, physical symptoms that have been cleared by my GP after tests showed nothing was physically wrong.Talked to the psych, and he said \"Ok well I can cross taper you from Wellbutrin slowly back to Prozac.\".I swear I keep hearing never to take those together, and even my past psych wanted me to be off prozac completely before getting on Wellbutrin years ago.Note I have horrible health anxiety and dread feeling any negative physical symptoms (to the point I annoy my GP about it) and it's starting to make me feel helpless. I'm constantly bothering people and terrified of dying, and just... Feel like a waste of time to my doctor, a waste of resources to my nearby hospital when a panic attack gets so unbearable it feels like I'm fucking dying, and a bother to my loved ones even though they try to be helpful and reassure me I'm not dying.Last night was possibly the worst panic attack since I've been on Wellbutrin, even worse than Prozac PAs. Basically I was eating soft stick candy, swallowed a whole piece because I have a bad habit of not chewing my food, felt like it was stuck in my throat, tried coughing/throwing it up, began to panic when my throat started feeling weird after trying to force myself to throw up, and panic ensued. Fiance checked, nothing was in my throat and turns out it was probably a phantom feeling in my throat.But anyways, about the medication.So... I've agreed to do a cross taper and lower to 100mg for 2 weeks before adding in Prozac 20mg if I felt ok.Is this ok?Also, secondary question.What do you think of patients who suffer from these things? I'll be completely honest... I genuinely feel like a horrible person for wasting the time of people who help others that really need it.I had gone to an Urgent care when I started experiencing really bad breathlessness and a nurse came in to talk to me, I told them what I was feeling and mentioned it felt worse than most of my panic attacks. She asked me if I had a history of anxiety, answered yes, and she did my vitals and left. Later a doctor came in to check on me, nurse pulled her back outside and I had heard her say \"No no, she's having a Panic attack\" and their voices became more muffled as they walked away.It just... Kinda confirmed what I was already feeling and connected with other experiences of having gone to hospitals feeling absolutely shitty, with doctors recognizing me and seeming annoyed, or seeing my GP look at me with.. I dunno, not really pity, but something else that just makes me feel like I'm disappointing him, and it's not his fault... It just sort of destroys me, because every time he clears me of any physical illness, he just reminds me to find a suitable therapist and combine it with my medications, despite me knowing and not telling him most therapists around me have a year long waiting list and the ones I tried that DID hear me out... Well, didn't help at all. One I tried recently missed appointments constantly, telling me to wait until next week... for 4 weeks straight. And when I finally saw her, I wanted nothing more than to just spill the beans and vent and try and work through recent trauma with just a really horrible and abusive friendship that I'd managed to cut off, and...She said that before that, we had paperwork to fill out for the next 2 sessions. Not homework or therapy paperwork, mind you, paperwork paperwork.It's just... A helpless feeling. I feel like a bother to most doctors having the anxiety I have. I want to get to a therapy asap to stop having these obsessive thoughts about my health, and in turn, let you guys do what you do best, y'know?I'm really sorry to bother you all here. I guess I want some insight? Validation? Criticism? Confirmation of whether or not it's a huge inconvenience/nuisance for you all? I'm not sure... Any answer on the second half is welcome. Thanks, and again, sorry. ###Output :Physician - PsychiatryProzac and Wellbutrin are very often prescribed in combination and is perfectly safe.You need to chew before you swallow your food. Basic skills of life here. There's a reason we have teeth. Please use them.There's nothing inherently wrong with you seeking medical reassurance when you're anxious about something, but also understand that medical resources are limited and healthcare workers are burnt out and very overworked. If someone comes in for the 4th or 5th time with anxiety symptoms that are similar to the past 4-5 times, it's human nature for the doctors to automatically assume it's anxiety again, which is neither medically urgent nor emergent. It becomes harder and harder for the doctor to justify medical workups when the cause seems very obvious.Having experienced anxiety symptoms for so long and so often, you can learn to recognize when it's anxiety vs something new that would feel different. You can learn how to start taking an active part in recognizing triggers of your anxiety and learning to avoid triggers (i.e. CHEWING your food) or de-escalate your symptoms before they become severe. As a psychiatrist, I'm acutely aware of how difficult is to find a therapist who can take insurance within a reasonable wait list (you should still get on those wait lists, it'll be your turn eventually). In the meantime, you can look into online Cognitive Behavioral Therapy (CBT) courses you can do on your own from home. It's not as effective and personalized as working with your own therapist, but it can get you to start learning the basic skills and concepts and start practicing those skills while you're waiting for a therapist. Therapy will be essential for long-term control of your symptoms. Meds alone will never be enough."}
{"text": "###Input :This is... An incredibly well thought out and insightful comment :')Yeah the chewing the food part was definitely my own fault, even my parents point out I eat way too fast and it's always been a terrible habit to break out of, something in my brain, whenever I try to chew, just says \"Stop it, it's food, get it in before it's gone\" so I'm genuinely trying to slow down but slip up like yesterday.The medical reassurance thing has sparked up pretty recently and I'll try my best to at least limit the urges to go. The problem is that even though I've had countless panic attacks, something new ALWAYS pops up. A different symptom that just freaks me out every time, jumps up out of nowhere, and automatically is flagged as \"This is new. Panic, you're dying.\" Just when I get used to one symptom, another pops up. Like the breathlessness, which was never really a symptom until recently. Something I noticed after I'd gone to the doctor and got cleared was that trying to tell myself \"You're fine, it's new, but nothing is wrong with your lungs and heart, just distract yourself.\" Tada, as soon as I'm not thinking about it, it goes away, and as soon as I think \"Hey, look at that! It went away!\" It comes right back because I focus on it, even if it's positive. But at least I got that down, trying to tell myself as long as I'm breathing and not unconscious I don't need to go to a hospital.About the CBT online courses, I had no idea that existed. Usually I'd only take DBT for years and not CBT even though I thought it would help more (but therapists kept saying \"well you have BPD so let's focus on DBT\" even though... I graduated it.)I usually assumed I NEEDED a person to have CBT therapy with, so is there a specific site you'd recommend? I'm genuinely kinda excited at the prospect of it being online. ###Output :One suggestion I have is for your to start keeping a list of the symptoms you have when you have anxiety/panic, and also checking out descriptions of anxiety symptoms from REPUTABLE medical websites like WebMD, MDConsult, Stanford Health, Massachusetts General Hospital, Johns Hopkins Health, etc, and generate a master list. When you have a new symptom, check it against the master list to see if it's considered a common anxiety symptom, and if it isn't THEN go get a medical workup.You can do a Google search for online CBT classes (be aware these are not usually Free, and if they are, there's usually a catch). Here are a few with good reputations:https://cbtonline.com/https://www.beatingtheblues.co.uk/private-patients/https://cogbtherapy.com/free-online-cbt-workbook (this is free, no catch, but very basic)"}
{"text": "###Input :This is amazing. I've never considered a master list and I'll get on that right away. I kinda wanna make a physical and digital one and make them both look nice, so it seems I've got a new art project :DAlso the free online CBT workbook seems best while I look for a CBT therapist or at least get into the therapy waiting list from the psychiatric hospital nearby I get medications from. I apologize for being a little difficult, but here's my question:Concerning symptoms in general, what if it's a new symptom that feels particularly severe or a general symptom from before that feels significantly more severe than usual?Usually I start to panic once let's say... I have dizziness, and suddenly that dizziness morphs into lightheadedness and a feeling faint sensation. Luckily I've been able to tell myself \"just lie down, this is probably anxiety\" but that was waaaay before, with my health anxiety ramping up again I'm afraid of just freaking out once something comes up and I forget in the moment.Although, I do guess that comes with the territory of learning my symptoms. But like I said, if a symptom is extremely severe, I should probably check with other things like accompaniment of other symptoms that are new and not anxiety related, or if something happened to spark the symptom right? I'm really sorry, I just wanna make sure I know when to panic and when not to, although I realize that's also something I'll need to work on, controlling panic. ###Output :I encourage you to read up on Box Breathing techniques. When someone gets stressed or anxiety, its easy to start hyperventilating, and hyperventilating can induce anxiety symptoms. So learning how to control your breathing can go a long way towards getting anxiety and panic symptoms under control. As soon as you notice that youre feeling anxious, take yourself away from the trigger and go find a quiet private place, preferably dark, and take 5-10 minutes to do the Box Breathing technique. Most anxiety symptoms will go down by doing that and youll be able to better differentiate where youre having anxiety or an actual new concerning symptom.https://www.webmd.com/balance/what-is-box-breathingI also would suggest you find some guided progressive muscle relaxation videos on YouTube and start learning that skill. Its incredibly effective at calming anxiety attacks. If you can successfully complete a whole session, youre probably not going to feel much anxiety afterwards."}
{"text": "###Input :Hey! Im a 33F. 59, 215lbs. Diagnosed with arthritis in my back in 2020. No daily medications normally. ER just started me on prednisone 60mg daily, metaxalone 800mg TID and diclofenac 75mg BID. I have had chronic back pain for years now. I work as a nurse and as you all know the constant pulling and lifting of patients is hard on the back. I did some dumb things as a new grad working short in long term care and ended up with lots of back pain. I went in 2020 to have it evaluated. My NP did an X-ray and it just showed arthritis. She ordered PT but at that time I was working a covid unit and they started mandatory extra shifts and I wasnt able to schedule the PT. About 6 months ago I started having issues where when I would go to stand up my back would catch and Id be stuck bent over for several minutes until it loosened up. I kept saying I was going to schedule an appointment but never did. (I know, I know. ) At work the other night my toes/foot went numb. I ended up going to the ED. They did a CT scan of my lumbar spine and told me I had bulging discs. When the ER NP came in, he told me I had 4 bulging discs in my lumbar spine and he felt they were causing nerve compression which was causing my numbness/tingling. He said I was at risk of herniating and put me on a 10 lb weight restriction until I follow up with primary care for a MRI. (They are a small ED and have no MRI available.) The CT report just came through on MyChart and it says I have bulges at L4-L5 and L5-S1. So am I understanding that that would only be 2 bulging discs? Im thinking my husband and I maybe just misunderstood him when he came in. This is a different side of nursing for me and Im not too sure about the risks and such with disc issues. Is the risk of herniating really high? My job wont put me on light duty because it didnt happen there and they just told me to ask for help with transfers/boosts. I work on a very heavy floor thats not considered ICU but they still call it critical care. Its lots of post ops and amputations. It tends to require a lot of lifting and pulling. Im just feeling really anxious about work and I guess am just looking for reassurance/ guidance. Interestingly enough two days before my foot went numb I was having nerve pain going across my shoulders and radiating down my arms. So Im sure Ive got stuff going on higher up as well. I was able to get a PCP follow up on Wednesday so Im hoping to get more information there.Also- is it common for the numbness tingling to come and go? Im assuming its the meds helping? Because at first it was continuous. Now sometimes it travels up my leg into my thigh but It wont last very long. Maybe an hour or so and then goes away.Sorry for the novel- thank you if youve gotten this far. ###Output :I question everything this ER NP has told you. You're correct, if your report says L4-L5 and L5-S1 that's two discs. Not sure why they said that those disc bulges are causing the pain. It's well known that imaging findings in back pain, particularly minor and common findings of disc degeneration, do not correlate well with back pain. That is to say, imaging findings like yours are not necessarily the pain generator. Was a physical exam done with a lower extremity Neuro exam?"}
{"text": "###Input :The NP, MD and nurse never once looked at my foot. I was at work when it started. Im a vascular nurse so I checked pulses and my other nurse friend did a very quick assessment for weakness but it was fine. At the ED they all just kept telling me it was sciatica, which Ive had before but its never made anything go numb. Then once the CT came back they said it was nerve compression from the bulging discs. ###Output :Hopefully your primary care doc will actually do a physical exam.I'd caution you against recommending things based off of what you've seen. That's unsafe, inaccurate and bad practice."}
{"text": "###Input :This post is about my dad, who is about to leave the hospital after a 2 night stay.Age: 55Sex: MHeight: 5'8\"Weight: ~180-200Race: whiteDuration of complaint: 5 daysLocation/issue: Esophageal tear, 4 stomach ulcersAny existing relevant medical issues: T2 diabetes, high BP, GERD, alcoholic for ~25-30 years, anxiety, compressed ulnar nerve due to bulging cervical discs - lots of back pain and numbness in armCurrent medications: metformin, no BP meds (had a bad rxn), alprazolam, venlafaxine, there are others I can't remember but they're not super relevant to my concernI'll be brief here, but can answer questions if needed. I don't live near my parents so I'm hearing everything from my mom.Wednesday: Dad isn't feeling great, but that's not uncommon due to the alcoholism-diabetes combo and current back pain. Mom and dad go to the gas station, dad goes to the bathroom, employee informs mom that dad has passed out in the bathroom. They call the ambulance, blood sugar is 54, he's given glucose, and feels better. Refuses to go to hospital, mom takes him home.They walk inside, he feels lightheaded again and vomits multiple times. Mom goes to get a towel and he then passes out and begins to aspirate vomit. Mom sits him up and slaps his back until he can breathe again. Brief comedy break- he says \"wow! I feel better!\" He goes to the bathroom and is bleeding a lot from his rectum. Refuses again to go to the hospital (he's an ornery fellow, but it's understandable because he doesn't have insurance).Thursday: He goes to his PCP Thursday morning and PCP says he has lost up to 1/3 of his blood and needs to go to the hospital. Dad refuses again. No major events occur the rest of the day.Friday: Dad tells mom he's feeling alright, he eats some food, seems normal. She goes to work. She returns and I'm not sure what exactly happened, but he begins bleeding profusely from the rectum again and goes to the hospital Friday evening.Drs can't identify the source of bleeding and are thinking diverticulitis. He continues to bleed and is given 5 pints of blood over the course of the evening/overnight. They prep him for colonoscopy in the morning. Drs tell mom situation is critical and to be prepared for the worst.Saturday: Dad doesn't respond well to the barium so they do endoscopy through the mouth instead and find an esophageal tear and 4 stomach ulcers. The esophageal tear finally resolves on its own so they didn't do any repair. Rectal bleeding largely subsides but there is still some with every BM. They plan to do a colonoscopy later. Hemoglobin was 9 at intake, now is 7.6. He's on a magnesium drip and gets another pint of blood for a total of 6 pints. Saturday night is not too eventful. Blood pressure is low despite typically high BP.Sunday: Bleeding has mostly subsided. Hemoglobin is still very low. BP still low. GI doctor no longer wants to do colonoscopy and says dad can go home. Floor Dr and nurse think he should stay. Dad is worried about medical bills and claims the hospital is \"trying to kill him\" so has opted to go home.I have two questions- should he really be going home?? And given he is a physically dependent alcoholic, should he be given alcohol or no? Mom says he was not given alcohol during his stay and did not have any seizures or severe withdrawal symptoms. Last time he had alcohol was probably sometime Friday morning or afternoon. I know quitting alcohol cold turkey is very dangerous so I'm surprised he has been mostly ok in that regard. He's anxious, irritable, and paranoid that the hospital is killing him, but otherwise not terrible. Is he over the hump after 2 days cold turkey? Should my family remove all alcohol from the house and keep him dry? Supervised small doses?I'm surprised he's allowed to discharge himself so soon after nearly dying, when his stats are still bad and his doctors don't even agree. My family hasn't been given much information and don't know how best to take care of him at home. He can be quite the asshole and doesn't listen to anyone (even his doctor) so restricting alcohol or anything else would be difficult.I'd appreciate any advice on home care, what to look out for, and especially what to do about alcohol. For reference his intake varies a lot but sometimes it's as high as a whole 750mL bottle of rum in one day. Supposedly it has been \"less\" lately due to acid reflux.Edit Sunday Aug 7th: his hemoglobin had gone up, but dropped back to 7.7 and there's a small amount of blood in his stool. So he's still at the hospital for now. ###Output :Glad that he is staying in the hospital.He should strongly consider medications such as naltrexone (oral or intramuscular injections that last for 30 days) or acamprosate which can reduce alcohol cravings. This is the type of medication he should get a prescription for once he is discharged. Once he is home, remove any triggers he might have at home.Wish you and your dad the best"}
{"text": "###Input :My son (19M) 6'1\" 210lbs who lives approx. 2 hours away at university. No relevant health history besides depression. No routine meds. Doesn't smoke or drink. Yesterday, around 18:00 apparently, he took 50 500mg acetaminophen tablets in a suicide attempt. I was notified at around 02:00 this morning by my ex-wife. I immediately called 911 and notified them of the situation. Ultimately he was taken to the ER a little after 03:00. I have been unable to speak with him due to being Baker Acted. My ex-wife was able to find out that they'd given him something to induce vomiting. My question is roughly 9 hours after ingestion he should definitely be receiving Acetadote, right? I'm not saying that he he isn't, but it wasn't mentioned apparently. It has been quite sometime since I've worked in critical care (RN), but we would have definitely put him on Acetadote. Am I safe in assuming this is the case? Also, in an otherwise healthy young man, what, if any, longterm complications might we be looking at? Thanks in advance for any help. ###Output :No long term complications if he recovers from this, which he should if the timing is correct. There's only 2 ways these go 1) liver failure or 2) complete recovery. He should be early enough in his overdose to be treated."}
{"text": "###Input :My sister (30, Hispanic, 5'3\", about 250 lbs) has several medical conditions and a long history of undiagnosed neurological symptoms.Two or three years ago, she started having numbness and weakness in her hands and feet and sometimes arms and legs that got much worse in the heat. She was having a couple of other symptoms at the time (can't remember, but I think one was having trouble seeing out of one eye) that made us wonder if she might need to be screened for M.S., but she didn't have insurance at the time and it resolved after a couple of months, so she never got it checked.Last year in June, she started having multiple grand mal and absence seizures per day, including episodes of stat ep, and an EEG confirmed temporal lobe epilepsy. She also had periods of disorientation with no obvious seizure activity. She tried several medications and they finally settled on max dose Depakote. She has not had a seizure in six months that she knows of.Two or three months ago she suddenly developed the inability to tell if her bladder was full and she also had sudden full releases of her bladder. This has been improved with medication.On June 8th, she went to the ER for a severe headache. She was diagnosed with cervicogenic headache caused by muscle spasms in her back and neck (new onset).On June 29th, the ER gave her a steroid injection (for asthma) in the front of her left thigh and her thigh immediately went numb. It remained numb until this past Monday, when she developed severe pain in her thigh with difficulty walking and bearing weight on that leg. There was no redness, swelling, or other obvious indication of infection or blood clot. Her PCP said it was likely femoral nerve entrapment as a result of the injection and that it would likely resolve over time.Last night (Thursday), just before 5 pm, she had a sudden onset of left sided numbness in her face, neck, left arm, and left leg. She could no longer feel the nerve pain in her thigh at all. She also had blurry vision in both eyes. The paramedics noticed slurred speech, word finding problems, and facial droop. She was able to make it to the stretcher with help. By the time that she got the ER (level 2 stroke center), her entire left side was paralyzed and she had zero sensation on that side. Whenever she tried to lift her left leg, visible muscle spasms were present in her thigh. She also could not feel her pubic region at all and had great difficulty urinating. At no point did she have a headache. She said she had no lapse in memory and does not believe she had a seizure (her SO was with her also). Her blood pressure and blood glucose were normal. Head CT and MRI did not show signs of either a hemorrhagic or ischemic stroke. After a couple of hours, she showed slight improvement - able to slightly lift her affected arm and leg, although she still has no sensation. The facial droop and slurred speech had mostly resolved, but she was still having word finding problems. She was told it was likely a TIA caused by her Nexplanon and that it would be completely resolved by morning. They said if it wasn't a TIA, it could either be an unusual presentation of a seizure or a psychiatric condition (she has depression, anxiety, PTSD, and ADHD, all controlled). She was admitted to the step down unit for observation. They said they could not give her any of her medications until the hospitalist approved them.This morning (Friday) my sister had recurrence of the left sided numbness and could no longer move her arm and leg. The hospitalist was surprised to find that the symptoms had not resolved. The hospitalist said it was likely not a TIA and that they would be looking for other causes, like M.S. The symptoms slowly began to improve again, then the numbness returned along with the paralysis. This has improved slightly again. She had a repeat head MRI and CT, an echo, and a carotid ultrasound, all normal. She was assessed by speech therapy (normal) and PT/OT, who found severe deficiencies and recommended inpatient rehab. At no point throughout the day was she given any of her regular medications, including her Depakote, which is critical for her. The nurse didn't answer any of her call lights all day, and she sat in her own urine for hours, tried desperately to hold her bowels because he was so irritated every time she called that she was afraid to use her call light.Her case worker informed her that both local inpatient rehabilitation centers denied her admission because she didn't meet the criteria based on the neurologist's diagnosis (which we had not yet been updated on). Finally the neurologist came and did a super quick assessment. My sister could lift her left arm about three inches off the bed and her left leg about two inches, and still had almost no sensation. She still could not walk or bear weight at all. The neurologist said that they had ruled out all emergent causes and that it was probably a manifestation of conversion disorder and that it would go away in a few weeks. She will be discharged tomorrow and given a referral for home health.After the neurologist left, my sister started crying. She felt dismissed and judged and crazy and she started wondering if she was faking the whole thing. I reassured her that what she was feeling was real and that I believed her 100%. I called the patient advocate, but they were gone for the weekend. I contacted the house supervisor and requested either a different neurologist or a transfer to another hospital. She said she would talk to the neurologist to see what he was thinking. After they talked, they basically denied both requests, as well as a request for inpatient rehab or PT, and said she would still be discharged tomorrow.There are stairs that lead up to her mobile home. Her SO is not strong enough to assist her with the at home care she needs until home health comes through and she will clearly need significant around the clock care. She will not be adequately cared for at home.I'm not sure if we should just do the best we can until she can contact her regular neurologist on Monday (there is no after hours emergency line), or if we should check her out tonight and take her to an academic hospital for a second opinion and further testing. Our closest major cities are Shreveport, LA (1 hr), Little Rock, AR (2.5 hr), and Dallas, TX (2.75 hr). Any advice would be extremely helpful.This is what I know about her medical history:Hard of hearing Temporal lobe epilepsy (June 2021), last known seizure 6 months ago Cervicogenic headache due to neck/back spasms (June 8) Asthma Unstable SVT (frequent episodes for awhile, but no episodes in a few years) Fibromyalgia Left leg - possible femoral nerve entrapment (June 29) Rectal abscess surgery (Feb 8) ADHD Depression Anxiety PTSD Chronic/frequent laryngitis? (sore throat, loss of voice, and fever every two to four weeks for at least a year, not diagnosed) Upper back pain/vomiting when eating (April) Severe sleep apnea - hasn't received CPAP machine yet Urinary incontinence Non-alcoholic fatty liver disease Chronic rib pain - both sides, since teenager Enlarged spleen (Dec 2020) Hypertension Hyperlipidemia COVID (2020) PCOS Acid refluxThese are the medications I'm aware of:Ozempic (for weight loss) Metformin (for weight loss) Cymbalta Depakote Albuterol Gabapentin Oxybutynin Indomethacin Trelegy Singulair NexplanonShe rarely drinks alcohol - causes back and shoulder pain. She does not smoke cigarettes. She has her medical marijuana card for epilepsy, but rarely used it until this week, when she began smoking frequently to try to control the leg pain.Please let me know if you have any questions. ###Output :I hate to be that physician but in the absence of any actual findings on multiple MRI, ECHOs, Carotid US, sometimes conversion disorder may be more likely than a rare esoteric disease. That being said, what led you away from conversion disorder?"}
{"text": "###Input :Thank you for responding. I thought that required a pretty significant stressor. The only thing that's come up in the past couple of weeks is the nerve injury. Nothing else has really been stressful lately and her mental health has been under control. The altered mental status and muscle spasms left me with the injection that it is medical in nature. Also her history of neurological issues presenting over the past three years. I was thinking Todd Paralysis or MS might be more likely. They didn't do a spinal MRI, a spinal tap, or nerve conduction studies. Not sure if it was necessary or not. ###Output :Conversion disorder does not require a significant stressor to be present, although significant is a relative term in itself. That being said, an extensive work-up would include MRIs with/without contrast of brain, cervical spine, thoracic spine, lumbar spine +/- lumbar puncture. If this has all been done and negative, it is more likely conversion then a obscure neurological disease although the latter in itself is difficult to rule out."}
{"text": "###Input :Given the timeline Ive described, would it be reasonable to assume the relationship between Covid and these complications?Would it be reasonable to assume the relationship between MI and demand ischemia?Interestingly, the transfer hospital did not initiate treatment for COVID-19. Could this have changed the trajectory of the case? ###Output :Sounds like the likely timeline is COVID infection --> demand ischemia, MI. Given the situation, it sounds like the transfer hospital and receiving hospital appropriately triaged the issues and treated the most life-threatening issue (the acute MI) first.This patient had a lot of risk factors for getting very sick with any infection, not just COVID. Going without clopidogrel likely also helped precipitate the MI, though no one will be able to say to what extent.I don't think that initiating COVID treatment at time of presentation would have made much difference."}
{"text": "###Input :Hello all... I am a white 33yr old male, 5'9 180lbs no meds taken currently. This is the second time I have had cellulitis in two months. I was wondering if sea moss was beneficial in any way to help the healing process as well as make it faster it's extremely painful and I have it on both of my feet in lower legs I'm afraid to go to the hospital because of the area that I live in they are too quick to judge and stereotype you and I have extreme anxiety going to the hospital so is there anything that I can do to get this healed and taken care of as quickly as possible please any and all comments ideas and suggestions are welcome and will not be criticized or Taken the wrong way ###Output :If on both legs not likely to be cellulitis.Please include one of preferably more of the pictures in your post as an imgur.com or imbb.com link. It makes it easier to help with something when it can be examined visually."}
{"text": "###Input :My dad (52M, no prior health issues except mildly high blood pressure, on a blood pressure med) is currently hospitalized for a pneumothorax after an injury. He broke several ribs, and one of them pierced his lung. The pneumothorax was small, so we assumed hed heal fine on his own, but yesterday he had to be transferred to the critical care unit because he had developed AFib in his sleep. Once his heart rate was stabilized, they put in a chest tube, because X-rays showed air and fluid. Hes been draining a lot of blood and fluids from the tube.They arent sure if the AFib was caused by the collapsed lung, but he has no history of irregular heartbeat or heart problems. Is this common after a pneumothorax? ###Output :Essentially, anyone can develop atrial fibrillation at any time for numerous reasons including you and I. That being said, the stressors on his body could have induced a state conducive to this, or it is possible that these are 2 separate problems that happen to occur around the same time, ie a person with a stroke who also has a UTI. One would not have necessarily induced the other in this case."}
{"text": "###Input :Please take the time to read this. I am extremely sick and not sure if I am going to survive much longer.31M. 5'8\"; 125LB; Caucasian; trouble breathing/abdominal pressure; 7 year duration; condition undiagnosed - separate diagnosis of reactive hypoglycemia; current medication (Acarbose 50mg every meal); ZERO drugs/drinking/smoking/vaping/caffeine;My name is Jason Otto. I've been so sick for so long I don't care about online anonymity anymore. Here's a pic of me to prove I'm not making this up:https://ibb.co/1vHzn3xI am extremely messed up. I have been unable to work for the last 8 years and savings have nearly run out. I am now homeless (living out of my car). I have traveled the United States in search of help and I am currently at Harvard. I thought I would get help here but it's more of the same: condescending doctors who take very little time to even talk to the patient and figure out what's wrong. I don't know where else to turn.I am currently looking for a doctor that gives a shit about his/her patients. I'm looking with someone with integrity. I am willing to travel anywhere in the country and can be there within 24 hours. Most dismiss me after the usual 20 minute appointment and tell me nothing else can be done. There is no brainstorming, no critical thinking, no followup, nothing. I don't think that these people understand how serious this situation is. I cannot work, I can barely get out of bed (now my car-seat) in the morning, my cognition is in the toilet and I am unable to function in daily life. I am a vegetable.My problems began in April 2013. I had been having gastritis for a good 6 months and was treated unsuccessfully by several GI docs and their PPIs and H2 blockers. Out of desperation, I went to a chiropractor at the recommendation of a friend. He said he sees all sorts of weird stuff and he will ACTUALLY LISTEN TO YOU. Sold.I see this guy and he thinks my gastritis is due to a hiatal hernia. I now know that this can be seen on an xray and that he was completely full of shit, but I was desperate so just told him to \"fix me please\". Desperation breeds bad decision making, and without family support I didn't think twice about it.He said he could manipulate it back into place and laid me down on the table, stuck his fingers in exceptionally hard, deep into my abdomen, just under my ribs, about an inch below my xiphoid process, and pushed in and pulled down toward my naval very forcefully.I feel like he moved something out of place.Since then I have had trouble breathing, eating, and feel like I'm constantly being hit in the stomach. I feel like the life is being sucked out of me. It's hard for me to move, it's hard for me to think, refreshing sleep is next to impossible, and I feel like I'm stuck in overdrive all the time because I am so uncomfortable that I cannot calm down. Something feels out of place in my abdomen, almost like it was shifted downward, and no one can seem to tell me what it is or how to treat it.I've had CTs, MRIs, xrays, and many other tests. GI has been ruled out with extensive testing (EGD, barium swallow studies, gastric emptying scans, etc.) It feels like it is outside of my GI tract, almost as if my liver has been displaced. When you go to a doctor and say you are having problems in the epigastric area, you are referred to a GI. GI has been ruled out, and there is nothing wrong. It feels like it's some sort of organ or something else that has been forcefully moved. I feel like I'm in hell in my own body.I struggle to focus because I feel the need to constantly lay down. It's like being hit in the stomach and needing to sit there for a moment to just relax and catch your breath, but the feeling is constant and never goes away. This has crippled me and I cannot do simple things like reading books.If anyone has any idea on what this could be, or has any recommendation on where to go or who to see, PLEASE let me know. I'm someone who always repays the favor, and if you can point me in the right direction or help me in any way, I will more than make it up to you.I used to be a somebody, and now I'm rotting away in my vehicle. I've lost 40 pounds because the thought of food makes me sick, and I cannot find relief.Thank you.-MAlso, THERE IS NO PAIN. I need to make that clear. It's pressure/tension that is constant and I do not feel pain with this at all.I also feel a beating heartbeat in the area, like my heart is pushing against it. The heartbeat is pronounced.Here is a link to an image I uploaded showing the area (under xiphoid process, near liver and diaphragm): https://ibb.co/ByrJ4xSScan list:CT chest, abdomen; MRI chest, pelvis, abdomen; xray chest, pelvis, abdomen; Abdominal ultrasound; Echo, stress test; Tons of blood workEGD; Barium Swallow Study; Colonoscopy; Gastric Emptying Scan; Capsule Endoscopy; Pillcam ###Output :This is now getting filled with bad advice and advertising. I think good suggestions that will come up have come up, and the discussion is over."}
{"text": "###Input :Since you're already in the neighborhood, have you tried this group? https://undiagnosed.hms.harvard.edu/ ###Output :UDN is a good thought, and I think worth looking into. I hope this suggestion gets upvoted more. They have great success stories and are run by great people. It also illustrates that \"I am at Harvard for medical care\" can mean a bunch of different hospitals, clinics, and doctors, who all have varying expertise and areas of focus.However, a couple things to point out:It's a research study, so not the same as \"having a doctor.\" You also need a study recommendation letter from a health care provider.\"We cannot accept all applicants.\" Eligible participants \"have at least one objective finding.\" I honestly don't know how they define that, e.g. is weight loss objective enough?\"After all of the necessary information is received... it typically takes 6-8 weeks... to decide whether to accept....\"They have about 12 clinical sites across the US, not just Boston.Not trying to dissuade OP. If it were me, I would absolutely be looking at UDN. Let them decide whether you're eligible or not. I'm just trying to provide perspective about what to expect."}
{"text": "###Input :Thanks!It does seem structural but I'm having a hard time getting anyone to believe me. Most docs don't even want to hear my history of how this happened. They're on auto-pilot and seem to just want to know what the symptoms are.I'll look into sympathetic nerve damage. ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."}
{"text": "###Input :Thanks I added that to my list of things to look into and will be following up with someone on Monday to hopefully evaluate it. I have a list of everything that everyone on here has said and I'm going to bring it to the attention of the next doctor I find. ###Output :To be honest I wonder if you had some traumatic injury to the celiac plexus. This sounds like a neuropathic pain secondary to the chiropractic manipulation. This is a very unusual story you give, so I can't say I have a strong hunch what is going on, but this seems like a reasonable thought. I'm sorry you've ended up in this predicament. You may consider seeing a pain specialist for discussion about a very particular procedure of a type of nerve block."}
{"text": "###Input :I've been thinking the same, and am trying to find out how to know for sure. I'm told that x-rays show the diaphragm, as well as CT scans, but nothing is ever mentioned. I've had an ultrasound of the abdomen as well which I was told would show something if there was a problem, but nothing is coming up. ###Output :Just so you know, x-rays show the diaphragm so-so, but not great. CT would certainly show more detail. Earlier you stated a hiatal hernia \"can be seen on an xray,\" which is true in the sense that an obvious one would show up, but not all would show up.Likewise, an ultrasound of the abdomen could in theory show some diaphragm abnormalities, but that's not often what the sonographer and radiologist will be looking at most closely."}
{"text": "###Input :t that's not often what the sonographer and radioloThank you.I have had a lot of imaging, including CTs, over the past several years. Do you think a second opinion from a radiologist would be a good idea? Usually you get an order from a doctor and the radiologist does and reads the scan, but are there options for people who just want a radiologist to look over old testing? Can I pay someone to look at old tests? ###Output :In general, radiologists definitely look at old scans, and that could be considered a second opinion. This pretty much means the patient has to bring the images on CDs.However, when this happens, it involves a \"front line\" non-radiology doctor (medicine, ortho, neuro, etc.) who sees the patient and usually is ordering a new scan and wants to know how today's MRI of the hip compares to the 2015 scan from Far Across The Country Clinic, LLC. Rarely the front line doc might have old scans only and just want his/her local radiologist to take a look as a courtesy.I have never run across exactly the 2nd part of what you're suggesting: patient directly sees/pays a radiologist to review stuff (with no front line doc involved). This probably exists somewhere in the world, but it has a sort of \"boutique\" feel to it."}
{"text": "###Input :Hi Docs & Medical Community -Coming to you all hear with some saddening news. It's been approximatley six weeks since my partner \"attempted\" suicide via hanging, and I have had extremely limited information on his current condition due to a variety of factors. These include being a non family-member, and his remaining family being very difficult to work with, less than caring of his current condition, and not being the ideal parents. The background for these are for another subreddit, but I'm happy to divulge any information if you all need more. I will try to be as analytical and non-emotional as I can in this post, as I'm only attempting to gather information from those directly involved in the field, as opposed to my resources of compiling random pages on the internet. Hope you all can help, and if you need any information please ping me.For security reasons, this is a throwaway, but I will be checking the post on my main account routinely and can log back in to answer any questions you all may have. Thank you very much for your help.I made an original post on r/TrueOffMyChest yesterday, that you can find here. It may have some information that may be relevant, although focuses more on my emotional state and less on the actual medical facts.---Patient Information: USA, 25M, 6'0\", 192, White, Attempted Suicide Via Hanging - Hypoxic Brain Injury. No exisiting medical issues - daily workouts w/ weightlifting and cardio, very diet and food aware. Current medications include 20mg daily Wellbutrin, started 2-3wks before event happened. Prior to Wellbutrin, 20mg of Prozac daily. Casual smoker (vape-nicotine) and regular alcohol intake (2-3 drinks/mo). No recreational drugs. Past history of mild depression and anxiety, routine therapy. Zero previous suicide attempts or thoughts at self-harm.---The last several weeks have been quite stressful and devastating as you can imagine. There's a lot more to the information-specific side of the story, but the long story short is an abusive, neglectful, and incredibly religious mother, who has cut off her son. She is unwilling to call the hospital for daily updates, and obviously they can't release any information to myself or his friends, as we're not family. We have been able to get some limited information through friends of friends - my partner was a graduate school student in biology, and has many friends who know some individuals who work at the specific hospital he's at and were able to nail down some information. With the exception of yesterday's update, in which my partner's best friend drove to the hospital and used one of his friends there to squeeze some actual information (I'm not sure that's legal, but we are totally in the dark and the only person who has information will not share for her own greed), we know nothing concrete.The information yesterday was helpful in a way. For my full emotions, I can't say I'm any better, but from a purely medical standpoint I'd like some help deciphering it. Again, I understand this is a sticky situation involving HIPPA and legality, so want to be clear that I am not advocating for any unethical or illegal reporting standards. I fully understand the rationale and logistics behind HIPPA and it's protection laws. I hope, from a personal perspective, you all can see how we had to do what we did in order just to learn SOMETHING. I am not a judgemental person, but his mother is subjectively awful for her behavior in the past and now, withholding information and not even picking up half of the hospitals calls regarding updates about her own son. We just have to work with what we have.The reason I bring this up at all is due to the fact I want to stress the 'concrete' nature of the status update yesterday - while all of our other updates have had questionting validity due to them being passed through multiple sets of ears and open to interpetation, this one came directly from the source. Anyways, I will attempt to construe a timeline below:Mid-Feburary: Initial incident occured. I discovered my partner hanging by a constructed noose in his bedroom. While I don't know how long he was cut from oxygen, I know that it was >4min and <11min. If it was closer to 4, I'd assume he'd be awake by now. If it was closer to 11, I figured he may be confirmed brain dead and/or medically dead at this point.I called 911 and began CPR immediatley. 911 was quick response, and from call time to arrival was no more than 3-4 minutes. In this 3-4 minute period, I opened his airway and performed CPR while simeltaneously on the phone. I did not detect a pulse nor breathing, and once the EMTs arrived, they relocated me into another room for comfort & questioning while attending to him in the field. They shocked his heart back from AFIB, and I do not remember them confirming if they restarted his pulse.Late-Feburary: 13 days after event. I have no information. I am called by my attorney (who I called to be safe and attempt to find out more info) to see if he knows anyone who can get any contact update. I have contacted his mother by now who has expressed her disgust for her son and says he is an \"unforgiveable sinner\" and wishes not to be contacted by me anymore. When my attorney calls, he gives me no information other than \"no brain activity.\" I immediatley assume brain death, and am disheartened (to say the least) at this news. I assume at this point that it is irreversible and he will not wake up.Early-March: Limbo period of no information update. My attorney can only guarentee me that he will have any information if she dies - in which case I will be informed.Through grapvine comprised of partner's close friends, limited information is listed that he has been transferred to a highly-rated neurosurgery hospital, and has been moved from \"Critical\" to \"Critical-Stable\". His body is improving, but no update on his brain status and activity. No one knows who authorized the transfer, or if it was done by the State or a hospital administration decision. His mother does not answer my request for comment. Brain activity has gone from \"no brain activity\" to \"little to no brain activity\" if that makes a difference - it did not to me, at least not at the time.Late-March/Present: Partner's best friend made the state-crossing drive to his current hospital, which as of yesterday, he is still at and not reported medically dead. Source-based information was relayed as follows: Still in \"Critical-Stable\" condition, with significant brainstem activity. They would not say if it was a persistent or permanent vegetative state, rather they listed it as a \"medically-induced coma to allow the brain to heal.\" They implied that they COULD wake him up if he wanted, but they were holding off to see if he would have a better response. I'm unclear on what that means. They could not give him an exact date on when he was moved from one \"level\" of inactivity or trauma to the other, so I cannot confirm that. They said his OFFICIAL condition was \"Stable, but Unresponsive\" which could mean a number of things. I am optimistic that they have taken away the notion of a sudden brain death, but am trying not to a) get my hopes up, and b) speculate on anything that was not explicitly confirmed.In addition to those updates, they said his vitals were normal, and he had sleep/wake cycles, but no voluntary response to stimulation. Whether this is due to a brain injury or the medically-induced coma or some combination of the two is unknown. While he is still on a ventilator, it was reported that it is no longer breathing FOR him, simply assisting him in his breath. His heart was put on bypass, but is pumping on it's own at the moment. This is the last update I have.---So, here we are. This is a lot of words. I want to state - I don't know how to feel. I'm not writing this post for someone to sit here and tell me it's going to be okay. I know, logically, there is a very small percent change (<5%, if not smaller) of him ever waking up, and a fraction of that small chance of him being \"normal\" in the sense that he was.My intention with this post is to try and get some real life experience from those who have seen something similar or have an area of expertise in this field. I've read a LOT of things on the internet, some of which make sense, some of which don't, and some of which conflict each other.IF YOU HAVE ANY ADDITIONAL QUESTIONS OR NEED ANY MORE INFORMATION, PLEASE LET ME KNOW. WILL UPDATE AS SOON AS I CAN.---I'm not religious, but ask all of you to send some good thoughts his way. You never know. I know that there are a thousand possibilities of varying severity through this outcome. I'm hoping it's the one that he's happy with. ###Output :Thats a very sad and difficult situation, Im so sorry.Im not sure we can help a lot with all this second hand information.The fact that he has a wake/sleep rhythm and triggers the ventilator means that hes not brain dead. The first fact means hes probably moving to (at least) a persistent vegetative state.The chances that he recovers without important disability are slim. Its very hard to predict if this remains in the range of persistent vegetative state or if more consciousness will recover. A next step would be if meaningful communication would be possible.An MRI, EEG and the results of a neurological exam will help inform prognosis, but there still will be significant uncertainty."}
{"text": "###Input :Age 40 Sex MHeight 6'1 Weight 190 Race W Duration of complaint Week Location Left index Any existing relevant medical issues PsA Current medications Biologic Include a photo if relevantLast weekend when planting a very large agave/century plant, I got three spines in my left index finger. Two I got out (but they hurt for days after -irritant/poisonous?). The third I felt a stick but didn't see a mark and couldn't find anything to remove. All week the finger has been warm, red, stiff, and a bit swollen. No change in a week, though now the first joint is a bit painful when pushing on it. I've got PSA, so used to having stiff hands, but this is a little different.I've held a very bright flashlight to it and cannot see any foreign body under the skin.For sure had DTAP 8yrs ago when my first was born. Not sure since.Go to the GP? Let it ride? If the doc, do they just throw oral antibiotics at it, or is there something more effective? ###Output :Missing critical elements of history and no images. You may have an infection and you should seek care. Infections in the hand can be serious."}
{"text": "###Input :29F, 5'2, 80 something lbs, end stage liver failure etc.This one might be long, but I appreciate any kind of advice or input. I'm concerned my sister has been kind of pushed to the side since COVID19 and she's currently in critical, critical condition despite having been discharged. My family is confused on what to do, how to help her, especially since she's been denied a liver transplant. But anyways, here it goes:On March 5th my sister was found collapsed on her bathroom floor, she was completely yellow. Her boyfriend rushed her to the ER, where he was told to call family (us) because she wouldn't make it. From there she was transferred to a larger hospital, placed in surgical ICU and had a team immediately on her case. At this point her liver was failing, and she had an infection but they didn't know the source nor the bacteria causing it. She couldn't breathe on her own etc. Over the next week they threw all the antibiotics at her hoping something would stick, put a tube in her stomach to drain fluid that had built up around her bladder, put her on 24/7 dialysis since her kidneys began to fail, so many tests ran, I unfortunately can't recall all the details right now but if there are any specific questions I can likely answer.It was very touch and go for a while but her fever had gone away despite never finding out the source of infection. She was tolerating the dialysis and the last day I saw her she looked like she was doing a little bit better. Then COVID-19 hit my state and we were no longer allowed to visit her. Phone updates from the RN told us she was doing better, but they never had any specific information on what specific doctor's were saying, questions we had just weren't getting answered and my sister was unable to tell us what was going on. Within one week, we were told she was well enough to go down to general, despite previously being told she would go down to regular ICU first, and be in the hospital for at the very least a total of 6 weeks. She could breathe (not very well) on her own at this point and could communicate, so the hospital was no longer relaying information to us despite her not being in good enough condition to actually understand what was going on and couldn't remember what doctor's were saying to her. The next day we get a call that she's getting a port placed for out patient dialysis, and she was discharged that same day.We knew she wouldn't be 100% obviously but thought she would be better than she is. She comes home and can't walk, can't breathe very well at all, is completely yellow, is in constant pain and honestly looks like she won't be able to make it much longer. We don't know if she can survive with this liver, she was denied a transplant (whole 'nother story) and despite getting outpatient dialysis she looks worse and worse. She was told she was getting a home care nurse, they aren't coming now. She was supposed to originally be getting PT, they won't come out anymore (honestly don't think she's at that point now anyways). I'm trying to facilitate the care she needs and I'm trying to get her appointments set up but all doctors are only doing video call (completely understand). I'm just so scattered right now and have no idea why she was discharged. Should I take her back? Will they even be able to do anything? I don't understand and I'm just looking for any kind of advice I can get.Edit: The liver failure was precipitated by alcohol abuse and exasperated by the sepsis from her bladder infection. The last we had heard from the transplant team was that she was considered a good candidate (after 3 interviews) despite the alcohol abuse. We got a letter in the mail yesterday stating the denial. I am not trying to negate from the alcohol abuse, that was the reason her liver failed. Just that she also had a lot else going on that led to the condition she is in. ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."}
{"text": "###Input :Ineligible? Its probably the alcohol. Transplant has very strict regulations. I cant believe any transplant team would say shes a good candidate if she lost her liver due to alcohol abuse. Just like with cigarette smokers. You have to quit and show at least 6 months to a year smoke free before you can even get on the list. Its a long process.I had to wait five years after my stomach cancer to get my transplant. So I did my best to follow my diet and restrictions set forth by my nephrologist and dialysis center.Im only speculating, about your situation. Im sorry if any of this sounds harsh.It took 3 years of waiting on the list and finally as my health took a turn for the worse, my ex donated his kidney to me 15 months ago.If she will not comply with the program, theres no reason to transplant a healthy organ in a person who wont stop those destructive behaviors. The restrictions/rules are there for a reason. I had So many moments of pure anger, crying, frustration and hopelessness. But thats normal considering the situation.I AGREE, she needs to be hospitalized. Her dialysis center should be advocating for her. Find out who is the social worker for her clinic and contact them ASAP.Also, did you know that for a liver - you can donate just a portion - it doesnt need to be the entire organ for a successful transplant. You (family) could still get tested while you work with the transplant team to make her eligible.My mom has cirrhosis of the liver & she too was ineligible because she was a heavy smoker and soda drinker. She wouldnt quit. Shes outlived all the doctors predictions. But shes suffered tremendously. I finally got her and my dad to quit about five years ago. Shes still too afraid to have transplant, shes set in her ways. So everyday is sheer hell at this point. Im terrified for her with COVID-19. One person has already died at her assisted facility living.Heres my take on part of the reason she was worse after she came home is most likely the dialysis. Its a new thing for her body. It has to adjust to it slowly over the next few months. Depends on how bad she is. It wrecks havoc on your body. You can have extreme lethargy, dizziness, headaches, nausea and cramping.She has End Stage Liver Disease. She is living with terminal illness. The only real thing besides humor & my kids that helped me cope was educating myself. About my disease, dialysis etc.I am so sorry this is happening. Wishing you both the best in the future to come. ###Output :It's hard to tell you what's happening or what to do without more detailed info, although I completely understand that you do not have this information, and this is all exacerbated by the current isolation requirements. If I were you I would be focused on finding someone to talk to who can explain things better to you or her medical power of attorney (which, by the way she should definitely have at this point). Does she have a follow-up appointment with a liver doctor within the next week?What medical problems did your sister have prior to March 5th when she was found down in the bathroom? Do you understand what is the primary source of her liver failure? Most common things are alcohol abuse, hepatitis C, or toxicity from a Tylenol overdose... others have what's called \"cryptogenic\" liver disease which means \"it's a mystery\" but these cases usually don't present as rapidly and dramatically. Sometimes even young healthy patients just have really bad luck and get a bad viral hepatitis that leads to fulminant hepatic failure in a very short time span.Reasons for being denied a spot on the transplant list generally fall into one of three categories: 1 - not sick enough yet, 2 - too sick or has other serious other problems that mean even with a transplanted liver she would not survive long enough to benefit from the very scarce resource of a liver donation, and 3 - not eligible due to history of current or recent alcohol or drug abuse.From what you describe it sounds like she was reasonably healthy and has had a sudden dramatic decline in her health which included an ICU stay with multi-organ failure (liver, kidneys). Then at some point she had somewhat \"stabilized\" enough, although remained in overall poor health due to her illness. At this point she was discharged home with home health, outpatient dialysis, and PT for rehab, but given the current worldwide situation those services are not being very reliable. Pain, weakness, and some shortness of breath are honestly part of her disease and may not (by themselves) warrant re-admission to a hospital... depends on the severity and whether there is any intervention that could be done in a hospital setting to improve her. Perhaps she should have been discharged to a skilled nursing facility, but these have specific requirements which she may not have met. I can speculate all day but without detailed information it is hard to give good answers.I'm sorry for what you and your family are going through - both the fear of your sister's declining health as well as the uncertainty and confusion you are dealing with. I know it must be very frustrating. Like I said above, the most important thing is getting more info. And if she truly is getting sicker and looking worse at home them take her back to the hospital ER. They may or may not readmit her, but at least she would be evaluated and you'd have a chance to talk with someone about her situation."}
{"text": "###Input :Thank you so much for this thoughtful reply, I'll try to clarify on some of the things you mentioned. I'll try to be as concise as possible.The cause for the liver failure is alcohol abuse, unfortunately.2 weeks prior to March 5th I saw my sister and she looked healthy. She had been complaining about UTI pain and she told me she saw a doctor and got antibiotics, I told her she needed to go back if she's in pain still since it could spread to her kidneys and she said she would. She never did either of those things, so that bladder infection I'm sure, is a result of a long standing infection. She didn't look jaundice two weeks prior, she has always been a drinker, however until this happened unfortunately I don't think anyone (in the family) knew just how bad it got. Apparently she was drinking very very heavily the week/2 weeks prior to collapsing. We didn't hear much from her the week prior to the hospital, her boyfriend told us she was trying to kick alcohol and wasn't feeling well. I honestly can't tell you exactly how things got to the point that they did, as she was living with her boyfriend at the time. I certainly have my own questions as to why it took her collapsing on the floor yellow as you wouldn't believe for him to get her to the hospital... But that's another story and something I'm trying to think about right now.I'm guessing her reason for not getting a spot on the transplant list is either due to your #2 or #3. We were assured when they first started speaking to us that alcoholics are eligible for liver transplants if they feel they are a good candidate, and they thought she was. We went through 3 separate interviews. We just got the news she was denied via letter in the mail just yesterday.She has a follow-up appointment via video call with a liver doctor on Wednesday.I've talked to my mom today about how we need to set up a POA. We didn't think she was going to make it while she was in the hospital/when we could still visit, so while my mom was acting as her advocate, nothing legal has been set up yet. I agree, that needs to be done asap.I forgot a couple things in my original post about how she was considered to have sepsis due to the infection, and she had aspiration pneumonia. Not sure if that's relevant at this point. I'm just taking with my mom rn were trying to make sure we're including as much info as we can remember.Your summary sounds very much on point, and that's kind of where I'm at. Do we take her to the ER? Do we wait until her video call on Wednesday? I can't figure out why she was discharged, and I don't feel like we were armed with enough information about her current condition before she was discharged and were confused on what to expect, what were working with, etc. She's currently in a lot of pain, she's not very alert today, she does have dialysis tomorrow. I'm just so confused lol.Thank you for your help, I'm trying to prepare for what my next move is going to be, everything has been so confusing having COVID19 thrown ontop of all of this. I do feel like this lack of communication wouldn't have happened before all of this, and it's just been confusing trying to figure it all out. She came back to us very very sick, and I just have so many questions. ###Output :Sorry that you and your sister are in this situation, but for this extra information and the long standing alcohol dependency/usage, it sounds like she was denied on that basis. Yes, there are circumstances that can alcoholics can get listed but transplants are reserved for candidates that can make use of their own life and the life of the person whose liver is being transplanted. In other words, it isn't just her life that they are considering. The decision to offer or deny someone a transplant is not a light decision, it involves a whole committee that looks at all aspects of the patient being considered. They look at the usual age, sex and medical history, but also socioencomic history, psychiatric, social structure and support. They usually require a certain number of months of sobriety and vigorous compliance to AA, follow-ups, medications, etc before they can seriously consider any candidate as there is nothing worse than transplanting someone, and that person end up going back to old habits, get lost to follow-up and wasting a healthy transplant that could have gone to someone else. However, just because she was denied now, does not mean she cannot become eligible later.Long standing alcohol consumption can lead to eventual liver failure, and any binges on top of that can throw someone into fulminant hepatic failure and the resultant complications, which sounds like the situation your sister is going through.Unfortunately, she is very, very, very sick and her condition is unlikely to improve dramatically, and she will have more setbacks along the way or she may have an abrupt decline, even while waiting for a transplant. Failed livers have a very high chance of more bad things happening, even with the best therapies and intent. If she is not doing well, such as she is having increased confusion, or unable to be aroused, fevers, gastrointestinal bleeding, I would bring her back to the ER where they evaluated her for transplant (the large hospital, sounds like an academic hospital), if you can. If she cannot make it to the hospital where the transplant evaluation is possible, the closest ER will do, they can stabilize her and decide what to do once she is stable.Hoping for the best! Let us know if you have any more questions."}
{"text": "###Input :Not the OP but have seen plenty of cases of 'young' alcoholics with severe or fulminant liver failure. I've also seen plenty of much older alcoholics who don't develop any of the usually associated diseases. It's a bit unpredictable but generally someone who develops severe disease at a young age will have been drinking a very significant amount over a sustained period of time. And some people are particularly vulnerable to disease unfortunately. ###Output :The degree of liver damage related to alcohol can definitely vary person to person, and probably has a genetic component to it. Just like some people can smoke their whole life and not get lung cancer, some people can drink and not develop cirrhosis (I don't recommend anyone try this). Those cases are the exception to the rule. Smoking and alcohol generally have a dose dependent insult to the respective organs.But definitely have seen early 20s in full liver failure and die, related to alcohol. Some might argue that the developing liver during childhood are more prone to alcohol-related damage.Wow you and your family are really having a terrible month. You seem very calm and reasoned despite the fear and chaos going on. In any family facing these kinds of ordeals it is always very helpful to have someone like you who can rationally absorb information and help others understand.Things that you should \"go to the ER now\" for would be an altered mental status to the point of near unconsciousness even when you try and speak to her, unbearable pain that is worsening, fevers, significant breathing difficulty (a very rapid respiratory rate like 30+ times per minute or otherwise looks like she is \"getting tired\" of breathing), a rapid expansion of her swollen belly, or if she cannot do simple tasks of daily living like drinking water or using the restroom on her own. If she is not quite that bad I think it is likely safe to take her to dialysis tomorrow. The dialysis nurses will have a keen eye for patients who are too sick to be at the outpatient center, if they don't seem particularly concerned about her and she tolerates dialysis well then I think she can go back home and await the hepatology appointment / video call on Wednesday. Hopefully you will have much more information after that and can then come up with a plan for the future.Patients with alcoholic liver disease do indeed received transplants all the time. Just because she was not a candidate once does not necessarily mean she never will be. For liver failure caused by alcohol or drug abuse, most donor networks will require abstinence for some period of time (usually several months at a minimum)... but it also sounds like she needs quite a bit of \"medical optimization\" before she would be well enough to undergo a liver transplant anyway. She needs to recuperate and heal from her infection more and keep taking all the liver failure medications they prescribe. They may also be waiting for her kidneys to hopefully recover some. Hopefully in another week or two she is feeling a bit better and stronger... once she is able to she should strongly consider some kind of addiction recovery program (there are many free ones as well as ones covered by most insurance companies).My very best to her and your family."}
{"text": "###Input :Father, white male, 73 Approx 170, 58 Date of onset 2015My father is currently in a nursing home with the diagnosis of dementia. What is odd about this is that the dementia was sudden onset. The first thing that happened was that my father had an episode they called syncope in December of 2015. He fell down and according to my mother he appeared to seize up. My father is a poor historian since all this and my mother as well so I have to relay this as my memory serves and as she told me so some pieces are missing and some things may be confused.After the syncope episode he did go to the hospital. I am not sure what treatment he started at that time. I believe he had a work up for stroke and seizures and it was negative. In the subsequent months/years my father began to become obsessed with checking his blood pressure. BP readings were not abnormal at this time but he was convinced something was wrong with him. In the medical records it was documented that my father stated something is wrong. That was the last time my father was ever somewhat normal. He lost interest in his usual interests. He appeared quiet and withdrawn. I believe at this time he was taking medication for high blood pressure, prostate medication, cholesterols meds, and Zoloft.My father deteriorated badly enough that he was especially confused one night. My mother and I were concerned enough to take him to the ER. He had severe hyponatremia. I believe his sodium was in the critical range. He had a long hospital course. I believe the hospital corrected the hyponatremia carefully and slowly and I do not find fault with them over this. During the hospital stay my dads heart went bradycardic and he coded. He had to receive a pace maker.After they corrected the sodium my dad never came out of the confusion. He underwent so many work ups to see why he was experiencing the confusion. All the scans, PET scan, blood tests were negative for anything that would explain the confusion.My dad came home with the pacemaker and remained confused. He remained with a flat affect. Loss of interest in hobbies. Diagnosed with dementia at this point. The doctors couldnt explain why a sudden onset of dementia but said this wasnt the usual presentation.Sometime after this my dad had an episode of status epilepticus and went to the hospital. He was placed on a seizure medication at this time. I dont know which one but I can tell you that after he began seizure treatment his personality returned. He improved somewhat.After this he began to deteriorate to the point of not being able to use the restroom in his own. He started wearing diapers. He became bedridden. My mother decided to place him in a nursing home. He recognizes family but isnt oriented to time and space. I do know he began mirtazapine around this time. I was hopeful this would improve his condition if it were not truly dementia. I believe its been about a year since and my dad remains confused. Hes still wheelchair bound.I read promising studies regarding mirtazipine but as time goes on Im not hopeful he doesnt have dementia. Im posting this in hopes anyone can provide any insight over my dads case. My hopes are that he had pseudo dementia.Ill add that all of his care was provided by the VA. We never accused them of any wrong doing. His primary care doctor and neurologist no longer work at the hospital. They asked us repeatedly if my dad was an alcoholic. We would ask why he seemingly developed dementia overnight and they would ask us if he were an alcoholic. My dad was a heavy drinker at times but we didnt feel like alcohol contributed to anything so said no. I know from working in GI that if someone is an alcoholic its hard to hide from a proper work up. Its possible my dad drank more than I knew and its possible that he truly did have dementia but hid it. I guess my question is does this sound like true dementia? Is there anything else that can be ruled out? ###Output :You say sudden, but it sounds like this has been slowly progressive now for almost 6 years, not overnight. That's a fairly typical course for Alzheimer's disease, with initial loss of memory, later urinary incontinence and more global confusion, and later loss of mobility and total impairment. Pseudodementia has particular findings on assessment that indicate for or against; one element is depression. Your father has been on antidepressants, but it's not really clear, at least to me, what depressive symptoms he has had other apathy and loss of affect.But other things don't fit. Neither pseudodementia nor Alzheimer's dementia present with seizures. Severe hyponatremia can, but that would need a workup and cause. Sometimes the cause is brain injury causing syndrome of inappropriate antidiuretic hormone (SIADH), which lowers sodium, which can cause seizures, but it's still not obvious why the first episode of syncope. Eventually severe bradycardia requiring a pacemaker, but not initially?Timing and type of head imaging makes a difference. With the the triad of dementia, incontinence, and now loss of mobility, has there been any discussion of normal pressure hydrocephalus? It would usually be picked up, or at least suspicion identified on CT at some point, but it partially fits and should at least have been ruled out."}
{"text": "###Input :Based on the history you give I would be very surprised if he had not had imaging of his head either CT or MRI and this would certainly have identified if normal pressure hydrocephalus was the cause of his symptoms and this is important to rule out as if identified early it is treatable.It does actually sound pretty good for a history of dementia and I was unclear from your history whether he had in fact had a stroke as this can sometimes lead to a form of dementia known as vascular dementia which is common but presents slightly differently to the more common Alzheimers dementia. In vascular dementia the progression of symptoms tends to be step wise with sudden deteriorations followed by a plateauing of symptoms and then further sudden decline. In Alzheimers the decline tends to be more of a slow and subtle deterioration. You can actually develop seizures with Alzheimers disease which can develop relatively early in the disease but they can be treated with anti epileptics.Dementia cannot explain the hyponatraemia though; however from the history there are 2 common causes for hyponatraemia. Firstly your father was being treated for hypertension and quite a few of the medications used to treat high blood pressure can cause hyponatraemia. This increases if people are on multiple agents to reduce blood pressure and diuretics tend to be the worst but ACEi and ARBs also cause it. Secondly there seems to be some suggestion of alcohol use and at times you say your father was a heavy drinker. Alcohol particularly if drinking over recommended safe limits can also cause hyponatraemia as well as seizures. It is also a risk factor for developing Alzheimers disease and can actually cause a rarer form of dementia known as wernicke-korsakoff syndrome; although from the description you give I suspect this is unlikely to be the cause. ###Output :Its not uncommon for people to say what youre saying, which is they are shocked at how rapidly a person can deteriorate. I hear it all. The. Time. And its totally understandable.The reality is he was slowly deteriorating before that episode, and you didnt notice it. People with early dementia are good st hiding it. We as doctors get used to picking up on the small signs but family doesnt always realize it. Ask them to recall something very specific, and they cant. But they keep light happy conversation very well. And they always seem happy and they say things are going well. In reality they dont remember much.Then something happens. They get sick with whatever and family is shocked at how it becomes full blown dementia. This is classic presentation for a UTI in the elderly. Something that little can make them completely confused.I suspect that was going on for him. You said he had a heart attack, his brain may have not gotten enough oxygen for a short but also, and that can cause permanent damage. You touched on sodium, Im sure you know correcting that has potential downsides as well.Regardless of what caused it, it is what it is now. Outside of it being one of his medications causing it, I suspect theres nothing you can do. Theres some medications they use to treat it, Im not familiar with them.Sorry youre dealing with this. Its hard to watch someone slowly slip away. Make sure youre taking care of yourself, a therapist can help often. And reading up on how to deal with dementia patients is helpful also, theres lots of small things to do that make both of your time together better"}
{"text": "###Input :What are permanent treatments for sleep apnea? Due to the fact that obstructive sleep apnea is the result of anatomical characteristics, the question of a permanent cure is complicated to answer. You can definitely do a home sleep apnea test to be sure if you have it or not. Ongoing, sleep apnea may be treated by a CPAP machine or an oral appliance. A CPAP is worn nightly and works by opening up the airway with air pressure. CPAP is effective for the treatment of sleep apnea, but many patients find it difficult or impossible to tolerate. Continuous Positive Airway Pressure machines are machines in which doctors give the nasal mask to the patients that provides continuous air pressure, which opens the blockage in the passage that was causing obstructive sleep apnea. As a result, the patients can easily breathe, and they dont feel any breathing sensation or apnea. Due to this, the patient sleeps well with no snoring, and they wake up fresh in the morning. So this treatment is a very important treatment; however, patients first dont understand this, but once they start using it, they start noticing some changes. They feel active because earlier the sleep, which was not complete or used to be in fragments, you were waking up in between, and you were not aware of it, but now that sleep is complete, the patients feel much better. In addition, if people say that they will ignore it and say they dont need these machines, they will bring complications. Because if you are short of breath and there is less oxygen supply of blood to the organs of the body. There is the possibility of having a heart attack very much; if one has diabetes, then it may get uncontrolled; if someone has BP, then it may get uncontrolled, there is a chance of stroke. Also, the other life-threatening disease may get fatal because of obstructive sleep apnea. So it is very important to identify obstructive sleep apnea, get it diagnosed, get treatment, and, if needed, use a CPAP machine, which is very important for your life. So if you do these things along with lifestyle modification like early dinner. Few exercises can be done, such as walking, working on weight reduction and looking at your health benefits to reduce the use of CPAP machines. In this video, our SimpliHealth expert, Dr. Preeti Sharma Senior consultant Pulmonology and Critical Care at Apollo clinic Chandigarh explains the diagnosis and treatment of obstructive sleep apnea. https://www.youtube.com/watch?v=-GhgspGvrQY ###Output :There isn't a permanent treatment for OSA. There are many treatments for OSA with various indications and various treatment success. CPAP is the most widely applicable with the most consistently positive outcomes. Oral appliances can improve symptoms and in some people normalize their overnight obstructive events, but doesn't have as good long term outcomes as CPAP. Some people may benefit from a surgery where their jaw is moved forward, but it only applies to certain people when their jaw is set very posteriorly. There are also hypoglossal nerve stimulators, but are effective in only certain instances of OSA in which the airway closes in a certain pattern."}
{"text": "###Input :My son is 5 weeks old, I am not sure of his height right now but he weighs 9lbs 4oz. his medical history is complex and I believe it is valuable information so I will start with that..When my son was exactly 1 week old we went to his first pediatrician appointment, they noticed he was looking a bit yellow so they did a bilirubin test the levels came back critically high (21). We were immediately brought back to the hospital and they started him on bili lights however they never tested his bilirubin before we discharged from the hospital I had him at, so we truly dont know how long his levels were that bad. We are RH incompatible so I am certain thats probably what caused the really high biliWhile hospitalized for the bilirubin, we quickly noticed our son was having problems breathing. He was holding his breath for pretty long periods of time. A nurse told us at one point that his respiration rate was only 14.. he was having desaturations and bradycardia with this so he was quickly life flighted to a hospital that was better equipped for this situation. Our son spent 1 night in the NICU and then 9 days in the special care unit. It took him EXACTLY 48 hours to have another breathing episode at this hospital. He was life flighted at 10 pm and then 48 hours later at exactly 10 pm he started having issues again. They did a 1 hour EEG and told us there was nothing substantial And that they didnt find it necessary to do a 24 hour EEG. they decided to try Pepcid 0.2mg because they started to think this was reflux related. At the same time they started the Pepcid he stopped having these breathing episodes. They did not run any further testing and just stated that he was having reflux and was holding his breath because of the acid coming up.My son is now 5 weeks old. We were home for less than 2 weeks and we are now hospitalized again. On Wednesday around 3:30pm our son had what looked to be seizures. His eyes were looking to the left, they were sort of vibrating rhythmically in small side to side movements (not across the entire eye. They stayed looking to the left but kind of vibrated??), and he was unresponsive. We snapped in his face and tapped on him, talked to him and everything and he just was not responsive. He ended up doing this 3 times back to back. Each episode would last about 30 seconds with a 1-3 minute break between each of them. We took a video of it and showed it to our pediatrician who immediately told us with certainty that our son was having seizures. He was admitted to the hospital that night.. they did blood work and did find his electrolytes slightly out of normal ranges, however just a few hours later when they repeated the labs he was back to a healthy range and I was told that couldve happened because of the IV fluids he was on..Once again, our pediatrician made the call to send him out to a better equipped hospital. They sent him to a childrens mercy he was there for 24 hours on an EEG which they did not find anything on.. they told me hes not having seizures and that this movement is normal Im sorry but I truly dont think this is normal. Ive never seen a baby do this and our pediatrician found it alarming enough to send him out to childrens.. our pediatrician has 30 years of experience. Hes a smart guyChildrens mercy discharged us with no answers. We begged them to run more tests or consult with a neonatologist and they refused we left that hospital and went to another one in the area that is well known for their high quality PICU & NICU. we went in and showed them the video.. the nurologist that watched the video said he also does not think this is seizures, however he doesnt think its normal.. right now the plan is to do an MRI tomorrow. In the past he has only had CT scans done, but nothing was found on them..I am absolutely desperate. Our kid is being life flighted twice in his first month of life, and hes spent nearly half of his life in the hospital at this point something is wrong, and no one knows what direction to point us in I asked about the eye movement possibly being related to a balance issue or an issue with his ears and they told me no.. Ive asked if reflux could cause it and theyve told me no Ive asked what could cause it and they give me broad answers I need a direction to go with this. Neurologists dont seem to be finding anything. Could this be a cardiac problem?? Does anyone have any advice on what to ask for if the MRI Comes back normal? Our son needs help. He is miserable. He doesnt sleep, hes not eating very well he gets hungry every two hours and I dont even think hes getting enough milk because he falls asleep every time hes eating and wakes up so upset because hes starving he doesnt let me put him down. I am not being dramatic when I say I have to hold him all day and all night. He will not sleep unless someone is holding him, and usually that someone has to be me. I need help something is wrong and I cant keep doing this. I dont have the energy in me to keep fighting with these doctors.. please help ###Output :Were seizure like episodes actually captured on EEG? Did he do the weird stuff while the leads were actually on? It's possible to have seizures, but have a normal EEG if you're not actively seizing.However, not all abnormal movements are seizures."}
{"text": "###Input :24F 57, 190lbs Meds: Lexapro, Buspar, Zyxal, Allegra, Pepcid, metoprolol tartrate, NuvaringPMH: postural orthostatic tachycardia syndrome, mast cell activation syndrome, hypermobile Ehler Danlos syndrome, and Celiac diseaseOther background: moved to NYC over the summer, works in cardiac surgery and critical careBefore the past few weeks, I had symptoms well under control with meds and lifestyle.3 weeks ago, I woke up out of the blue with itchy, raised hives all over my entire body. I went to urgent care and got a 5 day run of prednisone and steroid cream. Hives continued to fade and pop up all over. A week later, I went to my allergist. She gave me hydroxyzine to manage itching. A few days before it started, I had gotten my flu shot and COVID booster (Pfizer). She said maybe it was a hypersensitivity reaction to one of the vaccines, and that wouldnt last more than a few weeks. We couldnt come up with another trigger other than maybe environmental due to the apartments heat kicking in or the weather changing to cold.After seeing her, things worsened. The hives have been terrible still. Ive been getting pain, hives, and swelling in my small joints (fingers, wrists, ankles). Today, my face started swelling too. I have no idea if its still a vaccine reaction, a new allergen, or something else. Its getting harder to manage and no new ideas from my drs. Any ideas? ###Output :If you have urticaria, this is acute urticaria. They can both be managed the same way.Finding a \"cause\" for most urticaria in most patients is not a reasonable expectation. Laboratory and other evaluation is not evidence based. Following the evidence-based treatment approach in Figure 2 will greatly improve most patients: https://onlinelibrary.wiley.com/doi/10.1111/all.13397"}
{"text": "###Input :Gender - male Age - 54 Weight - 165lbs Height - 5'11So my father has been a heavy alcoholic and smoker for 40+ years but im concerned about his health. About 15 years ago he went to the doctors to get some tests done and his doctor literally said to him \"I don't know how you are standing here in front of me\", He also had a blood pressure of over 200 and his blood pressure is still at around that level today.But a few months ago he felt really dizzy to the point where He got a doctor's appointment, Then at the doctor's they did a ECG on his heart and said that he must of had a silent heart attack. They also took his blood pressure and it was 260/180.But my father still drinks and smokes like crazy, He did take tablets to lower blood pressure but he still doesn't care.Seriously, How the hell could he still be alive when he has been living with critical blood pressure of over 200 for at least 15 years? Cause apparently if you have a blood pressure of over 180/120 then you have a 80 percent chance of dying within 1 year.Now I love my father but I think he is a ticking time bomb and im worried ###Output :The body can adapt to a lot of things, seems that your dad is lucky. Not sure what type of advice youre looking for, seems that you know the answers. He should stop drinking and smoking and take his blood pressure medication because youre right, he is a ticking time bomb, he could suffer a brain hemorrhage or a heart attack at any moment, or even start to develop symptoms of lungs, heart and liver conditions."}
{"text": "###Input :He's also not vaccinated against covid although I think he caught covid a few months ago because he was pretty Ill (He just couldn't be bothered taking a test tho). He has also never got a vaccine in his life (Apparently) and he was offered to get his covid/flu vaccine but he just doesn't want tohe is a heavy smoker and alcoholic (Does it everyday), He also use to do alot of other drugs back in his early day (I.e coke, ketamin, Ecstasy etc) but even his doctor said to him 15 years ago that he should be dead.Now I know that things such as heart attacks, Strokes etc doesn't seem to run in my family luckily and both of my grandparents (his parents) are still alive, my great grandparents (His grandparents) also lived to thier late 90s so maybe genetics plays a role here but still, I thought him having that silent heart attack a few months ago would of motivated him into getting his shit together but it hasn'tAlso, The doctor's gave him folic acid tablets to treat his blood pressure (Which I don't really understand). He also went for a scan the other day on his heart but they lost his scan results ###Output :Folic acid is known to help reduce the risk of having a stroke. It looks like you cant do much else if your dad doesnt want to help himself a bit. Genetics might be doing their part here, theres really no way of knowing for sure why he hasnt any other complications, but thats a good thing :)"}
{"text": "###Input :(EDIT Below Original Post ) I kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many have responded, thank you again, It really means so much.I been staying with him for 99% of the time in the hospital. I went home for one day out of 35 days.He was having issues all of this year, mostly without not being able to eat. We went to ER early June and test results came back okay (or so we were told)He became really sick and malnourished so we took him to ER again in Sept and they performed a CAT Scan. They found a Mass.Biopsy of the Mass diagnosed it as Stage 4 Lung Cancer and now he's been in the hospital for over 5 weeks.He had a cardiac arrest which lead to him being put on life support but they carried on with doing radiation to treat the mass and shrink itHe has SVC Syndrome, Pleural effusion (chest tube) Gastrointestinal tube present (Possibly getting a G-J) , HCC Lung Cancer and AFIB ( Atrial Flutter)Medications: (TBE) He's been/are onFor Pain: Morphine , fentanyl , Versed,Blood Thinners: Heparin, Zerelto, LovenoxBlood Pressures: Levophed, MidodrineDiuretics: Lasiks (oral)Lasiks (IV) 10mg to 20mg back to 10mg.Spironolactone (current)I really don't know what to do. They want us to tour LTAC facilities and we're scheduled to meet Palliative Care later on today..Chemo is an option but he might be too weak to do so..Idk if we should transfer hospitals to get second opinions or what.there isn't much I can do besides this. Being supportive and smiling.. Reaching out to people for help/opinions...This feeling of uselessness is overwhelming..EDITED (Additional information): Thank you for all the replies and upvotes... It means a ton. He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing a lot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment. He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk several times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility. They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathing on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay. He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's a lot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest. I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all. https://i.imgur.com/rea1isQ.png ###Output :Sorry to hear.(HCC stands for hepatocellular carcinoma, a kind of liver cancer. It can metastasize to the lung, which can be a cause for confusion. Or perhaps he has a lung cancer and the acronym you were provided isnt quite right. Probably not of much consequence to the following discussion.)If there is talk of LTAC and he is on versed, I am guessing he is still requiring mechanical ventilation?One cannot be precise without seeing all the data but the typical prognosis with this general picture is very poor. If someone is ill enough to die while in the hospital while receiving optimal care, the odds of complete recovery after resuscitation are low (in the neighborhood of 10%). In those who go to LTAC on a chronic ventilator, only a minority ever come off the vent (~30%), and there is a high short-term mortality in these patients even when stage IV cancer isnt in the mix. Stage IV cancer of any kind, with very very rare exception (some testicular cancer, etc), is not curable.Meeting with palliative care seems like a very good next step. If they do not suggest it themselves, I would ask for a family meeting with the palliative care docs, ICU docs, oncology and radiation oncology docs all in the room together. This is often the best way to get a complete picture of the current medical issues.If he is not currently able to make decisions for himself, as I suspect from information provided he is not, the main question for you and your family is: what is the minimum quality of life he would accept? Some would say that unless current therapies have a good chance of returning them to independent living with intact cognition, they would not want to be maintained alive by machines or treatments. Some would say that if they can think but require complete assistance, that would be enough. Some would say even being maintained in a state in which they have no awareness of the outside world is acceptable.The main question for his doctors is: what are the chances his current treatments will get him to that minimum qualify of life, whatever it is for him? If the treatments and supports offered have little chance of returning him to a state he would find acceptable, then one could view his current therapies as prolonging a state of suffering.Sorry again for what your family is going through."}
{"text": "###Input :Very well said.I want add that if you look at the data for people who go to LTAC and are successfully liberated from the ventilator, and are alive and independent at 1 year... It's somewhere between 5-10 percent. It's a long road to get there, even without metastatic cancer.Something I'd like to add about the quality of life comment that I think is important to share with family members... Everyone has a quality of life minimum that they would accept. It's our jobs to tell the people we love what that minimum is while we are alive and healthy so that our love ones know what our wishes are. If (when) something happens to us, it's up to our love ones to state the decision we've previously made. There's always going to be emotions during this tough time, but guilt or regret should not be one of them.In Healthcare we commonly refer to the surrogate or next of kin as the \"decision maker\", but really the decision maker is always the patient. The surrogate is the party that speaks for the patient when they are unable to and brings the patients desires to light. ###Output :HCC stands for hepatocellular carcinomaIn EPIC, a lot of diagnoses in the problem list are labeled with (HCC) after their name, like \"Acute heart failure with reduced ejection fraction (HCC)\". I have no idea what it means, but this is probably where OP got it from, and the pt probably doesn't have hepatocellular carcinoma.Edit: Just looked at OP's screenshot and you can see what I was talking about.Yes. Probably means the word salad pointed out by the other poster just before you. Never heard in a clinical context. Reason #649263 that epic sucks."}
{"text": "###Input :HCCs are a method used in coding to show how \"sick\" a person is. It's used for Medicare reimbursement calculations for payers (insurance), incentive programs, etc. It's part of Risk Adjustment. Heirarchical condition code....or something like that. I can't even remember right now and I'm a certified Risk Adjustment coder. ###Output :Is there any good reason that this stuff is exposed to actual healthcare workers?"}
{"text": "###Input :Another aspect to note is that patients who see palliative care earlier have a much better prognosis - longer survival times and higher quality of life scores. ###Output :Pulmonologist here. I am also the medical director of a hospice for the last 15 years. First, I am very sorry for the difficulty that you, your father, and your family are having to deal with. As a physician, and particularly in doing pulmonary/critical care as well as hospice, I have tried to help people through these tough situations for most of my career. Each case is individual and each patient is an individual with their own beliefs and values and dreams.Over the years, I've spoken to many dying patients and their families about their illness, and what I've tried to do is to give them the perspective of a physician in order that they can then use their own values and beliefs within the framework of a physician's perspective...using what we know and applying their own perspective.As a physician, my perspective on your father is that he is dying. Please don't take that as callous...it is not meant that way. Most people think of dying as a moment...and it certainly can be...car wreck, heart attack, massive stroke... those thinks can take a life in the blink of an eye. However, for many, if not most, people...dying is a process. It can be several hours or several weeks...or longer It begins when you know that nothing else can be done for the patient and all you are trying to do is maintain, and despite your best efforts, the trend is that the patient continues to decline. All patient's have good days and they have bad days, but for a dying patient, when you average it out, the trend is that they continue to worsen.It's at this point that I think it's important to find out what kind of death your father really wants. That can sound very brutal to some people...but remember, we're physicians and we experience this life and death everyday, and we see patients who die peacefully and comfortably and we see patient's who die alone and in horrible circumstances. With those experiences in mind and with our practicality, we begin to think about what we would want for ourselves. Ask any physician or nurse friend of yours...chances are they've thought about it a lot...far more than other people. They tend to know exactly how far they're willing to go before they just want comfort.From your post, you've spoken to your Dad about his care:He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.When he says \"chance,\" what does he mean? Chance of a cure?...chance to go back home?...chance to get a little better and be off the ventilator? In other words, you need to know what his goals are. If his goal is cure, there is no chance. If his goal is going home to the way his life had been...there probably is little chance of that either, though there may be a chance to go home...I don't have enough information. But first, find out which of his goals are potentially achievable with his doctors. Once you know what goals are potentially achievable for your father, you and his doctors can talk about what would have to happen to achieve those goals.Eventually...at some point however, because of the nature of our existence, none of those goals will be achievable, and at that point it is reasonable to give your father permission to let go and to seek comfort in the final moments, days, or weeks of his life. I say that because many patients continue to fight because they think that's what they're suppose to do or because they think they'll be letting down their family if they let go. They endure unnecessary suffering because no one has offered them a path of comfort and acceptance or because they made a vow to fight on and they don't want to renege on a promise they made to someone.We all eventually die. Some of us will never know what hit us because it comes too quickly. For those of us who are struck with a terminal illness like cancer, the only benefit is that we may have enough time to get our personal affairs in order and make peace while having some control over the dying process. As a physician, I know how I'd want to die, however, I don't try to push that on any of my patients. There are definitely patients who don't want to do much at all and just want to enjoy what life they have left. There are other patients who can't die in peace without trying everything including investigational treatments. I respect them all but as a physician I have to make sure that they are making those decisions knowing all the facts and the possibilities and risks.Start by talking to your father about his goals and discussing those goals with your father and his doctors. Give your father permission to do what he wants whether it's letting go or fighting to his last breath. And make sure that in the end, his comfort and wishes guide what decisions you may have to make in his stead. I hope this helped a bit. As best as I can on a reddit post, I'd like to give you, your father, and your family a big hug and my wishes that you all will be comforted in the days ahead."}
{"text": "###Input :Thank you for the supportive information. I really appreciate the time you took to type this out.He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing alot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment.He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathe on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay.He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's alot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest.I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all.https://i.imgur.com/rea1isQ.pngI kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many over responded, thank you again, It really means so much. ###Output :I'm sorry you are going through this.Your father is going to die. I'm no oncologist, but this seems like he won't get into a situation where he can be treated with chemo or other targeted therapy (I assume they looked at that through his biopsy).A second option can help informing treatment decisions and with accepting this terrible news, but looking how to make sure your father is comfortable for the coming period seems like a good idea."}
{"text": "###Input :Hi all, I'm looking for some assistance for what my next steps are, as I'm just a grad student and not a medical professional.TLDR: 48/F with late stage liver failure and diabetes. Estimated 3-6 months to live. She suddenly is not lucid after stopping most treatment and starting an SSRI. I want to know if this sounds like encephalopathy, and if it does, can it be caused by these treatments?My mom (48/F/caucasian) is currently in the hospital for late stage liver failure. The current prognosis is that 10% is functioning, which is complicated by her diabetes. Last month she was in the hospital with 20% liver function, and had a second toe removed (the first was amputated in 2019).I brought her back in after my dad called complaining about how she can no longer stand, speak coherently, stop crying, and was in constant pain, which we were told was encephalopathy. Since she was removed from the ICU, a family member has been here for the entirety of visitation hours everyday to help her eat, get to the bathroom, etc, so we have witnessed this whole process. After a week or so of treatment with diuretics, she was lucid, starting walking, ate all of her food plus snacks, etc, though still in pain. She was able to verbalize that.Due to the IV teatments they were giving her, she accumulated 40 lbs of fluids in her legs and and abdomen, which they said couldn't drain due to her hemoglobin levels/blood pressure. It started weeping from her legs as a yellow liquid, and eventually she developed dozens of sores on her leg bandages and the legs swelled to 3x their regular size. She was in excruciating pain plus itching, which from what I've read to pretty standard. That all said, she was still able to verbalize this and was lucid.5 days ago, she was told by the hospitalist that there is nothing they can do, and instead of palliative care, she should now be in hospice care. She was incredibly upset by this, but was still lucid. At that time, the palliative care doctor prescribed her an SSRI (not sure which one, they would not tell me) and the hospitalist stopped all other treatment other than blood pressure medicine, insulin before meals, oxycodone upon request, and benedryl for itching upon request.The timeline since then is as follows:Friday, she started receiving the SSRI. She was still lucid, calling people, and complaining of pain.Saturday, she stopped eating, speaking, or drinking anything. She just lays in bed, and if you ask her a question she stares blankly at you. She will nod sometimes to questions. She ate very little, and only when urged to.Sunday, she was about the same. Barely ate and doesn't speak at all.Today, Monday 3/15: she is still the same, and hadn't had any sort of fluid since the previous family member left at 6p the day before and I arrived this morning. She has had no bowel movements in 24 hours. The palliative care representative prescribed ritalin to make her more alert, but it hasn't done anything. We are currently working on transferring her to a hospice care facility.She looks like someone on a heavy dose of oxycodone, but she hasn't had any in days. All she does is stare at us and occasionally eat a piece of candy when prompted. I asked the hospitalist what could cause this so suddenly, but he said there's nothing they can do, as it is not encephalopathy. He referred me to hospice and would give no other information.All of that long background is to say this: this doesn't look like how her encephalopathy manifested before (crying, pain, etc). Is it possible for it show up differently? The only new medication introduced last week was an SSRI, but since she only started it Friday, it seems weird that it would have an immediate effect like that, since I would think that it takes some time for it to get to the liver and metabolize (or not metabolize) and cause a rise in her toxin levels. I have also always been told that it takes weeks for SSRIs to be effective, but I don't know how that changes in cirrhosis patients. If this is not encephalopathy, but what is causing this sudden change?I want to make sure she is receiving proper care, as I'm not able to clean much from her doctors and she is not lucid. Thank you for any guidance on this situation!Here are the papers I read regarding this, in case that is important:2015, Issues in the endstage liver disease patient for which palliative care could be helpful2017, Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicityNote:I don't know her current numbers, as they messed up her labs this morning and apparently don't redo them when that happens. ###Output :I imagine this is one of the toughest times you and your family have ever had to go through. Please don't neglect yourselves whilst looking after your mother and seek appropriate support, particularly psychological, as necessary.I am a psychiatrist, so I will try to answer your query regarding the SSRI. I'm afraid my internal medicine knowledge isn't up to date enough to help with much else here.All SSRIs are hepatically metabolised. They can therefore accumulate over long periods of time, so they must be used cautiously in liver impairment, and SSRIs with long half lives should be avoided. Of the SSRI family, citalopram / escitalopram have the least known effect on hepatic enzymes and are typically the SSRI of choice. Some specialists may prefer paroxetine, due to it having the shortest half life. Whichever is chosen, the general rule is to start low and go slow. I trust your mother's doctors have stuck with this rule. In which case, I suspect there has not been enough time for the new SSRI to accumulate to sufficient levels to be responsible for her acute deterioration, particularly if her deterioration began after just one or two doses.However, even if the SSRI isn't doing any harm, we need to ask ourselves, is it doing her any good? In the state that you have described her to be in, especially since the deterioration, I would struggle to justify continuing the SSRI. At this stage, I would argue the potential harm outweighs the potential benefits. And who knows, I might be wrong about the SSRI not being responsible; if it gets discontinued and your mother starts perking up, then all the better.Sorry to hear about this awful situation, do take care."}
{"text": "###Input :You seem to have knowledge about how SSRIs work, wondering if you'd take a look at my post, possibly had SSRI-related damage happen to me. https://www.reddit.com/r/antidepressants/comments/raqwkk/my_life_has_been_upended_and_i_dont_know_what_to/ ###Output :I'm sorry to hear you and your family are going through this. I agree with her physicians that unfortunately it does sound as though your mother is approaching the end of her life and palliative/hospice type care is appropriate.Given your description, I suspect that her current condition is likely caused by hepatic encephalopathy, where toxins like ammonia build up in the body as they are unable to be processed by the failing liver. The treatment for this is usually medications that promote frequent bowel movements, like lactulose or other laxatives, as the bowel is the only other route by which these toxins can be removed.Hospice care should be focused on your mother's values and what's important to her. If you feel that it would be important to your mother to be more awake and with it during this time, it would be reasonable to ask her physicians whether medications to treat encephalopathy could be restarted. However, the counter argument is that by being more awake, your mother may also be less comfortable, the avoidance of which is another goal of end of life care. It could be that this is why her physicians have felt that holding these medications to promote her being less aware is best for her at this time. This is a conversation you should have with her palliative care doctors and together figure out what is the best way to care for her. Again, I'm very sorry and hope this helps."}
{"text": "###Input :9 weeks ago i got pain on my right side under my rib cage. shortly after that nausea, bloating, and indigestion started. then my bowl movements were unpredictable and of all different types (loose... dark... normal... soft... constipation...) then dry heaving started.i have had a hell of a time getting treatment because im not critical enough during this covid19 crap. through multiple urgent care visits i finally got one to take urine and blood samples. they also got me an ultrasound and a telemed appt with a gastroenterologist.the urine was normal, but i was slightly dehydrated. not surprising given i was so nauseous drinking water was difficult. blood test was also normal except for a slightly low RBC count/low iron. the ultrasound showed no evidence of gallbladder problem, but did reveal some potential (likely benign) tumors in my liver. those apparently are completely incidental, and not urgent to diagnose immediately, but i do need to get a CT scan on them once covid restrictions lighten up.this past weekend vomiting returned for a few hours. i also developed a mild fever, and then chills with low body temp. i was also salivating uncontrollably. i had to chew gum to get the salvation to stop. it was weird af.i can only eat small portions of easy to digest food. like grapes and cream of wheat. complex foods or larger portions usually throw me into severe nausea/belching/etc. I've lost around 6lbs this far.i'm waiting for a h. pylori stool sample test to come back in the next 48hrs. at this point im praying its positive so i can get an answer and some relief.is this normal? 9 weeks feels really long. every time i think im improving it hits me and gets bad again. do i sound like im describing an ulcer? and if so does it seem like the bacterial type? can it really take this long to heal? i called the gastroenterologist and im trying to get a follow up appt soon. i realize this is the internet and is not a substitute for true medical care. im just having lots of anxiety and would love some opinions. 9 weeks of constant nausea starts to fuck with your head.note - I've been on anti nausea and proton pump inhibitors for 4 weeks. i take no other meds including nsaids. there's also no history of cancer/ulcers im my family. im also a middle aged male (early 40s). i have no major health issues, injuries, or surgeries. im an avid fitness freak. seasonal allergies, mild rosacea, and depression are my only real health problems to date.any thoughts appreciated. im in hell. getting help during covid is slow. im miserable and have a hard time living daily life. ###Output :Most people with changes in their stools between constipation and diarrhea have irritable bowel syndrome. There are related conditions like sphincter of Oddi dysfunction or biliary dyskinesia that also cause RUQ pain and can sometimes affect stool consistency.H. pylori would be unusual with your symptoms, but it can present in many different ways. It doesn't typically cause diarrhea or other stool changes (unless it bleeds, but that's usually pretty obvious). Furthermore, if you get a stool test for H. pylori, and it's positive, that doesn't mean it causes your symptoms. Many people are asymptomatic. It really takes an endoscopy that shows significant gastritis or an ulcer to make a clear association between your symptoms and the effect of the bacteria.Your liver findings are probably not related. We see incidental liver lesions on ultrasounds all the time. But sounds like your doctors aren't too worried. I agree a CT down the road is a good idea. These are usually benign things, like hemangiomas, but worth getting a more clear diagnosis for these just in case.Other things to consider with nausea / belching with higher calorie foods is gastroparesis, which is where your stomach doesn't empty properly.I know it will be hard to get much workup now, but that's really the only way to narrow this stuff down. The tests we typically do are things like endoscopy (probably of most importance in your case), gall bladder scans, and gastric emptying scans."}
{"text": "###Input :thanks for this reply. i should have been clearer. i have had \"looser stool\" than normal at times. but not diarrhea. i don't believe I've had diarrhea even once so far. not sure if that natters or not. my most recent one (sry this is so gross) was small and seemed to be covered in a whitish substance. maybe mucus from excess production in stomach?also thx for the heads up that a positive pylori test doesn't mean that's the cause. frustrating, but good to know nonetheless. ###Output :Loose stools would lean towards IBS as well. But its a pretty nonspecific symptom and doesnt narrow things down a ton. :-("}
{"text": "###Input :There are some parasites that can cause liver cysts and start giving you all sorts if weird symptoms. Did you travel anywhere before symptoms began where you walked barefoot on soil/sand or drank water from a source you dont usually drink from? ###Output :People sure do love parasites around here. Unlikely the explanation for OP.From your comment below:Entamoeba - This causes colitis, which is bloody diarrhea, not alternating stools and RUQ pain like OP describes.Liver flukes - Almost always asymptomatic. But, easy to check for with a stool O&P like you suggest.Cystic echinococcus - OP had a liver ultrasound. CE would show a bunch of cysts, and should be apparent to the radiologist."}
{"text": "###Input :From what I've learned from House MD, it's definitely either sarcoidosis or lupus.Also, you get an upvote for your username. ###Output :TuberculosarcoidolupusCANCER."}
{"text": "###Input :I was reading this tweet thread from Dr. Monica Gandhi about molnupiravirhttps://twitter.com/MonicaGandhi9/status/1415093950000422912Molnupiravir was not developed for SARS-CoV-2- originally thought of as a broad-spectrum antiviral because it is a \"nucleoside analogs\". We use those a lot in HIV but they basically inhibit the virus from replicating because this compound interrupts the process of copyingwhich led me to this article in Business Insiderhttps://www.bloomberg.com/news/features/2021-03-25/merck-mrk-molnupiravir-pill-could-change-the-fight-against-covidThe first antiviral approved in the U.S. was idoxuridine, a herpes treatment regulators green-lit in 1963, generations after the discovery of antibiotics. Its among a widely used class of drugs called nucleoside analoguessynthetic versions of nucleosides, critical building blocks of DNA and its counterpart, RNA, the messenger molecule that delivers instructions to a cells protein-making factories. Nucleoside analogues prevent viruses from replicating, or from replicating effectively, inside cells.When they do invest, they have much more incentive to focus on chronic diseases than acute ones, which entail inherently shorter treatmentand revenuewindows. If you look at what drugs have been developed against viruses, you have HIV, you have hep C, you have herpes. Those are all chronic infections. That means longer-term therapy,And so here I am, my High School Biology in mind, wondering how if day to day my cells are dividing and so need to replicate DNA, how providing a drug that inhibits replication is safe, especially for chronic diseases where the drug is taken on a daily basis for well, the long term.For the care and feeding of the automod:I am a 60 year old male, non-smoking, and this question has recurred off and on for a few years now, mostly in by frontal lobe I believe, though friends insist that that is located in my rectum ###Output :Antivirals like acyclovir and similar nucleoside analogues act only on the cellular machinery within viruses, but not the cellular machinery in human cells. You are right that both viruses and human cells replicate DNA, but they do it in a different way. Some antivirals work on viral DNA polymerase, some work on viral reverse transcriptase, and some probably do something else that I don't know about."}
{"text": "###Input :I 34(F) have been seeing a dermatologist over the course of several years, unfortunately Im in a healthcare system that is hit and miss with varying levels of doctors. Its also a healthcare system with a different first language to mine.I have been diagnosed with rosacea and seborrheic dermatitis. My skin goes from angry inflamed redness to dry and flakey.Initially I was advised to use steroids on the redness inflamed areas and to moisturise 2-3 times a day. To be honest, this doesnt work. Im using steroids weekly. I saw a good dermatologist who prescribed elidel cream which is ok, though it has not really worked well enough to prevent flare ups.Since then I was prescribed skinoren (which burns), told to wear sunscreen with multiple application daily and to start tacrolimus ointment. Avoid stress (Im a mum of 2 very small children and a critical care practitioner, so easier said than done).One dermatologist told me to stop steroids on my face as I had ?lines as a result of long term use. So should I completely stop?I cannot start tetralysal as Im breastfeeding.Are my options limited without oral medication? Will the results be worth me weaning?Im feeling pretty miserable as a woman when I can no longer wear make up without significant flare up and people asking what happened to your face?Advice is conflicting, often superficial and although I understand its chronic, will I ever have good enough skin to feel my normal self again? I only developed this in the past 6-8 years.Obligatory: BMI 20, non smoker, enjoy a glass of wine regularly. No other medical conditions or medication. ###Output :Topical corticosteroids are inappropriate for long-term use. Pimecrolimus is much safer for long-term use and tacrolimus is more potent than pimecrolimus. Many who use azelaic acid use too much quantity and get irritation. Much smaller quantities are appropriate. Adding additional agents such as topical ivermectin and metronidazole may additionally help for rosacea, as could imidazole antifungal agents and similar for seborrheic dermatitis."}
{"text": "###Input :33F, recently diagnosed with PCOS / insulin resistance, high TST, low cortisol.Im at a pretty critical point in getting my hormones fixed and after my appointment today I was notified that if I want to continue seeing the doctor that I see, there is a $100 fee per month to continue under her care. I see her three times a year but they want $1200 to ensure a spot to see her. They were very clear this was not insurance related and would be my responsibility...seems shady?? Hoping some medical professionals can explain it to me if its legitimate since, as it stands, it sounds very questionable. I want to understand. ###Output :A physician can charge out of pocket whatever they want, not shady. Billing insurance is totally separate. This is a concierge model of healthcare that typically gives a patient more reliable access to their doctor (and is typically more expensive than other doctors). I suggest you find a different doctor that fits you situation better."}
{"text": "###Input :26F 56 120 lb No medications Non smoker No known medical issues Migraine symptoms approximately 1x/week for the last 4 weeksSo I did an MRA on Friday afternoon and the technicians gave me the results in a CD without any explanation. I didnt have a chance to speak with my neurologist. My boyfriend, who is a senior neuroscience biomedical engineering PhD student and has seen many brain scans before, immediately pointed out a strange deformity in my MRA. On the saggital view in the top middle of the brain close to the motor area there is a bump. His first thought was subdural meningioma. It was dark in the MRA image so he thinks it may not be a tumor because it isnt highly vascularized. Could it be a chat? Could it be a meningjoma covered by a subdural hematoma?Background - about 4 weeks ago I started having migraine symptoms basically for the first time. Nausea, dizziness, feeling out of breath while exercising even though I am a relatively fit person...and I had 3 episodes of mild throbbing pain on the side of my head. So I went to see a neurologist who recommended a MRA/MRI.He tried to book it before Id be set to go out of the country on holiday for 3 weeks - all the way from US to a beach in Thailand with possibly limited access to medical care. We only booked the MRA because the most urgent goal was to make sure it was not an aneurysm.I had yet another episode today - lots of nausea and feeling sort of dizzy and hard to balance at times. And I have my flight tomorrow early morning ... 30+ hours!The main question here is - how likely would it be for my situation to be dangerous enough that I should not get on a 30+ hour multi-flight trip? Any counter-indications towards flying that I may want to be aware of given my symptoms and this MRA result? The problem is that I cant speak to my neurologist until Monday morning - by then Id already be in Thailand (or sick / critically unwell due to the flight?).Any help would be greatly appreciated!! Im ok with flying as long as I can be reasonably sure that I am not putting myself at risk by doing so. ###Output :Unfortunately, Without the images or report, it would be impossible for anyone to give advice here. Can you call your doctor or the doctor on call before you leave?"}
{"text": "###Input :Definitely call the Dr on call now. ###Output :Your symptoms would not match anything you described may or may not be on your MRA images. That being said besides vascular anomalies nothing else can be commented on in an MRA. So seeing dark or light things outside of the vessels does not mean anything, that's what the MRI is for."}
{"text": "###Input :My mom was diagnosed with Diverticulitis/Ischemic colitis on Saturday. I picked up an Rx for her and it said take every 6 hours.Yesterday, I called urgent care to see if taking it every 8 hours was a possibility, as my mother has moderate dementia and it's difficult to get her up in the middle of the night. They said no...has to be 6 hours, but I don't have to wake her up in the middle of the night.This makes no sense to me; if it's not allowed to switch to 8 hours, then it means it's critical to take it every 6...which means I have to wake her.I already have sleep issues, and waking her at 3am every night is going to be a whole ordeal and struggle. Sure, I'd love for her to sleep through the night, but I don't see how they can say I don't have to wake her. It doesn't make sense.I just want to do the right thing. Can someone give me guidance? Thanks!!Edit: I actually called the pharmacy first, before reaching out to the urgent care: they said they could not provide guidance. ###Output :It is rarely necessary to dose flagyl more than every 8-12 hours, this is sufficient for the large majority of indications as it maintains adequate blood levels. I don't typically give it more frequently than this and work in an ICU with very sick patients. Every 8 hours is a reasonable compromise. There is another medicine called augmentin that is used for diverticulitis and is twice a day.The general push recently has been to not use antibiotics for diverticulitis, though with your mother's age it is still appropriate to prescribe these. But in any event wouldn't get overly concerned about the flagyl dosing interval provided she is getting it more often than every 8 to 12 hours.Remember I do not know your mother's specific situation, so this is not meant to supplant the information from your providers, just that without any other details a less frequent dose of flagyl is adequate."}
{"text": "###Input :Thanks so much for this. I called her doctor and we'll see them on Friday. Thanks to your prompting, I asked if they would like to make any changes. They haven't yet...maybe because she already started...? Thanks again!!!This was an urgent care so she probably was not seen by an actual physician. ###Output :I think interrupting the night sleep of an elderly infected woman seems a bit of an odd choice even in the hospital.Give her one dose right when she wakes up, and one dose right when goes to sleep. Then space the others as evenly during the day as possible. (So for example, she goes to sleep at around 21:00 and awakes at 7:00 her doses should be at: 7:00-11:30-16:30-21:00).On the other hand, the active metabolite of metronidazole (flagyl) has a half-life of 9-19 hours. So taking it more than thrice daily is also odd."}
{"text": "###Input :Thank you much. It's 250mg. I called her GI doc to update them and to see if they want to do any changes, and they scheduled to see her on Friday She was seen in an urgent care so probably these were not prescribed by a physician ###Output :Fair enough, in my country every antibiotic has to be run through an MD (we don't really have DOs), so I assumed the same."}
{"text": "###Input :[16M] So 2 days ago i felt pain on my right eyelid, the pain is like bruise, I don't really care about it. The next day the pain wasn't gone, so I checked \"Inside\" of my eyelid and it's more red than the left side, now i am worried about this. My current hospital only accepts critical/emergency cases so I can't go there for now. What should I do about it? Is it bleeding inside?Edit : Nearby pharmacist says it's an infection/allergy and gave me eyedrop \"DexOph\", could this help me? ###Output :Ophthalmologist here. The picture isnt great, but it looks pretty normal to me. I wouldnt just use Dexoph without seeing an ophthalmologist. Dexoph is dexamethasone which is a steroid. Unregulated use of steroid eye drops can lead to both premature cataracts and glaucoma.You should go see an ophthalmologist.Edit: can you upload a higher pixel picture of the affected eye along with a picture of the normal eye for comparison?"}
{"text": "###Input :Female, 50, 5 5, 215 pounds, never smoked, seizures, chronic stomach issues like abdominal migraine and ileuses, breast cancer.I have lifelong chronic digestive issues, stemming from a major exploratory surgery when I was 5 years old. About 20 years ago, I started having major issues requiring hospitalization with NG tubes and all kinds of other fun stuff because of the adhesions from the 1974 surgery hardening and choking my intestines.Starting in 2006, after many other things failed, doctors treated both the pain and the hyperactive bowels using Dilaudid. Over the past 13 years, my tolerance has increased, through absolutely nothing but closely monitored physician prescriptions and instructions. Through all of these years, I have taken some hefty narcotics for about one week every month, and not at all the other three weeks. I have thanked God a thousand times that I don't appear prone to any type of addiction (Never smoked, drink a couple of times a year, no illegal drugs whatsoever, couldn't care less about gambling, etc. My worst vice is Amazon.)Between this and absorption/metabolic condition, I get extremely little relief from the highest oral dosage that my PCP is comfortable with: 8mg every 6 hours.I'm currently in breast cancer treatment, halfway through Herceptin infusions that are supposed to continue through September. From the very beginning, Herceptin gave me diarrhea, and it has worsened to date to the point that I am in the hospital about one out of every three weeks because such severe diarrhea that I am dehydrated, critically low on magnesium, excruciating cramps because it flares my chronic condition, and you can imagine the rest.Two weeks ago I went to the emergency room with the usual symptoms, was given my now usual dose of two milligrams IV Dilaudid immediately followed by 1 mg every 3 hours for the next 8 days inpatient. Normally, they start tapering off by spreading out doses around day 4 and I am home and much more comfortable by day 8. This time, however, they noticed significant thickening of my colon on a CT scan, so on day six, when the Dilaudid had just calmed my bowels and decreased my pain, they had me do colonoscopy prep, which not surprising brought excruciating pain back with 18 hours of non-stop diarrhea.SO... hospitalist has access to 13 years of hospital records outlining the progression of all of this, has recent records showing mastectomy, Herceptin, labs consistent with six months of diarrhea... yet still harangued me the entire visit, accusing me of being there basically faking it for the Dilaudid. I could never keep him focused enough on my actual issues to get any help from him or get any questions answered because he was so convinced that there was no illness, only addiction. He claimed he read my records. I couldn't get him to call any of my other doctors. I couldn't get him to look at the December prescription bottle the nurses took from my purse and locked up that was still half full. The day of the colonoscopy, for the first time in my life, I told them I was a 9 on a scale of 1 to 10 in pain ... I'm very conservative with those numbers. Asked if I could have just one dose of 2mg of Dilaudid to get me back on track and was denied. Then he started the discharge process that day... with renewed diarrhea every couple of hours and 9 on the pain scale AND no tapering of Dilaudid. Being on Medicare (disability on the first try, approved in 2017 in less than 90 days due to the severity of illness), I threatened to report him because I didn't believe I was ready for discharge, and he told me with hostility that I could stay one more day but then I was out.I was discharged with the same level of diarrhea I went in with, more pain that I went in with, and spent three lovely days in bed crying my way through Dilaudid withdrawal. All caused by a doctor who lectured me for 4 days on the opioid epidemic. I can't imagine how many people would have become addicted in my situation instead of just gutting out the withdrawal.How do I get this to stop? Isn't there any overarching agency or physician type or anything I can do to have it documented once and for all that there has never been an addiction problem and that there is a room full of files documenting the illness and the reason for the medication?I'm seriously considering stopping life-saving breast cancer medication because on top of all of the pain and diarrhea, I can't face another week like the week he put me through. This wasn't my first experience with a doctor so obsessed with this notion, but it was by far the worst.What the hell are people with decades of documentation, debilitating chronic illness, and zero evidence of any addiction at any time supposed to do? ###Output :I read it somewhere in this but you need to 1) go to a pain clinic and 2) have a medication contract that may even cover pain crisisDilaudid isn't a great chronic opiod and ideally you should be switched to methadone or buprenorphine, but again, that's something that should be discussed at the pain clinic.Also, I would reexplore with a GI your hyperactive bowels and see if you can find an alternative to opioids for it's management."}
{"text": "###Input :Awaiting my follow up appointment after questionable minimal supravermian atrophy that was found on my brain MRI last week. Im unable to find valuable information with the phrase supravermian atrophy online. Im hoping someone can shed some light on what a finding like this could possibly be related to. Im too impatient to wait until my follow-up to learn more about it.27F, 5 8, 138 lbs, European ancestry. I work full-time as a critical care RN in a peds ICU. History of gangrenous appendicitis age 5, Guillain barre related to a suspected tick-borne pathogen age 8, asthma (controlled by corticosteroids,) anxiety (relieved with PRN benzos,) vasovagal syncope episodes during ovulation since the age 16. I spent my early childhood on military bases with known toxic contamination (Fort McClellan, Fort Bragg.) I dont do drugs, I drink maybe 1-2 times a month. PALB2 & CHEK2 gene mutations. Dad was diagnosed with stage IV Glioblastoma, age 48. Paternal uncle died of a brain tumor age 3. Paternal aunt had endometrial cancer at 27. Mom has history of substance abuse, Sjogrens, rheumatoid arthritis. Maternal grandpa received a heart transplant (acquired heart disease,) maternal grandma and aunt had ductal cell carcinoma (after menopause.) I was out of work for over a month due to an intermittent fever ranging 99-103. No pathogens detected in my pancultures. Blood work was normal: CBC, BMP, TSH, HIV, Syphilis, B12, Vit-D, thiamine, folate. In the past year Ive had the following symptoms: fatigue (I could sleep 16 hours a day if I was able,) dizziness, occasional double vision, compulsive sighing/feeling out of breath, itchy/burning armpits, twitching throughout my body, headaches (~3/week,) cold hands and feet, high blood pressure, stress and urge incontinence (especially around ovulation,) severe abdominal pain right before a bowel movement, sometimes I pass out from the pain. Ive noticed changes in my speech: fluency, long pauses between words, losing track of sentences. I cant hear people or retain information unless Im staring directly at them, and I have worsening sound sensitivity. My memory has suffered. I will quickly lose new information and have difficulty recalling information on the spot. I find bruises on myself because Im clunky and clumsy.I want to feel young, healthy, and happy. Please help. ###Output :Can you post the full MRI report? I too have trouble understanding what that term means; the vermis is a part of the cerebellum, but the space above it (supravermian) in my experience refers to a space containing CSF, not brain tissue."}
{"text": "###Input :Hi so I (23f) have had a sudden onset of joint pain mostly in my hands and arms. It may have been more gradual than I noticed, but this week has been very brutal! Its like my finger joints are just VERY achey and my elbows are also in pain fairly frequently (mostly when my elbows are bent).I work on a computer all day, but am not a typist. I am usually working on excel spreadsheets doing data analysis which I guess I never thought of as typing as its more of a critical thinking thing as my main task. That being said my hands are on a keyboard for the majority of the day.Now my FIL had surgery for carpal tunnel syndrome last year, and it feels like exactly what he described and I am panicking a bit bc I didnt really think that I was a candidate for having this issue so early on in my life! Is it possible that I have carpal tunnel syndrome? What else could it be?Im just scared of the financial ramifications an issue like this may have (Im broke as shit!! But I do have insurance!), but I obviously want to take care of it ASAP instead of letting it get worse. What should my course of action be/how long should I wait before getting it checked out in person?Thanks in advance for your time!ETA: not sure if this is relevant to this issue, but I am in relatively good health. I am overweight but have lost around 50 pounds since the beginning of the year and am well on my way to a healthy weight. I eat mostly cleanly and walk a lot. I used to be an avid weightlifter but have not gotten back into it after a knee injury in 2018 (big part of how I became overweight... lack of movement & depression from losing my job & other stresses due to my injury). I also was a 4 sport athlete in high school: softball, swimming, track & field (discus & shot put), and volleyball. I dont know if any of this is helpful but if it could be a contributing factor I thought I would mention it. ###Output :Yes, it's possible for you to have carpal tunnel- it just really depends on your level of activity with hands.You aren't locked into surgery. I'd start with getting an ergonomic setup for yourself and taking frequent breaks from typing. I would also look into getting a wrist brace to sleep with at night, and begin using that for a week or two and seeing if you improve. Chances are if you take early action you won't need surgery for quite some time- if ever."}
{"text": "###Input :Wow, that is great news! Will that help with the elbow pain as well? Also do I still need to see a specialist or set something up with my primary care physician? ###Output :It can help with the elbow as well, yes.If you end up seeing a doctor they will tell you what I just did. I'd say hold off and start with what was mentioned unless it progresses significantly or it starts actively impacting your ability to function."}
{"text": "###Input :Hey, for the past year or so I've been smoking socially (about twice a month). I know that death/critical care rates are much higher for smokers, but I haven't smoked in about a month and don't plan to start again so where does that put me? I'm an otherwise healthy, moderately fit 18 year old. I know info isn't available for covid19, so if you know this regarding respiratory infections in general let me know, anything is helpful ###Output :Puts you somewhere between the smokers and the non-smokers, closer to the non-smoker side of things. Good on you for planning not to smoke again. That's about the best thing you can do."}
{"text": "###Input :Age: 30sSex: MaleHeight : 5Ft 8inWeight: 180Race: LatinoDuration of complaint: 5 months+Location: Texas, US. Abdominal pain, blood in stool.Medical Issue: Had recurring blood in stool that increased in intensity and frequency. Saw doctor and prescribed Cipro after which frequency of bowel movements and amount of blood increased. Given prednisone which seemed to increase amount of blood in stool. Had CT scan of abdomen which revealed hepatic mass lesions. Primary care doctor advised and arranged for admission to emergency room for an MRI of the abdomen. ER doctor however reviewed scans from CT and believed they were cysts and wouldn't proceed with MRI. ER doctor emphasized need for colonoscopy first which I have scheduled for 31st, but he worries that is too far away. For reference it took me 6 weeks to get the CT scan. I didn't get a referral/authorization for an MRI from my primary care doctor. ER doctor told me to return on Monday and that I may possibly be scheduled for colonoscopy through their hospital. How critical is all this? I'm worried as I now have to wait the weekend at minimum, but likely will have additional weeks of waiting for paperwork/insurance authorization/scheduling before I can get these procedures. ###Output :You didnt mention any blood test results (e.g. liver function test).Also, did the imaging study not reveal anything in your GI tract?Either way, yes you should undergo a colonoscopy as soon as possible. The results of the colonoscopy will inform further management decisions.If you feel like fainting, or experience any symptoms that you consider to be drastic, go to the ER.Best wishes."}
{"text": "###Input :Sorry in advance for the formatting. My mother is the patient. She is a 62 year old female, 52, ~140 lbs, a caucasian, and she has several issues with chronic pain/osteoporosis/degenerative disc disease/some nerve issues/arthritis that her doctor has prescribed a 12.5 mcg fentanyl patch for that she changes every two or three days. She was on a higher dose when she started using the patches but she did not like the side effects, so her doctor cut the fentanyl dose in half to 12.5 mcg. She is taking lexapro, wellbutrin, a blood pressure medication (I think bystolic), montekulast, and possibly a diuretic (unsure if shes still taking that) daily. As needed, she is prescribed voltaren gel and voltaren pills, Valium, and norco (hydrocodone 10/325). She has some additional health issues that arent relevant to my concerns (high bp, asthma, primary lymphedema, some allergies. Dementia runs in her family, but the people who have had it have all been very sharp until their early 80s.Since she has been on the fentanyl patch for a few months now, my fatherwho is a physician himselfand I (who live with her) have noticed some very concerning things. We all see the same physician, so he knows all of us and our character. I would like to tell the doctor about these concerns using a letter, but Im not sure if Im being too wordy or if I should contact him another way. Please give me your constructive criticism as to how I can effectively communicate with him so these concerns get addressed. Heres what I have written:Dr. Doctor,I am writing out of concern for my mother, [major_bummers mom] (DOB XX/XX/XXXX). I am aware that I have no power regarding my mothers care and no right to her personal health information. However, as a daughter, I have some concerns regarding my mothers current usage of the fentanyl patches you prescribe her. I wanted to reach out to you about them personally because I dont think she has the mental ability to realize how much of a toll these patches have taken on her. I realize not all of these concerns I have about her cognitive ability/memory/ability to preform daily functions could be attributed to her use of the fentanyl patches, but the timing leads me to think it is the cause.My father and I noticed that about two weeks after my mother began using the fentanyl patches, her overall productivity became much less than normal. She is now spending her days sleeping as much as she can (10 hrs per night with a 3-4 hr nap) and gets a significantly less amount of work done compared to before she started using the patches. She says she thinks her pain is under better control with the patch, but her avoidance of physical activity and her daily complaints of increasing or new pains tell me it is not working as well as originally hoped.My mother has seemed to slowly lose her critical thinking skills, her ability to remember things, and speak/think at her normal speed. She was the type of person to remember where everything in the house is, even years after it was put somewhere, but now she has started to lose things such as everyday items, important documents/records, and even her own controlled medications. (She normally hides them so she has to think about where they are before taking a narcotic, but recently she forgot where she put all of her scheduled medications and had my dad and I flipping the house upside down looking for them for about 6 hours. She also separated one fentanyl patch from the others and has been saying she has been unable to find it for days, making me wonder if she actually put two on.) Along with my concerns about her memory is that in the past month and a half or so, she has started remembering things that have never happened/things shes made up in her head and has been unintentionally giving my father and I completely false information, which has caused a lot of frustration within the family. She will become unnecessarily upset with us as she genuinely doesnt realize some of her memories are extremely inaccurate or have never been real. Usually, this results in an argument with her until she either gives up or understands our explanations as to how and why what she remembered couldnt have happened. She often asks the same basic question (such as are you going to work today?) several times per day because she doesnt remember the answer from the first three times shes asked. Her accounts of something that weve both seen are usually inaccurate.On bad days, her speech is sometimes very slowalmost incomprehensibleand my dad and I have to either work on completing her sentences for her or ask her to form a complete thought/statement before speaking. I dont feel like the person Im talking to is my mother and is instead someone that is either mentally handicapped, drunk and drowsy, or demented. She often seems mentally absent or half asleep when I am trying to have a normal conversation with her, even with no distractions.Lastly, my biggest concern is that her ability to react to things has slowed down substantially since she began having a strong opiate in her system on a constant basis. When I have the opportunity, I ask/offer to drive her places because she is a danger to herself and others behind the wheel. She has made a habit of going below the speed limit and stopping at places she has the right-of-way to be a safer driver, in her words. This is a woman that used to love to drive fast cars on racetracks. She has started to slam on the brakes when she approaches a stopping point because she does not slow down in time to stop properly/safely. It seems that her situational awareness has taken a nosedive since she started using the patches. If she were to cause an accident, which she has almost done on many occasions since starting the fentanyl patch, a police officer would absolutely see she is driving while incapacitated/under the influence of a drug.It pains me to see my mother like this and hope you understand my concerns. I am grateful for your time reading this letter and hope you will keep my observations in mind when proceeding with my mothers care. My family and I very much appreciate all that you have done for us. If you need further detail or have any questions, please dont hesitate to give me a call.Sincerely,Major_bummerEdit: added some additional health information and fixed grammar ###Output :Make it shorter and send it. The goal of pain management (in patients without terminal illness) isnt to completely eliminate pain or get people on government disability. Its to get their pain to a level that is tolerable enough for them to main functionality (keep being employed, for example). Sounds like your mom is on too many narcotics. Based on the problems you told me (all musculoskeletal), she probably needs to be tapered off narcotics completely."}
{"text": "###Input :Would a bulleted list be more appropriate for a busy doctor?She has been on narcotics for years as her spine is not in good shape at all (we almost went overseas for better spine surgery technology but couldnt afford it) so I doubt shell get off of the narcotics entirely anytime soon. Shes one of the few patients with enough pain that she qualifies for disability and deserves a relatively strong opiate, but not as strong as fentanyl. I still feel like she was doing better mentally taking more hydrocodone daily instead of using a constantly releasing fentanyl patch. Granted I wasnt in the room when he initially prescribed the fentanyl patches, but it seems like a huge leap to go from 3 hydrocodone per day to fentanyl without trying something like an extended release opiate that isnt as strong as fentanyl + comes with less risks. I know shes tried things like gabapentin and lyrica before but her body didnt like them too much and she reacted to them strongly. ###Output :There is no evidence that opioids work any better than over the counter meds for chronic, non-cancer-related musculoskeletal pain, so your assertion that she deserves a strong opioid is specious at best. Fentanyl is no better or worse than long-acting opioids, it is the dose that is most important. Regardless, her current situation is not acceptable (being zonked all day long) and I would argue that you have an obligation to notify their prescriber."}
{"text": "###Input :Age 16Female110lbs, maybe lessRussiaHello doctors,Our relative was hit by a car. We don't know many details at this time except that she is out of critical condition, but still unconscious.The reason for posting is because it's Russia and for most part, doctors don't really care for their patients, especially if it's a public hospital.Can someone please tell me what are some of the must be done tests, scans, blood work after an accident.Thank you ###Output :It's impossible to know without knowing how exactly they were injured. I would assume that if she is unconscious, they would do some kind of imaging of her brain to make sure there isn't any bleeding in there."}
{"text": "###Input :For example, this morning we had a 63 yo patient that had been sinus tach since her admission a day or two ago. She was alert but not fully oriented during morning rounds. This morning, over the course of an hour, she slowly went from 115 to the 40s. She ended up bradying down and a code was called. There was a short run of vtach right before we started coding her. She ended up regaining spontaneous circulation and was moved from step down to ICU.As far as her history, I barely saw her chart. I know she was suffering from c diff and chest pain. There was critical care protocol for fentanyl and propofol but other than that I have no idea.Is this something related to electrolytes? Cardiac issues? Need more information? Her ekg strips were normal sinus tach prior to the event. Ive also seen this in other patients that were DNR where they just Bradyd to asystole. Any insight is appreciated. ###Output :Definitely need more info. Bradying down essentially just means someone is dying. So for that patient in the ICU I'm gonna assume she has lots of possible reasons to die. Electrolytes absolutely, acid/base yes, hypoxia, hypotension, MI, PE etc etc. The list is literally endless. Brady codes are the most frequent ones I have seen usually."}
{"text": "###Input :I'm trying to understand a current family situation where I believe doctors are being hasty with care.My brother in law, about 30 years old 6ft 250lbs, is currently in the hospital for acute pancreatitis due to alcoholism which stressed the one kidney he had (genetic one kidney). He's currently sedated on vent, dialysis crrt, and insulin drip. He was admitted a week ago after he called an ambulance. With only symptoms being nausea and stomach pain. Since being admitted he was bumped down to 30% oxygen with breathing therapy, 5.0 PEEP, and his vitals and blood work were all in normal ranges for an adult male. Then they lessened his sedation and he was responsive. Hand squeezing and pointing. However other blood work and vitals dipped a bit after he had breathing trouble from bile due to pancreatitis.Additional: I think initial intubation was due to shock/hyperventilation upon admission or lung infection? Doctors have said all organs are viable. Torso MRI showed a good gallbladder, liver, and lungs without liquid. Family told they should not worry about organ donation yet(family match donation to improve health). Organs are not necrotic.I'm not trying to decide if my BIL needs a DNR. That's not my choice to make. I'm just curious how doctors factor offering it or when it's needed.TLDR; So, why would a doctor recommend a DNR for such a young patient that could seemingly recover? When do you consider patients to be at a point of no return? Is it standard to ask any critical patients to sign a DNR? Do Doctors weigh stats before offering or just their judgement?If you were this patient would you ask for a DNR? ###Output :Your BIL is critically unwell and requiring multiple organ support. He has de-facto multi-organ failure because his kidneys are needing dialysis, his blood pressure is being supported by drugs and he is being ventilated for what sounds like ARDS.The DNAR is if these things stop working, so he does not undergo futile CPR. If he recovers and leaves ICU theyll tear that DNAR up (or you can ask them to), but it wont affect the quality of his care to have one in place.Currently -depending on where you are- he isnt a transplant candidate due to the alcohol, as well as being critically ill."}
{"text": "###Input :Absolutely this. DNR is NOT the same thing as comfort care or withdrawing life sustaining treatments. Them asking about a DNR in this case probably means they think he is unlikely to survive or have a good outcome from CPR. But its important for everyone to consider what they would want done if they were to have a catastrophic health event, regardless of their current health.Okay but studies have shown that a DNR can result in lower quality of care, and typically do. In the BIL's case, although he is critical, he is responsive, and has only been in the hospital for a week. He has made significant recoveries like oxygen levels being reduced and other blood work levels being stabilized to healthy amounts.We are being told both organs have capacity to recover or with the kidney some function. They aren't necrotic. Couldn't he still qualify from a family member match willing to donate? Doctors have not moved towards that idea either.I guess my question is- how does a doctor stack the odds like that? Yes, on paper he has three machines doing organ functions. But is there not potential for recovery? If the oxygen intubation progresses with therapy, he could also remove feeding tube. There is also potential for getting pancreatitis managed, and kidney support with regular dialysis treatments or donation.Does a doctor weigh statistics or is it just judgement? And what helps them make that judgement? Because I feel like someone with the potential to recover, who is pretty young, would not be a candidate for a DNR.Now if there was a clearer document that outlined CPR in a worst case scenario then yes I see that. But signing a generic DNR with chances of recovery and treatment options seems very pessimistic. Especially given that BIL has a condition that can cause asphyxia and there have been cases where DNRs do result in vent being removed. ###Output :Simple answer is at the moment none of his organs need replacing- or rather theyre broken in a way a transplant wont fix. An organ isnt like a broken gear, the whole system needs to work for the organ to work.And nobody is taking him off life support prematurely due to a DNAR. Its simply stating if his heart stopped beating that would be the end of treatment. irrespective of age, if he reaches that point he isnt surviving in his current condition.As previously mentioned, if he continues to make progress forwards then theyll tear up the DNAR anyway, but at the moment your BIL is not somebody I would expect to survive chest compressions- it would be another organ not working, without the ability to support it or replace it to ensure survival."}
{"text": "###Input :When you sign a DNR it isnt just a genetic DNR. There are different sections to it. It asks if you are ok being on a vent if needed. It asks if you are ok having a feeding tube if needed.You can be ok with life support, just not CPR if it comes down to it. ###Output :This is a difficult question to answer without knowing the full clinical picture. What is his day to day ventilation settings? Just because he is down to 30% doesn't meet his PEEP is down. How has his spontaneous breathing trials go? What does his CXR show? What do you mean the blood work is great? What are his I/Os? How is his kidney function?"}
{"text": "###Input :He's got a feeding tube because he's been sedated. But he's had bowel movements. Constant IV hydration drip but no urine in catheter.They had been doing breathing therapy with him that is when they lowered his sedation and oxygen. He seemed to be doing better with 30% and then bile in the tube then his condition worsened. He's now at 50% again. They have done several torso scans but they haven't given details on the scans diagnostics.That's most of what I have based on what I've been given. They said his kidney and pancreas are not necrotic. He did have an infection in his lungs when he was admitted but they cleared out several days ago. However since he had bile with the intubation he has liquid in the lungs again. ###Output :There's far too many details still being missed here to state that his care is hasty. You have an individual who has one kidney on continuous dialysis while having low blood pressure. He is making no urine at all. For some reason, he was intubated for pancreatitis, so I assume it was because of ARDs. He sounds critically ill."}
{"text": "###Input :To clarify, just because the organs aren't necrotic doesn't mean they are functioning. Also organ donation has nothing to do with DNR. The appropriateness of someone to donate only comes after they have died or are literally about to. In the US people self-declare at the DMV so the organ donation services already know their intent in most cases.He has multisystem organ failure, plus underlying conditions which will make his recovery harder than someone without those (alcoholism, solitary kidney) based on what you have written, so it is absolutely imperative to find out what his wishes might be regarding code status. In the absence of any clear directives from the patient in the past, the family is asked to predict what the patient would choose for themself if they were able to sit in on the discussion and weigh in--basing this off of past comments, how they engaged (or avoided) healthcare interventions on their own, etc.I suggest that his designated healthcare agent and any other family present, have a care conference with the intensivist. This is a time set aside in a nearby conference room, not at the bedside or in the hall. Include one of his nurses if possible, any specialists who can make it (often harder to arrange) and then the unit's social worker/case manager. The purpose is to outline exactly where he is on his trajectory, what the major challenges are, what the expected chances of recovery appear to be at this point, and then a discussion of next steps. Find out more about why the doctor was recommending DNR. Hear what they have to say about this based on their experience. It might be because they don't feel he will likely be resuscitated if they make attempts, therefore, to attempt shocks and compressions would be futile. If they feel it would be futile, then it would represent only harm to the patient and not comfort or cure. I cannot predict what they are thinking so you need to find out, but this has been my experience from working in ICU as an RN and Care Manager.If he cannot be weaned off of the vent shortly, he will need a trach and a PEG (feeding tube in his side). If he stabilizes enough to be discharged from ICU (off of CRRT, off of high vent settings, off of any vasopressors that are stabilizing his BP, only on X number of antibiotics, etc) then he will meet criteria to transfer to a ventilator rehabilitation hospital or LTACH (long term acute care hospital).If this happens, it is a long slog. Is it something he would want? Also, he might not survive it and could have a downturn at any time, heading back to the hospital. Knowing this, is this something the family would predict HE would want? If so, you have your answer. If not, then it is appropriate to consult hospice to make him comfortable. Another service to consult if you have it available is Palliative Care. In many hospitals they are consulted for complex cases like this who are taking a long time to recover. They are particularly helpful to the patient to improve quality of life while recovering, as well as provide support and guidance to family.At the end of this long post, I offer you two things. One-you are in my thoughts. I know how difficult this is and you are on a crash course of learning right now. Two, please use this resource that many families in your position find extremely helpful--patients let us know so often this has helped them in cases like yours: Hard Choices for Loving People booklet ###Output :If this was me I would want a DNR and a DNI signed. More importantly, I would want a MOLST form singed indicating exactly the care that I would want, the care that I don't want, and for how long. That is to say, give me antibiotics for one week and see how I do, if nothing's happening then stop all unnecessary treatments.What I like to see in patients is an end goal. What happens far too often, is patients will sit in an ICU for an extended period of time deconditioning and not getting better, but family does not want to do anything for fear of making the situation worse or feeling like they are murdering a family member by taking away care. Recognize that his pancreas is not well at all. His kidneys are not well at all. His liver is not well at all. Assumedly, his lungs aren't either.Let's say he is extubated. Now we have a burnt pancreas. And kidney. And liver. If you are this young and have liver dysfunction or failure, that's a life of slowly getting sicker and sicker until you can possibly but probably not get a liver transplant in the future. It's painful. If his kidneys are truly shot and he requires dialysis in the future, that's 50 years of spending 3 days a week going to get dialysis and sitting there having your blood cycled over and over for hours, just to go home and not feel well. Then you do it again. Then you do it again. That's a lot of stress for a 30-year-old. A 30-year-old that already has alcoholism. If your pancreas is constantly becoming inflamed, diabetes maybe in the future or at least insulin dependence. A 30-year-old diabetic will have a low quality of life.DNR and DNIs are to preserve a patient's dignity thinking about the long-term consequences to their health and quality of life. The idea that saving people is enough, is not enough. By stating do not resuscitate, You're saying to give a chance, but don't take it farther than he would like given all that has happened, and will happen in the future.The doctor sees this all the time. The doctor sees a family that holds on to hope that everything will be okay because their family member is \" a fighter, \" but neglects to see that the patient has already fought 25 rounds and has been knocked out three times. And also neglects to see that, if they come out of the fight, they essentially will have an agonizing future for the rest of their life."}
{"text": "###Input :Hello Reddit,My younger brother was 27, Male, maybe 6 foot and 375 pounds, half white/asian, no drugs, no smoking, extremely rarely drinking (like less than once a month).I don't recall what his early symptoms were but I found a virtual chat that said he may of had \"uncomplicated cystitis\" and had antibiotics prescribed for it. He saw a urologist and eventually had a nephrostomy tube, then had surgery later and was noted with a failed kidney. They were unable to remove it due to his weight and having hemorrhage concerns, at least that was my understanding, and that's it for a his existing medical condition, with an exception.I'm first wondering how he developed this condition to begin with. Would the failed kidney have caused the infection? I wish I had the full records so I could paint a better picture, but ultimately I can only guess that his high blood pressure was a cause, plus having a high stress job.Ever since all this, he had to urinate every like hour and this caused issues with work and sleep. I really don't understand why this kept happening and nothing was given to him for it. Would having a failed kidney cause that? This started back at the end of 2020 and the tube and surgery may have been in Q2/3? I now can't remember what happened first.From that I'm mostly wondering about the reason for frequent urination and if he would have got infected some other way outside of high blood pressure. He almost never leaves the house, and I fear he'd only get sick if a family member came home with something.Fast forward to the bulk of my reason to post. On January 13, 2023 he mentioned some nasal congestion and some body aches. He didn't seem to get better on the 14th so I asked if he wanted to see a doctor and he said not yet. This eventually came with some headaches so we tried to go to an urgent care but the wait times were 3+ hours so we figured try a Teladoc (98point6 for this call) and get an appointment later. He mentions a head ache lasting 4-5 days, dull/sharp pains in waves from front to back, also going behind his eyes. He was taking ibuprofen, and was asked about a fever and he said he wasn't sure but his head seems warmer compared to his body. They basically said to take Afrin and Excedrin and go to urgent care if things don't get better. When he went to take the afrin that night, he blew his nose and had a nose bleed, and per our father he had nose bleeds from time to time, but not that super often.Come January 19 I take him to urgent care and I do have his visit summary. Blood pressure 174/89 (why the fuck didn't anyone talk about this), temporal temperature of 98.1 (maybe the medication lowered it?), pulse 90, respiration 18, oxygen saturation 97. They gave him Toradol and sent him home. I feel like a fucking asshole that I wasn't in there with him, I had to drop him off and attend a work meeting that I should of canceled, and our mother picked him up. This is all very local, like within 15 minute drives.He doesn't seem to get better and on the 22nd he talks about some vision issues so I immediately take him to the nearest ER, which is a satellite and not attached to a large hospital. He goes to a back room almost immediately after checking in - alone, and again I feel like a fucking loser as I should of gone there with him to help explain everything - who knows exactly what he said since he was dealing with headaches. I did come back and talk to one of the nurses, but that didn't seem to change anything they expected.He had the following lab tests done, CBC With Diff, CG4 PANEL POC, Comprehensive Metabolic Panel Poc, PCR Influenza A & B and Covid 19 (POCT). Also had a CT Head W/O Contrast and EKG. Done today was just the CG4 and Comprehensive Metabolic, guess the CBC was still processing? I don't recall any notes on this, and his MyChart is closed.They didn't seem to find anything, even though he had a 171/105 blood pressure, they did ask if he had history and I didn't have a full answer, but said it wouldn't be surprising since the rest of the family has medication for it, but he didn't have a primary care doctor to prescribe it. He had trouble finding one since COVID and it really pisses me off that I didn't help him find one somehow. He also had 100.1 temperature.They gave him .9% NaCl (NS), tylenol, benadryl, toradol and reglan, and sent him home.The next day I don't remember exactly what triggered this, maybe balance, but we took him to the ER attached to the hospital and the doctor almost immediately said he wasn't going home that night, he saw something. They put him in a gown and my brother was shivering mad, and he normally likes it cold. Sometime that night I believe he got a room and had some tests, and they said he had meningitis, and shortly after was uncertain of contagious so the room was adjusted and we had to wear N95 masks and a face shield / gown. This went for maybe 2-3 days, and it bothers me so much because this was the most critical time that I could of had talking to my brother and I minimized my time like a coward and asshole. I believe our mother was there the whole time though.After that 2-3 days it was cleared for bacterial and said likely viral (they never said what he had) and the additional PPE was stopped. I remember he texted me to bring apple juice, yogurt, and fruit cups, which I did, but asked if it was okay because I thought hospitals didn't want outside food. They said it was okay as long as it conformed to a low sodium diet, which those did.During this I know he had a lumbar puncture, which is likely how they found the meningitis, and had a CT/MRI that they said was clear. Then suddenly the next day he developed delirium. He was able to answer our questions and knew who we were, but it was like he was living in a video game or something. He'd also spring up very quickly pulling wires to urinate (and frequently) which caused concerns for the monitoring and fall prevention, since he was a little wobbly and I think bumped his side one day because of the bar being down for the accessibility access for the toilet.The doctors believed the delirium was due to his lowered sodium levels, which could have been to the frequent urination and low sodium diet. He was drinking a ton of Gatorade at home back home, probably around the 16th I was buying him multi-packs as I felt those helped me recover. Eventually they put him on a EEG and because of the frequent getting up and sometimes he'd just try to rip the things off, they restrained him. I wasn't there when it happened but our mom was there and it sounded a little traumatic, like saying \"why are you doing this mommy, and then attempting to bite her\". Not sure if that's exactly what happened but he was restrained. Either at that point or shortly after he did have a nurse assigned to be next to him 24/7 to monitor, and help him pee as he'd be responsive if he had to go and the nurses asked.During this delirium he'd talk about random stuff, sounded like he was in a game, he couldn't explain where he was, but he was still answering questions. Everyday I visited I'd ask if he knew who I was and he'd start by laughing and saying of course, and I had to be more specific with him and he'd confirm my name and that I'm his brother. During this time we had a family member with him 24/7, but would occasionally talk to him, I know I'd hold his hand and he'd squeeze back, but we'd end up sitting to the side talking to each or reading a book, etc.Finally on the 30th I was coming in to swap out with our father, who said that my brother was a bit quieter today, maybe he was finally getting some much needed sleep as it seemed like he wasn't getting any. I also noticed that he had an oxygen tube under his nose, which wasn't there before. I didn't want to wake him so I didn't do much, and this was the first day I decided to pop up my switch and play some yoshi crafted world, and I kept one ear bud out just in case.I know he had a lumbar puncture done either before I came or just as I came, and an MRI earlier (might have been the previous day, it's becoming a blur now and I hate it) and the neurologist said they see a lesion, and it looked like one of the quadrants of the brain. I honestly can't remember but it felt like a sizable portion. I also looked at the EEG from time to time as I assume they were looking for seizures and I swear I saw alerts on the machine detecting them.This was the first time that I was going to pull the all nighter, and it was normally our mother that would do that and I offered to stay but she wanted to get some rest which I understood. A bit after I was there I noticed they swapped the tube with an oxygen mask, and I regret to this day that I did not look at that monitor better, seeing if oxygen was dropping, etc. There was a nurse there but I don't know how well they were watching, I swear one of the guys before was on his phone most of the time. I remember there was a night shift change, and I don't recall how long after before the most traumatic part happens. I did ask if my brother snored normally to our parents, as I never really heard him sleep and our father said yes, and he should get a sleep study done. It reminded me of our father's sleep apnea when napping on the couch during movie night. I don't remember how long this went on for, but I think they adjusted the bed height or something, don't remember... yet another thing to add to my list of regrets.That night after playing a bit I remember my arms getting tired so I pulled the little side table near me to prop my switch up on so I could just use the remotes, and all of a sudden a bunch of nurses come rushing into the room and one of the nurses checks his neck and says no pulse, then a code blue is called. I am escorted out of the room and just panicking. I don't remember hearing the monitor beeping prior (remember 1 ear bud and I had the volume at like 1 tick), and I don't recall him snoring just before either. For all I know the sensors were faulted and he was out for awhile, I have no idea how immediate it was, or if maybe the table pulled/squeezed the oxygen tube (this all happened in like 10 seconds). I know that his monitor was beeping a lot earlier due to his blood pressure, and I don't know if they gave him medication, but I don't remember that monitor beeping at all that day. Maybe the last nurse silenced it? I don't know. I also don't know how well the nurse was watching. One of the nurses in the morning/afternoon was great and I know she was looking at his face and the monitor with great focus, and I fear the night nurses not so much. I know the nurse that night was from newborns, and just helping out.I don't understand why or how he code blued, how quick it was, or anything, but I know it took them over 20 minutes to bring him back and he was on a ventilator. They did the 24 hour thermal treatment of going cold then normal, and after that for the next few days they'd do an eye test and pain test with no responses. On February 1 they did some test with a dye to see blood movement in the brain and I saw the results that night saying there was little blood flow but not clinically brain dead. I had a spark of hope but knew I wasn't a doctor. The next day we talked to the neurologist and confirmed that he was indeed brain dead and I felt like I lost my brother for the 3rd time in that hospital. Once during delirium, then the cardiac arrest, and now. We had to decide when to pull the life support, and I watched him officially die, for what felt like the 4th time.Having to find the courage to join our father for the funeral arrangements, then the funeral which was a visitation before cremation, then picking up the urn a week later, it's been waves of trauma and it still feels like yesterday a month later. Everyday I've gone home to see my parents, and touch the urn and cry. I don't understand why he's in there and not at our house playing video games with his friends.I don't understand how he got sick to begin with, he moved in with me back in May and I tried to make things as comfortable for him as possible. This was his first winter with me and I think this house is a bit drier than the parents he lived with, but I wouldn't think that'd cause the issue. He almost never leaves, he works from home and plays games. If he caught anything it'd be from me, and I know I got sick at the end of June with COVID and he caught that from me, what a fucking loser I am. I did another trade show in September and got sick, not sure if he got it then, he didn't report time off to work (and he tries to take every time off he can).I don't understand why the teladoc didn't ask other questions, or the urgent care to find anything. Then later the first ER only commented on the high blood pressure, and it wasn't until the second ER that they knew something was up.Why did he get delirium, why did they let sodium levels drop? What was going on with the oxygen? With the monitoring he had, how did they let a cardiac arrest happen?I have so many questions and it pains me knowing that even if I get knew, it doesn't change that my baby brother is gone. We had so many plans this year, such as cooking better for ourselves, working out to lose weight, and most critically spending more time outside of his room to try new things like restaurants and take vacations. The last vacation I had with him was 2007, and he was in Hawaii with the parents in 2008 where I was rejected from going because I didn't have a job after high school.Before his delirium I remember one big ask, which was to get a hug, and that he was ready and wanting to go on adventures with me. I hadn't seen my brother much outside of a quick dinner talk from time to time, and when he moved in I was glad to be bonding with him again, and we didn't even get 1 year. We had so many plans, and the world robbed him of that.During the visitation I played the Halo song \"Never Forget\". He was a big Halo fan and that song always gave me the feels. I hugged his cold body for that entire song, wishing I could give him more.This is a long post and I apologize, I just needed to write, and I wonder if anyone knows what may have caused things. I fear that my lack of knowledge and experience failed to get him to the ER sooner, but it didn't seem like that even helped, they may have just done the same as they did on the first visit and turned him around.I failed to protect you brother, I am so sorry. This world is just not fair and you deserved so much more. You were the nicest person anyone would of met and you made those around you happier. I miss you so much brother, and I love you even more.I will see you again one day. ###Output :I'm sorry for your loss.Delirium can be caused by many factors including infections, metabolic imbalances, medications, and underlying medical conditions. In your brother's case, the low sodium levels may have played a role, but it is also possible that there were other contributing factors such as an underlying infection or a reaction to medications.His low sodium could be due to frequent urination, or due to his low sodium diet, or it could be due to an underlying medical condition such as adrenal insufficiency or kidney disease.Don't know about the oxygen - but, changes in oxygen levels can occur due to changes in respiratory function, changes in blood pressure, or changes in heart function.The fact that he was on monitoring does not guarantee that a cardiac arrest could not occur. It is possible that the cardiac arrest was due to an underlying medical condition or a sudden event such as an arrhythmia. But, ultimately I don't know."}
{"text": "###Input :Im not sure if this is the appropriate place to post, Ill delete if not.33F, Current diagnoses: anemia, bulging discs, arthritis. Im on slow release iron and vitamin B12 daily and mobic and skelaxin PRN. I see a PCP regularly. Ive always been an anxious person but lately its been significantly worse. I lost my sister at the end of 2021, she was at home recovering from covid and died unexpectedly. It was a very traumatic experience, I watched the paramedics perform CPR on her. Im also a nurse, worked a covid unit the first 2 years of the pandemic. Ive got a lot of negative feelings from that as well, like most hcw. I find myself crying more often than not. I find myself unable to sleep because Im reliving the night my sister died and the days that followed. Its not just when Im asleep though. Itll hit me when Im driving or at the store, just these intrusive memories replaying and I cant make them stop.I work third shift, I come home and stand next to my husband because Im convinced hes not breathing. I have to watch his chest rise and fall several times before I believe hes ok. I panic if he doesnt respond to a text, I almost left work one night because I was freaking out convinced he was dead, he was home with covid and had just fallen asleep.I now work a unit thats not technically critical care but our patients are very sick. (Post op, pressors, a lines ) I often feel so heavy in my chest by the end of the night sometimes until I get home because Im so anxious that I have forgotten something or done something wrong.When I did my physical I did discuss my grief with my PCP but told her I felt like I was ok. I do this thing were I like to say Im ok even though I know Im not. Its getting to a point though its obviously interfering with my life. Im just not sure who to turn to. Ive never sought care for my mental health so I was going to go through my employers EAP but its so overwhelming. Theres therapists, social workers all kinds of options. But theres no psychiatrists available. I dont really know if theres a reason I should be seeking one or if I should just start with a therapist. I think I just feel overwhelmed by all of it and need help in which direction I should go.If youve read all of my ramblings I greatly appreciate it. Any and all advice is welcomed. Thank you all for your time! ###Output :I think you would benefit the most from having both psychological and pharmacological therapy together.It sounds like you're in a different country than mine, and your healthcare system may be slightly different, but I hope this largely applies.I think your first step ought to be going back to your primary care doctor and telling them what you've written here.Your primary care doctor should be able to signpost you towards the appropriate psychological service, who can do their own assessment and determine what type of psychological therapy is best suited for your needs.At the same time, I think you would benefit also from pharmacological therapy, but it's not necessary for you to see a psychiatrist immediately. Your primary care doctor is trained to assess and prescribe treatment for common and uncomplicated psychiatric conditions. If it later becomes clear that your illness is more complex than it first appeared, or if you don't respond to the first or second-line treatments, you could explore getting a referral to see a psychiatrist then.You should also look into seeing your employer's occupational health service, who can, I hope, help support you in your work and make any necessary adjustments. I would strongly recommend discussing your health with them especially if your mental state starts interfering with your ability to work.I hope things start getting easier for you soon."}
{"text": "###Input :What type of medical tests should I ask my doctor to perform to look at underlying medical issues or deficiencies that might be responsible for my hair loss. I have complained in the past and she only looked at iron.Im a 34F who has lost probably 60% of my hair over the past 3 years. I have no history or family members with hair loss. I am east European with light brown, fair hair. However, I have always been complimented with how full, soft, lush my hair is. Hair loss is all over rather than patterned. ###Output :This post has very little information about your general health, no information about your medications, inadequate information about the alopecia distribution, and no quality images of your scalp. Meaningful comment is not appropriate."}
{"text": "###Input :No medications (aside from Advil as needed), not considered alopecia, images wouldnt be relevant considering to the average person, it just looks like I have thin hair, but I know what it was beforehand and the loss I experience showering daily.I have always had perfect health. Also, I have a very clean diet, eat white meat or fish daily, lots of organic produce, avoid fast food or junk food (besides chocolate). Dont smoke, drink maybe 2 glasses of wine per month. Active lifestyle.I do still experience cystic acne as an adult, and have oily skin. ###Output :Hair loss is alopecia. If you choose not to share relevant information, meaningful comment is not appropriate."}
{"text": "###Input :This response is a bit harsh, and repetitive. Perhaps you could assist the OP by describing what YOU consider to be meaningful and relevant, as it appears she is trying. Also, you are the one with the degree. ###Output :Good suggestion. I need precise information on the anatomic distribution of the hair loss. Additionally, I need information on the appearance of the scalp and the hair follicle appearance in involved and uninvolved areas."}
{"text": "###Input :26F, 57, 177lbs SLE Lupus, Ehlers Danlos syndrome, and pseudo tumor cerebriThis is the first post and I took the advice given and got medical help. Well the ER didnt do anything but, give me fluids they did another CT with contrast and told me the findings were most likely old. Plus I take blood thinners already and I should be fine ( I take blood thinners because I have a stent in my brain and I had heart surgery long story). The new CT showed  IMPRESSION:Tiny sliver of hyperdensity seen in the right frontal lobe along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage.Proximal Jugular Veins: Diminutive on the right, normal on the left.I also got in contact with the on call doctor since my neurosurgeon is on vacation and he said the location of hemorrhage isnt concerning. Plus if all I have is an headache I should be fine. Just to note he did see the ct report or films.So I just want to be sure Im make a good decision to not do anything. I still have a terrible headache accompanied with nausea that doesnt seem to go away. My mom is worried and keeps insisting I need to take this seriously.I hope this is legible its hard to type with a terrible headache. Thanks again I appreciate you guys ###Output :you're on a blood thinner and they said its okay to continue while you have a hemorrhage? what?! did you have an angiogram? i don't understand this. do you have a cereberal venous thrombus?Physician/NeurosurgeonWe get a huge number of consults for hemorrhage that are almost certainly not hemorrhages on our review. If a neurosurgeon already consulted and said this is nothing then that is reasonably likely to be true. It could be artifact, calcification, post-op change from a prior procedure, or any number of other things. I think OP should track down the on-call neurosurgeon again and get a better explanation.Physician, Emergency Medicine | Moderatorone would assume a radiologist would be a little more careful in hedging if they werent sure. lord knows they hedge when they need toPhysician/NeurosurgeonThat is a poor assumption. They call surface SAH all the time that arent. There is a lot of volume averaging on the hemispheric convexities and it makes little light spots appear pretty regularly."}
{"text": "###Input :Is this standard practice? Hematology question.Female, 50, Arizona. Too many ailments to list.I've been anemic for at least a couple of years. One of my Dr's asked me who was managing my anemia. Ummm, nobody? So she referred me to a hematologist. The next day, I received a seemingly random text from a cancer center. The Dr she referred me to is both an oncologist and hematologist. Thus the cancer center wanting to schedule me an appointment. ###Output :Nope thats normal. Hematology and oncology often are done in the same fellowship. Doesnt mean you have cancer at all54ReplyShare"}
{"text": "###Input :Assistance for interpreting Ultrasound, Chemistry, Hematology, and Urinalysis resultsGood day everyone!! May i ask for assistance with interpreting/reading may mom's results (shown in pictures above) and her potential ailment, we're really suffering financially these past few days, i'm very sorry and thank you for those who would help!! Gender: F Age: 60 ###Output :Who ordered the tests for her? They need to be the one to interpret the tests because they know what they are looking for. Tests in isolation with no context really arent useful. The lab that processes tests also have parameters that are normal based on the sample processing, and none are listed."}
{"text": "###Input :PLEASE help me figure out why my legs/feet are cyanotic and can't get oxygen when sitting down. No quality of life and at risk of further permanent damage. Every specialist and hospital is baffled :( Pic inside.'ve posted here before in the past (now deleted), but that was over a year ago. I got a lot of great suggestions and every one of them has now been ruled out.History:30 year old white female, thin, non-drinker, vapes nicotine, no drugs or medsHealth issues prior to this situation: POTS, heart arrhythmias, and EDSA year ago, after my post, I was hospitalized with a vast array of neurological symptoms. To make a long story short, I ended up having a severe B12 deficiency that went unnoticed for 2 years. Low serum B12, extremely high homocysteine and MMA.After getting on the B12 injections, all of my initial symptoms have resolved, except this leg thing which I've never been told is related to the deficiency and idk if it is.Leg Issue:Feet PictureDuration: 15 monthsOnset: Began with some numbness in my toes and transient foot pain when walking, also difficult to walk as if I couldn't feel where my feet were (although sensation was intact). Coloration starts looking funny. A month later, I was sitting at my desk working for about 4 hours and looked down and my feet/calves looked like corpse limbs. Saw a vascular surgeon and had a terrible result on ankle brachial index test. He had me admitted to a major hospital and warned me of risk of double amputation. After release from hospital with no answers, I saw about a million specialists.Symptoms: when in a dependent position (sitting, essentially), it takes about 10 minutes for my feet/calves to start turning colors. They became ice cold to the touch, mottled, dark purple/blue (and sometimes blackish), and there is no detectable pulse in the feet or ankles on doppler or otherwise during this state. The longer I sit, the worse they get. It also has begun to spread higher and higher, if I sit too long it will now go all the way up to my thighs. It is not painful when sitting, they simply feel freezing cold. When I stand up to walk, they are moderately painful (not nerve pain, achey), and walking is clumsy and difficult for a bit. Occasionally, they will become hot, swollen, and bright red but there is no identifiable trigger for this. It happens rarely and isn't related to sitting or elevating them, unsure if this is even related. This cyanosis issue has caused muscle and nerve damage in my feet. Also, lack of toenail growth and yellow thick toenail color.What helps: elevation, when I elevate them, eventually the color will return to normal (pale) and the temperature usually stays cold. Walking also can help the blood flow return to normal. That's it. Soaks in warm water will help the warmth return, but does not solve anything else.What we've ruled out and tests done:Raynaud's syndromeCardiac causesPAD - MRI of both legs showed no atherosclerosis or other signs of PAD. Doctor mentioned \"the veins in that area are very narrow but no other findings\". He didn't write that on the report and MRI was marked as normal.I had 2 venous doppler exams. Both were done while my legs were elevated and in their good state. Both exams were normal. I expressed again, when elevated they have good blood flow, can they please do the test while my legs are dependent? They said it isn't possible.POTS Blood Pooling - It's not blood pooling, it's a lack of blood flow or a lack of oxygenated bloodBurger's syndromeAll autoimmune conditionsHematologic conditionsDependent acrocyanosis caused by POTSPretty much everything else that I'm sure I'm forgetting hereWorking Diagnoses: PVD of unknown cause, Venous Insufficiency of Legs (Don't know how they got to any of these conclusions but they are also just guesses at Doctor's admission)Other Factors: I do have motor (distal axonal) neuropathy throughout my body, caused by the b12 deficiency, however I have been told this is not related, and the neuropathy is also present in my arms and hands which have no issues in dependent positions.So for one year now under advice of my doctors, I have my feet elevated pretty much at all times. I can not sit on a couch with someone, I can't sit at a desk to work, I can't sit ever. This is affecting all areas of my life, I am babying my feet and legs all day long. I can't do normal things without being able to sit like a normal person.I am out of options, and completely desperate to save my feet. They are already muscle atrophied and partially paralyzed. They are very painful at night when I'm lying in bed (but not usually during the day).Summation: Cyanotic, cold, pulseless feet and calves when sitting. Every time. Will spread up my entire legs if I sit long enough. Clinical damage to muscles and nerves in affected area. MRI and venous doppler are normal. Feet are fine when I'm standing, walking around, or have them elevated. There are NO triggers to this except sitting. (Not triggered by temperature, stress, foods, anything but sitting). There is NOTHING that alleviates this situation except for elevation or walking.I have no idea what is happening but I can not live like this anymore. I have no quality of life. No doctor can give me any answer.I have lost all faith in solving this, but maybe a reddit miracle can happen. You never know. If you read this far, thanks for reading. ###Output :How was Buerger disease ruled out? Biopsy?This is clearly severe peripheral arterial or venular disease - either medium vessel or small vessel.You ABSOLUTELY should not be using any nicotine products. This is in all likelihood driving the process."}
{"text": "###Input :Thank you so much for replying.I don't actually remember how they ruled it out, but I brought it up to multiple specialists who had various reasons why it wasn't. But even still, I did quit vaping/nicotine for 9 months during this and the condition continued to worsen. I started using my vape lightly again recently, but I will stop 100%.Is it possibly reversible if I stop immediately? (I'm stopping regardless after reading your message).And just one more question, I also thought obvious PAD but they say it's ruled out because no atherosclerosis and normal doppler. Is that inaccurate? ###Output :You can still have an inflammatory/autoimmune process causing similar symptoms.I dont know what workup youve had, but ruling out all autoimmune conditions is a pretty significant claim, though with the right lab work you can estimate a likelihood.Id consider some of the vasculitides/rheumatic conditions such as anti phospholipid syndrome, cryoglobulunemic vasculitis, etc. they often come with other manifestations but there is obviously not a full history and physical exam above.Many of these are associated with autoimmune diseases such as lupus, but they are not pathognomonic by any means.Have they done a biopsy?"}
{"text": "###Input :No biopsy due to concerns about infection/wound not healing with the blood flow issues.You're right, I have no idea if they truly ruled out all autoimmune diseases. But I did have significant testing for it. The main hospital did all their own testing and when I was negative for everything, the doctor worked with Mayo Clinic and used their full autoimmune testing panel or whatever and was still negative for everything.I do remember some reasons coming up: no inflammation markers, negative ANA multiple times, 3 rheumatologists cleared me and told me it was vascular not rheumatological in origin. I was tested for and all the types of vasculitis (without biopsy just blood work).And these are some of the reasons I can remember for saying no to Buerger's:- My symptoms only come on in the dependent position and at no other time, all their tests showed no blockages or clogging or weird patterns of veins, no claudication, no blood clots, no change in symptoms when exposed to cold, and I think some more stuff. I know my vascular surgeon sent images and case history to some massive network of vascular specialists and the consensus was that it was not buergers (but again, who knows).My neurologist is absolutely convinced that I have Marfan syndrome but I did not get the genetic testing for it yet. And I'm not aware if that can cause this but it's the only other thing I can think of.EDIT: I just went through my mega document of all my labs and tests, and anti phospholipid syndrome could fit, because I do have a history of blood clots and also recurrent miscarriages (5 by the time I was 29). I am trying to find the exact lab names of the tests for this right now to confirm (that's always hard lol). (I found the names, I was tested for aCL IgG and IgM antibodies and results say<10 GPL<10 MPLThey also looked at regular IgA = 288.9, IgM = 50There's a bunch of other IgA and IgM and IgG tests in there too with other words in front of them that I don't understand but all seem normal. ###Output :Did they do lupus anticoagulant (LA) or anti-beta2 glycoprotein 1 (a(beta)2GPI) with those antibody tests? It sounds likely that those will have been covered in the workup described. If so then its unlikely to be anti phospholipid syndrome, at least from initial workup. Given the description of symptoms there is still a possibility of antibodies to other things such as anti prothrombin, anti-annexin, anti-phosphatidylserine, etc, but the clinical correlation is weak at this time and testing is not routinely performed since there is much uncertainty about their significance. It may be something a rheumatologist could speak to in more detail.One of the key criteria with testing though is that testing should occur within a short period of time from any event such as blood clots or miscarriage if I remember correctly. If it is not done within a short period of time it may not show up on testing (I dont routinely deal with APS so I dont know the timing recommendations). I could not say if the current cutaneous and vascular manifestations would be included, but a rheumatologist may be able advise further.I do agree it is worth another follow up and discussion with a rheumatologist again to discuss the possibility of the diagnoses in this thread, multiple good differentials on the list from other physicians as well. It sounds like youve already had an extensive workup, but at the end of the day if you have a progressive pathology and no answers, you have to keep searching and discussing it. Best of luck."}
{"text": "###Input :Huh, that's very interesting.I was told they tested for all lupus stuff but I don't see LA or the other antibody tests in my records, unless they're using different acronyms for it or something. They did do a bunch of prothrombin tests which were normal.Thank you so much for your help here. I think I need to go to a different state to see a rheumatologist, I've seen all the best where I live and after looking at my labs they tell me they can't do anything for me. But I'll keep trying. ###Output :Lupus anticoagulant is actually not associated with lupus, rather it is associated with APS, as is the anti beta 2 one mentioned previously.They are part of the testing for the Sapporo criteria in APS diagnosis."}
{"text": "###Input :Did they ever do an angiogram while you were symptomatic? Or a mri or Ct with contrast while you had active symptoms? ###Output :The problem with the studies you received such as the MRI and CTA is they dont have the resolution to see smaller blood vessels. This would require a biopsy. Some medium and small vessel diseases respond to immune suppression with steroids etc, the treatment for Buergers is not smoking. Others such as livedoid vasculopathy (a vein disease) require anticoagulation.So again not vaping is essential to save your legs. Wouldnt recommend other nicotine containing products such as patch or gum, but bupropion and varenicline are effective smoking cessation aids.Personally if smoking cessation isnt effective and the symptoms progress I would want the biopsy despite the admittedly very high wound healing risk. There may be a proximal area with less advanced disease that is amenable, and your symptoms are end-stage.Can PM me if you have specific questions."}
{"text": "###Input :Thank you so much.I did not have that spinal reflex test done. And I understand now about the biopsy. I am quitting cold turkey, I don't react well to bupropion or most medications honestly.I will ask for the biopsy and I do have a referral right now to a new hematologist, only problem is all the new specialists I see just keep telling me everything has already been ruled out. I'll still go though of course! ###Output :Uh ignore the spinal reflex part, that is a lame joke"}
{"text": "###Input :LOL and I was sitting here googling that, confused as hell. So now you've made me laugh and you've terrified me with the end-stage comment :OI guess it's time to submit my application for Dignitas. Can you pls write me my physician recommendation? It would also be lovely if you could attend my death, Switzerland is beautiful. (and maybe write a eulogy about me too, I think you'd be very good at that) ###Output :No no end-stage vascular disease not end-stage you.Stop vaping (done). Advocate for a biopsy in an area that has a little better blood flow but might provide an adequate specimen. Followup with the specialists and try your best to stay positive even though it's a shitty situation."}
{"text": "###Input :Hematology questions. (mother with acquired aplastic anemia)Obligatory info so the bot doesn't eat me: 69F , 5'3 \", 185lb , White , USA , Former smoker but 20 years totally off, no drinking or illicit drugs, full list of prescriptions is further down the post, duration of about 6 months (2 pre-diagnosis, 4 post-diagnosis) location of complaint is... blood?First, thanks for looking. I know my questions here are going to be weird and kind of specific. My mother was diagnosed with acquired severe aplastic anemia this past July. For those who don't know it is a disease of bone marrow failure which means the creation of different types of blood cells is severely limited.I'll try to be short about it - my mom had increasing weakness and bruising until ending up in the ER with Hgb of 4.6, platelets of 4, WBC 3.2, ANC 1, ALC 2; she spent a week in the hospital where they did a bone marrow biopsy and a million other tests to figure out the cause. (previous to this she had no other health issues)July 12th she was diagnosed with aplastic anemia, with bone marrow cellularity of 20%, reticulocytes between 0.02-0.03 (range 0.018 - 0.158 x10E+12/L), very tiny PNH clone (<1%) was given a PICC line and started horse ATG on July 14th in combination with cyclosporine 600mg + Promacta 150mg. Had almost no issues with the ATG treatment but became refractory to platelets pretty quickly and thankfully HLA matched ones were found. She was released once they found the appropriate dosing for the cyclosporine to not be at toxic levels.My mom is still going twice a week to the heme/onc clinic for blood tests and receiving blood if Hgb dips below 8 (approximately every 3/4 weeks) and platelets if they dip below 20 (approximately every 7-11 days). The tests are monitoring the need for transfusions, monitoring for blood cell lineage response, as well as checking for liver and kidney function.Currently taking 125mg x2 a day of Cyclosporine, 150mg Promacta, 20mg prednisone, along with 400mg acyclovir, levofloxacin, fluconazole, B12, Folic Acid, Vitamin D3/Calcium, 20mg x 2 Famotidine and 25mg metoprolol (for heart palpitations, the only med she was on previous to this) I'm sorry I don't remember offhand the exact dosings of the preventative antimicrobials and for the vitamins.I was asked to post the full lab values, so I am only going to post the most recent ones which were taken 11/29.Of note: Last blood transfusion 11/11, last platelet transfusion 11/26 (HLA matched, I guess they work really well)ComponentYour ValueStandard RangeFlagWBC3.8 X10E+09/L3.8 - 10.6 X10E+09/LRBC2.44 X10E+12/L3.73 - 4.89 X10E+12/LLHgb8.2 g/dL11.6 - 14.6 g/dLLHematocrit(HCT)23.2 %34.1 - 43.3 %LMCV95.0 fL82.6 - 97.4 fLMCH33.7 pg27.8 - 33.4 pgHMCHC35.5 g/dL32.7 - 35.5 g/dLRDW25.9 %11.8 - 15.2 % HPlatelets143 X10E+09/L156 - 369 X10E+09/LLMean Platelet Volume8.1 fL6.8 - 10.4 fLNEUTROPHILS %46.1 %44 - 77 %LYMPHS %44.6 %13 - 44 %HMONOS %8.8 %4 - 13 %EOS %0.1 %0 - 6 %BASO %0.4 %0 - 1 %ABS Neutrophils1.8 X10E+09/L2.24 - 7.68 X10E+09/LLABS Lymphocytes1.7 X10E+09/L0.80 - 3.65 X10E+09/LABS Monocytes0.3 X10E+09/L0.30 - 0.90 X10E+09/LABSOLUTE EOS0.0 X10E+09/L0.00 - 0.40 X10E+09/LABS Basophils0.0 X10E+09/L0.00 - 0.06 X10E+09/LTYPE OF DIFFERENTIAL | Auto diff performed RBC Morphology 1+ PolychromasiaOnto the questionsAfter all that, my questions are mainly about what certain things in the blood values mean and also things I have heard from other patients with this disease that I want to confirm if they are real or not. There isn't really time to discuss any of this when my mom sees the hematologist at the clinic and I don't want to be a bother acting like I know anything about blood or medicine and asking a million dumb questions.1.) What does +1 polychromasia mean here? From what I understand it's off-color red blood cells, usually very young ones. It has shown up on almost every CBC since treatment began.2.) What does the elevated RDW mean here? It has been elevated since treatment.3.) How does getting transfusions of red blood cells affect these numbers? I asked once about the most recent reticulocyte count (3.2%, ARC 0.084 x10E+12/L) hoping that it was indicating some response to the immune suppression, but was told that donor blood will also have reticulocytes in it so the count doesn't matter.4.) Things such as nucleated red blood cells and ovalocytes have also occasionally popped up on the reports alongside the polychromasia. What do they mean in this context?5.) Is it correct to understand that on diagnosis her bone marrow could only make enough cells for a Hgb of 4.6, but that it may have improved since then, but still be under the transfusion threshold? (ie if it improved to 6.5 or so but they wouldn't know if she continues to get transfused <8)6.) My mother's doctor is a hematologist/oncologist but does not seem to have any specialty in treating aplastic anemia, tho he seems to be doing things mostly right. I have been trying to find someone in the city that does have some specialty in aplastic anemia but it has been very hard. I have been through the AAMDSIF listings for her city and not come up with much. I am surprised because there is a major medical school and center there with a full heme/onc division and also sections for benign hematology and rare blood diseases. Is it weird to try and contact these sections for help finding a hematologist with an interest or specialty in treating this?I think that's all I have for now - feel free to ask for any more information needed, I've got piles of it. If you're wondering why I'm so rabid about this, my father had leukemia and I was too young to understand why they were doing the things to him they did, or why they didn't do other things, and it seemed like he was adrift in a sea of complicated medical situations and opinions and unusual symptoms. This time, I want to know as much as possible, to be able to advocate and educate. I am also very interested in medicine and anatomy (but I'm too dumb for something like medical school, so it's just a weird special interest) ###Output :Agree with answers from /u/Spicy_Antigen.Regarding her doctor, he certainly has treated aplastic anemia before. I don't know if there are really enough aplastic anemia patient for any hematologist to have a \"specialty\" in it. If you want a second opinion, I'd reach out to the major medical center in her city."}
{"text": "###Input :Iron vs Iron Saturation? [Hematology]Can anyone explain the practical difference between these two test values (not just the technical definition), and what it would mean if someone had normal Iron but low Iron Saturation?i.e. How could the saturation end up low but the iron level itself stay normal, physiologically?The numbers are 63 mcg and 18%, respectively, in case you're wondering, with the range listed at 50->180 for Iron and 20->48% for the Iron sat.tyvm!Age: 30, Height: 180cm, Sex: M, Non Smoker ###Output :It's not easy to ELI5 this. Iron level basically just measures the amount of \"free\" iron released by your body into your bloodstream at the very second that your blood was drawn. It will change from hour to hour and day to day. The iron level is basically meaningless because it doesn't tell you anything about how much iron you actually have in your body. For example, your body needs a certain amount of iron in your blood at any given point. Even if you're iron deficient, you could have 63 on your lab and you could be iron overloaded, and it could still be 63 on your lab.The iron sat tells you indirectly how much iron is stored in your body. A low saturation means your body stores are low."}
{"text": "###Input :What can these blood tests indicate? (Infectious doctors? hematology doctors? Nuerologists? )Male, 28, 68 kg, 183 cm. White. Sweden. Previously diagnosed with Lyme Disease. One major event of disease progression was food poisoning from eating raw fish.Symptomatic presentation:Numbness in body and limbs, and in skinDecreased body awarenessAnhedoniaDecreased sense of smellDecreased sense of touchDecreased hearing quality, level and resolutionLost access to brain areas and higher functionsBrain fogShort term memory affectedAffected bodily, space and time perceptionTingling in skinFloaters in eyesWeight lossMuscle lossDepersonalizationDerealizationAn altered mental state described as a conscious comaChronic fatigueNauseaSexual dysfunction, loss of sexuality, anorgasmiaGeneral weaknessVery dry skinNot able to have a feverTESTS DONE IN JUNE: VEGF-A 114 pg/ml, reference: >42,6 pg/ml. Candida glabrata 1,6 x 10^6 KBE / g Stool, reference <1.0 x 10^3 (<----*>Streptococcus Sp. ELISPOT 4.1 (ref > 3).**[**U75] ASO (streptolizyna)  255,03 u/ml < 200.Tryptophan Metabolism in urineSerotonin PathwayKynurenine Pathway IgG subcategory Type 4 1, 14 g/l, 0,004-0,86 Zonulin 71,88 ng/ml <55 Lactate / pyruvate 13,7 Quotient <12,9 Adrenaline 6,20 ug/g Crea 2,0 - 5,5 Dopamine 126,81 ug/g Crea 130 - 240Histamine in stool 1419,7 ng/ml <959Blod Analysis Cabinet of Medical AnalystBabesia sp 2.9% (out of 500 assessed erythrocytes) other detected co-infections: - Bartonella spFound in the analyzed fields of view: Pathological erythrocytes: anisocytosis (defense mechanism?)misshapen blood cells: - ovalocytes, lacrimocytes, dacrocytes - it may indicate an infection of the haematopoietic systemInternal cell structures : rod-shaped, branched, ring-shaped, grainy, - may indicate a multispecies parasitic infection ###Output :Thats a rather eccentric collection of lab results. What kind of doctor ordered these?"}
{"text": "###Input :Infectious disease specialists. ###Output :Oncology? You don't mention a history of cancer"}
{"text": "###Input :My bad. It wasn't specialist in oncology. The doctor works and conducts research with supportive therapies for cancer, hyperthermia.Only labs that are off are being posted of course. 50+ more tests have been done. Including 2 MRIs of the brain and spine. ###Output :These labs suggest your doctor(s) are not practicing modern, evidence-based medicine."}
{"text": "###Input :Some discussion on liver lesions? Hi guys!So I went to the ER a week ago with pain in RUQ after lager. The doctors thought it was gallstones or gastritis and wanted an ultrasound - it came back with a 5.4cm lesion on my liver. I then went for an MRI, the ER doc said it didnt look benign or a cyst and wanted to admit me for more investigation. I also had a CT scan and they don't have much information on it. My bloods are normal also. My symtpoms include; extreme fatigue, right shoulder pain, stomach bloating, 8 weeks PV bleeding with black blood(they are investigating this too), and severe itching on legs. I know due to my age its most likely not cancerous as I'm only 26. But there is cancer in the family too. I was meant to be there for a biopsy this morning but the consultant (gastro) wanted to cancel it and get a second opinion on my scans from a hematology clinic before a biopsy.I just wanted to bounce this off people for your thoughts. I'm not asking for anyone to diagnose me as I know its up to the medical professionals. But I just want to see what people think ###Output :Much more information needed here - I'd suggest posting the radiologist report from all the imaging, all bloodwork results, etc."}
{"text": "###Input :37M - MRI of Cervical Spine - \"Diffusely low signal\"Hi there,Having some MRIs done for some nerve issue i'm experiencing. Cervical spine MRI showed up fairly normal but I'm not entirely sure what this means.\"Diffusely low signal intensity marrow likely represents hematopoietic marrow. Hematological correlation is suggested.\" ###Output :Usually adults have fatty bone marrow. Hematopoietic bone marrow can be an indirect sign of hematologic conditions. Hence the hematological correlation to make sure."}
{"text": "###Input :Thank you kindly. Hematopoietic is just various types of blood? ###Output :Hematopoietic cells are the cells in our bone marrow that produce the blood cells"}
{"text": "###Input :68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6\" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important? ###Output :Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding."}
{"text": "###Input :I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions ###Output :It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother."}
{"text": "###Input :1: It really seems like he should have been diagnosed and started treatment for MDS after the bone marrow biopsy/aspiration in July 2021, not 11 months later given the fact he has tried so many therapies for ITP with no response. It also notes that patients \"typically have mild-moderate thrombocytopenia.\" He has always been below 50K, surely that's not moderate?What is your opinion on his history/diagnosis?2: I believe the nurses screwed up with premedicating him for his tranfusions during his last hospital visit. He had negative reactions on the two days I know they deviated from what is clearly on his chart AND on the request from his hematologist/oncologist which tells them what medication he needs when. Then, units aren't even ordered for the following two days, a man who is recorded as transfusion-dependent in his chart. Prior to his hospital visit, the premeds were followed almost exactly with no negative reaction, and after noticing his head bleed, the nurse followed the premeds exactly with no negative reaction. I am going off of his medical history acquired from the hospital which notes exactly when the medication is administered (not being confused with when they charted it). His cause of death is noted as acute respiratory failure due to PNA, but its only because we took him off the oxygen due to the head bleed which I believe they caused.Am I looking at this wrong? Did they mess up?THANK YOUI know, it's a long one. I really appreciate it if you took the time to read through it and give your thoughts and opinions.I know he had a rough disease, and I believe I could accept his death, but something in these hospital notes stinks... ###Output :Having treated many patients like this, these cases are often very difficult to manage. They sent off clonal hematopoiesis of indeterminate potential (CHIP) which is helpful in identifying mutations that may be causing cell abnormalities in MDS and sometimes garners targetable mutations eg IGH, del5q, ringed sideroblasts. However many of these we do not have detailed data given rarity so their effects on treatment are still unclear. In February 2023, that loss of chromosome 7 confers a very very poor prognosis along with refractory thrombocytopenia. I believe getting palliative care involved at this point may have been warranted. I do not believe any treatment wouldve changed his course by this time.I dont think a mistake was made by not treating him since signs of transformation to AML were not evident on the marrow from 2021. A score we use to predict transformation would also predict that prognosis was good with low chance of AML transformation in the next 10 yrs. Your father also has an extensive cardiac history and the drugs we use to treat MDS to AML have significant side effects including heart failure which Ive seen happen before from anthracycline. He had too many comorbidities so Vidaza was appropriate when it was given which is used to treat AML. Wed classify him as medically unfit but not frail and these patients are typically very hard to treat. Patients also become refractory to transfusions over time because their body starts making antibodies towards platelets. I do not think the mix up with premeds made a difference.Watching a loved one die from a hematologic malignancy is not easy, especially MDS. Please make sure you take care of yourself as well. I am very sorry for your loss. You did the right thing letting him go like you did. There was no meaningful way out of his situation where he would go on living a quality life. Please know that his medical team did everything they could."}
{"text": "###Input :Hey yall My kiddo (3M, approx 42 pounds, 3.5 feet tall) (daily meds are nexium, senna, zyrtec, tenex, atarax, melatonin) got referred to hematology and I'm drawing a blank on what questions to ask. He had a blood smear that had \"abnormal lymphocytes\" and a high level of lymphocytes. He started seeing Immunology a few months ago because he's always had frequent infections and fevers just about daily for most of his life. Immunology doesn't have any diagnosis, but are thinking of referring him to rheumatology. Im just not really sure what questions to ask or what to say really. If there's a better sub for this, please point me in the right direction. Thanks y'all! ###Output :Where does it say \"abnormal lymphocytes\"? That's unusual language. \"Atypical\" lymphocytes are seen with viral infections, classically mono. If the blood smear was the reason for referral, I would ask what the results mean. If the answer isn't clear, keep asking until you understand. They will tell you the differential diagnosis for the findings and what additional tests they recommend. There might be none.Frequent infections are the rule in childhood, not some weird immune deficiency. Is he really having fevers every single day for 3 years? Also, one of the most common findings with immune deficiencies is poor growth and your son is a tank :) Rheumatologic conditions in preschoolers often come with poor growth, rash, joint swelling, and very abnormal blood tests. But they can be more subtle and I can't say on the internet if that's a possibility in your case."}
{"text": "###Input :i meant atypical, im sorry! it was in the notes for the test result.He has fever just about every day, if its not fever, its right under fever (99.9-100.3) but most days its 100.4 or higher. He usually gets sick 1-3 times a month, and he stays sick and his pediatrician says thats too much especially for a kiddo not in day care or anything like that. Hes been hospitalized a few times and they havent been able to figure out what causes it. This is something weve been dealing with pretty much since he was born. ###Output :Has he ever had a CRP or ferritin? What was the total WBC and neutrophils on the blood count?I think hematology is unlikely to solve this for you. Between immuno and rheum they may have some recommended tests for uncommon causes of recurrent fevers."}
{"text": "###Input :3F with persistent nosebleeds, referred to hematologyMy daughter 3F has had persistent nosebleeds since she was 18m. We had a blood draw the other day for Von Willebrand screen and her Ag%, factor activity, and factor VIII numbers were normal. However, the lab still did show high Prothrombin time, INR, and aPTT. However, I have no clue what that means. We've been referred to pediatric hematology but the first appointment isn't until April. Can someone give me a run down of what these kinds of results potentially mean? Should I look for a hematologist with an earlier appointment? ###Output :Could be platelet aggregation/functional disorder, a possible other factor deficiency like prothrombin, fibrinogen, factor V, or factor X or an acquired factor inhibitor (less likely at that age). These would all affect both PT and PTT times.We worry most about these folks with procedures or when she hits puberty and starts having menses. Its good that she is getting checked out by hematology. There is no urgency unless youre noticing other signs of spontaneous bleeding like bloody stools, large spontaneous bruises or joint swelling (common place to bleed for hemophiliacs)."}
{"text": "###Input :Low MPV?Hey, just a quick question! My son (3M, 42lbs, 43 inches, daily meds are Tenex, Atarax, Nexium, Senna, Cetrizine, Albuterol) has always had a low MPV on every CBC since birth and I was just wondering if that meant anything. I know theres a lot of components when it comes to blood, but Im just curious about that one thing. He does have a hematology appointment coming up next month, I just wanted to know what yall thought. ###Output :Low MPV (mean platelet volume) usually doesnt mean much. We worry moreso when they are enlarged. If MPV is actually low <7, it can indicate problem with production but we very rarely see this. Reduced production can happen for any number of reasons eg infection, medication effects or reduced bone marrow production. Usually we would review a blood smear to see exactly whats going on and heme can do this."}
{"text": "###Input :any heme docs who can interpret this CBC?24M, 5'10, 200 lbs, East-Asian.Elevated BP (usually around 140/90), No alcohol use, no drug use. not on any medications. Not diagnosed with any conditions. Family history of DM2, High Blood Pressure.No complaint and no symptoms of any kind, but I recently went to my PCP to get a checkup due to an older sibling being diagnosed with DM2 recently. The physician ordered a CBC with differential/platelet and CMP. CMP results were completetly normal, but many markers for the CBC were off from the reference values.I asked my PCP the significance of the results and he told me that he's not quite sure. Then, to make sure that the results are not due to lab error, he had me take a second blood test about 3 weeks after the results of the previous one. The test this time included Iron and TIBC as well as Ferritin. Results basically came back identical to the results of the first test.He basically asked me to schedule a visit with hematology because he's not sure how to interpret the results. I just scheduled a visit with a hematology group near me but it'll be mid august before i can see them. Seen as I just need someone to interpret my CBC results, i figured it might be quicker if one of the docs here on reddit can do a quick reading so i can have peace of mindThe results the second test (with comparision to the values of the initial test) are as follows:https://imgur.com/a/gxgM99T ###Output :Low MCV like this with normal hemoglobin is likely a hemoglobinopathy like thalassemia. Could also be something like spherocytosis. Hematology should look at a blood smear, maybe run hemoglobin electrophoresis and can give you a more definite answer as to what is going on. Your RDW being elevated suggests that you're churning out new cells or possibly have a vitamin deficiency. Lots to discuss with hematology here but nothing that is ominous or emergent. Normal ferritin suggests that you aren't iron deficient which was tested because of low MCV."}
{"text": "###Input :Should I be concerned with repeated abnormal CBC labs?For some background, Im a 35 year old female, relatively healthy, normal BMI, no major health events, Ive never smoked cigarettes, rarely drink, not taking any medications.During my most recent physical (3/23), my practitioner was slightly concerned about my CBC lab results from 2020. At that time, my platelets were low (81 103/uLtheir standard range is between 140-400 103/uL), but all other values were within normal range.After the physical, I had my labs drawn and everything was normal with the exception of my platelet count. The platelet count was inconclusive and there was a note stating that they were unable to give numerical value for the platelet count. My practitioner messaged me and said that she had never seen this before and advised me to have my labs redone. She also advised the nurse to collect my new sample in a sodium citrate tube.I had my labs redrawn last Friday (4/14), and as of yesterday I had not received my results. I typically get these results back in 1-2 days, so I decided to contact my physicians office. A nurse promptly replied and told me that my blood sample had spoiled before it made it to the main lab for processing, and that I needed to come back to redo the test.This morning a woke up to a message in my patient portal stating that the blood sample did not spoil, and hematology assumed that there was essentially an abnormality with the sample.Im going back to have my labs redrawn this morning.Im not quite sure what to make of all of this? Ive been trying not to dwell on it, but Im becoming concerned after all of these failed attempts to obtain my platelet count. I would greatly appreciate any suggestions or guidance! ###Output :Was the low sample done in the new tube your PCP suggested? If not, she is correct in suggesting it get drawn in that tube. Sometimes the chemical in the normal CBC tube interacts with the platelets and gives a falsely low number."}
{"text": "###Input :Basically Im just a little nervous about all this, (Leukemia, Pulmonary Arterial Hypertension are my main concerns ). Can anyone offer any guidance or insight into these findings and help me understand my questions better? Thank you for reading this novel, I truly appreciate any help or guidance anyone could give me. ###Output :Do you snore? Now you say you are sleeping better, are you having fewer of these nocturnal episodes?**Lab / Test results ** are normal. Almost completely normal. While the \"normal ranges\" for our lab tests may not match your bodies, being within 10-25% and stable is completely normal (for you). I do not see any abnormalities at all here really. Your ECG may show slightly tall P waves (maybe MAYBE slightly taller in May if I squint) but an ECG is not accurate enough to that degree. Also, there are other areas of the ECG with some variability, this likely means the positioning of the leads from May does not exactly match that of the prior."}
{"text": "###Input :HANK YOU SO MUCH! What you said, I think you may have figured it out. Last year, I started grinding my teeth at night. I would wake up in the middle of the night because I would slam my teeth together, and started to develop TMJ pain. So, I had a custom night guard made, but then I found I would it would keep my lips slightly parted while I slept, which dried my mouth and throat while I slept. So, I bought a velcro anti-snoring head strap (https://www.amazon.com/gp/product/B081NJT3YF/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1 but an older model) but in order for it to keep my mouth shut, I had to get it pretty snug, which I now think may have been pressing on my airway.The last week or so, I've been only attaching it partially (the part on the front part of my jaw, and wearing a sleep mask to keep out light, which helps keep it from riding forward/backward and falling off my head, and I haven't had any significant episodes since. A little chest pain here and there, and a sensitivity to any form of anxiety or overstimulation (I think my body might just be in a very hypersensitive healing state right now to encourage rest, I was only getting about 4 hours of sleep during those episodes, and waking up several times a night).I am waiting on old ECG's from 10+ years ago, so if it shows the taller P-Waves, I guess it might just normal for me, probably precipitated by the head- strap airway obstruction. I've always had chemical sensitivities that manifest as chest-tightness/shortness of breath. I've had many doctors since childhood tell me that I might be considered borderline asthmatic, but I am a minimalist when it comes to pharmaceutical interventions unless I cannot get around it with diet/exercise/lifestyle changes.I will still go ahead with my doctors appointments for due diligence, but I think you have solved it and helped ease my anxiety enormously. Thank you again! : ) ###Output :That is very interesting! But yes that was interesting when you said you were sleeping better now. Demonstrating that you can tell when something is better. I would not worry about the old ECGs, I would not have really called that R Atrial Enlargement, it is mostly normal.Happy to help!"}
{"text": "###Input :What does this mean? Need a set of eyesHi, I went to hematology/oncology for low WBC count that resolved on its own and I have had lymphnodes that are palpable in my neck for years which have already been checked by another oncologist/surgeon/2 GPs and they werent concerned. However the recent DR I seen took an ACE test and I was elevated. I waited 6 months went to another doctor to re-test and it was at 136 while the cut off was 80 at this particular lab. Im very concerned and I have an appointment with a pulmonologist in a week. I have been stressing because Google says that high ace levels either indicate Sarcoidosis or Lymphoma. Does ACE levels mean malignancy? Google has such limited information on ACE levels and I need some knowledge. Im very concerned with Lymphoma. ###Output :Usually concerned about sarcoidosis more than lymphoma with a high ACE level. They both can be co-diagnosed but this is a very rare phenomena. Pulmonologist is exactly who you need to see next as the lungs are most affected in sarcoidosis. Given prior work up, Id have low suspicion for malignancy."}
{"text": "###Input :Please help me understand this. Scared19, Male, 60, 180 lbs, Usually healthy, Works-out 5 days a weekHi there, I went to hematology for a low WBC count and while there I mentioned to them that I have had palpable lymph-nodes in my neck for 3.5 years and I have already been checked previously by 4 doctors including a pediatric oncologist and had multiple ultrasounds which suggest its non-concerning. However, she took an ACE level test and it came back elevated and she said something along the lines Youre ACE levels came back elevated and it could suggest sarcoidosis and if youre concerned go to a GP and get it measured again  ANYWAYS! I didnt think much of it and let it be for 6 months & I went to a Nurse Practitioner to repeat my CBC out of curiosity which showed everything was normal and my WBC was 5.6 which was great. I also asked for the ACE level test to be re-measured and they didnt know what that even was. They had me come back after they researched it and then they took a small vile of blood. They sent it off and it came back high at a 135 and cut off for that lab was 80. I am freaking out because he contacted the hematologist doc and they said I should go to a pulmonologist. I feel perfectly healthy and better than I ever have. I am freaking out because google keeps saying ACE levels being high indicates: Lymphoma, Multiple Myeloma AND Lung cancer. I am absolutely plummeting right now and nothing makes sense to me. Please give me some advice OR knowledge. Its hard to find stuff online speaking about ACE levels. ###Output :ACE level is a very nonspecific test. It is not recommended for exactly this reason. Positive tests have <25% chance of having sarcoid, especially if they aren't sent for a good reason.I would followup to make sure but this is a good example of why we don't just send off a bunch of tests for no good reason - you end up with anxiety and chasing down a number of things that are not real."}
{"text": "###Input :okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this? ###Output :Very unlikely. We dont use it as a test to look for malignancy."}
{"text": "###Input :okay thanks for the responses. my NP i seen doesnt even know what the ACE levels mean and has no knowledge on it. think i should go back and see my actual GP? or is this something i can just let be elevated ###Output :I would be hard-pressed to know how to deal with this nonspecific test without seeing you and your lab records and getting a full medical history. So again I would followup. Depending on the level of suspicion a chest x-ray, chest CT or even biopsy might be warranted.It is generally more productive to wait until there are some symptoms but I can't reassure you that you definitely don't have sarcoid or a different autoimmune disease. It does not seem like you have cancer based on the lymph node surveillance"}
{"text": "###Input :Scared to death - Possibly cancer (leukemia/lymphoma)Hi, my husband is a 26-year-old M. He is 510 and weighs 190 pounds. No medical history beside hypothyroidism and takes 100 mcg of Levothryoxine. His mother has hypothryoroidism and his brother had a condition as a small child where his body attacked the collagen in his skin (scleordermia??). He had Covid in June and recovered in 3-4 days. He had routine blood work done because he has never had blood work done, and I encouraged him to do that. He works out regularly, and never gets sick. He does not have enlarged lymph nodes, no night sweats, no pain, or fatigue, weight loss, ect.He initially received a call from a local family doctor towards the end of January about abnormal blood work. His neutrophils were coming in at 0.1 as well as low WBC and high lymphocytes, and they wanted us to follow up with hematology/oncology. We were told that this blood work did have a bad blood smear that could affect the results. We found a hematologist/oncologist with a major hospital nearby and the lab work down below has been done by her office.We met with her today, and she said that his lab work on the 1st was not significant, and she would have not accepted him as a client had this been his initial labs. However, since he had the initial 0.1 neutrophils with the other small practice, she took him on. She said the blood work was not too off on the 1st, but that she wanted repeat lab work done. The CBC from the 14th was done after our appointment. She said during our appointment that if the lab work looked similar or was trending outside of the ranges more so then she wanted to do a bone marrow biopsy.We are scared shitless, and this has flipped our world upside down. Any insight or advice would be greatly appreciated. What is your take from these test results? Has anyone experienced this and its not been something as serious as cancer? Thank you in advance.February 14th 2023L : WBC (3.6-10.6) : 2.7RBC (4.5-5.9) : 5.17Hemoglobin (13.5-17.5) : 14.8Hematocrit (41-53) : 43.4%MCV (80-100) : 83.9MCH (26-34) : 28.6MCHC (32-36) : 34.1RDW SD (36.7-47.2) : 37.9RDW (11.3-15.6) : 12.4Platelets (150-400) : 236MPV (8.6-12.4) : 9.9L : Neutrophil % Auto (42-72) : 34.6%H : Lymphocytes % Auto (18-45) : 50.4%Monocyte % Auto (2-12) : 10.9%Eosinophil % Auto (0-5) : 2.6%Basophil % Auto (0-2) : 1.1%Immature Granulocytes (0-0.5) : 0.4%L : Neutrophil, Abs (1.8-6.8) : 1Lymphocytes, Abs (1.2-3.4) : 1.4Monocytes, Abs (0.2-0.9) : 0.3Eosinophil, Abs (0-0.5) : 0.1Basophil, Abs (0-0.1) : 0Immature Granulocyte, Abs (0-0.04) : 0Feburary 1st 2023L : WBC (3.6-10.6) : 3.1RBC (4.5-5.9) : 4.9Hemoglobin (13.5-17.5) : 14.1L : Hematocrit (41-53) : 40.8MCV (80-100) : 83.3MCH (26-34) : 28.8MCHC (32-36) : 34.6RDW SD (36.7-47.2) : 37.1RDW (11.3-15.6) : 12.2%Platelets (150-400) : 235MPV (8.6-12.4) : 9.7Neutrophil % Auto (42-72) 42.9%H : Lymphocytes % Auto (18-45) : 45.2%Monocyte % Auto (2-12) : 8.7%Eosinophil % Auto (0-5) : 2.2%Basophil % Auto (0-2) : 1%Immature Granulocytes (0-0.5) : NoneL : Neutrophil, Abs (1.8-6.8) : 1.3Lymphocytes, Abs (1.2-3.4) : 1.4Monocytes, Abs (0.2-0.9) : 0.3Eosinophil, Abs (0-0.5) : 0.1Basophil, Abs (0-0.1) : 0Immature Granulocyte, Abs (0-0.04) : 0February 1st 2023CMP All within normal limits.02/01/23 Pathology review blood smear report : Surgical Pathology ReportFinal Diagnosis : Neutropenia, rare circulating plasma cells  The concurrent flow cytometric analysis is negative for abnormal lymphocyte population  There are no significant hemolytic changes, dysplastic changes, or circulating blastsHistologic EvaluationPeripheral Blood MorphologyLeukocyte differential : Cells counted (100) : Bands/segmented neutrophil 54, eosinophil 1, basophil 0, monocyte 7, lymphocyte 37, plasma cell 1.Leukocytes : Neutropenia. Neutrophils are mostly mature and without dyspoiesis. Lymphocytes are mature and without over atypia. Occasional circulate plasma cells are present.Erythrocytes : Adequate with normal morphologyPlatelets : Adequate with normal morphology02/01/23 Leukemia/lymphoma phenotyping report by Flow Cytometry ReportComment : There is no evidence for increased blasts, increased plasma cells or abnormal lymphoid population. A negative flow cytometry does not exclude malignancy.Leukocyte DifferentialCD45 Dim Area : 1%Lymphoid Area : 59%-T Cells : 78%----CD4:CD8 ratio 1.5NK Cells : 12%B Cells : 8%----Kappa : Lambda ration 1.8Monocytoid Area : 3%--The monocytoid population has typical antigen expressionMyeloid area : 34%--The Myeloid population has typical antigen expressionANA Hep2 IFA w/ Reflex ENAANA IFA Screen : NegativeCMt1 : ANA IFA : NegativeFolate Level : 11.4Hep B Surface AntigenHep Bs Ag : NonreactiveCMT : Hepatitis B Surface AgHep B Core Antibody (Total) (ARUP)Hepatitis B Core Ab TotalHep B Core Ab Total : NonreactiveVitamin B12 Level (345-1485)  427HIV Av/Ab Combo  ScreenHIV  Ag/Ab Combo by CMIA : NonreactiveHep B Surface AntibodyHep B Surface Ab : NonreactiveESR, Westergren (0-15)  5TSH : (0.46-4.88)  2.54Hep C AntibodyNonreactiveHCV Signal to Cutoff Ratio : 0.05LDH (125-265) : 139 ###Output :This is a slight neutropenia, without symptoms and with these blood tests the likelihood of leukemia is incredibly low.Also, this is not a lymphoma."}
{"text": "###Input :Hi, thank you for your response. Based on the work above what makes you rule out lymphoma? Once again thank you! ###Output :From history: No enlarged glands, no night sweat,no weight loss and no fatigue. No description of splenomegaly or hepatomegaly.From differential: No clonal phenotype, no abnormal peripheral lymphocytes. No blasts.From biochemistry: Normal LDH, normal ESR, no anemia.Basically, none of the warning signs for lymphoma, neutropenia isn't even common in a lymphoma unless there is lymphocytosis or infiltration of the marrow. And ALL infiltration of the marrow should give more symptoms.Edit: I understand this is stressful, so I'm not trying to dismiss you, but I am trying to calm you."}
{"text": "###Input :Would a cbc with differential show blasts if they are present? I got a cbc recently and it didn't even have a line item for blasts. Just neutrophil, lymphocyte, monocyte, eosonophil and basophil? ###Output :The standard is to report blasts if they are present."}
{"text": "###Input :Would an automated cbc report as well? ###Output :You can really never know, sometimes it counts them as lymphocytes"}
{"text": "###Input :What could it be?16 year old male , 61, 105 lb, doesnt take meds, balanced diet, teenager so not a ton of exercise. Complains a lot about bone pain (legs and arms) and is always tired. Referred to hematology after standard labs, these are all labs the Hematologist pulled.These are the labs: Cd8% Tcells : 14 Cd8 absolute :204 Cd 16 + cd 56 (nk cells) : 64 Bilirubin direct: .30 Neutrophils : 28.6 Lymphocytes: 57.1 Monocytes 8.2 Basophils : 4.1 Absolute neutrophils : .9 Manuel nrbc : 2.0 Igm : 37 Wbc: 3.0 Mcv : 79.5 Mch: 25.5 Mchc : 32.2 Rdw: 16.6 Mpv:10.7 ANC .9 Segs % 28.6 Iron 223 Calculated TIBC 438 Iron saturation 51 Creatine .66 Ferritin 8 ###Output :Hard to say. Lots of info missing but cd8 cells are low. Absolute neutrophils are mildly decreased. Possible signs of iron deficiency.Guessing some sort of immunodeficiency. Best evaluated by both heme and immunology."}
{"text": "###Input :26, F. Slightly elevated RBC and high absolute lymphocytes.I [26,F] just got blood work done yesterday - routine chemistry and hematology tests. I weigh 120 lbs and Im 54. I do not smoke but used to vape. Everything under the routine chemistry test came back normal. My RBC shows as high (5.17). The reference range is 3.80-5.10. My lymphocytes were also high (4301 cells/mcL). The reference range for this is 850-3900 cells/mcL. My wbc, MCH, MCV, neutrophils, hemoglobin, and hematocrit are all normal.I got cbc tests done a year ago and they came back normal. I was sick all last week with either a cold or the flu. The doctor said my throat looked red. He used the stethoscope to listen to my heart and lungs and said everything sounded good. Could being sick last week cause the RBC and lymphocytes to be high? I have pretty bad health anxiety. Doctor didnt call me with the results yet but I can see them online. ###Output :High lymphocytes are likely from infection. RBC count is only ever so slightly high and normal by most standards. Nothing to worry about. Simply being dehydrated could also cause both counts to be falsely elevated."}
{"text": "###Input :Hematology investigation; can anyone please translate?Age: 36Gender: MaleWeight: 88kgs, Height, 175cmsLocation: CanadaEthnicity: SE AsianMeds: 40mg Pantaprazole 2x a dayAbout 2 weeks ago I posted asking what the docs here thoughts my hematology panel results meant (post below)https://www.reddit.com/r/AskDocs/comments/dis3kq/can_someone_decipher_my_hematology_panel/Following the results, my GP sent me to get a hematology investigation done. Below are the results.results: https://imgur.com/EINgINCCurrently my GP is away, but I will follow up in a week or so. In the meantime, would any docs here be kind enough to shed some light on what the terms mean? ###Output :Homozygous Hb E likely fully explains your CBC which has a pretty low MCV (ie your cells are small) but otherwise is normal. This in and of itself should not cause any real problems, though as noted there could be implications if you plan on having children. The most common scenario would be if a child inherits HbE from you and a beta thalassemia mutation from mom, which could result in the child having a form of thalassemia.A single alpha thalassemia gene deletion = you have 3 out of 4 functioning alpha hemoglobin chains. This also has no real significance in and of itself - people who have this and nothing else (including no HbE) would have totally normal labs. Again, your MCV is low because of the HbE and not the single alpha deletion.Hope htis helps."}
{"text": "###Input :reading my hematology results does it look like anemia?im female, 20 years old and i have graves disease, recently getting these results back im wondering if any of them point to anemia.(Hematology WBC 5.3 4.0 - 11.0 x E9/L RBC LO 3.96 4.00 - 5.10 x E12/L Hemoglobin 126 120 - 160 g/L Hematocrit LO 0.348 0.350 - 0.450 L/L MCV 88 80 - 100 fL MCH 31.8 27.5 - 33.0 pg MCHC HI 362 305 - 360 g/L RDW 12.0 11.5 - 14.5 % Platelet Count) ###Output :No. By definition it's not anemia."}
{"text": "###Input :15 y/o male, R arm swellingHello doctors of Reddit,My brother is a 15 yo male with 1 week of R arm swelling and mild/dull pain on shoulder abduction . He is an avid basketball player who trains very hard and he uses his right arm to shoot the ball. 3 days prior to onset of swelling someone hit him hard on the right shoulder. He didnt think much of it, but has mild ecchymosis on the shoulder.1 day after symptom onset he went to the ER. Ultrasound negative for DVT and echogenic material. CT scan of arm and chest negative for blood clots and mass. CT scan did not see a cervical rib but noted minor thoracic inlet narrowing. CBC normal PT/INR normal CPK elevated D dimer positive (ER physicians were unconcerned due to imaging) Protein C/S normal factor Leiden V normal Normal radial pulseHe was sent home with hematology and vascular surgeon follow up. The ER physicians suspect this is an overuse injury causing some type of impingement that resulted in the swelling of the arm.So far his arm circumference has dropped by 1 inch and his arm feels less tight, as in you can pinch the fat, which was difficult to do before. His pain has improved. We will follow up with the specialists but also a sports medicine doctor.Could this really be an overuse injury? Can such an injury really cause the whole arm to swell?Thank you all. ###Output :Holy shit at that ER work up. Seems.. thorough.Could be the bruise or a muscle strain causing swelling as well"}
{"text": "###Input :Protein electrophoresis and Lambda/Kappa Chain ResultsHello guys,Context: 23 year old M with most likely beta thallessemia based on other results who also presented with elevated wbc of 13.9 and lymphocytes of 5100. Doctor did some thalassemia and protein electrophoresis tests to confirm thalassemia.Thalassemia results came back consistent with beta thalassemia however my doctor does not know how to interpret the SPEP results and will send me the hematology. Wanted some input before my hematology appointmentProtein: 8.2 H (reference 6.1-8.1)Beta 2 Globulin: 0.7 H (ref 0.2 - 0.5)Kappa: 444 H (ref 176-443)Lambda: 269 H (ref 91-240)Kappa/Lambda ratio: 1.65 ( ref 1.29-2.55)CMP: WNLCBC: besides the ones listed above and other values typically associated with beta thalassemia is WNLSymptoms/Problems: noneAny inputs would be appreciated. Thank you! ###Output :Could be consistent w/ beta thalassemia, which affects hemoglobin (the protein in RBC responsible for carrying oxygen) and this can lead to anemia. The elevated beta-2 globulin might be the body's response to increased red blood cell breakdown, common in beta thalassemia. But the SPEP test isn't the main diagnostic tool for beta thalassemia; other tests like hemoglobin electrophoresis and genetic testing are more specific."}
{"text": "###Input :please help. 2 low wbc in a row, now seeing hematologyMy husband. Male, 48. Healthy.First wbc 3.5, no differential was done. Everything else normal.3 weeks later wbc 2.8 and neutrophils 1.4 with 1.5 being the lowest level for norm. Says 50.4%. All other levels still normal, monocytes normal but higher end. 0 immature granulocytes.Doctor said he knows we are scared, but really, really doesn't think it's cancer. Thinks most likely was fighting some kind of virus, but sending to hematology to be sure. Also has 2 immediate family members with rheumatoid arthritis.I'm very scared. ###Output :When just the WBC is low, your doctor is right, it's usually recovery from an infection. Cancer tends to cause more than one type of blood cell to be low, which doesn't seem to be the case."}
{"text": "###Input :Asking on behalf of my sister. Liver lab levels insane, among other strange things.Because the leukemia/lymphoma lab is taking forever to come back yet we have a ton others, her pcp isnt giving her much more info. Wonky highs and lows.36F, overall healthy, non-drinker and never smoked. Had 2 successful pregnancies and birth. Eats and maintains healthy diet and exercise. 57 145. All vaccines.3 weeks ago she started feeling achey. No upper respiratory stuff but general aches, fatigue and headache. Took several covid tests and negative. Ended up going to Hawaii where she thought she actually had covid there and those were also negative. She was complaining of the same thing. At one point, thought it was sun poisoning. Shes seemed to get worse and worse. A week later, which was 2 days after returning home she went to the ER for what she thought was severe dehydration. It wasnt that but they werent sure what it was. Said to see her pcp.ER doc did a handful of labs. Initially told her to see her pcp for follow up labs for mono or leukemia. Her joints ache, a weird floaty face feeling, no fever, no upper respiratory, majority of joint pain is in her legs and toes feel strange. Headaches here and there. Otherwise, she feels okay. No notice of brushing, bloody noses, rapid weight loss.Labs below. If a number is in here more than once its because it was the second lab test when increased. Nothing of concern went down, but only up. Only test we are waiting on, of course, is the leukemia one. Mono all came back negative and no antibodies.Sediment rate 4 - normal, Smudge cells - mild, C reactive - higher at 12, Polychrom, platelet morph and others in category this tests were all few or normal, WBC 8.02, Rbc 5.1, Hemagblobin 14, Hematrocit 41, MCV 83, Mch 29, Mchc 35, Rdw sd. 40, Mpv 9 - low., Nrbc 0 , Neutrophils 23.5% low, Lymphocyte 70% high, Mono 3.9%, Eos 1.0 % bordering, Baso 1.2%, Ig .1, Neutrophil # 1.8, Lymphocyte # 5.64, Mono # .08, Eos .08, Baso # 10,Edited and added below AST -57, ALT 61,Others I missed: Anion gap 2, Globulin 3.5, Albumin/gobulin ratio 1All plasma levels seem in range besides glucose bordering high.Can anyone share if youve seen a blood work up look like this? The overall sickness has been going on for 3 weeks now and is increasingly getting worse.If its not CLL like our minds are nervously going towards, do you recommend she ask for a referral to hematology or rheumatology? Weve heard a virus already thrown in there and Im just wondering what virus out there does this to your body bc even tho Im not a dr her liver numbers arent ideal with some other markers showing some poor function Any comment to give insight would be great! Thanks. ###Output :Where are the liver labs? And how did CLL get brought up?"}
{"text": "###Input :CLL was brought up bc of the higher absolute lympho count and the moderated smudge cell. The ER doc wrote it on discharge to pcp. ###Output :I'm a ED physician, and this...sounds unusual. In CLL, the white count should be significantly elevated which in this case, it is not. Furthermore, the presence of smudge cells is not necessarily indicative of CLL. I be surprised if this was CLL. This is likely some sort of viral infection if I had to guess."}
{"text": "###Input :Post-Stroke Pneumovax?47f, hx of PCOS and gerd, overweight.I had an ischemic cerebellar/medullary stroke in 2021. It occurred 3 days after my second Pfizer vax, but no providers have really considered a link other than hematology, who saw me once and ruled out clotting disorders. He thought there could be a correlation, but said that there was no existing evidence. They never found a real cause. I was Covid negative at the time of my stroke but had a moderate case in April of 2020, so it had been 10+months. My cholesterol was elevated at the time of the stroke, so Ive been on a statin since then, and its remained in the normal range.Im an RN and am definitely pro-vaccine and pro-science, but Ive been hesitant to get my Covid boosters since the stroke. Also, I have Kaiser and my stroke has triggered a recommendation for the pneumonia vaccine. My own PCP wont advise me. When I asked her the risks of the pneumonia vaccine and named my fear of further stroke, she told me to speak to my family.Has anyone seen any discussion or research regarding this, or can anyone offer recommendation regarding both the boosters and other vax? Thanks so muchDont inbox me if youre an anti vaxxer because Im not interested ###Output :In massive datasets there has been no correlation between Pfizer and stroke, although there has been risk of cavernous sinus thrombosis with the AstraZeneca vaccine.Pneumococcal vaccination hasnt had quite the sudden pileup of data, but thats been studied and no link to strokes.Prior COVID infection raises cardiovascular and cerebrovascular risks even up to a year later, even after mild illness. That and bad luck are the most likely culprits for you."}
{"text": "###Input :Are promyelocytes showing on blood test normal?M 27, 6'1'', 150 pounds. I recently had bloodwork done due to low energy levels/pale skin. RBC was 4.0 and WBC was 3.4, both low but I guess not far enough outside the range to be a red flag yet. Hematology is having me retest in 4 weeks.What is concerning me is I have promyelocytes of 0.06 when this should be at zero, and everything I've read says this is never a good sign. My doctor and hematology didn't mention this at all in their notes, should I be concerned?Really appreciate the help.EOSINOPHILS,MANUAL COUNT0.16 x1000/mcLBASOPHILS, MANUAL COUNT0.03 x1000/mcLPROMYELOCYTES, MANUAL COUNT0.06 x1000/mcL ###Output :Best to call your GP and discuss this. Those cells are usually indeed found in the bone marrow instead, not in the blood."}
{"text": "###Input :High eosinophils anxiety or underlying issue?Age : 24Sex : MaleHeight : 61Weight : 190Race : CaucasianDuration of complaint : unknown how long persisted under radar.Location : North America / SoutheastAny existing relevant medical issues : none.Current medications : propranolol.Hey everyone, for any with experience in hematology, I went to the doc a month ago for routine work and a check up. After a blood test returned, it appeared that everything was normal, nearly in perfect ranges, with the exception of my eosinophil count.Normal ranges are between 0-500 per x value and comprise 0-6% roughly of all white blood cells. My white blood cell count alone was practically perfect (middle of range, if not slightly favoring lower end) and all individual white blood cells were in optimal ranges, however my eos was rated at 1500, nearly 3x the standard, and at 19%.For some context, I had just gotten back from a trip in California where I had a fairly massive reaction to poison ivy or oak or sumac, it covered a significant portion of my legs (60%) and it was streaked on my torso and my arms. I also, not even a week before, had been ill or had an allergic reaction to something in a house I stayed in that is suspected to have some mold in it and cats which im Allergic to. I was sick for probably 3 days.I have my second blood test tomorrow and am a bit stressed by this. Any direction, advice, anecdotal evidence etc is appreciated. ###Output :Almost certainly due to your exposure to the plant."}
{"text": "###Input :Worried about a blood cancer but doctors aren't? Petechiae that come and go?25M, 6'0, White, 175lbs. Manual Labor Job, lifted weights until june 6th (mostly due to workload) No alcohol/smoking, only THC gummies. USA(Prior Health Concerns)-Rosacea-Late Dec 2020 I tested negative for covid, unbearable stomach pain/bloating whenever I ate. Lost 11lbs over 7 days until I could finally eat again. Saw GastroEnter early Jan '21. Gastroscopy, upper endo, colonoscopy. All biopsied, no inflammation. No blood in stool. Total mystery to them that resolved and never came back. Had remnant pains the next few months, tingles/tickles around torso, all resolved in time with no medications/treatments.-August 2nd, had knot under left armpit for two months ultrasounded, ruled benign, not pathologically enlarged(Current Health Issues)I've had issues the last few months. My hands felt cold/stiff in the fingers, no pain. This lasted only a few days before going away, (June 1st). GP said Raynaud's. Almost as soon as the finger issues stopped, I went to the ENT for a migratory feeling of fullness in my throat for multiple weeks that turned out to be acid reflux, and issue I have had off and on for the last handfuls of years (Maybe once a year), but never like this. I'm on omeprazole 20mg daily and that has been resolved. Back issues (now believed by trial/error to be caused by highly acidic food (Homemade hot sauces) have all but recently resolved. Migratory from spine to flanks, almost always symmetrical radiating irritation/tightness. Only two instances of sharp pains when eating spicy/acidic food, so I associate that with the acid reflux. These back issues never affected my mobility, and only ever had an issue like this when I had the moderna vaccines (Which kicked my ass for three days each)My biggest concerns have been my blood work. Initially my doctor was worried about my platelets on June 6th. (Still had back issues). I was on a plant based diet, and he recommended I go off it because he has no experience with it until we see what's happening. I resumed a traditional diet until follow up bloods and peripheral smear on June 22nd. Almost everything bounced back into normal range, or at the very least recovered significantly. No concerns on his end other than slightly low wbc, peripheral smear great. I felt better, and resumed a plant based diet until I felt started to have back/hand issues again.Aug 2nd - I also noticed some flat individual dots on my trunk/legs. Only about 5 at the time. Some of which are raised. He said they are petechiae, never go away, and that was that. Two of which I vaguely remember noticing a few years ago but cannot be certain. More bloodwork and smear done. Both smear results are of no concern to GP or hematologist (Facility requires all bloodwork reviewed by Hematology across the street as per policy)The last handful of days I noticed a cluster under my left armpit of petechiae, which had mostly faded before returning again today, but not as prominent. I have a hematology appointment on the 15th. Both doctors are not concerned of Leukemia, but Hematologist is still interested to see what's up and GP said all his resources are exhausted.I have no organ enlargements/lymph node enlargement/no fatigue/nightsweats/weight loss. No inflammatory markers, healthy kidneys/liver/spleen. No reduction in appetite (Quite the opposite) Only Low wbc and mild hand symptoms that come and go that had remedied when returning to traditional diet but dropped since returning to plant based. The last three days I have noticed minor \"tickles\" around my body. I wouldn't say itching. Similar to the tingles I would get when I had my stomach issues about 3 years ago. None of my symptoms ever got worse at night, quite the opposite.(Questions)Would cancer symptoms wane and reoccur? Would my bloods have recovered so fast if I it was? I honestly don't know what to think at this point. I feel like by now if it was leukemia it would have been caught in the blood smears or my conditions would have worsened, not (mostly) resolved?I understand my WBC is low, but would it be considered pathologically so? All abnormal labs are posted, everything else fell into normal rangeshttps://imgur.com/FZEIlnE (Bloodwork)https://imgur.com/Lhw9UC1 (Petechiae) ###Output :Blood smears are diagnostic for blood cancers. If theyre normal, you dont have blood cancer."}
{"text": "###Input :Worried about a blood cancer but doctors aren't? Petechiae that come and go?25M, 6'0, White, 175lbs. Manual Labor Job, lifted weights until june 6th (mostly due to workload) No alcohol/smoking, only THC gummies. USA(Prior Health Concerns)-Rosacea-Late Dec 2020 I tested negative for covid, unbearable stomach pain/bloating whenever I ate. Lost 11lbs over 7 days until I could finally eat again. Saw GastroEnter early Jan '21. Gastroscopy, upper endo, colonoscopy. All biopsied, no inflammation. No blood in stool. Total mystery to them that resolved and never came back. Had remnant pains the next few months, tingles/tickles around torso, all resolved in time with no medications/treatments.-August 2nd, had knot under left armpit for two months ultrasounded, ruled benign, not pathologically enlarged(Current Health Issues)I've had issues the last few months. My hands felt cold/stiff in the fingers, no pain. This lasted only a few days before going away, (June 1st). GP said Raynaud's. Almost as soon as the finger issues stopped, I went to the ENT for a migratory feeling of fullness in my throat for multiple weeks that turned out to be acid reflux, and issue I have had off and on for the last handfuls of years (Maybe once a year), but never like this. I'm on omeprazole 20mg daily and that has been resolved. Back issues (now believed by trial/error to be caused by highly acidic food (Homemade hot sauces) have all but recently resolved. Migratory from spine to flanks, almost always symmetrical radiating irritation/tightness. Only two instances of sharp pains when eating spicy/acidic food, so I associate that with the acid reflux. These back issues never affected my mobility, and only ever had an issue like this when I had the moderna vaccines (Which kicked my ass for three days each)My biggest concerns have been my blood work. Initially my doctor was worried about my platelets on June 6th. (Still had back issues). I was on a plant based diet, and he recommended I go off it because he has no experience with it until we see what's happening. I resumed a traditional diet until follow up bloods and peripheral smear on June 22nd. Almost everything bounced back into normal range, or at the very least recovered significantly. No concerns on his end other than slightly low wbc, peripheral smear great. I felt better, and resumed a plant based diet until I felt started to have back/hand issues again.Aug 2nd - I also noticed some flat individual dots on my trunk/legs. Only about 5 at the time. Some of which are raised. He said they are petechiae, never go away, and that was that. Two of which I vaguely remember noticing a few years ago but cannot be certain. More bloodwork and smear done. Both smear results are of no concern to GP or hematologist (Facility requires all bloodwork reviewed by Hematology across the street as per policy)The last handful of days I noticed a cluster under my left armpit of petechiae, which had mostly faded before returning again today, but not as prominent. I have a hematology appointment on the 15th. Both doctors are not concerned of Leukemia, but Hematologist is still interested to see what's up and GP said all his resources are exhausted.I have no organ enlargements/lymph node enlargement/no fatigue/nightsweats/weight loss. No inflammatory markers, healthy kidneys/liver/spleen. No reduction in appetite (Quite the opposite) Only Low wbc and mild hand symptoms that come and go that had remedied when returning to traditional diet but dropped since returning to plant based. The last three days I have noticed minor \"tickles\" around my body. I wouldn't say itching. Similar to the tingles I would get when I had my stomach issues about 3 years ago. None of my symptoms ever got worse at night, quite the opposite.(Questions)Would cancer symptoms wane and reoccur? Would my bloods have recovered so fast if I it was? I honestly don't know what to think at this point. I feel like by now if it was leukemia it would have been caught in the blood smears or my conditions would have worsened, not (mostly) resolved?I understand my WBC is low, but would it be considered pathologically so? All abnormal labs are posted, everything else fell into normal rangeshttps://imgur.com/FZEIlnE (Bloodwork)https://imgur.com/Lhw9UC1 (Petechiae) ###Output :Blood smears are diagnostic for blood cancers. If theyre normal, you dont have blood cancer."}
{"text": "###Input :Can MCV go up by a few points over a month, still in normal range - should we be concerned? All levels listedMale -48 (my husband)WhiteWeight 163No signs/symptomsCan an MCV increase in one month by 3 points?Been seeing doctor since April 2022 for low WBC and neutrophils. Everything else was normal. (found on routine bloodwork)Followed by hematology. They aren't all that concerned, but I have a question.This latest test (50 days after last one) his WBC went back up to 4.3 (previous low 2.8) and neutrophils are 2.5 (previous low 1.4).Of course now I see that his MCV went up to 95.8 from 92,8, before that 93.8 (still normal, ref high is 100)MCH stayed same at 32.5 (norm)MCHC went down from 34.5 to 33.6 (normal, ref low is 31)RDW 12.6 stayed same (norm)RBC went from 4.64 to 4.53 (still normal, ref low is 4.2)Hemoglobin went from 14.9 to14.6 (still norm, ref low is 13)Platelets, all other counts normal for him.Normal B12, Folate normal at 29.4Are these counts any cause for concern? Can they go up and down within range?He's had 4 blood tests within 3 months so I can see the fluctuations. Also to note, he's having heel pain/inflammation starting last week (from running we think). They did test for RA due to strong family history (dad and brother) but negative. Although doctor said that doesn't mean he's not developing it.And he has been eating a lot less healthy this month and gained some weight. ###Output :This change is within normal lab variation. Nothing to worry about."}
{"text": "###Input :Worsening Breath hunger with normal blood panel resultsMy doctor doesnt seem to think theres a problem here. Does anyone have an idea why I find it so hard to breath? Walking up the stairs is becoming more and more difficult. Im 33/f (I hope this makes sense, its translated from German)Material submitted: Whole blood or supplement, EDTA blood, GlucoExactinvestigationresultDimension reference areagraphicprevious valueCLINICAL CHEMICAL TESTSglucose10560-100The multiplication of the measurement result by a factor of 1.16 required for the GlucoExact tube was already 60-100 mg/dl (3.3-5.6 mmol) normal fasting glucose: 100-125 mg/dl (5.6-6.9 mmol) abnormal fasting glucose: >126 mmol/l) Diabetes mellitus (guidelines of the DDG from 10/2004, confirmed in Diabetologie 2010; 5: 109-112)performed.mg/dl (>7.0GOT (ASAT) GT29160.7<0.9Creatinine (Jaff)GFR (calculated, according to CKD-EPI)11460min/1.73m2COFIRON BUDGETferritin13-150LIPOS METABOLISM/ATHEROSCLEROSIS RISK DIAGNOSTICS45-23075cholesterol134triglycerides62mg/day20-150HDL cholesterol51mg/day48-83LDL cholesterolmg/day10-155LDL target values according to the ESC/EAS guideline: Diagnosis and therapy of dyslipidemia (2019 version): In the case of a low cardiovascular risk, an LDL cholesterol target value of <116 mg/dl (<3.0 mmol) should be set, and in the case of a moderately increased cardiovascular risk of <100 mg/dl (<2.6 mmol/l) should be aimed for. If the cardiovascular risk is high, the LDL. Cholesterol maintained at less than 50% of baseline and at least <70 mg/dl (<1.8 mmol/l) and very highcardiovascular to be sustained to less than 50% of baseline and at least to <55 mg/dL (<1.4 mmol/L).non-HDL8314-185Secondary non-HDL target values according to the ESC/EAS guideline: Diagnosis and therapy of dyslipidemia (2019 version): with a moderately increased cardiovascular risk <130 mg/dl (<3.4 mmol/l), with a high cardiovascular risk <100 mg/dl dl (<2.6 mmol). at very high cardiovascular risk <85 mg/dl (<2.2 mmol).VITAMIN DIAGNOSTICSVitamin B12197-771 1.8-9.0folic acidTHYROID DIAGNOSTICS TSH basal value1.250.4-4.0TSH in the reference range as an indication of a euthyroid SD functional position (assuming an intact HVL axis). Please note the changed reference range.Page 1/2amedes MVZ 1. Laboratory. and Microbiology Leipziger Chaussee 1911 06112 Halle/Saale Tel.:0345/44507-100 FAX:44507210amedeswithdrawal inputSurnamePIKE EMMAborn05/20/1989 (933 years)Payer checkout investigationYour number 7014147367 barcode number701414736707/26/2022 07/26/2022final resultlab noYPWG26 5414resultDimension reference areagraphicprevious valueHEMATOLOGICAL DIAGNOSTICSSMALL BLOOD COUNT5.44.0-9.0leukocyteserythrocyte hemoglobin4.2TA39-5313.0120-16.0hematocrit MCV3836-4789.880-9630.728-32MCHC34.230-36platelets150-400Commentary on findings: [1] Please note the changed reference range.This finding was medically validated by Dr. Biro, F for Laboratory Medicine ###Output :While your blood tests are normal, there isnt much of any investigation for shortness of breath (aside from demonstrating that youre not anemic). A typical workup for shortness of breath will include chest imaging (usually starting with a chest x-ray) and pulmonary function testing (breathing tests). If you doctor isnt comfortable working up your symptoms its always reasonable to ask about a referral to a pulmonologist."}
{"text": "###Input :27F immunocompromised and sick for two weeks. Getting worse. Rheumatologist is out of town and ER doctor sent me home pending blood test results that are still processing. Insight?Demographics: 27 female. Height 5ft 6in, weight 190lbs. Married.Conditions: rheumatoid arthritis and lupus; SVT.Meds: 2000mg sulfasalazine, 400mg plaquenil, 200mg Cimzia injection every two weeks.Non-smoker, no alcohol, no caffeine.Duration of complaint: 2weeksI have four doses of pfizer covid vaccine.Currently negative for covid.Two weeks ago before my scheduled Cimzia injection I spiked a low-grade fever. It was about 37.8c. Since then, my temperatures have been 37.5c to 38.5c. Acetaminophen will not bring my temperature down. It initially started with fatigue and headache and fever.Last week I began to get a sore throat, sweating, clamminess, chills, mild sinus pressure, confusion, shortness of breath, and a slight cough.I went in for monthly rheumatology bloodwork on 7/28. Ill attach the results. Mildly decreased WBC and Neutrophils.On 7/29 I went to the emergency room as my primary doctor instructed me to because I was not improving. Many cultures were taken. WBC further decreased and neutrophils were more than half of the previous day. There is a WBC Morphology pending pathologist review.Sepsis cultures have not shown any growth over the day.X-ray of chest showed no abnormality.Im confused as to what could be causing this. The ER doctor also said he was confused and it could be a medication or a nasty virus (was not tested for these) and that I have neutropenia and I am quite immune compromised but left it at that.Today, 7/30, I have had more difficulty breathing, particularly with movement or talking. Im coughing green/yellow thick mucus. More fatigue. My lungs feel heavy.Im thinking of heading back to the ER tomorrow if symptoms get worse, but Im not sure it will do any good for me or provide me with more.Is there any insights?Ive reached out to my rheumatologists receptionist as well as my primary doctor. However, Monday here is a holiday so the offices are closed. The earliest I could see my primary is on Tuesday, and Im not sure how much further it will progress by then.here is the link to my imgur albumI understand that some of the blood work with the hematology panel is still pending.Also, what does it mean with the WBC morphology Reviewed by technologist Sent to Pathologist for review? ###Output :I wouldn't wait a day more. Go to the ER. In my opinion you should be started on broad spectrum antibiotics asap, while waiting for results."}
{"text": "###Input :Any other possible causes of low WBC count? am hispanic 23F, 5'1, 105 lbs.Symptoms: some fatigue, occasional night sweats (maybe 1-2x/every 2wks for ~4-5 mo) that are drenching and wake me up, palpable non-tender L posterior auricular lymph node, submental, and R posterior cervical lymph nodes (but have been told by a otolaryngologist in a class these are probably just shotty/only palpable because I am thin), I mainly just saw a doctor to establish care after moving and for a physical because it had been a while.Medical hx: childhood asthma, internal hemorrhoids ongoing on/off for 4 yrs dx by colonoscopy, iron deficiency without anemia 2 yrs ago (likely d/t vegetarian diet)Current medication is Nuvaring. I drink max 2 drinks/wk, I do not smoke, and I do not use any drugs.Lab results:-CBC w/Diff: Repeated 3x over 2 months, same results. Results here of manual diff:WBC 3.1 10e3/uL 3.9 - 11.2 10e3/uL LRBC 4.9 10e6/uL 3.7 - 5.2 10e6/uLHemoglobin 12.1 g/dL 11.3 - 15.1 g/dLHematocrit 38 % 34 - 45 %MCH 24.8 pg 25.7 - 34.1 pg LMCHC 32 g/dL 32 - 36 g/dLMCV 78 fl 79 - 98 fl LRDW 13.7 % 11.0 - 14.9 %Platelet Count 180 10e3/uL 165 - 366 10e3/uLMPV 12.2 fl 9.0 - 11.8 fl HAutomated Nucleated RBC 0 %/100 WBCBand Neutrophil % 1 % 0 - 1 %Segmented Neutrophil % 43 % 43 - 74 %Lymphocyte % 49 % 17 - 46 % HMonocyte % 6 % 4 - 13 %Eosinophil % 1 % 0 - 6 %Basophil % 0 % 0 - 1 %Absolute Neutrophil (Segs and Bands) 1.36 10e3/uL 1.90 - 7.80 10e3/uL LAbsolute Lymphocyte 1.52 10e3/uL 0.90 - 3.20 10e3/uLAbsolute Monocyte 0.19 10e3/uL 0.26 - 0.86 10e3/uL LAbsolute Eosinophil 0.03 10e3/uL 0.03 - 0.52 10e3/uLAbsolute Basophil 0.00 10e3/uL 0.01 - 0.10 10e3/uL LRBC Morphology Comment Present RBC: Manual smear Review PerformedPoikilocytosis 1+ AOvalocytes Present ATarget Cells Present A-Other labs:normal CMP, negative ANA screen, negative rheumatoid factor, normal Vitamin D, normal B12, normal Folate, negative for hep B & hep C, negative TB skinMy question:My Dr. did an e-consult with hematology, and they were dismissive I think because I am young and relatively healthy and all of the above possible explanations were negative/normal. They said that it was likely just low WBC due to genetic variation. I have never had a low WBC count in the past (last cbc w/diff in 2020 was normal) and no one in my family has a low WBC count. I understand that it still could potentially be a \"normal\"/ genetic variant low wbc count, but are there any possible explanations for my results that have not been explored above and should I push to investigate or should I just wait and see if I start getting infections or other symptoms like they said I should? I am a student in a healthcare field and could just be over-analyzing and worried for no reason! ###Output :I wouldn't pursue anything further with this if you don't have frequent infections or any other symptoms. Some people just run on the lower end, and that's fine."}
{"text": "###Input :29F. Low wbc and neutropenia. Referred to hematology. Stressed because it takes time to see specialistI just need some peace of mind, something that can calm me down my pcp called me after my cbc test and said that they want to refer me to Hematologist just to make sure they dont miss anything. The soonest appointment for hematologist is in the end of January! I dont know what to do because all I can think of is Cancer or HIV because what else can explain my low wbc 2.9k/UL (3.9-12 standard range) and neutrophils 34.8% (40-70%) high lymphocytes 52.4% (25-45%) and high basophil 2.1 (0-2%) I am absolutely terrified and cant wait that long to find out whats causing it Can PCP run other tests in a mean time? ###Output :What else could cause it? A viral illness. Nutritional deficiencies. Drug induced neutropenia. Benign ethnic neutropenia. There's many potential causes besides what you jumped to. There are some tests your doctor could do, like a peripheral blood smear, folate and B12, some liver function testing and some screening panels depending on clinical suspicion from history and exam. Many of these may have been done or deemed not necessary."}
{"text": "###Input :Hereditary iron deficiency?Profile: 25, female, 58, 175lbs, active, Caucasian-Mediterranean, Complaint: -extreme fatigue despite adequate sleep -dizzy/ fainting spells -poor circulation -blood pressure and blood sugar fluctuations -severe brain fog -dissociative episodes -debilitating anxiety/ depression Has been going on for the past 5 years and steadily getting worse.Recent labs: Hemoglobin A1C: 5.6 Glucose fasting: 5.0 mmol/L Ferritin: 40 ug/L Hematology profile normal, electrolytes normal, kidney/ liver function tests (urine & blood) normal, B12: high 836 pmol/L Cholesterol: 4.82 mmol/L LDL: 3.01 mmol/L HDL: 1.51 mmol/L Non HDL: 3.31 mmol/LHello! So I (25F), my mother (50), and my grandma (74) all have iron deficiency. We all have no underlying illnesses, except that grandma and I are subclinical hypothyroid. No kidney or liver issues. No other inflammatory diseases, crohns, celiacs, etc.Recently I found out that ferritin is optimal at >100 ug/L. Pretty pissed because 5 months ago it was 54 and I was told it was normal and now its 40. all of my symptoms align with iron deficiency.Can anyone shed some light as to what the root of this may be? Is it possible its just hereditary?Thanks in advance for any responses. ###Output :Well, you all (presumably) menstruate. So you lose iron monthly. That can cause iron deficiency."}
{"text": "###Input :Yes. Thats what we assumed it is.. but it seems odd as we all eat meat. I know that certain foods like dairy can block iron absorption though. ###Output :It's not uncommon at all. Many people who menstruate are iron deficient"}
{"text": "###Input :Elevated liver enzymesI am a 29 YO male, 510, non-smoker (occasional marijuana smoker), there has been no symptoms or duration.So I made a doctor app because of high blood pressure, she sent me for bloodwork and the results showed elevated liver enzymes AL-something was 129 when normal is 9-65. After numerous questions it was noted that I chronically used extra strength liquid gel Advil 400mg (took 2-3 a day for a long time due to chronic neck pain). The doctor said this COULD be it but had to rule everything out and advised to immediately stop taking Advil. This was Monday June 20th. Extra bloodwork was taken (HIV, Hepatitis) but results only came back stating my enzyme levels got worse, now 165. So I got my third set of bloodwork today for more in-depth bloodwork under hematology. The doctor is still saying that she THINKS it COULD be the Advil use but they dont know for sure whats causing it or why its getting worse. I also have a ultrasound scheduled for July 11th.Im trying to remain calm but why is this suddenly happening when Ive NEVER been sick like this, I dont have pain in my liver, I dont have yellow eyes or skin (which the doctor asked). If it wasnt for routine bloodwork catching it I would never even know. The doctor says its still mild and its good we caught it when we did but we got to figure out whats causing it. She mentioned something about auto immune disease or gastro also but my mind is going to the darkest depths.. cancer. I have this sinking feeling like Im dying now. Please any insight or input. I know you guys wont have answers for me from a simple Reddit post but anything. ###Output :Many causes. Looks like good appropriate workup is being done. If you're overweight, fatty liver is a possible cause"}
{"text": "###Input :Referred to hematologist at a cancer center for chronic leukopenia, thrombocytopenia, and anemia, wondering if my bloodwork could be indicative of anything serious?TLDR; I'm wondering if my bloodwork could be indicative of any serious issues besides iron deficiency anemia. Screenshots of my results are at the link at the bottom.23F, 52, 113lbs, dont smoke, rarely drink. I take Vitamin D3 supplements.I have iron deficiency anemia. Im a lacto-ovo vegetarian, so Ive always assumed that my anemia is related to my vegetarianism. Last April, I was prescribed iron supplements by my doctor. I took them for awhile and my iron levels had improved as of October and I wasnt anemic anymore. Around the same time I started slacking off taking my supplements (havent taken many since October) and as of last weeks bloodwood, Im anemic again. Im not surprised about that. My physician said she was going to refer me to hematologist to see what their recommendations would be as far whether supplementation alone is fine or if they'd suggest an iron infusion.The past three times Ive had my bloodwork done Ive noticed that my WBC and platelet count was low and would think Huh thats weird, but assumed it had something to do with my anemia. The doctor never mentioned a problem with it so I figured it wasnt really anything to worry about. At the end of our appointment I asked if my anemia is related to my vegetarianism or if its hereditary. She said she wasnt sure because of my low WBC and platelet count, so thats why shes sending me to the hematologist so they can look into it further. This was slightly off-putting to me because I expected the answer to be my vegetarianism because thats what Ive always assumed. It possibly being related to another underlying issue has been bothering me a little bit. On the appointment details, she noted: Thrombocytopenia (chronic), Leukopenia (chronic), and iron deficiency anemia secondary to inadequate dietary iron intake.Fast forward to today and I get an update from my doctors office that theyre still in the process of making the referral to the hematologist. They let me know the referral request was sent to our local cancer center. Normally, I dont really worry about stuff like this unless given reason to worry. Im aware that hematologists often work at cancer centers so Im assuming thats why she referred me there. It just has me slightly on edge because my dad goes there for his chemotherapy. The type of cancer he has isnt hereditary, but its still a little concerning to get referred to the same place where your dad got diagnosed with cancer and is getting treatment. My grandma has leukemia and also goes there to have it monitored. Im not sure if hers is hereditary or not.When I was researching leukopenia a little bit more and its possible causes, another thing thats bothered me a little bit is that I dont really see much of a link to iron deficiency anemia like I originally thought. So I'm not sure what could be causing it. I saw that low B12 can, but my B12 levels were checked last year and they were pretty good. My WBC was even on the low side then. Other details is that Im African American on my moms side and Mexican on my dads. I haven't had folate or copper tested, so maybe a deficiency? I also recently found out that my paternal great grandfather was a hemophiliac. Several people in my family have had cancer.Anyway, heres my recent bloodwork. I was wondering if anyone has any input on what this could mean to put my mind at ease while I wait for my hematology appointment.https://imgur.com/a/63OzoXP ###Output :Your physician did the exact correct thing to refer you to hematology. The low platelets and white blood cells could be from many things. I agree that anemia is most certainly from iron deficiency. Given your ethnicity, low WBCs can sometimes be familial and we do see this more in the Black and Hispanic population. I am unsure why your platelets are low and this needs to be worked up. Leukemia is not hereditary. Hemophilia is hereditary and sometimes acquired but usually the former. Please let hematology know about this family history. You may also want to ask your mother if there is any history of sickle cell in her family given race.There is testing that can be done for folate and b12 deficiency but these levels (even when low) rarely affect WBC or platelet count. Based on your labs, there isn't anything that screams something ominous like cancer. Maybe autoimmune if anything as we see chronic non-life threatening low cell counts in these patients often"}
{"text": "###Input :32F, Fatigue, Migraines, Mild Bradycardia, Mild Anemia,Hi Reddit,My girlfriend has chronic fatigue, migraines, weakness, dizziness, and occasional stomach pains which cause her to be unable to work or leave the home somewhere around 1 in 4 days. She has been to several doctors who all use a very compartmentalized approach that simply finds nothing. Getting her to go to more doctors is a challenge, partly because of the fatigue but also because it seems to go nowhere (and I can't blame her). Here's the medical history as we've found it so far:Basic InfoWhite female32 years oldBorn Russia living in United States5'2\", 95 lbs.No tobacco, vape user, moderate drinkerLittle useful family historySymptomsMigraines and other headaches, 1-2x/wk, varying in response to NSAIDs and triptans (sometimes helps, sometimes doesn't)Often feels dizzy or says room goes black when she \"stands up too fast\"Can also black out under substantial stressCold hands/feet that she sometimes complains are numbLast year had several instances of extremely severe stomach pain, once resulting in hospitalization (has no reoccurred this year), no cause foundFatigue 3-5x/month severe enough to not leave home even without complaints of headacheDepression, PTSD-like symptoms from childhood traumaRecently measured heart rate of 57 bpm in eveningDiagnostics AttemptedHead and abdomen CT & MRI, negativeColonoscopy, Dx: gastritis, recommended treat with PPI and dietBloodwork, positive results: mild anemia (says all bloodwork since childhood was same), mild vitamin D defBloodwork, negative results: CBC and other basic hematology, thyroid issues, Lyme diseaseRx / TreatmentNexplanon implant (~2 years)J&J corona vax, 3/2020, no boost (previous infection: Delta)Bupropion + psychotherapy for depressionVitamin DIbuprofen and/or triptans for migrainesAdd'l InfoOften has trouble sleeping at night, ends up sleeping in morning until early afternoonDiet could be better (eats at random times, often not the healthiest foods)Does not exercise (dislikes running, weight lifting, outdoor activities in sun/heat)Stress seems to trigger episodes but can happen even without stress triggerAnyone have any idea what to try next for diagnostics? The reading of 57 bpm is a newer symptom and was contemporaneous with the cold/numb extremities, so perhaps some kind of cardiology workup? Having a partner that is constantly sick with no idea what's going on is stressing us and our relationship, but more importantly worries me that something significant may be being missed. ###Output :HR of 57 is normal.I know you said doctors have used a very compartmentalised approach, but I would actually use the term thorough.Incredibly so. While I appreciate how frustrating it can be for all of these things to come back negative, it is reassuring that theres no gross medical abnormality.The tests she has had are all incredibly sensitive and have even been repeated in different modalities, so the chance something has been missed is slim to none.I strongly suspect that what youre seeing is the effects of a functional disorder. With a functional disorder, there is no physical pathology resulting in symptoms. Rather, the symptoms are a manifestation of psychological trauma and/or psychiatric issues; two things that we know your partner unfortunately has.It is important to note that these symptoms are incredible real for the individual, even in the absence of physical pathology. This is not faking in any way.Your partners history is highly typical of this: general, multi-system symptoms with normal investigations.The management of these conditions is challenging. When theres a physical pathology, we can target it. When there isnt, theres nothing physical for us to target.That leaves us with the non-physical targets, which in this case is psychology/psychiatry. The most effective treatment for functional disorders with a known mental health history is treatment of said mental health history through a combination of medical and talking therapies."}
{"text": "###Input :Psoriatic Arthritis and Taking Methotrexate: Blood Work Comments[31][F], 5'2\" 90 lbs, white and Hispanic, biologic taken, no longer taking Methotrexate with psoriatic arthritis. No drinking or smoking.My rheumatologist is taking me off Methotrexate due to my blood work, in conjunction with me feeling absolutely awful.Can a doctor please explain why those comments on the two blood results were written? Is it that serious? Meaning--my doctor wants me to take a repeat. What is concerning?I attached the photos w/ Imgur:https://imgur.com/a/FDmJ7A0\"RBC01 3.49 Low 3.62 07/23/2021 x10E6/uL 3.77-5.28 Macrocytes present. Anisocytosis present.\"\" Neutrophils (Absolute) 01 1.0 Low \"\" Alkaline Phosphatase01 128 High 76* 07/23/2021 IU/L 44-121 AST (SGOT) 01 70 High 29 07/23/2021 IU/L 0-4 \": Hematology Comments: Verified by microscopic examination\" ###Output :Youve got a macrocytic anemia, likely due to the methotrexate causing a folate deficiency basically the blood cells are bigger than normal and not developing properly.The anisocytosis just means you have a variety of different sized RBCs, meaning its likely that you are within 90 days of when the assumed folate deficiency started - blood cells live on average about 90 days so you either have a mild deficiency or its somewhat new.Neutrophils can be low for many reasons, its not at a super worrisome level but couple with the anemia its likely partially due to one of the multiple mechanisms of immune suppression from methotrexate.Alk phos/ALT/AST are liver function tests, its just saying theyre slightly elevated. Overall not super worrisome levels but again likely due to cytotoxic effects from methotrexate.Its more so they dont want you to GET bad rather than the labs ARE bad. They are borderline right now but when you have a known drug causing it, you want to stop it sooner than later. They are likely just recheckingnit to make sure they dont need to do further intervention to prevent worsening effects and ensure your body is recovering before they would try an alternative therapy or restart the current therapy if absolutely needed.Definitely a conversation to have with them for more details, not a rheumatologist so I dont know all the cytotoxic effects of methotrexate off the top of my head."}
{"text": "###Input :Persistent elevated platelets35F, I have had platelet counts consistently ~500 for the past several months, on multiple repeat test. No other abnormalities on CBC. I have seen a hematologist and done several followup tests: no iron deficiency, no JAK2, CALR, MPL or BCR-ABL mutations. I had an abdominal ultrasound which showed normal spleen (incidentally found some gallstones). I take Wellbutrin 150mg and Lamotrigine 200mg. My last normal platelet count was in 2017, at 375.My question is like....do I need to pursue this further, and how? My hematologist wants to do a bone marrow biopsy but is unclear on what she expects it might find given my other results. My primary care doctor seems completely unconcerned (I checked back in after hematology and he just said \"I think that is all.\") I, of course, have done a thorough google and read all about the association with cancer, and given that no more benign cause has come up I've gotten pretty worried, but I don't know how much that's something I need to think about at my age/without any other specific symptoms. Can you just have higher platelets for no reason, or is it something I need to keep looking into? ###Output :Hematology could go either way - biopsy or no biopsy. Without symptoms, many would opt for no biopsy and monitor. Some would be more aggressive and do the biopsy because 10% of those with thrombocytosis secondary to a myeloproliferative disorder lack mutations. So theyd essentially be looking for an MPN. You could go either way and set a limit eg do a bone marrow if they keep rising or hit a certain number, you develop symptoms or other cell counts are abnormal."}
{"text": "###Input :Thanks for this! My hematologist wants to do the biposy, but the only thing she's talking about finding at this point is essential thrombocytosis, and if I had that we would just be doing regular labs to monitor it since I'm young and low risk. I'm already doing labs frequently to monitor the unexplained result, so for my money I'd rather put it off unless something more suspicious does come up. Glad to hear that's not insane ###Output :Just want to say that this advice shouldnt be substituted for your hematologists recommendations. Id discuss some of the suggestions mentioned and see if she is amenable to monitoring. She may have more information than I do about your situation as well eg low cell counts etc. that I am not privy to and this may change course of care."}
{"text": "###Input :Recurring severe petechiae on 5f, multiple doctors confusedMy daughter 5F Caucasian. No significant medical history. She has had recurring petechiae on her elbows and occasionally knees for approximately 3 months. She is otherwise very healthy and full of energy. The petechiae occur mostly while she is at school, always on predominantly left elbow with occasional right elbow and knees. They do not occur every single school day, but most days with varying severity.She has visited multiple GPs and a pediatric hematology specialist; none of these have been able to find an explanation. She has had multiple complete blood counts, clotting factor tests, and other bloodwork taken. Platelets, red blood cells, white blood cells completely within good normal ranges. All other tests returned completely normal findings aside from marginally low ferritin and fibrinogen. The hematologist said neither of these were of concern to her.Some images of the petechiae on various days recently:https://imgur.com/a/OHKjDtlAny ideas would be very much appreciated.EDIT: Sorry, I forgot to include this information! They are non blanching and totally flat. Non itchy. They go away within about 24 to 48 hours, only for new ones to appear.The doctors have generally identified them as petechiae, but can't determine a cause. ###Output :Sometimes skin biopsy can help with to diagnose conditions such as this.They looks raised and scaly. Can you run your finger over them with your eyes closed and feel them?Petechiae are generally considered to be less than 2 mm, and these are larger than that. I wouldn't describe it as petechial. Maybe purpura, but I can't tell if it's blanching.Does it itch?Pediatric psoriasis can look similar to this and occur on the extensor surfaces."}
{"text": "###Input :Sorry, I forgot to include this information! They are non itchy and non blanching. ###Output :Are they flat, or can you feel them.They're totally flat; not raised or bumpy."}
{"text": "###Input :Iron/vitamin D low even when supplementing?26F, 133lbs, 56 Non-smoker, no recreational or pharmaceutical drugs.I recently had my ferritin retested as Im supplementing to raise my levels. Around a year ago it was 44 (ug/L) and now after taking supplements every other day its gone down to 26. My vitamin D (I take between 2000 to 4000 daily depending on the weather) is the exact same at 92 (nmol/L).Additionally looking at my blood work results my TSH went from 2.62 mIU/L to 1.29. My hematology/differentials are also all on the lower side and my MCH was flagged by the lab.All this being said, my doctor assured me my bloodwork is fine (I dont feel fine hence the bloodwork). Hoping to gain some insight into what could be causing this please. ###Output :Make sure you take Iron with OJ/Vitamin C and Vitamin D with food."}
{"text": "###Input :I do both these things! ###Output :Hey there. Lots to unpack so I'm gonna do this in bullet points.You didn't post your hemoglobin. Your hemoglobin should be going up with iron supplementation. Ferritin too, but I guess as an interested third party I wonder what it is, and what it was.your differentials are allowed to be all over the place, it's just the population breakdown of your white blood cells. It's constantly in flux as cells die and are born. I suggest paying less attention to this.your TSH is still within normal. Secondly a low TSH generally means your thyroid is not needing any more stimulation. I suggest paying less attention to this.vitamin d can be supplemented more aggressively I suppose. It is near normal.MCH is a completely and totally irrelevant lab valueI'm not really sure what symptoms you're having. From where I sit this feels like we're treating numbers that are irrelevant. I'd humbly suggest you stop looking at the labs so closely as I don't think they're holding the answers you seek. I'm not saying that your symptoms are irrelevant, but I am saying that these tests hold no explanation for any symptomatology."}
{"text": "###Input :Sorry about that - hemoglobin was 126 g/L exactly a year ago, 124 g/L now.Happy to expand on the rest. I deal with near constant fatigue and hormonal issues like hair loss, hirsutism, abdominal pain, and digestive issues. ###Output :Awesome, thanks for posting. Unfortunately, your symptoms are not very specific for one thing. This means they can be explained by a lot of different conditions. That's what makes them so frustrating-- they're not obvious and that can sometimes get your team challenged. I think that's sometimes why young otherwise healthy women get told it's anxiety. I'm sorry in advance if that's happened. You mention hair loss, abdominal pain, and digestive issues. These together make me think about vitamin deficiencies and malabsorption syndromes. Hair loss alone can also be autoimmune in nature. You'd need to expand more on the GI issues for me to say something meaningful. I think all my recommendations are going to be low quality because I can't have a sit down session to discuss all your symptoms at length (eg what type of GI symptoms, any other autoimmune symptoms).Most vitamins are not on routine labs, and you need to test specific vitamin levels based on the disease you suspect is afoot (which is why we usually start with the history of the disease before we go to look at labs). Do you have any history of abnormal eating patterns, like eating disorders in your past (or present)? If so, that's where to start. If not, I think we might need to go down the route of testing for malabsorption. Fat in the stool (steatorrhea, you can google that, NSFW obvs) is usually a good clue for malabsorption to start with. There are some skin rashes that people get from certain malabsorptions as well, so it might be worth doing a skin check.As a random doc on a computer I'd probably send you to a GI doc to discuss your gi issues at length and evaluate for malabsorption. Even if we are sure that's the issue, though, there are still many conditions that can cause it. If it's not the issue (and again, sorry, these symptoms are not too specific so sometimes a lot of trial and error is involved) it may be worth discussing with a rheumatologist. Your primary doctor can also evaluate generally for rheumatic diseases.On the note of your primary doc, it sounds like you may not have a working relationship. I'm an advocate of switching docs until you find one who seems to be listening and has good open lines of communication with you.Iron itself is kinda a tricky one to get right. Bodies generally don't love iron (in fact we make a concerted effort to not absorb it). You could try taking your dose every 48 hours as one trick (when your body sees oral iron daily it gets more resistant to iron absorption). However, I don't know that is the answer for any of your issues, which is why I first suggested against looking at these labs too closely.Sorry to be long winded - internal medicine people usually are. As a first step, I'd go to a GI specialist to discuss these gi symptoms, stomach pain, and hair loss together as a possible malabsorption phenomenon."}
{"text": "###Input :24F, feeling very sick after accidentally inhaling a lot of fumes from rotten potatoes. Could I have solanine poisoning?24F, 56, 111 pounds, Caucasian, never smoked, almost never drink, no recreational drugs, located in Charleston, SC. History of Ehlers-Danlos Syndrome type III along with a number of comorbidities, including cardiovascular and gastrointestinal issues. More details on medical history at end of post.There has been a smell coming from my pantry for the last several days that I havent been able to identify. Today, I opened the door and just got hit with this wall of fumes, and I decided enough was enough. I spent about half an hour tearing it apart and smelling every single thing in it. By the time I identified the potatoes and threw them out, I was feeling pretty terrible. My head kills, Im super nauseous, and Im having chest pains.I looked it up online and read that rotten potato fumes can be extremely toxic, but its hard to tell if Im feeling awful because of toxins or because the smell and activity triggered flares of my pre-existing conditions (see below). Its not uncommon for me to experience chest pains just from walking around the kitchen for a while, and I have a headache and nausea for the better part of most days as it is. It feels worse than normal, but not so much worse that it couldnt be a heightened version of the regular stuff.That being said, I have been experiencing some other unexplained symptoms over the last few weeks that I wonder might have been caused by inhaling the fumes before they were as noticeable. Ive been experiencing random spikes in temperature (99.6-100) that last for about 12-18 hours, go away, and then pop back up again a few days later. Ive also lost weight (from 122 to 111 in less than a month) with no changes in diet, and Ive had pretty bad diarrhea and abdominal pain too (mostly upper right, but it kinda moves around). Ive also had really bad dry eyes and dry mouth. (My rheumatologist has suspected Sjogrens for a while and ordered a lip biopsy recently, so thats happening soon.) I also have had a sore throat (kinda burns, probably related to dry mouth) and swollen glands.I have an unrelated diagnostic laparoscopy scheduled for next month, and theyre going to test me for covid before that. I dont think I have covid, and neither does my doctor. Mostly because the fever has been so off-and-on, and Ive had no cough at all. But Ill be tested in the next few weeks regardless.I just dont know how to tell whether the worsened symptoms Im experiencing should be worrying me or not. I sent a message to my doctor, but the office doesnt open for several hours, and she probably wont see my message until the end of the work day anyway (thats the time of day she usually sends me messages). If theres a chance Im experiencing poisoning, what steps should I take to manage it until I hear from my doctor?Health issues: EDS (type III), POTS, mitral valve prolapse, MCAS, pernicious anemia, gastroparesis, IBD, GERD, interstitial cystitis, idiopathic hypersomnolence, small fiber neuropathy, cervical instability, scoliosis, kyphosis, tortuous colon, vestibular adenitis (two past surgeries for this), and unexplained eosinophilia (pending hematology referral). Suspected esophageal dysmotility (doctor wanted to do a manometry, but I declined because it sounds awful, so this is unconfirmed). Suspected endometriosis (pending laparoscopy). Suspected Sjogrens (pending lip biopsy).Meds:Ditropan (10 mg/day), Metoprolol (75 mg/day), Nexium (80 mg/day), Sunosi (150 mg/day), B12 (1000 mg/day), Nexplanon birth control implantI have had no recent changes in meds apart from my cardiologist upping my metoprolol from 50 to 75 mg/day because Ive been dealing with shortness of breath, presyncope, and chest pains more often than normal lately due to inactivity (thanks, quarantine).Any advice would be greatly appreciated. Thank you! ###Output :You didnt ingest these? Typically large amounts in children of old potatoes could cause GI symptoms and some central nervous system issues. I would be surprised if the smell alone caused your symptoms and I doubt its connection to your undulating fevers. I am doubtful your symptoms are directly caused by the cleaning and smell. Perhaps it was irritating and triggering nausea, but without ingestion youre unlikely to be poisoned from potatoes."}
{"text": "###Input :NAD but I've worked in potato warehouses for many years, and also spent days shovelling out rotten potatoes in enclosed spaces.. I've never had an issue so I found it kind of weird to have these symptoms without ingestionWhen were you near the rotten potatoes? At the beginning you said it was in the last few days but later on it said the last few weeks.Temperatures above 98.6 and below 100.4 are considered mild fevers. Ive had one for a few months now. Your temperature is nothing to worry about unless it goes to 103 or above or if it lasts longer than a week.Symptoms of solanine poisoning are mainly gastrointestinal and neurological. Symptoms usually appear in 8-12 hours and go away in 24-72 hours. It is also only considered to be toxic if it is ingested through food or drink. ###Output :Temperatures below 100.4 are normal and not considered mild fevers. You are not having a mild fever for months, youre having a normal body temperature.Anything above 100.4 is considered a fever"}
{"text": "###Input :This is just a question but my normal temp is 97.6. Would 100.4 not be considered a fever? Or does that 100.4 go from possible normal temps and not the average body temp? Usually if my body is 3 degrees warmer than normal I don't feel well etc. ###Output :Hi friend, no that wouldn't be considered a fever. The body has a much greater range of normal temperature in general than people who use the empiric system believe. \"98.6\" is actually the direct translation of 37 C into fahrenheit. In celsius, (which is how medicine measures temperatures, even in the USA), fever starts at 38 degrees. That directly translates to 100.4. (That's why a temp of 99 is not actually a fever.) Though it appears higher than the 98.6 we're used to hearing, it's actually well within normal limits.The usual frame I'm used to is 36.5-38 as sort of the guidelines. Your temperature of 97.6 translates to 36.4444. My guess for that is just that temperatures taken outside the body can be less accurate. That's not a concerningly low temp to me; basically you fit well within the normal standards and you would not qualify as having a fever until you reached 38 (or 100.4)"}
{"text": "###Input :High Hematocrit with Low iron. Should I see hematology ASAP or continue further investigations?Hematocrit peaked at 47.5 this year. (Normal high range is 44)Currently Ferritin is 9. (Normal range 16-165)37f. Af Am. 59. 140lbs.Problems.Persistent headache. Severe abdominal pain. Raynauds without spasm - hands stay cold. Severe chest pain. Abnormal EKG (compared to previous) w/t wave inversions. Intermittent claudication with 0.7 ABI post exercise. Paresthesias. Sudden high blood pressure since my hematocrit went out of range. Fatigue. Night sweats. Sudden high blood pressure when hematocrit went up to 46. 12 yrs ago, retinal detachment left and tears/holes both eyes retina surgeon can be signs of microvascular/hematology issues.Meds.Continuous BCP 12 years bc of heavy bleeding. Amlodopine off label for poor circulation in legs/hands.Saw a hematologist and they declined to test for JAK2 mutation for polycythemia Vera because hematocrit wasnt that high and EPO was low normal 3.2.Unlikely sleep apnea. Live at 100ft above sea level. Dont smoke. Changed houses since hematocrit started climbing years ago, so carbon monoxide unlikely. Drink a gallon of water daily. 3 cardiologists say I do not have a heart or cardiopulmonary problem. Entire body has been imaged neck down for large vessel blockages. Neurologist did EMG and entire spine has been imaged for paresthesias. All normal.Should I continue the endless investigations? I have GI, rheumatology appts scheduled.See hematology ASAP?Take an iron supplement and see if I feel better? ###Output :I dont think you need workup at all"}
{"text": "###Input :Why is that? Does anything need to be done about my ferritin levels?Im at Stage 3 iron deficiency.https://maryannjacobsen.com/wp-content/uploads/2021/02/Stages-of-iron-deficiency.png ###Output :I mean you need iron but there's no workup needed for your blood count"}
{"text": "###Input :My hematocrit is 10% over the expected high range for African American women. So the equivalent in a white male would be 55 range.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578165/table/T2/?report=objectonlyAt what percentage over the norm for my gender and race does it need workup?Or is the white male range the standard that has to be used for everyone? ###Output :What's your hemoglobin? That isn't an abnormal hematocrit"}
{"text": "###Input :15+ also above the 97.5 percentile for my gender and race according to the US National Institutes of Health.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578165/table/T2/?report=objectonlyIm asking. If doctors dont trust the national institutes of health guidelines, what is the guideline I should expect them to use for abnormal?Do I need to be in the white male range for abnormal?Do I need to take iron supplements to pop my red blood cell counts into the abnormal for a white male range? ###Output :Just fyi there's no such thing as a NIH guideline. You're just quoting a table in a very low impact journal. Pubmed is the central database where most publications are stored. Usually when a publication only makes it to a low impact journal, that's because there are significant flaws in the study.Every lab that runs these tests have slightly different results and their own reference range.It's somewhat futile to go on a endless journey for mildly abnormal tests because unless there's major clinical consequences, chances are it's nothing. As you said yourself, you're above the 97.5% but that means 2.5% of the population has hemoglobins higher than that which is you.Anyway good luck"}
{"text": "###Input :Is this some kind of blood cancer?25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you. ###Output :This is a murky situation because both resurgence of HIV as well as other infections could cause high lymphocytes. If HIV is still negative then Id worry more about another underlying viral infection. If lymphs remain high and keep going up then Id ask for hematology consult. Your ID doc might want to send off flow cytometry to rule out any ominous diagnoses in the meantime. I wouldnt be too concerned about percentage of CD4 cells. Just worry about absolute count which is fine. High lymphs is nothing concerning unless it keeps going up on repeat."}
{"text": "###Input :How concerned should I be regarding leukemia, lymphoma or some other blood related cancer ###Output :Id have absolutely no concern for these things with these labs"}
{"text": "###Input :Just had new panel taken yesterday that just came back via Labcorp. Numbers are still wonky. Being referred to hematologist . Confused and terrified ###Output :No reason to be terrified. Your lymphs might be high but they arent going up. Numbers are seemingly almost the exact same as last time within deviation. Heme will likely send flow cytometry off but your ID doc couldve done this to get the ball rolling. Still doesnt seem like anything ominous. Bad things come with really bad labs, multiple cell lines affected and usually metabolic abnormalities."}
{"text": "###Input :Is this Lymphoma/ some type of Blood cancer25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you. ###Output :See what the haematologists say but I wouldnt be particularly concerned if your CD4% is lower, because your absolute lymphocyte count is high. When your lymphocyte count comes down your CD4 % will increase. I dont know why your lymphocyte count is (a bit) higher than normal, but its not usually anything concerning.The most important thing is that you are continuously undetectable on HIV viral load."}
{"text": "###Input :Help with CBC results?Im a 30y/o white female, 52, 138lbs. I used to stay very active, workout consistently. I never drink or smoke, and the only meds Im on is Fluoxetine 60mg for clinical OCD diagnosed several years ago.For the past 8 months I have had severe fatigue, breathlessness, irritability, exercise intolerance, sleep disturbances, heart palpitations and it seems I am constantly ill from flus or colds.Bloodwork initially showed low ferritin so we assumed it was that and did iron infusions. My b12, folate and T4 and Vitamin D were all normal. My reticulocyte count was quite low previous to the infusions and after treatment, its still low. From what my doctor understands, the absolute reticulocyte count should have risen substantially (even elevated) in response to the iron infusions as it would help my bone marrow get stimulated to make more red blood cells.Why would this be? My doctor is sending me to Hematology Oncology because she doesnt like the blood work results either, but my appointment is 2 months out due to living in a remote region of the country (US). Can anyone help me decipher what all this means? (I will put link to pic of labs) ###Output :What date did you get an iron infusion."}
{"text": "###Input :I got the 2 dose formulation. Once on 9/23 and again on 9/28 ###Output :This seems like pretty acceptable/normal lab variations then for such a short interval between lab testing and iron treatment."}
{"text": "###Input :What are your thoughts as to the Retic count being low? ###Output :I think it's likely appropriate given the timing. But, I'm not the specialist. I wouldn't stress"}
{"text": "###Input :So sick Im afraid Ill die35F, white, 5'4\" was generally healthy except for Ehlers Danlos and trauma-related mental health (being addressed) Was bitten several times by a mouse (no rash) and a month later, soon after having an operation of tubal ligation and IUD replacement (to stop periods) began having sporadic fevers. Thought it was due to surgical wound, took antibiotics, sporadic fevers continued. My surgical wounds are healing very slowly as in 6-8 weeks. This was October. December, elevated temp ranging from 99-101 every day. Shortness of breath, but chest CT showed healthy lungs. Nausea and weight loss but abdominal CT showed no problems. Persistent need to cough and clear throat and difficulty doing so, having to cough for a minute to clear it enough to talk.No one knows whats wrong. I now feel like Im dying. I dont say that to be cute, I feel like I need someone to watch me and Im scared. I have a hematology appt but its at the end of March and who knows if they can help me either.POSITIVE TESTS: mycoplasma hominis, ureaplasma urealyticum, SED rate 44 mm/hr and D-DIMER abnormal at 321 ng/mLIm taking doxycycline and am 2 days in and feel nothing.Negative tests done: CT scan of chest with contrast, ie no blood clots, Covid, CBC with platelet, mono, blood cx aer & an, urinalysis, panel hepatic function, lipase, cbc w pits/auto diff, chemistry labs, protein total serum, serum electrophoresis, TB test, ck total, rheumatoid factor, hiv, lactate, hs C-reactive protein, and sed rate ESR. All mostly within range.Help.EDIT some have said to add my meds, Im on a lot dont judge lolLexapro, Wellbutrin, Vraylar, Nuvigil, Provigil, Xywav, Glyco-whatever (the sweating pill), prazosin for nightmares, topamax, vit D, levothyroxine (thyroid just checked and normal), fiber, linzess, and I receive ketamine/lidocaine infusions but those started post-fevers ###Output :Need clarification, the organisms that you listed, were they wound cultures, blood culture, sputum cultures?If wound cultures, were they superficial, deep, or tissue (in that they took a chunk of tissue to culture)D-dimer and ESR will both be elevated in infectious processes, although it would be odd for CRP to be normal"}
{"text": "###Input :They were all blood tests! No wound cultures or sputum cultures ###Output :Blood cultures? I'm still unsure how they got these organisms"}
{"text": "###Input :Oooo are you talking about the mycoplasma hominis? That was a vaginal swab (embarrassing) ###Output :Same with ureaplasma?Ok just wanted to check this wasn't in the blood or something, but given location this is not a big deal and likely normal Flora.Sorry unfortunately I don't have much to offer, but at least you can be assured these organisms are likely not related to what's going on.A lot of things don't really add up in your post. You say you're \"generally healthy\" but you're on over 13 medications. What's the Topamax for? Migraines or seizures? How about the cariprazine? Were any of these medications started recently? Glycopyrrolate that I am assuming you're taking as well as Topamax can cause elevated body temperatures and the combination of the both of them might be the cause of your symptoms."}
{"text": "###Input :Topimax for weight loss, Vraylar+Lexapro+Wellbutrin for depression/anxiety/ptsd. When I said I was healthy I meant physically healthy? Guess I shouldve said fat. I do have narcolepsy, I forgot to say that but I view it as so separate. But ty for the info about the glyco and topamax! Ill bring that up with my doc and see if maybe that has to do with it. No new meds, latest one was Xywav in the summer. ###Output :While Topiramate does induce weight loss it's not usually my first choice. In addition, it's usually contraindicated in people with mental health disorders and is known to increase the risk of suicide. It also causes drowsiness and you already have narcolepsy. Given the interraction with the glycopyrrolate as well I'd discuss with your physician about transitioning to another agent such as a GLP1 agonist if the goal is really just weight loss."}
{"text": "###Input :Platelets count of 2000, but sent home?I was in the emergency room for bruising and petechiae. They checked my blood and everything came back within normal range except my platelets which came back at 2. They said I need to see an expert so they sent me home and told me to follow up with hematology tomorrow. They gave me 40 mg of dexamethasone. When I was there they made it seem like no big deal, but now when Im researching it Im a bit concerned. Other stories say people were immediately hospitalized for levels of 5-10 and efforts were made to quickly increase their levels. Now I cant sleep because Im so worried and cant find any real answers. Should I be concerned that they sent me home? Is 2 a level that will cause me to die in my sleep or something?25 female 53 150 lbs Regularly Prescribed 150 mg lamictal and 50 mg Vyvanse Dont smoke or use any recreational drugs Only other health problem is possible PCOS (based on polycystic appearing ovaries and low SHBG) I also currently have a cold if thats relevant? COVID test negative. ###Output :uhh... yeah not sure why they would've sent you home. Was it a community hospital? Is there a university hospital nearby?"}
{"text": "###Input :Yes, a community hospital. How would I go about transferring to a university hospital? Just call them and tell them whats going on? ###Output :Or just go to another ED? Your platelet is 2,000 right?"}
{"text": "###Input :Yeah its 2 and the rage is 140-150 so Im pretty sure that translates to 2,000. Will a different ER do anything different? Even if its the same hospital network?I have an appointment with the hematologist around noon. Theyre being pretty casual about this. Should I push to be kept? Or to have them intervene some how like a transfusion? ###Output :Just meet with them at noon"}
{"text": "###Input :Hypoferritinemia?Im 23 F. 53 and 125 pounds.I have severe gastroparesis (gj tube because of it), IBS, endometriosis, and now hypoferritinemia without anemia as well.I got a letter in the mail from my doctor saying hematology thinks I have hypoferritinemia without anemia due to a combination of malabsorption and losing a lot of blood from endometriosis issues. Im constantly dizzy and my joint pain baseline is never below a 7 anymore. They said it could possibly be because of this, but they arent sure.Other than a letter that said my ferritin levels were 4 & I also had low folate levels, so I was to schedule an iron infusion appointment a few weeks out, I havent heard anything else.My biggest questions are is this something that would likely be chronic, or fixed with a single iron infusion? & is there anything I can do to help correct this? ###Output :If you have a GJ and bowel problems you'll probably have ongoing absorption problems anyway.Have you considered trying to stop the periods with contraception so you're not losing more blood at least? You should avoid the pill if absorption is an issue but depot, implant and coils would be good options."}
{"text": "###Input :Ive used the pill for 12 years to try and limit periods, but Ive always bled through it anyway. My gyn is hesitant about using any other hormonal birth control because of how rapidly the endometriosis grows back after being removed. They didnt want to use any IUDs because of level of cramping I already get. They said at this point my options are to either keep taking the pill and hope it helps or get pregnant and hope that helps.Ive been on over 20 medications for a year to try and help my symptoms, but I see no improvement from any of them whatsoever except sometimes the dissolving zofran helps my nausea. I dont know if this is another sign of an absorption issue. ###Output :I'm surprised they are happy with the pill given your presumed absorption problems. A method that prevents ovulation eg the depot would be ideal and will make endometriosis better."}
{"text": "###Input :2.5 year olds bloodwork. Concerned.My 2.5 year old daughter has been refusing food, tired and constipsted. I get picky eating is a thing but this is beyond picky. Shes losing weight. Her doctor didnt seem concerned but there are levels on her chart that are totally abnormal and Im at a loss as to what I can do.WBC Learn more about this 5.96 103/uL WBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.80 103/uL - 13.50 103/uLRBC Learn more about this 5.07 106/uL RBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.70 106/uL - 5.40 106/uLHemoglobin Learn more about this 13.7 g/dL Hemoglobin Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.5 g/dL - 16.0 g/dLHematocrit Learn more about this 40.0 % Hematocrit Date: May 21, 2021 08:49 a.m. PDT Reference Range:29.0 % - 48.0 %MCV Learn more about this 78.9 fL MCV Date: May 21, 2021 08:49 a.m. PDT Reference Range:74.0 fL - 99.0 fLMCH Learn more about this 27.0 pg MCH Date: May 21, 2021 08:49 a.m. PDT Reference Range:25.0 pg - 32.2 pgMCHC Learn more about this 34.3 g/dL MCHC Date: May 21, 2021 08:49 a.m. PDT Reference Range:31.0 g/dL - 37.0 g/dLRDW Learn more about this 12.3 % RDW Date: May 21, 2021 08:49 a.m. PDT Reference Range:11.6 % - 14.4 %Platelets Learn more about this 370 103/uL Platelets Date: May 21, 2021 08:49 a.m. PDT Reference Range:150 103/uL - 450 103/uLMPV Learn more about this 8.4 fL MPV Date: May 21, 2021 08:49 a.m. PDT Reference Range:7.3 fL - 12.4 fLNeutrophil % Auto Learn more about this 33.8 % Neutrophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:33.6 % - 77.5 %Lymphocyte % Auto Learn more about this 57.7 % Lymphocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.0 % - 59.0 %Monocyte % Auto Learn more about this 7.6 % Monocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.0 % - 12.5 %Eosinophil % Auto Learn more about this 0.70 % (Low) Eosinophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 % - 4.00 %Basophil % Auto Learn more about this 0.2 % Basophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 1.0 %Imm. Granulocyte % Learn more about this 0.0 % Imm. Granulocyte % Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 0.4 %Neutro Absolute Learn more about this 2.02 103/uL Neutro Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.50 103/uL - 8.60 103/uLLymph Absolute Learn more about this 3.44 103/uL Lymph Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 103/uL - 7.30 103/uLMono Absolute Learn more about this 0.45 103/uL Mono Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 1.20 103/uLEos Absolute Learn more about this 0.04 103/uL Eos Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 0.50 103/uLBaso Absolute Learn more about this < 0.04 103/uL Baso Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 2.80 103/uLRetic Count.LC Learn more about this 1.3 % Retic Count.LC Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.6-2.6Imm. Granulocyte Absolute Learn more about this < 0.04 103/uL Imm. Granulocyte Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 0.10 103/uLMiscellaneous Hematology Sed Rate Learn more about this 16 Sed Rate Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 - 20 Routine ChemistrySodium Learn more about this 137 mmol/L Sodium Date: May 21, 2021 08:49 a.m. PDT Reference Range:137 mmol/L - 145 mmol/LPotassium Lvl Learn more about this 4.2 mmol/L Potassium Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 mmol/L - 5.1 mmol/LChloride Learn more about this 102 mmol/L Chloride Date: May 21, 2021 08:49 a.m. PDT Reference Range:98 mmol/L - 107 mmol/LCO2 Learn more about this 21 mmol/L (Low) CO2 Date: May 21, 2021 08:49 a.m. PDT Reference Range:22 mmol/L - 30 mmol/LAGAP Learn more about this 14 mmol/L AGAP Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mmol/L - 16 mmol/LBUN Learn more about this 16 mg/dL BUN Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mg/dL - 17 mg/dLCreatinine Level Learn more about this 0.30 mg/dL Creatinine Level Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg/dL - 0.70 mg/dLBUN/Creat Ratio Learn more about this 53.3 ratio (High) BUN/Creat Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.0 ratio - 20.0 ratioGlucose Lvl Learn more about this 88 mg/dL Glucose Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:74 mg/dL - 106 mg/dLCalcium Learn more about this 10.4 mg/dL (High) Calcium Date: May 21, 2021 08:49 a.m. PDT Reference Range:8.4 mg/dL - 10.2 mg/dLProtein Total Learn more about this 7.7 g/dL Protein Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.3 g/dL - 8.2 g/dLAlbumin Learn more about this 4.8 g/dL Albumin Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 g/dL - 5.0 g/dLA/G Ratio Learn more about this 1.7 ratio A/G Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.0 ratio - 2.2 ratioBilirubin Total Learn more about this 0.30 mg/dL Bilirubin Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg/dL - 1.30 mg/dLBilirubin Direct Learn more about this 0.0 mg/dL Bilirubin Direct Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg/dL - 0.3 mg/dLAmylase Lvl Learn more about this 68 U/L Amylase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:30 U/L - 110 U/LLipase Lvl Learn more about this 55 U/L Lipase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:23 U/L - 300 U/LAlk Phos Learn more about this 215 U/L (High) Alk Phos Date: May 21, 2021 08:49 a.m. PDT Reference Range:38 U/L - 126 U/LALT Learn more about this 19 U/L ALT Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 U/L - 34 U/LAST Learn more about this 57 U/L (High) AST Date: May 21, 2021 08:49 a.m. PDT Reference Range:14 U/L - 36 U/LCRP Learn more about this < 0.5 mg/dL CRP Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg/dL - 0.9 mg/dLGlobulin Learn more about this 2.9 g/dL Globulin Date: May 21, 2021 08:49 a.m. PDT Reference Range:2.2 g/dL - 3.7 g/dLImmunology/Serology Mono Screen Learn more about this Negative Mono Screen Date: May 21, 2021 08:49 a.m. PDT Reference Range:Negative ###Output :All these results look very normal, with the exception of a mildly elevated AST and Alk phos (most likely from a virus). Nothing here gives much of an idea what may be going on.Children can also have elevated Alk Phos from simply growing, so absolutely no worries there. Agree about the AST potentially being viral in origin. At my place we'd recheck that (by itself) in a few months but not worry about it in the meantime."}
{"text": "###Input :Husband with osteonecrosis and little game plan besides narcotics- is he being managed appropriately?Just a HUGE thanks in advance to anybody who responds. I'm a talker and I'm livid right now, so I'm trying to keep this just to necessities but may fail and leave out key details and/or talk about things that aren't necessary. To preface- I come from a \"medical family\" but it's primarily neuro and psych rather than ortho. I devour medical literature, podcasts, etc, have worked as nursing staff in psych and derm, just got my master's in health sciences, and am planning to apply to med school this cycle- so basically, please feel free to talk to me in technical terms, link to articles, etc as appropriate.Now onto the issue.Husband is 28M, 5'8.5\", 225lbs, white, occasionally smokes cigars (maybe a cigar or two a year?), and drinks moderately (down from heavy drinking a few years ago as part of work culture). About 5 weeks ago was diagnosed with osteonecrosis in both femoral heads. Started having pain just in his right hip in May, but really started to notice in June as it was limiting mobility. Got to the point in July where he couldn't go up and down the stairs- I was gone and he was texting me he had to army crawl back up the stairs to bed. Initially, he got an x-ray which had some \"fringe\" or something to that effect (I wasn't in the appointment so I don't really know what was said about it) but was concerning for possible osteonecrosis and MRI was recommended. While waiting, he went to PT, and the PT thought perhaps bursitis if not ON, but the pain kept worsening. Got an MRI at the end of August which showed osteonecrosis in both hips involving over 50% of both femoral heads. Right side had marked edema extending into the femoral neck and noted a \"mild asphericity of the head consistent with mild depression,\" subchondral fluid cleft, and diffusive mildly thinned cartilage. Left side had edema as well extending into the neck.Husband was referred to ortho, which in itself was a headache as PCP had to send that referral FOUR times. As we're waiting, his pain is getting worse to the point where he was using a cane and then progressed to needing a full set of crutches. If you could see his gait- it's just awful and was placing stress on other joints and was leading to back pain too. PCP started him on Celebrex 1000mg QAM for two weeks and then 500mg QAM after as well as gabapentin (titrated up to 900mg QHS). Got several labs drawn to check for a cause- including autoimmune labs- and the only abnormality was low vitamin D (15 ng/mL), so he was also started on OTC D3 5000IU daily and a prescription weekly dose of D2 (I can't remember the dosing). . The Celebrex seemed to help him the most, but after about a week on that, it was still only \"barely\" helping. As time went on waiting for ortho, the way he described the pain and sensation also changed, with more \"grinding\" pain.In what I've been able to read, it seems there are treatments that can help the pain (narcotics, staying off the joint, fluid aspiration for edema) and may treat earlier stages of disease (eg, core decompression, treating underlying cause to get blood flow back to the bone), but once the femoral head collapses, hip replacement becomes standard of care.When we were finally able to meet with ortho, the doc, while personable and nice, didn't really give us a lot of info. He didn't stage the disease at time of MRI, but kept saying \"mild.\" This annoys me because with the amount of pain he is in and asphericity of the femoral head, I wouldn't classify anything he's experiencing as \"mild\" myself, and surely not \"caught early/in early disease stage.\" We tried to impress the pain aspect and how limited his mobility is because of the pain. Doc kept hinting at \"something stronger\" to manage the pain and said we could schedule for aspiration for the edema. Also mentioned that he needed to stay off the joint as much as possible and should be using the crutches for any walking. Husband is terrified of needles (aspiration is done fully conscious and may need to be done every week or two to control pain from the edema), and with a history of SUDs in his family, being on narcotics for longer than a few days is also terrifying and he prefers not to. We asked about hip replacement, and he seemed not to want to do it, citing Husband's age. ORtho requested workup for potential coagulation disorder because we could \"save the hips\" if this was caused by a treatable clotting disorder, and he referred to hematology. No further discussion about replacement or why he didn't want to pursue it- just the age and potential for a clotting disorder.Neither one of us was thrilled with this. I wasn't convinced that restoring blood flow would magically re-shape his femoral head, especially with how he is now describing grinding pain. His half sister also does have a clotting disorder, but it's Factor V deficiency, so it's that she doesn't clot appropriately. But fine. Took them a week to get the referral to hematology, and a few days later, we have to call hematology and essentially was told he is a \"low priority\" patient and they wouldn't see him (they were rude, but I do get it because oncology patients need to take priority). Ortho refused to order the tests because \"we don't really order tests\" and said they'd send it to PCP. No follow-up scheduled with ortho until after the coag tests. This was about two weeks ago.About 10 days ago, his pain advanced so much that he finally did call in to the ortho clinic to as he was unable to sleep he was in so much pain. I picked up a script for 5mg oxycodone for him, and he's been taking this before bed reliably since and sometimes needs it during the day due to the pain. He hates it, and it barely touches the pain anyway. He called again last week because he is still in so much pain and essentially demanded to see the surgeon himself so we can get real answers about how we are not just going to \"manage\" the pain but resolve it. Thankfully, we see the surgeon tomorrow.Anyway, so today, we were able to meet with his PCP via telemedicine (he couldn't get to the actual hospital due to his limited mobility right now and still make it to the ortho appointment tomorrow). His PCP essentially said they a) weren't going to order any of the coag tests ortho wanted (they didn't have any notes from ortho and \"it isn't standard of care\") and if they wanted coag tests, they'd have to order themselves, and b) my husband \"needs\" to be more active, going to PT, walking, swimming if he can't put weight on it (note: the only pools here this time of year are at expensive gyms we cannot afford to go to), etc. My husband literally cannot do that. If he goes up and down the stairs more than once in a day, he's knocked on his ass in pain for the next 24 hours. He tried to impress this upon her, but she just kept saying how he needs to move it to avoid muscle atrophy, and if he can't, then the pain isn't managed appropriately. I don't disagree about his pain- it's not managed well at all- but her solution was to increase the gabapentin which tbh I don't think is helping him at all anyway. The bit about moving the joint more though directly goes against everything I've read about the disease, what the ortho told us, and what he experiences- he can manage his pain by being totally 100% sedentary, but that's not a lifestyle he wants (nor what is good long-term).So, wonderful docs of reddit, is he being managed appropriately so far? Is there something more I can do to ensure he has good care? I don't go into telemed visits with him since he takes him on headphones, but I do have to go with him when he goes in to the clinic since he cannot get around with me. I asked my older sis to send me some of the info on UpToDate so I can read more about what is actual standard of care. I cannot for the life of me feel good about it, and I feel like nobody is listening to him and his pain and what HE wants (solution, not management). Our world has radically shifted very rapidly, as he cannot do much at all or engage in hobbies or household chores or even the fun parts of a relationship most of the time. We are seeing a therapist to help manage it, even, but all the medical teams seem to be doing is throwing narcotics and giving him mixed messages and refusing to actually give us real insight into the disease process or why they don't want to resolve it. And yeah, I'm really mad about it all.Thanks again to anybody that can give me any insight into this. ###Output :Osteonecrosis / avascular necrosis of the hip, it can be bad. I kinda agree with the ortho - be as reluctant as possible with a hip prosthesis. I don't like the term \"hip replacement\", cause it makes it sound like you change the hip with an equivalent. It's not. A metal prosthesis has a limited life span - 10 - 20 years. Given enough time, the prosthesis will eventually fail. He's young, so he'll be doomed to have a failure while still in prime age. Then he'll have a bigger problem, since replacing a replacement is a much bigger surgery, sometimes it may not be possible at all, and there's a chance he'll have to remove a hip joint altogether while still only 40-some years old.There's a chance his osteonecrosis may dwindle, without completely destroying the femoral head. Sometimes it just leaves a small irregularity in the top joint surface, and it can be usable. I often see that the \"acute\" inflammation like necrosis dies out. It would be wise to wait and see how things progress. Hopefully, he can have pain relief with medications temporarily.So, I think the treatment right now seems wise. You want the problem to be solved right now with a hip replacement, but the ortho know that will bite you back in a few decades. When he says it's mild, he's probably referring to how it looks on xray, and mild there is a good thing."}
{"text": "###Input :hanks for the reply. We know he would need another replacement in his life time (or multiple replacements of the hardware) if he were to have it replaced now, although the rate of failure of that THA is what is unknown to me and what nobody seems to have discussed with us. My best friends mother had bilateral THA in her teens and is in her 50s now with an additional 3 replacements, and is still healthy, so I may have some rose colored glasses with the n=1 sample size there. I think I will look up the data about revisions.I worry so much because I see his QOL just deteriorating in front of me. He doesnt want to die, but I know he doesnt want to live like this. Not just the pain but being unable to do what he finds meaningful. Pain management is great when theres a positive end in sight, but if its going to be a long-term that has a very high likelihood of ending in THA anyway, I cant imagine he would want to live like that. The trajectory hasnt been good so far, and Im somebody that needs hard data and numbers to reconcile any differences between patterns I see and what I am told might happen. As a radiologist, you may not have an answer, but how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)? Do you get to know who is symptomatic and how symptomatic? Previously I was trying to find studies or case studies and just couldnt find anything promising myself, and I was also focused on the quality of his pain, since there seems to be a different type of pain now.Along the same vein, how often is common to repeat images while waiting? How quickly have you seen deterioration? Its only been 5 weeks since the MRI and just shy of 3 months since the X-ray, but I am worried about how its progressing and wondering if it may not be as early or mild now as it was then. ###Output :how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)Don't have an exact number, but it's not uncommon to improve, and I'm often amazed of how well some seemingly terrible looking hips can end up, given time. Conditions with bone marrow edema are generally painful. I believe bone marrow edema in itself is causing much of the pain. The edema will usually / eventually resolve in time. A few months at least. Sometimes more than half a year. When / if the edema is gone, remaining pain will often depend on how damaged the joint surfaces are, and degree of osteoarthritis. From the description you quoted, it's not too damaged now. \"Mild depression of the joint surface, mild cartilage thinning\", I have an image in my head how that looks, and it's not too bad. As long as the joint surface isn't completely destroyed - and it isn't on those exams he's taken - there is a chance yet he could avoid THA.There is a chance it may develop into further joint destruction, but can only wait and see for that. Follow-up MRI 3-6 months after the first, maybe, depends on the clinical situation. Regular xray is often enough to assess damage to the joint surface.Also - while I'm not really questioning the diagnosis he's given, there are different conditions that causes bone marrow edema in the femoral head. \"Transient migratory osteoporosis\" is self limiting, and possible to mix up with osteonecrosis."}
{"text": "###Input :Help with hematology analysisIm a male 39 years old, 78 kg, 173 cm. I use CBD for anxiety daily, no other medication. My MCV seems to be a bit high in the analysis.MCV 98.1 Hemoglobin 9.3 mmol/l Erithrocytes 4.8 / pl Hematocrit 0.47 l/l Thrombocytes 214 NL Leukocytes 6.4 NLAll other parameters, including thyroid TSA and liver ALAT are good, also glucoses, glycosilated hg, cholesterol and triglycerides are good. I drink almost daily, but no more that a couple of beers, smoke socially, and dont do other drugs. Red meat consumption is very low but Im not vegetarian. My diet is (I think) good, but probably too much bread. Should I worry about the MCV? What does it mean? What could be the consequences?Edit: I should also say that I do boxing 2/3 times a week, and bike 10km 5 days a week. ###Output :The most likely cause is your alcohol use. Alcohol is a well known cause of macrocytosis.Other possible etiologies include B12 deficiency (worth checking a B12 level but unlikely in your case), hemolytic anemia (very unlikely in your case as your hemoglobin is normal), liver disease, certain bone marrow disorders such as genetic conditions or MDS (those are very unlikely in your case).The macrocytosis itself is not concerning but it does mean that you have significant alcohol use. I would try to cut down.It's helps determine the cause of your anemia (low hemoglobin). You shouldn't worry, but you should follow up with your doctor to go through the next steps to work up your anemia with a high MCV. This is a common thing that has a pretty well trod diagnostic pathway that you and your doctor can work through"}
{"text": "###Input :Diagnosed with Chronic Myeloid Leukemia in November, fired from oncology office, 2 months without chemon September went to the ER for feeling under the weather and some blood work came back abnormal and I was referred to a hematology oncologist a month later. Went in and did the biopsy and everything. The doctor said that she calculated the risk from all the numbers and I'm in the intermediate risk stage but hopefully with the oral chemo for life, I should be able to keep it from turning into AML or the least, extend the quality of life.Come to find out that the doctor I was rushed in to see was actually a traveling doctor and she'd be leaving at the end of November. I then was forced to see a male doctor in the practice instead of the other female due to scheduling conflicts and bad weather. I felt very uncomfortable with the doctors bedside manner, the way he implied that I somehow forced a surgeon to take my thyroid out instead of trying medications first, didn't let me talk and explain that I was experiencing bad side effects from the chemo and also experiencing pain. This all happened and came to a head in March.He basically said that I was seeking drugs and that he wouldn't make any changes to my treatment (which was Bosulif 400mg/once a day). I was given a prescription and 5 refills. I then tried to speak to the director about being switched back to the female doctor and she said that the male Dr wouldn't sign off on that and if I was unhappy with the decision I can seek treatment elsewhere.I got my last refill in February and so have been off chemo since Feb 22nd. I tried to get into another oncology office but after the previous cancer center sent over my records, I've been told 4 times now that they have the referral and will contact me by end of day or the next day, for the last 3ish weeks.I can feel the pain in my thighs, hip/pelvic bone is growing and starting to get to effecting my daily routine.Does anyone have any advice on what I can do from here?Edit in case it's relevant: I also have Addisons and Graves Disease (well I had my thyroid taken out last June), Idiopathic Intracranial Hypertension, Thyroid Eye Disease, Ulcers, Gastritis, and gastroperisis. ###Output :So what you have been taking is a -tinib drug which inhibits/blocks a growth hormone receptor (called tyrosine kinase). It really isn't classified as chemotherapy. That said, I would see a primary care doctor for now, to have the prescription renewed, while you wait to establish with a new oncologist."}
{"text": "###Input :Ah, okay, was oddly explained to me in the beginning.But, I have gone to my primary care and they basically said that they can't prescribe the medication or treat the leukemia and that I need to try to work with the cancer center to find a new oncologist office. I've reached out to a few and had my referrals sent over but the days are just passing and no calls though a few have confirmed receiving the referrals. ###Output :This is odd. I fail to see why a MD/DO would not prescribe at least 30 days of this medication. It isn't really a chemo drug and most physicians learn about it in medical school."}
{"text": "###Input :Donating Blood with Fatty Liver / NASH42 White Male, 510, 181 PoundsMedications: Wellbutrin, Pepcid, Prilosec, AdderallI currently have Fatty Liver / NASH with F2 Fibrosis. I keep seeing things asking for blood donors due to a current shortage, but my local blood bank lists \"Liver Disease\" as a disqualifying condition.Over the past 7 months, I've lost 50 pounds due to diet and daily exercise. At my last hematology visit, all of my liver blood tests were in the \"normal\" range. So is there really a reason that I shouldn't give blood? Or do they really mean that cirrhosis is the disqualifier for blood donation? ###Output :Fatty liver is not an exclusion to blood donation. When they list \"liver disease\", they mean problems that can be transmitted via the donated blood products. That means viruses, like hepatitis B or C. Cirrhosis does not exclude anyone from donating blood, but the person may be taking medications or have abnormal blood counts or have abnormal vital signs that would prevent the donation."}
{"text": "###Input :Juvenile Xanthogranuloma22m with two skin lesions that were biopsied and turned out to be \"Juvenile Xanthogranuloma\" (adult type).The PA who did the biopsy didn't seem too concerned. I'm a little confused as it seems that it normally happens to infants and I can't find much other information about this online except in medical journals.Some research says it's rare, while other research says as many as 1% of children can be affected and that it's usually underdiagnosed. One study says the average dermatologist sees 1-2 cases per year, which doesn't seem too rare to me. It seems that 10-20% of cases occur in the third decade of life (people my age).I am also slightly concerned about an association between multiple juvenile xanthogranuloma and \"hematologic malignancies.\"What has been your experience with this as a dermatologist/GP/etc.? Is this rare? Do you ever see it in adults in their early 20s or teenagers? Would having two lesions count as \"multiple JXG\"? Do I need to be getting bloodwork done? It's been months since they first appeared and no other ones have appeared.These developed after I got the COVID vax's. Apparently JXG results from a \"proliferation of histiocytes\". Could this be due to the immune response caused by the vax? I have not found anything about this link in VAERS. ###Output :2=multipleThese are very uncommon in adults. Feel free to have a thorough investigation if you feel it is needed. The yield is very low.Your theory on pathogenesis is interesting and unprovable."}
{"text": "###Input :Polycythemia Vera?For the last ~10 years, I've had multiple CBCs done and regularly had slightly elevated hemoglobin and HCT%. My pediatrician and then primary care (until about age 25) never thought twice about it, as they were at the very top range of normal. Then, when I switched doctors in 2019 due to a move, I had a CBC done and my current PCP is much more concerned.The last three CBCs showed: Hemoglobin: 17.4, 17.5, 17.5 HCT%: 49.6, 49.4, 49.8, all taken within the last year. All other labs are normal (RBC slightly elevated too, understandably). I even have a CBC from 2011 with HGB 17.5 and HCT 49%, and 2016 at 17.4 and 50% respectively. The institution they were taken at consider those within normal ranges (though at the upper bound). The most common JAK2 mutation is negative, and so is the EPO testing (as in its normal). I don't have any noticeable symptoms, other than some occasional moderate fatigue and malaise that may or may not be related.I was referred to hematology and the doctor was moderately concerned. She would like to order additional gene mutation testing for less common mutations, and some other more basic labs. The former of which is likely to be pretty expensive. She also was clear in saying that PV is technically cancer, and could lead to stroke etcetc. I am what I would consider highly medically literate, but still found the latter comments fairly scary. At the same time, she mentioned dehydration and sleep apnea as other causes. I find both to be somewhat unlikely given that a. being dehydrated at every blood test seems unlikely and b. i don't snore (though i know you can still have sleep apnear regardless, its far more rare).My real question is: from all of my research, the lab values I'm seeing are really just above normal and may even be within normal ranges at some institutions. To what extent is it worth continuing to pursue the root cause? What do I have to worry about most? If one of those other gene mutations comes back positive, what's my prognosis? ###Output :I would defer to your hematologist for a real discussion, but your hematocrit at or below 50% is pretty non-concerning for primary polycythemia vera. Based on my reading you wouldn't even phlebotomize unless you HCT is >54%. There are plenty of other causes of secondary polycythemia beyond sleep apnea, including just simply having a higher than normal hematocrit.But to be sure, take your hematologists recommendations are far higher value than my thoughts. I deal with the secondary causes a lot more that primary PV."}
{"text": "###Input :This makes a lot of sense to me, appreciate you answering. I agree and defer mostly to the hematologist.It becomes a challenging question when the labs that were ordered (myeloid NGS panel) are quoted at $1K+ and I have to decide if I want to follow through on that. ###Output :A good question to your hematologist is what she's going to do with a positive result. If there would be a treatment that would significantly reduce your risks and improve your life, the $1000 might be worth it. If she would just monitor your blood counts the testing might not be worthwhile. agree with the original physician response.Just wanted to comment on whether or not to do NGS for $1k. I think this is a little excessive if only for high Hgb. Id maybe try CALR mutation first. This is the second most common cause of high Hgb or platelets. Maybe do MPL. Also how are your platelets? And do you smoke by any chance or live at a high altitude?While PV can transition into a cancer, it is also easily controlled with things like hydroxyurea and therapeutic phlebotomy to keep your Hct down. Its not as scary as say full blown myeloid leukemia. Its something that is treatable.Just my 2 cents as someone who works in the field. Maybe bring these issues or questions up the next time you speak with your hematologist. I think the Pulm MD above also had a good thought about if any of these mutations come back positive, what does it do for your future monitoring and treatment?"}
{"text": "###Input :Elevated white blood countAge: 41 Height: 5' Weight: 175 Conditions: hidradenitisHi. I've sat chronically at 12 as my white blood count for several years. I've had issues with fatigue and feeling weak but it's recently increased with the addition of excessive sweating while asleep and at times during the day. my gp sent me for a routine workup where I have spiked to 15 without any illness(ie no colds etc). She repeated the test the following week and I was at 15.66. She's referred me to hematology. I'm overweight and do smoke a half a pack a day. I've been a chef for 20 years so I'm very active despite these lingering habits(sober now for 6 years). So I'm curious what to expect at the appointment if it's even necessary or if I just need to change my lifestyle? Thanks very much ###Output :Smoking, overweight and hidradenitis could all contribute to an elevated white blood cell count. The sweating stuff is non specific, only sustained drenching night sweats are particularly concerning, and they are not subtle at all. Do you have the differential on the CBC?"}
{"text": "###Input :I don't, she hadn't uploaded my tests to my portal. She's been my gp for a few years so she knows my conditions etc. The night sweats only cause me to pause because I haven't had them like this since before I quit abusing alcohol. I guess I'm just wondering if I actually need to see a hematologist or if it's something I can try to manage on my own? She ordered a chest x-ray as well, I have no idea what that has to do with any of it! ###Output :The Hematologist can at least look at your differential, maybe do a couple tests to rule out uncommon chronic leukemias and similar disorders and give you the all clear so the matter doesnt need to be addressed again. If youve got an appt, may as well go to it at this point. 15 is high enough that we wouldnt resent having to see you hehe. Now if you were sent when it was 12, that would suck, and we get a lot of those referrals as well. Its reasonable to get a once over by a blood doctor for a WBC if 15, but most likely to be fine from that perspective."}
{"text": "###Input :M-Spike. How concerned should I be?My allergy doctor somehow decided to test me for some antibodies & some other things due to some unusual symptoms and I had an M-Spike result. She was quite concerned.Specifically, the test was \"Protein Immunofix Electrophoresis, Serum Details\" and the result was \"abnormal band identified as monoclonal IgG kappa.\"I went to my primary care provider who ordered some follow-up tests, which I just got back. The results are in the table below. Most are normal, but the first one is presumably a repeat test (and same result) of the igG kappa.On Wednesday I'm meeting with a Hematology/Medical Oncology doctor. In the meantime I'm wondering if I should be losing sleep over this. Because I am.I'm 50 yrs old, 5' 9\", 150 lbs., male, I take pepcid, non-smoker. I've been having some strange symptoms for five years (balance, adult onset scoliosis, right sided fatigue, bone pain on the right side).Thank you. ###Output :Note: I am not a hematologistLooks like monoclonal gammopathy of uncertain significance (MGUS). A small percentage of people with this condition will progress each year to a low-grade malignancy called smoldering multiple myeloma or to overt multiple myeloma. Some people may develop other malignancy of the plasma cells (mature B cells that produce memory antibodies). Most people are simply monitored for rising amounts of the monoclonal protein over many years, and don't require treatment.Monoclonal proteins may be associated with elevated Factor VIII, which can predispose patients to blood clots. If you have a history of DVT or pulmonary embolism, the presence of these proteins could be a reason to consider ongoing anticoagulation medication long-term. If you haven't had a blood clot, it may be a reason to consider DVT prophylaxis when in high-risk situations, such as surgery or long periods of travel or prolonged bedrest.Your hematologist will probably tell you to have blood tests periodically to monitor the level of monoclonal protein. Based on the data that you gave, it doesn't look like you have a large amount of abnormal protein, so you are unlikely to require treatment."}
{"text": "###Input :I have experienced a change in bowl habits and I have been seen by a gastroenterology who diagnosed me with IBS. My primary recently ran a total bilirubin test and found my direct bilirubin was elevated (direct = 0.3 indirect = 2.0. He wants me to see a hematologist. Is this common?Hello and thank you for reading. I am a 25 year old male, no prior medical history, non smoker, non drinker, very active (run 20 miles a week). I started to have increased bowl movements (5-7 a day on bad days), very lose stools. Its been pretty frustrating. I made an appointment with my GP, he ran standard blood work (CMP/CBC) and the only thing there was elevated bilirubin of 2.0 which he said was just Gilbert's syndrome.. He referred me to gastroenterology.The gastroenterologist ran a C-reactive test, calprotectin stool test, whatever the celiac marker test is, and all were normal. His assessment was that it is IBS and no treatment is needed. I went back to my GP per a followup. He felt it was worth doing an ultrasound of my abdomen and a total bilirubin test. Ultrasound was normal, bilirubin test was 2.0 indirect and 0.3 direct. The normal direct is suppose to be < 0.2.The direct bilirubin test was done on November 4th. I'd seen the results and assumed they were not remarkable. On November 22nd, I get the following e-message from his RMA:\"Your recent labs indicate your direct bilirubin is high which could indicate hemolyis. You need to follow up with hematology as soon as possible. Feel free to contact us as soon as possible\"I was pretty irked to get this message 20 days after I'd already seen the lab results myself. I also felt like more context would be helpful on what as soon as possible meant... does it mean in the next few days or next few weeks or next few months...Ultimately, all I was wanting to know is if this is common practice for that lab result... could that elevation of direct bilirubin be related to Gilbert's? I appreciate the insight. ###Output :It's probably going to be Gilbert's. But who knows, sometimes it's not."}
{"text": "###Input :Thank you for your time and thoughts. I imagine that is what it will be and perhaps he is just being thorough. It struck me as odd that he wanted me to see a hematologist. What are the most common other things one would be concerned about if it isn't gilberts? His RMA wrote about hemolysis concern given the very mildly elevated direct bilirubin, but wouldn't I have abnormal rbc (anemia) blood work if that was happening.I haven't been able to hear back again given the holidays and have been a bit worried by the message. ###Output :Hemolysis is the only other common thing"}
{"text": "###Input :6F, 50lbs, 3 11 Melatonin supplement at night (.03mg), probiotics Medical history (not sure if its relevant) - she was diagnosed with neutropenia when she was 2. Saw hematology for a period of time because they suspected cyclic neutropenia (her levels fluctuated over 6 weeks of finger pokes), but since she was healthy, and didnt seem to have other symptoms, they did not want to do a spinal tap. The few times shes had bloodwork since, her levels have been within normal range. So possible neutropenia of childhood. I recently invested in a personal ECG device (Wellue Pulsebit EX) for me to keep track of my own arrhythmias. But I used it on her, and got irregular heartbeat results. The AI analysis describes it as PACs/supraventricular tachycardia, though Ive tested her 8 times in the last 2 days at differing times and four of them have come up as this and one came up with PVCs (so 5 out of 8 were irregular). I am curious if this is something I should speak with her doctor about, or is this because the device is not taking her young age into consideration. I looked up PACs in young children and while it says some are normal, if they are more frequent then they should be investigated further. Im trying not to worry myself silly, but I would definitely appreciate any insight. Thank you! Im going to comment with a photo of one of the readings, since I cant figure out how to add a photo and text to this post. ###Output :These are not approved for children. Do not use them on her.Children have very different hearts than adults. Their heart rates are generally higher. It is generally not recommended to routinely screen asymptomatic children with monitoring devices like this. The thought process is that it generally leads to a lot of anxiety (as you've probably noticed) and unnecessary testing without actually saving very many lives. If she passes out, bring her to a doctor to have her assessed by machines designed for interpretation of children's hearts."}
{"text": "###Input :Iron Deficiency with normal-\"high\"- hematocrit, rbc and hemoglobin ?Hey guys,25M, 184cm, 95kg, white, diagnosed depression/anxiety on lexapro 10mg, don't drink/no smoking, ex recreational drug user.For reference: I recently had a comprehensive blood panel that revealed:Ferritin 19.3 ug/l (30 - 300 ug/l)Transferrin Saturation 11.7% (16 - 45 %)Hematocrit 49 % (40 - 53 %)RBC 5.7 T/L (4.5 - 5.9)hemoglobin 17.2 g/dl (13.5 - 17.5My GP says you won't have symptoms of Iron deficiency unless it shows in hematologic parameters (hematocrit, hemaglobin, rbc, ...). Is this true?Many thanks in advance! ###Output :This is generally true. However, as a male you shouldn't be iron deficient. At the minimum get tested for h pylori and celiac."}
{"text": "###Input :35m, obese, do I have cirrhosis?I am a 35 y/o male. Diagnosed with nafld very young, back in 2007. I don't drink, or smoke, my diet is pretty shit. My weight usually hovers around the 300 mark. My AST has always been normal and my ALT has usually been elevated. When I lost weight in 2017-2019 my enzymes fell to within normal range for the first time in forever. My last ultrasound was in 2016 and it showed fatty liver.Since 2019, I have gained a significant amount of weight, getting to my heaviest ever at 350 lbs. 6 months ago, I had labs drawn and they were AST 49 ALT 140. Everything else was normal expect for my wbc, 13, and crp at 20! These have been elevated since I was in my teen, have seen oncologist, hematology, etc. Never able to find a cause.My question is, is it too late now? Have I finally don't irreparable damage by gaining this weight back?I don't have any follow up testing scheduled at this time. My triglycerides are normal, etc. Seems odd to me. ###Output :Cirrhosis isnt a diagnosis made by AST and ALT levels. Get an abdominal ultrasound, or CT to look at the liver. You may need a biopsy at some point to characterize the degree of non alcoholic liver disease. I doubt you have cirrhosis but more of fatty liver that could definitely progress to cirrhosis.Try to lose weight, exercise, eat healthyBest of luck"}
{"text": "###Input :Would those number be something to worry about in this setting? My AST and ALT? ###Output :Lose weight. Lots of it. Any damage as of now is still reversible. Later, not so much"}
{"text": "###Input :Do you agree with the diagnosis of Aplastic Anemia? Or at least does it seem likely/feasible? I know that is very difficult to answer on such limited information.Is the current treatment plan of observing a good one? Based on my reading online (again, not always reliable) it often talks about the dangers of not treating Aplastic Anemia. Thank you for taking the time to read through this, and for providing input. ###Output :Theres hypoplasia. Dont think Id call it aplasia. Not so stoked that things are going down. I think the second opinion is reasonable. Id check counts monthly, not every 3 months, at least for a while. Something aint totally right here. But I dont think Id call it aplastic anemia at this point."}
{"text": "###Input :Papilllary thyroid cancer- RAI or notI'm a 30 F,Height 5'10, weight 139, caucasianPapillary thyroid cancer, total thyroidectomy with central neck disscection March 1st 2022Pathology showed classical papillary thyroid cancer, hematological invasion: No, Extrathyroidal invasion: No, lymph node invasion: yes, biggest 0.7 cm, 6 lymph nodes with many having psamomma bodies( did not detail in report). Should I get RAI? I can't self diagnose but im in intermediate category. No genetic testing because my cancer is not genetic?Do you think RAI is appropriate for me? I'm scared go getting a second cancer, salivary glands going and having bad teeth, etc.No known history of radiation exposure or family historyNon-smoker, Non-drinker, Non-recreational drug user- not really relevant ###Output :This decision depends on a number of factors to include number of nodes, size of primary lesion, etc. Based on your description, it sounds like you had a number of nodes that had papillary thyroid carcnioma. which would put you within the intermediate risk group based on the american thyroid association below (I've highlighted the pertinent criteria:ATA intermediate risk (520%) category includes patients with: (i) microscopic invasion of tumor into the perithyroidal soft tissues; (ii) aggressive histology (e.g. tall cell, hobnail variant, columnar cell carcinoma); (iii) PTC with vascular invasion; (iv) clinical N1 or >5 pathologic N1 with all N1 <3 cm in largest dimension; (v) multifocal papillary microcarcinoma with microscopic invasion of tumor into the perithyroidal soft tissues and BRAFV600E mutation (if known); tumour larger than 1 cm with BRAF v600E mutation could confer an intermediate risk of recurrence but has not been proven yet, based on a prospective study.In these cases, it can go either way based on discussion with your endocrinologist. Some will monitor thyroglobulin levels and obtain serial ultrasound, some will recommend RAI. In young patients (<45 years) there isn't a lot of great evidence to say RAI improves survival in those with small central compartment nodes.The decision all depends though on your specific risk factors and various other aspects of health that are outside the realm of feasible determination just through an internet post. Work with your endocrine provider, discuss risks, benefits of each; and you can likely come to decision as to what is best for you."}
{"text": "###Input :Bloodwork check pleaseAge: 28, sex: female, height: 51, weight: 105 lbsplease advise on this bloodwork. My doc said its fine but Im unsure. Cuz it looks not fine. I attached previous tests for comparison.Automated Hematology WBC 13.6 x103/mcL (High) Date: Feb 22, 2023 10:46 a.m. EST Reference Range:4.5 x103/mcL - 11.0 x103/mcL7.2 x103/mcL Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:4.5 x103/mcL - 11.0 x103/mcL8.6 x103/mcL Date: Dec 14, 2021 09:48 a.m. EST Reference Range:4.5 x103/mcL - 11.0 x103/mcLNeutro Auto 76.8 % (High) Neutro Auto Date: Feb 22, 2023 10:46 a.m. EST Reference Range:42.0 % - 72.0 %56.2 % Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:42.0 % - 72.0 %48.8 % Date: Dec 14, 2021 09:48 a.m. EST Reference Range:42.0 % - 72.0 %Lymph Auto 17.9 % (Low) Lymph Auto Date: Feb 22, 2023 10:46 a.m. EST Reference Range:25.0 % - 45.0 %36.0 % Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:25.0 % - 45.0 %44.1 % Date: Dec 14, 2021 09:48 a.m. EST Reference Range:25.0 % - 45.0 %Neutro Absolute 10.41 x103/mcL (High) Date: Feb 22, 2023 10:46 a.m. EST Reference Range:1.40 x103/mcL - 6.50 x103/mcL4000 IntlUnit/L Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:1400 IntlUnit/L - 6500 IntlUnit/L4200 IntlUnit/L Date: Dec 14, 2021 09:48 a.m. EST Reference Range:1400 IntlUnit/L - 6500 IntlUnit/LBUN 6 mg/dL (Low) Date: Feb 22, 2023 10:46 a.m. EST Reference Range:8 mg/dL - 21 mg/dL9 mg/dL Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:8 mg/dL - 21 mg/dL10 mg/dL Date: Dec 14, 2021 09:48 a.m. EST Reference Range:8 mg/dL - 21 mg/dLBUN/Creat Ratio 7.5 mg/dL (Low) Date: Feb 22, 2023 10:46 a.m. EST Reference Range:10.0 mg/dL - 20.0 mg/dL11 Date: Jun 23, 2022 10:52 a.m. EDT Reference Range:10 - 2014 Date: Dec 14, 2021 09:48 a.m. EST Reference Range:10 - 20 ###Output :Do you have any symptoms? Your BUN will be slightly low because you're a small person. Your WBC and neutrophils are slightly high, which is consistent with an acute infection or inflammation, but difficult to comment without context."}
{"text": "###Input :3 year old male with unilateral swollen cervical lymph node, urgent?About 5 days ago I noticed that a lymph node on the right side of my sons neck was quite enlarged. When I palpate, it doesnt seem to hurt him, it is not mobile and feels more rubbery/hard. I would estimate it is 2-3cm across. He had Impetigo 2-3 weeks ago but it has been resolved for a week and he didnt have swollen lymph nodes at the time. He does not have any symptoms of illness currently and there is no one in the home sick. He is eating well, no recent weight loss. Is this something that should be evaluated within the next few days or is it fair to watch for 2-3 weeks to see if the lymph node goes back to the usual size? My son is 30 pounds, has controlled epilepsy and takes Keppra. He was followed by hematology for 1 year previously due to unexplained neutropenia. Has not had blood work in 8 months. ###Output :It likely won't return to its previous size, but will likely shrink down near that on the next few months (not weeks), if it doesn't or your concerned then make a non-urgent appointment with his doctor"}
{"text": "###Input :Do platelet transfusions require the same compatibility requirements of blood transfusions?My son is a 7 week old male. When he was 4 days old he needed a platelet transfusion. His blood type is O- and the donor was B+. From what I understand, an O- blood type can only receive O- donor blood. But what about platelet transfusions? His chart labeled the transfusion \" Pheresed Platelets.\" He was in the NICU during this time and I don't really remember why he needed a platelet transfusion. He had two blood transfusions because his hemoglobin was 3.7 at birth but I don't see any tests results for platelets in his chart until the day after his platelet transfusion so I'm not sure if they were low before. I can bring this question up at his next doctor's appointment but I just wanted to get a sense first if it's normal/ok to give platelet transfusions from a B+ donor to an O- recipient.If we call platelet transfusion day Day 1 then his platelet levels were as follows:-Day 2: 58-Day 4: 40 and later 43-Day 5: 46-Day 6: 49-Day 9: 127They eventually got up into the 200s and most recently was in the 500s. We are working with hematology right now but I just thought I'd share the results in case it's pertinent. ###Output :Nope.It is preferred but not as big as a concern"}
{"text": "###Input :Would viral pneumonia cause a WBC of >80k?24F, 55, 135lbs, USA, no alcohol or drugs, relevant pmh: aplastic anemia and pnh, meds: soliris, cyclosporine, promacta.Last week I tested positive for flu B and strep throat, was prescribed amoxicillin and tamiflu. I initially felt better, but then all of a sudden felt worse. My fever returned (highest was 102.4), wet cough, SOB, and severe fatigue. Went to urgent care earlier today and the dr did blood work and chest X-ray, and was diagnosed with viral pneumonia. However, he told me that my WBC was over 80k, but was not specific with the differential, which is obviously not normal for me. He said it could just be the way my body is responding to the infection. Is this normal or should I reach out to my hematologist? I know I probably should have went to the ER given my medical history, but didnt want to put more of a strain on healthcare if I didnt have to. Thanks for the help! ###Output :No, Thats a really really high WBC count and would be very atypical for a regular viral pneumonia. With your history of aplastic anemia especially you definitely need further evaluation urgently.That person has some sort of hematologic/oncologic process going on until proven otherwise.I would start with just repeating the CBC though."}
{"text": "###Input :Fingers, Toes turning black and rotting off. Desperate for answers! Also hematology and rheumatology blood results and symptoms that no doctors can explain. can't embed images here, so I made a pdf with all text, pictures, and labs. https://www.scribd.com/document/511582218/askdocs-pdf?secret_password=VqmaLuJA0tGw5bGE5xYp It will be much easier to read the whole thing there, with the images embedded, but I will copy the text here.36F, 55, 115 lb, white.  Primary complaint = fingers and toes turning black and rotten (pictures included).  Existing issues = random red cell destruction without cause, random platelet destruction without cause, swellings and rashes (labs and pictures included).  Medications = iron supplement.  Occasional Claritin, Advil, Prednisone.  No medication right now.  No recreational drugs or smoking.  Rare/light alcohol (an occasional drink on holidays or weddings)  Rotten Fingers.My left thumb got a blood blister so I put Neosporin and gauze on it.  The pain became so intense that I went 72 hours without sleep.  I went to urgent care, who removed the bandage.  The thumb was very swollen and the top third was black and crusty.  (picture)They sent me to the Emergency Room, where they removed the upper half of the thumb.  The pain completely went away, it was just a little sore and itchy.But a few days later, all the other fingers and 8 of the toes started turning black.(pictures)Thats the hand with the original bad thumb.  The pinkie has a blood blister, the index and ring fingers are turning black and crusting at the very top under the nail, and the middle finger is just inky blue/black without any crustiness or blisters.  The left picture was taken a day after the right one.  Right Hand:  no crustiness or blisters.  The fingers are just dark.  The index finger is getting kind of gooey (last picture).(pictures)Toes look blacker than fingers but not crusty.  All but the two smallest toes on right foot are turning black.The ER doctors were very kind but nobody knew why my thumb turned black and rotten.  Now here are all the other weird symptoms and bloodtests that doctors cant explain.  None of it seemed like a big deal untl fingers started rotting.  2. Rotting BloodFor years my annual bloodwork showed I was anemic.  For example(picture)But I had no symptoms of anemia other than feeling cold, so my NP said being anemic was just my normal and prescribed an iron supplement.Two or three times a year, I would get symptoms of extreme exhaustion that would last a few weeks.  Most of the time, I felt healthy. But for those weeks, I would sleep the entire weekend, wake up Monday, stumble brain dead through the workday, then get home and fall right back asleep.  After a few weeks, Id start to get better.  For years, my NP said it was nothing, just a virus.  But I never felt sick, just exhausted.  Then a doctor saw me while it was happening.  As soon as she saw me, she took my vitals, looked at my eyes, and said, this isnt all in your head.  We need to take your blood.  Here were those blood results(picture)It turns out that the exhaustion is because my blood starts rotting a few times a year.  I went to hematology.  They tested me for every possible cause of blood destruction.  But everything was normal.Tests included DAT/Coombs negative, PNH w/ FLAER no flow cytometric evidence of paroxysmal nocturnal hemoglobinuria No evidence of aberrant loss of GPI-linked markers tested in erythroid or leukocyte populations. Anti-CD45, glycophorin A, CD59, CD24, CD15, CD64, and FLAER tested. Complement: C3C, C4C normal, CH50 high (>60). Cold hemagluttinins: none detected, G6PD - high (>21.00). No hereditary spherocytosis or elliptocytosis. Infections negative.  Blood cultures normal.I can post the tests if anyone needs to see them.3. Bruises and Rotting PlateletsNormally I dont bruise any more than most people.   But once in a while, I get bruises everywhere.  My bra, underwear, and socks all leave big bruises.  Theyre painless and go away in a couple weeks so I never worried about it.  But when a doctor saw and tested, it turned out there were almost no platelets.  The picture shows the bruising left by a loose sock.  My whole shins were just big bruises that followed the pattern of the sock elastic.(picture)In a few weeks they were back up to 40 and the bruises were gone.  Hematologist found no reason for platelets to suddenly drop like this.  They checked for cancers and even took bone marrow but no answers.(picture)All the bone marrow tests like fish and genetics were normal.  4. Symptoms that Seem Autoimmune but Have No Rheumatologic Cause.  Sometimes I get rashes and swellings that doctors think is autoimmune(pictures)Rheumatology has tested EVERYTHING again and again.  Sedimentation rate, ferritin, and CRP are always high.  But nothing else is usually abnormal.(pictures)They biopsied some of the rashes and purpuras (which I dont have pictures of, theyre just little painless red spots that sometimes break out on my legs).  They all showed the same thing, leukocyto elastic vasculitis.  Heres one.(picture)But every other type of test for vasculitis has been negative.   Nobody has explained why someone healthy and pretty young like me should have chronic venous insufficiency either.I have only had one round of tests where there were any abnormal autoimmune results:(picture)But these things were only abnormal that ONE TIME.  Rheumatology has re-tested them so many more times and they are always normal.  They have tested for every other autoimmune disease and they are all normal.  The only rheumatology tests that are often abnormal are sediment rate, creactive, and ferritin being high.   Ddimer and visc is sometimes high but not usually.  PT, INR, and ptt are sometimes high too.  (picture)They dont think its cryoglobinemia because it was only positive once and negative a lot more times.  Also, my C4 was always high or normal and my C3 was always normal, even in the test where there was cryoglobulin.  (picture)The only other thing off on the bloodwork is subclinical hypothyroid.   TSH is high, but T3 and 4 are low normal.  I have no symptoms of  hypothyroid other than being cold.  And the cold could be from anemia.Please, does anybody know what this all means?I had accepted the lack of answers when it was just random blood rotting, swelling, and rashes.  I know the doctors tried hard.  I could live with all that stuff.  But these black fingers, I cant live with it.  It hurts too much.It feels like someone as healthy as me shouldnt have all these symptoms unless its connected somehow.  But nobody knows how.  Rheumatology thinks the rotten blood is not autoimmune because Coombs and other autoimmune tests are always normal.  But hematology says if its not autoimmune, then theres no other answers.  So far, I have no autoimmune diagnoses but doctors still act like I have something autoimmune.Monday I will see my NP and can ask for any tests anybody recommends.IS THERE ANYTHING I CAN DO FOR THE FINGERS AND TOES?  TO MAKE THE BLACK GO AWAY OR MAKE THEM STOP HURTING?I already tried asking a pain forum for tips, but I got a nasty message (Your complaining about 2 weeks of hurt fingers!  Do you understand that we have pain that is severe, intractable and forever*?*  I have ddd and a herniated L5-S1 disc.  I am in 10/10 agony beyond your imagination.  Your hurty finger is a joke.  Suck it up buttercup) so I deleted it and wont ask for help from patients again.I hope doctors will be more understanding. I get it, that there are other people who have it much, much worse.   But I dont have chronic pain so I never developed a high pain tolerance.  Typing this is killing me. Ive had a broken bones, a vaginal delivery, wisdom tooth surgery, and swollen joints, but none of those hurt that bad.  When Ive broken a bone, its only been blindingly painful for ten or fifteen minutes, then it settles down.  Then a few days of throbbing and aching thats relieved with rest and Advil.  This is the first time Ive had pain that Advil cant relieve and that doesnt settle down with time or rest.  I know other people with bad backs or arthritis have it worse.  I dont need to be told that.  But for me, this is too much.  What can cause this?The doctors seem confident that its not just psychological.But I cant shake the fact that I get more symptoms when Im sad or stressed.  I dont have any chronic mental illnesses, but I go through short periods of feeling down or anxious.  At the hospital, I held it together when they took off the black thumb.  I told myself that it was ok, that the pain was finally gone, that half a thumb isnt that important, that its my non-dominant hand, that I dont need a full left thumb to type or do most activities.  When I got home, I was so happy to be pain free and I had so much to catch up on, I just didnt think about it.  But then I looked at the discharge paperwork and saw that under Reason For Visit, they wrote GANGRENE, WET.  I knew that the thumb wasnt good, but seeing it called GANGRENE made me feel so repulsive and sad.  I spent 10 or 15 minutes just crying.  It was right after that little breakdown that all the other fingers started hurting and turning black.  Could all that crying have caused it?Theres also an odd discrepancy.  My black fingers hurt so much but my black toes dont hurt at all.  How is that possible unless the pain is all in my head?I am desperate for answers or relief if anyone can help.  Thank you to anyone who has read this far.TL-DR:  What causes rotting fingers, rotting blood, rotting platelets, leukocyto elastic vasculitis, swelling, rashes, purpuras, and maybe subclinical hypothyroidism but without showing up on normal blood tests for autoimmune or other diseases? ###Output :This is beyond the scope of all but the most seasoned hematologists and rheumatologists. It MUST be rheumatologic or a bone marrow disorder, nothing else fits all the symptoms. You should be referred out to Mayo Clinic or Johns Hopkins or something. I would say the rapid progressions warrants an inpatient workup until a cause or treatment can be found. If those fingers/toes get infected you could get septic pretty quick.Some type of small vessel vasculitis fits best, but theyve tested for all the obvious culprits so its hard to say why nothing has been found yet. Its definitely not in your head, but its no surprise that stress makes the symptoms worse. Stress makes a lot of things worse.I wish I could offer you more, but this definitely isnt my field of practice. Hopefully someone else has some ideas.Agreed agreed. This needs an inpatient work-up in a big academic center. We had a similar case on my MICU rotation in residency and he was getting continuous plasmapheresis while we tried to figure out what the cause was."}
{"text": "###Input :Are there any hematologist/rheumatologist crossover doctors? Like a single doctor who specializes in autoimmune hematology? It feels like rheumatology and hematology pass me back and forth and like both of them think I'm the other specialist's problem. ###Output :Not that Im aware of unfortunately. The problem is they are both at dead ends and think the other specialty will be able to help. Which is why you need your case elevated to the next level"}
{"text": "###Input :Why wouldnt you suspect infectious disease? Could there be local infectious disease or insect/animal bites that are common? In California we have Valley Fever which is not know outside of certain areas. Could a local infectious agent not well known be an avenue to look down? Some resistant bacteria? ###Output :Theres no infection Im aware of that causes your fingers and toes to necrose. The only way that happens from an infection is when someone is in septic shock and the vaso pressors they need to stay alive cause their small vessels to spasm shut"}
{"text": "###Input :So when is a black finger just Raynaud's and when is it gangrene? The right index finger isn't squishy, but the skin is breaking down and it's oozing something smelly. ###Output :OP, this is an indication that the tissue has died and has become necrotic. This tissue needs to be removed urgently. I am very concerned that an infection of this tissue could become systemic and fatal, potentially in hours.This is a definite indication to immediately head to an emergency room.I am so sorry you are going through this, but you need to be admitted and likely get surgery so that this does not become immediately life threatening.PLEASE DO NOT WAIT UNTIL YOUR APPOINTMENT IN AM"}
{"text": "###Input :EGD Path results32F, symptoms of weight loss, nausea, loss of appetite. Also have LLQ pain. Low platelets, WBC, hemoglobin. Had 2 BMBX in last year that confirmed hypocellularity of bone marrow, no official diagnosis of aplastic anemia or hypoplastic MDSyet. Monitoring blood levels monthly with Hematology. CT CAP showed what turned out to be an ulcer in pelvis, diagnosed via pelvic ultrasound. No further concern and no masses found. Spleen is slightly enlarged but Hematology not concerned.My PCP referred me to GI last year June. GI wouldnt see me until heme/onc cleared me for any cancer. Saw GI end of Nov and had an EGD+colonoscopy yesterday Mar 6.They scheduled a followup in 7 weeks (!) to discuss biopsy results, which I just got a few minutes ago. Any thoughts? Seems like: take a Tums and suck it up? Wasnt really expecting GI to find much but curious what this all means, if anything really. Thanks.Microscopic examination reveals duodenal mucosa with blunted villous architecture, acute and chronic inflammation within the lamina propria and overlying mucosa, Brunner's gland hyperplasia and foveolar metaplasia. Focal reactive epithelial atypia is identified. No evidence of dysplasia or malignancy is identified.Microscopic examination reveals gastric antral mucosa with a chronic inflammatory infiltrate within the superficial lamina propria including clusters of plasma cells. No evidence of Helicobacter pylori, dysplasia or malignancy is identified. ###Output :Some inflammation or other changes in the tissues of your digestive system, but they don't indicate any serious conditions like cancer or dysplasia (abnormal growth of cells)."}
{"text": "###Input :is this iron overload? high iron levels abnormal bloodwork32 year old female, white, smoker, 5'9, 125 poundsOver the last few months I have had my iron tested a few times first time iron saturation was 87% now it it 95% (added pics in comments). My diet has been liquids due to health issues. I have consumed 6.5mg to 7mg of iron daily and guarantee it's not more because I'm not on a regular diet. I take 2 ensure drinks, mainly fruit juices, water, gatorade, and occasionally tomato soup or chicken broth. No way have I consumed a dangerous amount of iron. I also have pain in my right upper quadrant that has been going on for months. Last ct scan was \"normal\" even though it showed mild liver edema. Also have had low platelets 72 to 97 and low wbc 3.1 as well. Hematology appointment set this week. But anyways I would love opinions on this. ###Output :I think your hematologist will be able to answer your questions better than any of us online. We dont know you, your medical history, your family history, or other relevant workup, and we cant examine you.Its possible theres an underlying chronic disease or inflammation is leading to the low TIBC and high ferritin, but the range of possibilities is so broad that itd be irresponsible for us to start guessing based on this limited information."}
{"text": "###Input :Reasons why OB wouldnt follow MFM or HEM recommendations?Trying to wrap my head around what is going on with my provider.Had two uncomplicated pregnancies (shoulder distocia in first, scheduled c section second). I am currently 17W and this pregnancy is going well thanks to some info/changed approach.Unfortunately, my husband and I suffered 5 consecutive losses after these pregnancies before this one. OB was not supportive when I kept asking and saying I was concerned. Went to specialist after not getting answers/support.It was discovered I have Factor V Leiden clotting disorder and 2 other borderline clothing disorders. Met with hematology who had me start lovenox in current pregnancy. Lab reults showing clotting disorder as well as notes CC to OB.OB is not supportive of me staying on lovenox (despite being currently managed by HEM)Additionally, she is arguing about my due date. Despite myself, MFM and other radiology imaging aligning (actually even measuring ahead of my calculations) whereas the uktrasounds she has performed are substantially off. Like over a week behind. I brought this up to my MFM and said its either user or equipment issue. And that they would speak with OB about correcting due date.This is important because I need to stop lovenox and transition to heparin before I go into spontaneous delivery.Again, she is refusing to acknowledge the MFM and change my due date to the correct due date.I dont even know what to say - I know people change physicians all the time but I have built what h thought was a good relationship with this provider and Im literally bothered by the contentious nature of this.Why short of ego would this provider not want to listen to MFM and HEM?I am in the northeast fyi ###Output :I cant say what the provider is thinking, but honestly this is causing you enough stress that it would be worth considering a change in provider.Agree with above comment. Switch OBs. This is unacceptable."}
{"text": "###Input :Do labs ever actually determine EBV reactivation? TL;DR I'm tired of being tired.My OBGYN doesn't know what to do with these results but refer me to an MD who is also a Naturopath.I've had daily fatigue and elevated lymphocytes for nearly 3 years. Initially, my PCP sent me to Hematology and now over to my OBGYN. Hematology increased my iron but when fatigue continued for months after, my OB ordered hormone, thyroid, and EBV panels..Hormone and Thyroid resulted in normal values. CBC done in late January: lymphocytes % =50.6, Neutrophils % =37. EBV panel (February): EBV Ab IgM to Capsid U/mL Value <36.00, EBV Ab IgG to Capsid U/mL Value 393.00, EBV Ab IgG to Nuclear Antigen U/mL Value <18.00. NOTE: Suggestive of a recent Epstein-Barr virus infection.No illness between mid 2019 and these results. Not even a cold. Definitely not mono (had that aged 15)Am I wasting my time going to see a naturopathy-focused MD? ###Output :EBV DNA would be the test that would detect EBV reactivation (that term is probably not a great one, but at the moment Im at a loss for a better one). Its ironically the one doctors check the least often, probably because they dont understand what they are checking for. EBV IgM, if positive, is certainly compatible with recent infection. The IgGs are all variably positive in different patients, to the extent that I place zero value in them. Transplant physicians have a legitimate use for them, but otherwise in my humble opinion they are checked inappropriately > 95% of the time, including in your case.The pretest probability that fatigue in a previously infected patient is due to EBV reactivation is extremely low.Hope that helps. Maybe an ID doc can weigh in better.Regarding seeing a naturopath, I would say if insurance covers the services/treatments they recommend thats a hint they are legit. If its out of pocket to a large extent, Id personally steer clear, but thats an individual decision. Its not medicine, so I really have no authority to judge there.Whats your absolute lymphocyte count?"}
{"text": "###Input :Can you give me some guage on these iron and blood results?Background. I've had elevated platelets on and off for almost 20 years. They've never been enough to cause further testing. This past fall they were elevated again ( I think they were around 540?) so my doctor sent me to the cancer and hematology center (terrifying) for further testing.Here are my results:Iron - 45ug/d L50-212 LUIBC - 341ug/dL 155-355Iron % Saturation - 12% 20-50 LRed Blood Cell Distribution Width - 15.2% 12.1-14.6 HPlatelet Count - *403x1000/UL133-382 HFERRITIN - 30ng/m l6-200Before this test, I had a previous test on my first visit with the hematology doc.My iron was 71 at that time. He put me on elemental iron supplements but I couldn't find them so I took normal iron supplements. He had me on them once every other day. After the second test where my iron was 45, I found the elemental iron and he said to take them every day.Another note that might not be of importance, I was on my heavy period during the second blood test.I'm going back tomorrow but I have a serious, serious case of health anxiety. I have trouble gauging what I should absolutely lose my mind over or what I should just be like, \"oh, I'm anemic.\"I have other lab results related to these but they all came back normal. I can provide those if needed though.When I had my baby 10 years ago, I had to have an iron infusion. But I've never had low iron show up on tests at any other time. Though, I've had the fairly high platelets come and go.Other info about me, if needed: I'm 42, female, obese, asthmatic, type 2 diabetic on metformin (fairly well controlled as I try to eat pretty healthy and am starting to exercise more), PCOS insulin resistance, and take the following meds:MetformingSingulairLexaproBuproprion (sp)Buspironexanax - as neededFerris Sulfate Iron supplement 65 mg 1x a dayOTC - benadrylMy anxiety has me positive I either have leukemia or that I'm bleeding internally from other type of cancer.If my results come back tomorrow and my iron is still low, is that really bad news? Does that mean they're going to need to check for internal bleeding or cancer? What is an really bad iron level? Can you help me find some relevancy?I appreciate you so much! ###Output :You haven't included all your results, which isn't helpful. What you have included suggests iron deficiency. Serum iron is a poor marker of iron deficiency and other labs are used to help sort out what's happening. This looks like iron deficiency. You mention anemia, which the labs you included don't inform about. Anemia is low hemoglobin. This all looks like iron deficiency. Menstruation is the common cause."}
{"text": "###Input :Does this look like Multiple Myeloma?My hubby is 78 male with history of anemia, heart disease and ckd. Nonsmoker. 5'9\", 178lbs. On torsemide, eliquis, carvedilol, entresto. Cardiologist referred him to hematologist and the abnormal results of lab work are: FLC ratio 0.20 Kappa 3.07 Lambda 15.47 Pt/INR 17.6 1.6 (eliquis likely) RBC 3.19 Hgb 10.1 Hct 31.9 Rdw 15.3 Lymphocytes 17.1I'm a nurse and these look concerning to me, but hematology is not my area. Thank you ###Output :Need more information. Light chain ratio isnt used by itself to diagnose MM. Would need immunoglobulin levels and immunoelectrophoresis looking for a monoclonal antibody. Really hard to tell. Anemia and abnormal light chain ratio could be from CKD. More testing needs to be done to help bring clarity to whats going on."}
{"text": "###Input :Thank you. I think there are more lab results in progress. Some had to be sent out and we won't have results for about a week. ###Output :Some take a while, especially electrophoresis. Feel free to come back and post with more results."}
{"text": "###Input :Monoclonal protein 1.76 Beta globulin 1.66 Still waiting on the rest. ###Output :So he has a monoclonal protein and its above 1.5. Im hoping its IgG. Now the trick is figuring out if his anemia and kidney issues are from myeloma or heart disease and poor perfusion. This will determine if he needs treatment or not. Agree with other person on this thread to make sure you test for amyloid. If he has a bone marrow (which he definitely should) then make sure they get a Congo red stain. Make sure you ask for this because many will not request path to look. This is not trivial as patients with amyloid secondary to light chain deposition respond amazingly well to daratumumab. Good news is myeloma is very very treatable these days. His b2 microglobulin is low which is a good prognostic sign."}
{"text": "###Input :I keep thinking amyloidosis but, his brother had MM. Entire family has heart disease and I'm thinking that they may all need to be tested. ###Output :MM isnt typically genetic. Familial cases make up 0.3% of diagnoses. Amyloidosis can be familial but is not the same as AL amyloidosis associated with myeloma. If your husband by any chance served in Vietnam, agent orange exposure also increases risk of developing MM.Your husband likely has IgA myeloma given how high is IgA levels are, which is the second most common form. A bone marrow will help make the diagnosis formal. He likely isnt feeling well from either the myeloma or a possible opportunistic infection in the setting of immune dysfunction from the myeloma.He should be seen sooner than February or at least have a bone marrow done before this time. Someone should be following up sooner with these numbers.If interested, there is also a website run by a physician with myeloma that tracks labs and has physicians from all over weigh in on care. Its free and worth looking into if you are not close to a large academic center."}
{"text": "###Input :35/F, nervous about upcoming appt...35 female, been dealing with a whole slew of issues for 3 years now. I am being seen at hematology/oncology for ongoing anemia. Was diagnosed with alpha thalassemia. Was also told I may have a slow growing lymphoma. Because of that, I had a bone marrow biopsy 3 years ago. No lymphoma shown, but was told it was only a 50/50 chance. Basically if it was in my bones. Doctor ordered a PET scan but my insurance said no. Been going back and forth trying to push for more testing but the doctors don't seem to want to do much of anything to help me. Blood work is almost normal, but symptoms are ongoing. Night sweats, low fevers at night, bone pain, fatigue. I have a ping pong sized lump on the back of my head. Brought it up to one of the doctors and they shrugged and said \"no idea why you'd have a lump there.\" And left it at that. I've asked for a biopsy of other lumps with no luck.My next appt is this week. I have a hard time advocating for myself and pushing for further tests. I get told no and shut down.Any tips for voicing my concerns better? I hate feeling like this and I hate feeling so defeated after all my appointments. ###Output :Very unlikely to be even slow growing lymphoma. Everyone is dealing with a whole slew of issues, honestly. Live life. Please dont look further for a disease. Youve done your due diligence."}
{"text": "###Input :Palpable Lymphnode for years no pain19, Male, 60, Very active and healthyHi there, 3 years ago I have noticed this lymphnode on the left side of my neck and when I turn my head to the other direction it feels huge. I have been to my GP and bloodwork was fine, he sent me to a surgeon who refused to do a biopsy and he sent to an infectious disease doctor who took LOADS of blood and it came back all good- I went back to the surgeon and he got tired of me and I pushed for hematology/oncology & he finally referred me there. When I went to the appointment she said she wasnt really worried and my blood was fine again. I have had 3 ultrasounds on it and it doesnt really seem to be getting bigger. Even after these 3 years it hasnt changed in size at all. Recently though I had a cold and a bunch of lymphnodes around it back enlarged and painful. They all went away but I was feeling this lymphnode again and its freaking me out. Its way bigger than my other nodes and it feels so hard. Im so irritated I never got a biopsy for it. Should I be concerned over lymphoma or no? Should I go back to the doctor? Please give me thoughts ###Output :Should I be concerned over lymphoma or no?You've had 4 physicians, multiple US, and blood work suggesting its fine. I'm not sure what else a physician over the internet is going to tell you at this point.Im so irritated I never got a biopsy for itWhy? Would you be irritated if it came back normal but you had a complication from the biopsy that you are still dealing with today? Would you be satisfied knowing the biopsy was normal, but there is a chance for a false negative?its freaking me outI think the bigger issue here is your anxiety. It does not sound well managed. This will lead you to never be satisfied regardless of what you do or have done. I would suggest your seek mental health therapy/counseling for this."}
{"text": "###Input :doc referring, can't figure out what's wrong, 32f 230lbs partial hysterectomy (have ovaries) in 2017 due to endo. Recently diagnosed PCOS after internal ultrasound. Massive weight gain within past year (80lbs) despite 900 cal diet and intermittent fasting. Whole body swelling, constant pain in feet, legs, back and pelvis area. I've had a slew of lab tests done and my doctor cannot figure out what is wrong. They are referring me to Hematology. They \"don't want me to worry\" so I'm getting half assed explanations. I'm frustrated and I really feel like my body is just giving up. My WBC has been elevated for over a year. I have attached pictures of my lab results. I have upcoming appointments for Hematology, a chest xray, CT scan of pelvis and Neurologist (daily headaches and vision issues) What would the point of a chest xray be if I'm not having difficulty breathing? Every time I ask for explanations they just skirt around it without giving me actual answers. I know speculation is not good but I would rather have an idea of what COULD be happening. https://imgur.com/a/sVjWCD9 ###Output :Have they ever ruled out hypercortisolism with a suppression test ? I can't find in your tests cortisol and ACTH values either"}
{"text": "###Input :I don't believe so, that doesn't sound familiar. Is this something I should speak with Hematology about once I see them? ###Output :It's an endocrine disorder that would fit most of your symptoms (and also the high WBC count)"}
{"text": "###Input :Wow, after looking at this I have SO many of the symptoms. I've been living with unbearable stress for about 2 1/2 years, it's caused crippling anxiety and I feel like I'm about to pop. I don't know if major stress could cause this or add to it. I'm calling my doctor now to see how I can have this testing done. Thank you so so much. ###Output :Let me know if you have updates. The first step is a simple blood test (performed in the morning around 8AM), to measure Cortisol and ACTH."}
{"text": "###Input :Just curious, why 8am? Is it tied to when most people get up or does it have to do with circadian rhythms and such? ###Output :The reference values are based on that time, when there should be the physiological peak of cortisol. Hormones fluctuate a lot during the day, cortisol more than others, so a simple blood draw is usually not enough to get a diagnosis. Performing it at the right time helps a bit, knowing that it should be at its highest level of the day ( the lowest is around midnight )"}
{"text": "###Input :I think the question is more so of \"how does the body know what time it is?\". If someone sleeps 11 am to 7 pm, it would be really interesting for cortisol to still be highest at 8 am. ###Output :That is a great question. People with insomnia or who work night shifts might have altered cyclesI might be misremembering, and of course would defer to you (you being an endorcrinologist..), but I feel that I remember reading in medical school about the cortisol cycle being the least affected by behavioral changes in sleep-wake of most the diurnal cycles."}
{"text": "###Input :I'm not sure, the second picture of my lab results has a TSH free line but it doesn't look out of range (that I can tell) ###Output :Your TSH is fine, 0.7 is a good value"}
{"text": "###Input :I don't know how to edit my post and not sure this info would be relevant but I'm always hot, constantly sweating. My temperature is usually around 99f. Also, both of my armpits are swollen, some days it hurts to even move my arms. The only time I've experienced something like that was after receiving my 2nd dose of Moderna and I was told it was swollen lymph nodes. ###Output :Is it possible youre night eating?If you were eating a strict 900 kcal diet I have a hard time imagining you would be maintaining that weight.Do you take ambien by chance?Also why exactly are you referred to heme? You posted a mountain of labs and no one here will review them all for free, do you know what labs exactly are abnormal they were concerned with?"}
{"text": "###Input :Mystery left abdominal painUpdate about 160 days later: mystery solved Had colonoscopy+EGD and emptying study. All that was found was mild gastroparesis. Two days ago I had a diagnostic laparoscopy and surgeon found deep endometriosis behind my uterus. Also found a large nodule of endometriosis higher up on my left abdominal wall, which explains the pain. Will have it removed in a few months and should be pain free.Original post: 32F 5'6\" 125lbs I have had left abdominal pain for about 3+ years now. It is directly left of my belly button. Most of the time, it's very dull and barely noticeable. However, a few days before my period it starts to intensify. Then during my period it is intense, to the point where my daily activities are limited. It has been getting worse over the months/years.The pain feels kind of like a pulled muscle, and when I move/sneeze/cough, it is extreme. The only thing I can relate it to is a labor contraction. When I move or stand up straight, also extreme. If I hit a bump driving in my car, extreme pain. Then after about a week, it fades away to a duller pain until it comes back more fiercely next month.I began the process of exploring this pain with my OB/GYN in 2019 and at the time it began, I had already had two miscarriages. I've had several pelvic ultrasounds and all were normal. We started the discussion of endometriosis and had some appointments set up with a surgeon for a consult on the laparoscopic surgery needed to diagnose it...and then he pandemic hit. My appointment got bumped, and bumped again, and then I got pregnant with my son who was born early 2021. I had no pain while pregnant and the pain didn't return until my period did.Early this year (2022), I saw my doctor again for the pain, loss of appetite, weight loss (now at about 35lbs lost in 2022), nausea. They did several blood tests and my WBC, RBC, and platelets all came in low. I was referred to hematology/oncology where we did bone marrow biopsies and several other tests. No cancer was found, but it appears my bone marrow might be in the early stages of failure, perhaps developing aplastic anemia. I get my blood counts monitored each month and they have been low, but stable, so no action required at this time. Hematology also did another pelvic ultrasound and a CT scan of chest/abdomen/pelvis. My spleen is slightly (barely) enlarged, otherwise everything is normal. No masses found.Now that hematology has done their thing, GI will finally see me. I saw them last week and am scheduled for an EGD and colonoscopy early Jan 2023.The doctors are reluctant to explore endometriosis at this point. Their reasons are: I had a \"successful pregnancy\", they do not want to do the surgery because of my blood counts being low (too risky I guess), and there really isn't much they can do if it's endometriosis anyways. They had me try an oral contraceptive for a few months and that did not help.Any ideas on what this could be? What questions I need to be asking? What other tests to request? Im at a loss and growing weary of spending money on all these tests that are coming back negative. ###Output :Have you been checked for an umbilical hernia? either by imaging or by a general surgeon?"}
{"text": "###Input :I have not met with a general surgeon. My CT scan of chest/abdomen/pelvis didn't show anything, which I'm not sure if it would or not. I brought up a hernia to my PCP because I had read an article about how hernias in females are often harder to diagnose and she felt my stomach and said she didn't think it was that. I will bring it up again.ETA: Wouldn't I have been in excruciating pain throughout pregnancy with a hernia, especially toward the end? I didn't have the abdominal pain at all during pregnancy. Just curious! ###Output :My CT scan of chest/abdomen/pelvis didn't show anythingIn my experience, radiologists often do not report simple fat containing hernias, so I always look at the CT images myself to see if there is actually a hernia that just wasn't commented on by the radiologistread an article about how hernias in females are often harder to diagnoseyou are probably referring to inguinal hernias not umbilical hernias. Maybe you could ask for a referral to a general surgeon depending on what ur pcp saysWouldn't I have been in excruciating pain throughout pregnancy with a hernia,No. Hernias can cause pain but many of them do not. And women very frequently get umbilical hernias during pregnancy. So thats why your history of pregnancy and now periumbilical pain made me think possible hernia."}
{"text": "###Input :Is this hematology panel indicative of chronic lymphocytic leukemia in a 61yo female?HematologyWBCA134.0-10.010*9/LRBC4.463.50-5.0010*12/LHemoglobin140115-155g/LHematocrit0.40.35-0.45L/LMCV9182-98flMCH31.427.5-33.5pgMCHC347300-370g/LRDW1311.5-14.5%Platelet Count270150-40010*9/LDifferentialNeutrophils4.12.0-7.510*9/LLymphocytesA7.91.0-4.010*9/LMonocytes0.70.1-0.810*9/LEosinophils0.20.0-0.710*9/LBasophils0.10.0-0.210*9/LGranulocytes Immature00.0-0.110*9/LWBC MorphologySMUDGE CELLS presentRBC MorphologySTOMATOCYTES presentHematology CommentsResults are pending ...Recent screening torso MRI:Potential mild cardiomegaly. Note that this is not a study accurate for cardiac evaluation. Possibility of left ventricular hypertrophy is raised. Please correlate clinically and with dedicated echocardiogram or MR imaging as required.An increased number of lymph nodes at both axilla and hila although these are still measuring within normal sizeA mild degree of edema at the lower gastroesophageal junction, may indicate chronic gastroesophageal reflux disease. Mucosal details are not available.Both kidneys have focal areas of volume loss; this is worse on the left and may indicate scar tissue, sonographic evaluation for any underlying pathology would be beneficial. Is there any concern for embolic events?Multilevel degenerative disc disease, described above. There is also likely bilateral L5 spondylolysis with potential for malalignment in addition to the scoliosis.There is a nonspecific bone lesion at the posterior left femoral head, a somewhat similar configuration focus at bilateral posterior pubic bodies. These potentially may be compatible with erosions or subchondral cyst formation, Recommend nonurgent radiographic correlation.Borderline prominent spleen correlate clinically.A small segment 7 cystic lesion can be assessed with nonemergent ultrasound. Possibly septated hepatic cyst, hemangioma or less likely cystadenoma. Reported using speech recognition. ###Output :Not really. White count is only 13"}
{"text": "###Input :Was the presence of smudge cells that tripped me up, but maybe that can be normal? Right now she's been having chest pain and I highly suspect CAD but without a positive ECG or elevated troponin they won't do anything further. ###Output :CLL typically has white counts in the hundreds, not 13.Without more details on the chest pain I cant really comment"}
{"text": "###Input :Please, please help...no one can figure out whats wrong and at my wits endI've posted here before and no one ever seems to answer but I'm getting so sick that I'm basically bed bound from pain.I'm a 32 yo woman, overweight at 280 lbs, diagnosed with Sjogren's, PCOS, and on these medicines:Metoprolol for tachycardia I've had since childhood Metformin for PCOS Spironolactone for low potassium I've had since childhood (used to have constant racing heart and passed out a lot as a kid because of low potassium) as well as PCOS Nuvigil for chronic fatigue Pilocarpine for Sjogren's dryness Doxepin for ribcage pain Rosuvastatin for high cholesterol Low dose naltrexone 3mg for chronic pain Trintellix for depressionA few years ago, like 5 years now, I was healthy and 125 lbs. Then I had my 2nd child, was about 180 after she was born, and developed PCOS. I could not lose weight and gained a little more and got to about 225.In Dec 2019, my psychiatrist put me on Trileptal for mood stability. About a month later, I started to develop pitting edema and severe low ribcage pain and then had absolutely zero appetite whatsoever. I went to the ER with grade 4 edema, severe low rib pain, and blood in my urine and bloody vaginal discharge. No sign of infection, no excess protein, nothing really out of the ordinary aside from GFR that would dip into the 50s before sometimes coming up again and blood. I did get low iron and potassium, needed iv potassium several times, but they could find nothing to easily explain symptoms. This goes on for nearly a year...I got up to 325 lbs even though I could barely eat or get out of bed. I truly thought I would die.I stopped taking my medicine when I couldn't eat, and noticed I felt worse after taking it again. I also felt worse if I exercised. So I stopped Trileptal and rested for about a month and slowly seemed to recover. Then my OBGYN found uterine polyps and I had surgery to remove them. The next month, my gallbladder was removed. The next month, I had surgery to \"fix\" my urethra since they thought maybe I was having urinary problems stemming from that.But I got better and tried to be okay mentally with the constant dismissals I got from so damn many docs before I finally got some help. It was extremely difficult and I suffered with health anxiety because of it but have done great with therapy. I even managed to get my weight down to 235 after starting exercise after being sure my kidneys were fine again at a consistent GFR over 110.Then a month ago, I got a very bad case of flu. The lower rib pain came back bad. I dismissed it as flu. Recovered from it, then had several days where every muscle in my body felt like it had been lifting heavy weights for days. Everything hurt, and doc said maybe mild myositis from flu. Then I noticed urinary changes. I normally have frequent urination, going a few times a night and usually at least every hour or more. No one can find a cause though. But suddenly not going at night at all and only going like 3 times in the day. Started having white flecks in urine sometimes and strong odor. Then urinalysis started showing blood in urine consistently. Then sharp pains in urethra all the way to anus at times, which I'd had before as well. I have brown vaginal discharge too. A few days ago, I couldn't pee at all and was sent to the er. They can find no reason for my symptoms...nothing on ct, no bacteria in culture, no stones, no nothing. No one knows, but I had to have a foley catheter inserted (was very painful like stabbing) because I had retention and could not pee. Was sent home with it and had it removed next day and I was able to pee again but then developed pitting edema. It's currently grade 1. No cause can be found.I will add in case it is relevant, just before the flu, my pcm referred me to neurology for mris of head and spine and nerve conduction test. I've been having nerve pain for several months. Buzzing, tingling, numbness, shocks, in various places for sustained periods and sometimes just sudden and then goes away. She was thinking the lower rib cage pain may actually be nerve pain since it feels burning at times like the burning headaches in the base of my skull and my neck. My thyroid is sometimes hypo but usually fine, my b12 and magnesium are normal, and I do not have any markers of diabetes other than just being fat currently. My grandma has MS, which she believes was healed by Jesus, but I know enough about it to know that's what she's trying to rule out I'm pretty sure.Can anyone, please , give me some insight about what might be wrong with me? I'm in so much pain with the gnawing, burning pain in the bottom of my ribcage and the electric shock pains in my urethra and anus, and I am so scared of the fact I've got urinary bleeding, vaginal bleeding, and putting edema but no one knows what's up. I've seen rheumatology, nephrology, urology, obgyn, even was sent to a hematology oncologist as a hail-mary.I stay away from Googleing anything because for one, I have too many symptoms to easily fit in a search bar, and I know there's no good coming out of looking at it anyway. I have gotten better care since changing hospital systems after last time this happened, the urologist I saw kept insisting the blood in my urine was from my vagina even though I still had blood in my urine after a catheter was used to sample, and I e just had a really hard time getting docs to push to figure out what's wrong. It feels like since I don't appear to be imminently dying, and they dismiss my pain and exhaustion, no one sees a point in helping.So sorry for the long post but I'm just trying to give as much context as I can. Please let me know if you have any questions as I'm happy to answer. ###Output :In the absence of objective findings on imaging and testing, it is possible that weight in itself can cause the multi-system problems that you have. Obesity unfortunately affects numerous organ systems in subtle ways initially."}
{"text": "###Input :Can someone decipher my hematology panel?Age: 36Gender: MaleWeight: 88kgs, Height, 175cmsLocation: CanadaEthnicity: SE AsianMeds: 40mg Pantaprazole 2x a dayGot some bw done recently for stomach pains, crazy ACID reflux nausea, bloating and right sided flank pain. Seeing my GP on Sunday, but wanted some ideas in the mean time.Image at link below:https://imgur.com/GaF9PCg ###Output :To me it looks like iron deficiency"}
{"text": "###Input :Thanks. That's kind of what I gathered from my uneducated Googling, but I just don't have any fatigue, brittle nails, hair etc. The only symptoms of worry (which started this whole thing) have been crazy acid reflux, nausea , bloatedness, abdominal aches and pains and sharp flank pains. ###Output :The deficiency isnt big enough yet to affect your hb more something to be aware ofThe other symptoms sounds like something else. Consider this probable iron deficiency as an accidental find during tests"}
{"text": "###Input :Multiple diagnostic tests and still no answers.Hi there! I am just looking for any answer, preferably from someone who has a background in hematology? I am a 29 year old female, and was hospitalized for an unknown illness in April (fever, chills, all over body aches). The doctors ran many tests (HIV, mono, Covid, Flu, RSV, blood cultures, abdominal CT, pelvic exam, pelvic ultrasound, CBC tests, etc.) and still were not able to find what was causing my symptoms. I worked with an internal medicine specialist after my hospitalization because I continued to get sick and have fevers every couple of weeks until July. She ended up testing me for many infectious diseases and they were negative (with the exception of EBV, but this didn't look like something new). Also tested me for an ANA marker (negative). Her biggest concern were my elevated platelets and WBC. She noticed these had been elevated for >6 months. I had a peripheral blood smear and saw slight leukocytosis with left-shifted neutrophilia and monocytosis, slight thrombocytosis with normal platelet morphology. No abnormal circulating cell populations identified.She referred me to a hematologist who I have been working with but still no answers. The hematologist tested me for a JAK2 mutation (negative), CALR mutation (negative), BCR-ABL (negative), and redid my CBC count. She had been thinking potentially essential thrombocythemia (ET). This time my reticulocytes are elevated and my circulating antibodies are elevated. I do not have an iron deficiency. My WBC and platelets continue to be elevated and they ran another peripheral blood smear with similar findings. Everything seems to point to \"favor reactive/inflammatory\". However, in looking through my historical lab reports, we can see this blood work has actually been a pattern for the past 9 years! I have begged her to do a bone marrow biopsy just to triple check for ET or other MPNs because it seems that about 50% of patients with ET have no genetic mutation but she said no. I just feel like I need to know why my bone marrow is pumping out immature blood cells and extras of others. Now she's referring me to a rheumatologist and I don't understand why except that I may have chronic inflammation. I have no joint/muscle/bone pain, my ANA marker test was negative. Could it potentially be something like autoimmune hemolytic anemia since my reticulocytes are elevated and antibodies?I'm just so tired of being dismissed by doctors over the years and not having answers. I am so exhausted all the time. I just want someone else to give me another opinion or potential ideas for new avenues to explore. I am following up with the hematologist in January and have an appointment with a rheumatologist that same week, hoping to get in earlier if someone cancels.Thank you so much in advance. ###Output :Were you tested for a mutation in a gene called MPL?Does your peripheral blood still show a left shift, or has that resolved?"}
{"text": "###Input :Hi! I wasnt tested for an MPL mutation, just CALR, JAK2, and BCR-ABL. The left shift was still there in my last blood test in late September. Not sure if it has been a left shift the whole time but in my past records (over 9 yes) my WBC is almost always elevated in addition to my platelets. ###Output :You might try asking for a MPL mutation test (can be done from DNA extracted from your peripheral blood or bone marrow aspirate). Also, do you know if your CALR test was done by PCR and electrophoresis, or sequencing (i.e., next generation sequencing, NGS)? The PCR + electrophoresis method can usually identify but not characterize atypical mutations (i.e., not type 1 or type 2), whereas NGS can identify and characterize any mutations. Only about 1/8 of essential thrombocythemias are \"triple negative\" (lacking mutations in JAK2, CALR, and MPL).Another angle would be trying again to get a bone marrow biopsy and see what that shows."}
{"text": "###Input :What are your thoughts on the left shift? ###Output :That's nonspecific. Causes could range from an infectious process, an autoimmune process, a malignant process, or none of the above."}
{"text": "###Input :Oh okay I see. Thank you! Did you see my other comment about the CALR test type? ###Output :Yeah -- so it's almost certain you don't have a classic CALR mutation (type 1 or type 2) but some small possibility remains you have an atypical one.If you end up getting a bone marrow biopsy done by someone (you can always ask the rheumatologist to order one and see what they say), you can always try to get a comprehensive NGS panel done on the resulting sample. Depending on who your healthcare system contracts with, this is usually a 50-75 gene panel that would include JAK2, CALR, and MPL, as well as various other genes commonly mutated in myeloid malignancies. It could still be negative, though -- about 1/4 to 1/3 of the NGS panel cases I sign out are negative. Hopefully this is something your insurance would pay for, as this is a very pricy test."}
{"text": "###Input :Do I have hepatitis b? [Lab Results]Hi there, I just recently started going to the VA and they did a lot of blood test on me. I will l double check with my PCP but to be frank, I would like a second opinion either way.Does the below indicate that I am positive for hep b, and it seems as though I've contracted it within the last 6 months. Is this accurate?Mandatory stats: 36M, 5'10\", 230lbs, white, no existing medical issues with STDs except I have HPV, no medication, moderate drinker, smoke cannabis moderately. USA.Lab Test: Hepatitis PanelLab Type: Chemistry/HematologyOrdering Provider: [REDACTED]Ordering Location: [REDACTED]Specimen: Serum (substance)Date/Time Collected: 30 Sep 2022 @ 1305Collected Location: [REDACTED]-------------------------------------------------------------------------Test Name: HEPATITIS B SURFACE AbResult: POSITIVE Units: --Reference Range: Interpretation: Never infected with the virus (consider giving vaccine)HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - negativeHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - negativeInfection likely took place over the last six months and is still active.HEPATITIS B SURFACE Ag - POSITIVEHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- POSITIVEHEPATITIS B SURFACE Ab - negativeInfection likely took place over the past six months and is in theprocess of clearing.  A false-positive is another possibility(HIV-positive people with this particular test result should have theirHBV viral load checked).HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- POSITIVEHEPATITIS B SURFACE Ab - negativeInfection likely took place more than six months ago and has beensuccessfully controlled by the immune system.HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - POSITIVEThe vaccine was successfully given to prevent HBV infection.HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - negativeHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - POSITIVEChronic HBV InfectionHEPATITIS B SURFACE Ag - POSITIVEHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - negative Performing Location: [REDACTED]Status: Final----------------------Test Name: HEPATITIS B CORE TOTALResult: NEGATIVE Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Final----------------------Test Name: HEPATITIS B CORE IgMResult: --Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Pending----------------------Test Name: HEPATITIS B SURFACE AgResult: NEGATIVE Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Final========================================================================= ###Output :Vaccinated and immune"}
{"text": "###Input :Nutritional advice regarding protein shakes/liquid dietHi guys! Im not really sure if this is the right place to post this, but I figured its worth a shot:) Im 22 female, 53 and about 220lbs (yes Im overweight, yes Im working on it, Ive lost 20lbs in the last 4 or so months) with autism and ARFID, I was also recently diagnosed with PCOS. Im currently only taking yaz birth control. Ive struggled with eating/wanting to eat since high school, and typically I only eat once a day because Im either not hungry or the thought of eating makes me feel sick. Recently, since I was diagnosed with pcos, Ive been placed on birth control. Ive noticed that I get hungrier faster than I used to, which isnt necessarily a bad thing. The issue is within an hour of eating, Im starving again. Ive just constantly felt empty but because im so hungry, I feel sick and cant eat, which obviously makes everything worse. My question is, since I dont have a nutritionist atm, and I have to go to the store Tuesday for groceries, if you guys had any recommendations on protein shakes or simple snacks that are super filling/cheap that I can get until I can work with someone on my diet? Im just so tired of feeling like this lmao ###Output :Your weight and PCOS put you at risk for diabetes. Talk to your doctor about adding metformin to your regimen. Get screened for diabetes. In the meantime high protein/low carb diet will help, but dont do it for too long."}
{"text": "###Input :How many nutritional supplement drinks is it safe or wise to drink in a day?In the past several months I have experienced a significant (and possibly severe) reduction in my appetite. I'm just not hungry, and I can't force myself to eat without feeling sick. Which more often than not leads to me not eating for several days, usually without even realizing it. I also can't sleep at night.. yay me. But that's not what I am addressing here.I had someone tell me since I'm not eating as much as I should, I should drink those Ensure shakes to make up for some of the nutrients I am not getting. What I want to know is how many should I be drinking each day? Just one? I also got myself fruit and spinach and stuff to make some healthy smoothies. I'm trying to plan good meals to eat, but my lack of appetite is making that harder than it probably should be.Diagnosed: ADHD, low blood sugar, asthma, and depression Current meds: Singulair for asthma Female, 5'6\", 130lbs ###Output :They're designed nutritionally balanced so you just need to match the calories you need."}
{"text": "###Input :Could lack of nutrition explain my (86F) Grandmother's poor health?I hope this is a relevant place to post this, I'm not sure which sub is best, but any opinions would be extremely welcome. Sorry for the long post.My Grandmother is 86 years old, lives in the UK and in the past 4 years has seen a tremendous downturn in her health and wellbeing. She suffererd a broken ankle 4 years ago abroad, and was put on a plane for a 9 hour flight home despite this so she could be treated for free in the UK. Shortly after she fell in the bathroom and hit her head, and her health has never even close to recovered since. Doctors have done every test they're willing to do on the NHS and they never find anything wrong.Those events certainly marked the start of her decline, but she is now getting much worse. She has no energy, often doesn't get out of bed, and is extremely unsteady on her feet. She describes this as being like a massive head rush where her legs simply give out every time she stands up. She can't cope with any situation outside of the absolute normal, is getting confused all the time but not in a way that reminds me of dementia. It's more that she simply doesn't seem to be able to think clearly or quickly. Her actual memory is generally ok. She is on Bisoprolol for a heart condition, and otherwise just vitamins.I do her shopping for her every week, and it's a constant argument. She wants me to buy enough food for MAYBE 2 days at most every week. I buy her more but it often just gets put in the freezer or goes out of date. She insists she eats plenty, but I simply can't see this being true. She weighs about 6.5 stone and hasn't got an ounce of fat on her body, she is scared to drink because of having to get to the toilet also.I don't live with her so I can't say for sure how much she eats, but it's can't be much at all. A brioche roll in the morning, a cake or something in the afternoon at most, abd no more than half a small ready meal on the evening, but again, I only buy her maybe 3 days worth of meals at most and they're often uneaten.She is beyond frustrated that she is just getting worse and worse, but I can't help but think the answer may be as simple as she is almost always nearly starving. She is a very stubborn person and refuses to even try to just eat more, or even try to sip a nutrient rich shake or something just to see if it helps. She talks like a person with a weight disorder to be perfectly honest.I appreciate that most of this stuff sounds like she's just old, but she's declining so rapidly, I just want to try anything that gets her even a small amount of quality of life back. I hope this is somewhere within the accepted rules of the sub, any opinions would be appreciated. Thanks. ###Output :Fractures are a huge risk factor for older people, and her story is not uncommon. While her poor food intake might make the decline worse, the relationship might be the other way around: she's feeling poorly and therefore has lost her appetite.I'd recommend you have a chat with her and her doctor first, where you bring up your concerns. It's also not uncommon for older people to be reluctant to discuss these kinds of issues with their doctors and family members to avoid \"being a bother\" or feeling like a burden. The issue is that those little things pile up quickly, and if they aren't taken care of, they become bigger problems. It might be best then of you bring them up, but keep in mind that she might be embarrassed. I am concerned about the dosage of her bisoprolol, as the feeling of her legs suddenly giving out might be a sign that she needs a lower dose or perhaps a different medication all together, but if she hasn't mentioned it to her GP then they wouldn't be aware of it. It might also be time to discuss perhaps getting a carer for a few hours every day, to ensure she's eating and reduce her risk of falling or getting UTIs from avoiding the toilet.It is important to remember that your gran is an adult, and so long as her mind is still all there, she can make her own decisions, even when neither you nor her doctor agree with her. Losing whatever control she has over her life, be that over her food or her medical care, could have a much bigger impact to her wellbeing than what you're perceiving from her intake right now, so all of these conversations need to be approached tactfully and keeping her as the decision maker."}
{"text": "###Input :Are 'superfood' nutrition supplements sufficient to keep my body from going into a nutritional deficit?27M. Occasional tobacco smoker. 5 foot 7.5 inches. Exercise regularly.Obviously, it's best to maintain a diverse and healthy diet filled with vegetables, fruits, meats, grains, nuts, etc.I'm well aware of that, but I've got a ton of other stuff in life going on that I'm trying to focus on, and diet is currently not my top priority. That being said, if I'm going to maintain a \"minimally effective\" dose of nutrients towards my diet - is taking a superfood supplement enough to stave off diseases, etc? Or would this be throwing a tiny bandaid over a gash?I eat mostly healthy foods, rice, meat, oatmeal, frozen fruits etc, but sometimes I just don't make the effort to eat enough fruits and vegetables. Mainly, there is a lack of diversity in the fruits I eat. I've heard that in general, you should try to eat diversely so you don't miss any crucial nutrients.Is supplementing with a nutritional powder like Green Vibrance from Vibrant Health or Vital Reds sufficient if I have somewhat of a healthy, but repetitive diet? ###Output :With a good balanced diet (which you clearly have) there is absolutely nothing to be gained from vitamin supplements.The supplements are at best less effective than a regular diet, and have potential for harm. You should avoid using them unless recommended by a physician.The point of a good diet is less that there are definite nutrients needed and more that eating a variety of foods with non-caloric bulk reduces risk of weight gain and metabolic syndrome. Theres no evidence that supplements of specific vitamins are good for you without specific deficiency; theres no evidence for superfood supplements and very little to justify the super in so-called superfoods.Eating a perfect diet every day is not practically achievable for most people. Eating a good diet mostly is whats important."}
{"text": "###Input :Nutrition questionI've been really good about monitoring calories, saturated fats, etc for a while and have lost quite a bit of weight. Is it wrong to splurge for a single night? I'll be having pizza with my folks and don't want to mess with my overall health. ###Output :I am not in the slightest concerned about you eating pizza for the evening. What worries me is the general context here, what is your relationship with food like? How much do you weigh and how quickly are you losing weight? If you're counting calories, how many do you eat in a day?"}
{"text": "###Input :I keep getting quad cramps above the knee every time i go hiking. Is this a nutrition issue or just overall shape?Want to preface this by saying i plan to see a dr or even nutritionist next week. However right now I'm on a hiking trip, so just kind of hoping for any quick advice.I'm 30M in good shape and health, but cardio has never been huge for me. Lately I've been doing spin a few times a week trying to change that habit. I've been hiking for a few years and never had any issues until the past year or so. All of a sudden every single hike i do, once it starts to get challenging i get bad cramps in both my quads right above the knee on the inner side.I've been trying to totally change my hydration habits, drinking a lot before and during the hike. Gatorade before and during, even tried supplementing with those emergency electrolyte packs. No change.I know it's a long shot but anyone ever had this start to happen and figure out how to fix? Or is it just getting in better shape? ###Output :Lack of calcium or potassium and dehydration is the most common cause- I dont think this needs a doctor but do take more than just a light supplement. A banana is actually perfect for preventing cramps."}
{"text": "###Input :Internist advised to go to hospital for nutrition but when?Hello,22year old female who has been vomiting for the past 13 days. Was referred to an internist. He has referred me to a gastroenterologist.The internist was concerned about my nutrition intake and told me I may have to go to the hospital for some type of supplemental nutrition. I asked him when but he was vague about it, and said I would feel shitty.Well, Ive felt shitty for a while, and was wondering at one point I would need to go for some type of supplemental nutrition. Have been vomiting all food for 13 days, and some fluids. Have lost weight (do not have a scale), but clothes are loose, and I track my calories and last week averaged 150 cals and this week averaged 300.I did have to pick up a prescription today and discussed it with the pharmacist who advised me to go, but I was hoping I could also get a doctors opinion since I would prefer not to go to the hospital if I do not have to.Thanks! ###Output :I would go today. 300 calories a day is not sustainable and your *body will be taking damage from that."}
{"text": "###Input :(1) In general hypoechoic lesion worst than hyperechoic?(2) I've been taking supplements such as Vit-D (2000IU almost 4 times a week), NAC and Zinc (once in a while) to avoid Covid based on what i've read. I also take whey protein/collagen at times for recovery after the run/weights. I've been reading taking too much protein or anti-oxidants can also cause cancer? Please comment if anti-oxidants can actually cause reverse damage?(3) I know ultrasound is safe in general, but what are your comments/thoughts on heat on the organs if i go for scan once every year. The radiologist scanned 15 minutes on my liver which was bit too much IMO(4) Would you recommend me to go for MRI? I know MRI are safe (no radiation), but again those Radio Frequency, no one knows how it impacts us in the long run?As you can read, i am anxious and hypochondriac. Would love to read your thoughts and comments.PS - Scan if you want to see https://imgur.com/a/GofAWbX ###Output :Hypoechoic is generally better and a cyst, but it depends on the actual look and situation. Hemangiomas are benign.Antioxidants seem to help, but there's not enough knowledge to say how much. (Maybe my own knowledge). That being said, antioxidants don't negate bad habits like smoking, alcohol, etc. Better diets and habits are the main way to reverse damage. There's a lot of literature easily found regarding epithelial oxidative injury. Too much anything seems to be bad. Water, protein, oxygen, etc etc.Ultrasound is considered safe. It is used on babies' brains if that helps you feel better.You should get an MRI if the impression on your scan says that the lesions need that kind of evaluation."}
{"text": "###Input :How quickly can you develop nutrition-based anemia?Thanks to lockdown and a breakup, something I thought never possible happened--I (28/F) began relapsing into anorexia, which I recovered from several years ago. For the past month, my diet has cratered, generally hitting 700-1000 calories a day. What I do eat is horrible--popcorn, Clif bars, and protein shakes. That's it--no other foods. Needless to say, I have lost a significant amount of weight, and I was thin to begin with. (For reference, I'm 5'2 and am 99 lb now--I was about 105 before).I run for 30 min 4x a week. Lately it has become harder and harder; my heart rate skyrockets, and I tire quickly. Is it possible for anemia to have set in due to poor diet already? I've struggled with that in the past due to the ED, with similar symptoms.(To be clear, I *know* I have to address my eating disorder; I am not so naive as to reduce the problem here to just anemia. I've done this rodeo before; I've already hit the weight I said I would stop at, and of course I am still restricting, because that's just how EDs work. I am seeking therapeutic help.) ###Output :It will be hard to tell you that and honestly probably easier to just get your labs checked. In theory, yes, it can happen but it would require a lot of conditional circumstances existing prior to this month to tip you over. In reality, probably not:You need to be iron deficient prior to this month so that your body can't make adequate RBCs this monthYour blood cells typically last up to 120 days, so you shouldn't drop significantly in a single month under normal circumstances even if iron deficientYou are female and if menstruating, that could be a source but usually it isn't enough in a single month (unless you were anemic to begin with or severely iron deficient to begin with or heavy menses)Honestly, your fatigue, heart rate, exercise intolerance is probably due to your inadequate caloric intake and your body trying to preserve energy (and breaking down your body fat/muscle)"}
{"text": "###Input :Anemia isnt the only potential issue here. All your cells in your body need food for energy. If you are using much more energy then you are putting in to your body, you're gonna run out of energy. You're starving yourself. Like when someone is ill from starvation. Just slightly slower. ###Output :Possible, but it's more likely that there are other factors contributing to your easy fatigue, such as dehydration and overall lack of metabolic fuel due to your restricting. While you're seeking help, I think it would be advisable to cut down on your exercise regime as well."}
{"text": "###Input :Nutritional Advice33F, currently 150 lbs, 5'6\", white. Previous diagnoses: PCOS, migraines with aura, acid reflux, several skin allergies. Medication: None currently. Alcohol: 1-2 glass of red wine per week, no recreational drugs.TL;DR: How the hell is one supposed to eat 18 mg of iron daily?Very bad choices led me to gain a lot of weight in my 20s, got to be a max of ~220 lbs by the end of 2018. GP told me I needed to lose weight, so I did. I started eating healthier and exercising more. For the past 4 months I've been eating below 1400 calories on average. I'm still losing weight, but I started to feel very tired in general, and get easily out of breath while exercising. GP send my to take a blood panel 2 months ago. Results came back and he said I was ok but said that since CBC values came considerably lower than the last few times, I needed to eat more iron rich foods. Since I'm already logging the foods with an app that tells me the nutrients, he said I should aim on getting 18 mg of iron daily, and explained all the ways of maxing iron absorption (vitamin C with heme iron, avoid dairy in same meal, etc).So it's been 6 weeks since I started paying attention to the iron. I use a digital scale, and verified sources (like USDA) to check iron amounts on every food. I still have severe issues trying to reach that daily amount. It seems like the only days I'm able to reach it is when I ether eat beef liver, mussels or a huge amount of spinach. I love spinach, but I don't really enjoy liver or mussels so I have to find ways to have them. Beans, lentils and seeds are good, but I can't have too many since I'm still losing weight. The days I have those with some eggs, I still can't reach 10 mg of iron.Past 2 to 3 weeks have been worse, I feel even more fatigued and dizzy than before. I think because of the pandemic measures in my country, my GP's office have stopped answering phones. I left a voice message but haven't hear back from them yet.So question is.. how do people do it? It seems an insane amount to get daily.If it matters, here's my last BP:Hc: 36%Hb: 11.9 g/dLRBC: 3.880.000 /mm3Colour Index: 79.33%MCV: 92.78 /um3MCH: 30.67 pgMCHC: 33.06 g/dLI would greatly appreciate any input on how to improve my nutrition ###Output :Hmm, based on those results your hemoglobin is low, however the pattern doesn't really look like iron deficiency. With the PCOS do you have a lot of bleeding? It could be that your body is just unable to keep up with the blood loss. You might ask your doctor to check your iron levels to be sure. I think the amount of iron you are eating is probably okay based on the results you posted. If you want to try to get more, you could try an iron supplement, but if you do start at a fairly low dose and go up gradually because it can cause some stomach upset. If you can't find iron supplements, you could try prenatal vitamins which tend to be well balanced and have high levels of iron. It's hard to tell just from the parameters you posted, but I would also be concerned about your vitamin B12 levels. Make sure you are getting the recommended dose of B12, and consider adding a B12 supplement. If you are still having trouble after a couple weeks of this, and your hemoglobin remains low, you should probably have your iron and B12 levels checked. (for the sake of clarity, we usually don't actually check B12, we check some other chemicals in the B12 pathway)"}
{"text": "###Input :I have not noted an increase in bleeding. I also go yearly to my gyno, last time I did a check was on January, PAP smear was normal, and last TV ultrasound showed normal follicles, gyno said she thinks losing weight might have helped.I haven't had my B12 checked, but the app to track nutrients tells me I'm almost always good on B12 levels.I'll see if I can find the supplements you suggested, and start from that. I don't see being able to take a blood sample again soon because of the COVID situation here, since only emergency appointments are allowed.Thanks a lot for your time and answer and have a lovely day! ###Output :The amount of B12 you're eating might be good for maintenance (to keep your level stable), but if you are low, you might need more. Especially if you have Had a poor diet in the past, the levels stored in your body might be low"}
{"text": "###Input :Child Weight/NutritionMy son is 4 years old and one month. He's 39.36 inches tall and weighs 40 pounds even. According to bmi he is obese. I am asking what would be good numbers of calories and nutrients to feed him? He's very active so I'm not concerned about excercise. Also his pediatrician says his weights fine and that bmi's don't always work right for children, is that accurate? Should I just not worry because a growth spurts close? I'm prone to worrying when there's no problem so maybe the doctors right? The only reason I'm even doubting the doctor is because he is, at a guess 375-400 pounds, and I worry he is more okay with obesity than he should be. My son was 9 ppunds and 8.9 ounces at birth, caucasian, non-Hispanic. If that's relevantEdited to add: He has just gotten over pneumonia twice and has low IGG, we are seeing an immunologist soon to figure out why. So taking him places to figure out calories and nutrients isn't really possible right now because we are staying inside. Just hoping for advice until I can take him out, thank you :) ###Output :Obesity at his age is highly associated with adult obesity, but far easier to fix now than later. Some kids slim down but many do not.Easiest solution is to meet with a registered dietician (NOT a nutritionist). They can help you plan meals so he has the right number of calories / balance of nutrients.That being said, the easiest (and one of the more effective) ways to slow weight gain is elimination of all liquid calories, even milk. Only water to drink."}
{"text": "###Input :I'm probably not going to make an appointment with a dietitian right now because of the coronavirus and my son also has a weakend immune system which I probably should have mentioned, so any ballparks would be helpful until I can get in. We have been cutting out calorie drinks besides milk at breakfast and juice with dinner. The confusing thing for me is he really doesn't snack, maybe he was just having way too much juice before. Thank you! ###Output :You can do a phone appointment with an RD."}
{"text": "###Input :What will happen to someone (29F) drinking only one 330 Calorie nutrition shake a day?A friend has been having a mysterious, very serious neck/jaw issue for the last two years, rendering her unable to eat solid food. She has been to many doctors, who were all unable to diagnose or treat the issue.She often lives on Kate Farms nutrition shakes, which have 330 Calories each. She would usually drink 4-5 a day, plus whatever else she felt able to swallow. Recently however, in particular after restarting taking her antidepressant medication, the feeling of choking on anything she tries to drink has worsened  she describes it being possible to drink a shake in the morning after waking up, but getting more and more difficult throughout the day.She reports that she has only had an average of one a day for the last 3 or 4 days. There's no sign that it's getting better, and she is feeling resistant to trying to drink more of them because it is so physically unpleasant/scary to do so. I'd like to present her with some solid information about the progression of malnutrition  what kind of symptom timeline can she expect if she stays at this extremely low Calorie intake?She is already obviously very low-energy and depressed. I'm looking for concrete info on how many days of 1 shake/day average it will take before other serious physical symptoms of malnutrition emerge.Thanks!Age: 29Sex: FemaleHeight: 5'4\"Weight: ~130, reports losing 50lbs from normal weight a year agoRace: ChineseLocation: Eastern US ###Output :They will die. This is not enough food to live. She needs to go to the hospital."}
{"text": "###Input :Flu-like ache but definitely not the flu. Could it be linked to a nutritional deficiency?32 F.Height 5' 11. Weight 145lbs.Vegan diet, health-conscious, mildly-moderately active.I've basically had fatigue and consistent mild pain since I was a teenager (my doctor put it down to depression). But this has continued into adulthood and I'm becoming determined to get to the bottom of it.But for the past couple of weeks I've been having this really weird sensation of a deep ache and tightness throughout my body, like it's in my bones and my joints. The closest thing I can describe it as is that it's similar to when you have body aches with the flu, but not nearly that bad. It's quite mild, but I feel like I can feel it throughout my chest/back/ribs, in my arms and hands, and occasionally in my legs. It's not debilitating, it's just weird and a little uncomfortable. It's not consistent either, it sort of comes in little waves/pulses. I get a deep pain in my leg bones sometimes when the weather is very hot or very cold, and it's a similar ache to that but again not as severe, just a similar 'deep'ness.Have you heard of this before?!I'm looking into getting some tests done to see if I have a chronic deficiency. Last time I was tested I was told I don't have anaemia, but I'm also interested in vitamin B12 and D deficiencies. Also considering getting the genetic sequencing test to look for MTHFR mutation, because from my own research it seems that a lot of my symptoms link up with this.Is there anything else I should get tested for?I typically eat a very healthy, balanced diet. I get plenty of protein, supplement with a good quality B12, take vitamin D drops in winter, occasionally take Floradix for iron if I know I haven't eaten much iron that day. Occasionally I take K2 and hemp seed oil for omega 3-6-9. ###Output :With vague non-specific body aches like that, a doctor can help elucidate a more thorough and specific history and exam. Not sure how long ago the last set of labs were and what exactly the hemoglobin and MCV values were, Id start with repeating routine labs like CBC and CMP, maybe a CK to check for muscle breakdown. TSH and vitamin D levels would not be unreasonable. The presence or lack of anemia on repeat testing can guide whether or not a B12 or homocysteine should be checked. Not sure why one would bypass these cheaper and possibly indicated tests for an expensive test for a gene variant that wouldnt change management without starting with routine labs and going from there.If one were truly concerned about malabsorption from diet, then consider celiacs testing and ruling out IBD if there are other GI issues."}
{"text": "###Input :Nutritional Advice needed/AlcoholismThis is kinda a weird one, and I'm not sure if it belongs here or some more niche subreddit.I am 25 years old, an alcoholic, I drink approximately 300mL of vodka every day or every other day. I have generally healthy eating habits, avoid pasta, carbs, eat primarily meat, vegetables, kefir, cottage cheese, low carb wraps, etc.. I do not drink anything containing sugar barring clear liquors. I have a family history of high blood pressure, which mine is manageable and better than most of my family. I think all things considered, barring my weight and alcoholism, I am relatively healthy, although I know I won't be forever with some of my habits.Through my insurance, I get gym memberships to basically everywhere for free, and just learned about this, and have been taking advantage of it. I'm not used to prolonged goal-oriented activity, and haven't been since maybe highschool track and field, though I went to the gym in college as well to a lesser degree. I didn't get a car until last year, and my exercise then consisted of a two mile commute by foot to work. I have hovered around the same weight for a long time, about three years maybe.I understand that alcohol has caloric content, which may impede my physical development as well as eat into my daily intake calorically.My big questions are as follows: Does it [alcohol] impede muscle recovery to your knowledge?If I exercise when I still hurt from a prior day's exercise, is that a bad thing? I want to go to the gym literally every available bit of off time I can spare, but I know overdoing things can cause bad effects depending on what they are. I'm not like, in agony, just tight in my legs and other places.I want to work on my alcoholism, but I've been very focused on dieting and exercise lately, and working in a pushy sales job during the holiday season means I got a lot on my plate in addition to those and I can't just fix everything at once I guess. ###Output :This question is the quintessential rearranging deck chairs on the Titanic. Instead of dealing with the alcoholism you quibble over other issues.Please find a drug and alcohol therapist, preferably someone who specializes in motivational enhancement therapy. Having seen a friend in his 40s go through fulminant liver failure from alcohol use, I can attest that it ain't pretty. His liver is still shitty but he's functional, but his brain is toast..."}
{"text": "###Input :Kidney stones training nutrition adviceThree weeks ago I've got my first kidney stone experience, and it wasn't pleasant. I just expelled it recently and went back to the hospital to do one more check up and also to give the stone to them in order to determine what kind of stone it is... After the check up they told me the stone went out and I was ok. But apparently I have another small one forming in my other kidney. They said it's small and even if it started moving I'll probably just expel it without any problems or pain, but I need to be careful on not making it grow bigger so I should drink plenty of water. So far so good.Now my problem is; I'm underweight and I've got a sedentary job, and I'm starting an intensive six months program at the gym to build muscle mass. This program include a very strict diet plan and the consumption of protein whey powder and creatine. I read in many forums that protein powder and creatine are not ideal for subjects with kidney stones history. And when I asked the doctor after my check up he just said \"doesn't matter what you eat, just drink a lot of water\". Now, I'm not an expert, but I do believe that what you eat does matter...I'm asking for advice here because I cannot see a specialist at the moment. I was wondering if taking protein powder and creatine wont have any negative effect on the formation of other stones as long as I drink plenty of water, or if I should avoid them...And if I should avoid them, are there any substitutes I can take?To give some context. I'm male, 32 years old, 187 cm and 69 kilos, never had kidney stones before, never took creatine before, I took some protein whey powder for about 40 days one year ago. I'm not under medications. I don't have any history of diseases.Any advice is really much appreciated. ###Output :If you can drink enough water, you can consume a bit more protein (not too much more; up to 60-65g is ok. More is not helpful and is wasted, unless you're training for the Olympics) without problems. Generally, taking more creatine won't help....it gets digested, and is no different than any other (much cheaper) protein. The issue is that the amount of water you need to drink to markedly reduce kidney stone formation is a lot...at least 2.5 liters a day. Most people don't manage to make it to 2 liters a day unless they force themselves to drink more water. It helps if you add a bit of flavoring (e.g lemon flavor) to it. Especially if you exercise a lot, you will need to drink even more. How much more? If your urine is totally colorless (not yellow), you're drinking enough. You can do your weight training and eat a bit more protein with no problem, but generally, one will not see any additional muscle increase by eating much more protein (more than 60 g or 65g per day). So eating 100 g of protein per day will not increase your muscle mass, and will increase the risk of kidney stones. All the protein whey powder and creatine are more psychological...you can get the same benefits by eating a couple of extra egg whites per day."}
{"text": "###Input :My arms fall asleep daily while sleeping and usually when using armrests in planes. Do I need to consult my physician on this?Hi there. I'm 28F 5'8\" 160lbs white, and generally very healthy and active. I have no major medical conditions, good nutrition, don't drink alcohol, workout several times per week (yoga, lifting, indoor climbing). I take hormonal BC to avoid painful periods (been on it for more than a year) and I started taking a long-term antibiotic for a skin issue a week ago (yes I'm aware they interfere).I've noticed that almost every day while sleeping lately, I wake up at some point with some of my fingers numb and prickly up to my entire arm being limp (where it flops around, can't move it, and have to \"shake it back to life\" so to speak). I remember this happening occasionally as a kid, as well, so it's not a new development. I take several work trips per year that involve flights and I tend to get a similar problem sometimes when using the armrests in planes.I'd say it mostly happens in my right arm (dominant) but I think it happens in the left arm sometimes, as well. I'm a bit alarmed that this seems to be happening so often. I'm guessing my brain wakes me up when this starts to happen so it can't be that long that it happens but I can't be sure, obviously. I'm just concerned that it may at some point cause damage if this keeps happening.I have a memory foam type of mattress, so I'm wondering if a different type of mattress would help? A side sleeping pillow? Maybe it could somehow be nutrition related?Any advice is appreciated, thank you! ###Output :Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.Most commonly, the sensation of a limb \"falling asleep\" is from an issue with a peripheral nerve, and not (as is commonly believed) from an issue of blood circulation.Some people (and I am one) are more susceptible to this phenomenon, but it can happen to anyone. When a nerve is compressed, it will stop functioning temporarily.There are places in your body that are more susceptible to this - generally where a nerve is running close to a bone, and where there is little flesh surrounding the nerve that might diffuse the pressure.One nerve that is very susceptible to compression or injury is the ulnar nerve, commonly known as the \"funny bone\". If you let your arm dangle at your side with the palm facing forward, the \"funny bone\" is at the back of the elbow, just above and towards the middle of the body from the bony lump you feel behind your elbow.A sudden blow to this area often produces a sudden sting / burning sensation that radiates down to the hand (this event is the reason behind the name \"funny bone\"). However, prolonged pressure on the area will also produce symptoms, and is the most likely cause of numbness and tingling in the hand and fingers while leaning on the elbow.Typically, the sensation of the pinky and ring fingers is the most affected, as well as the same side of the hand and forearm as those fingers.The solution that I have worked out for myself is simply to avoid leaning on that part of the elbow. Place the forearm on the armrest instead, or lean on the outside of the elbow, not the inside.This is not, of course, the only place that is affected by nerve compressing. Many people, when sleeping, have their arms under their head and / or pillow, or even under their body. Using trial and errors, you can probably find a sleeping position that will minimize the chance your limbs will \"fall asleep\"."}
{"text": "###Input :2 year old admitted to hospital, unresponsiveLatest update (since coming back to the US after private hospital was unable to treat him in February, and he was having retractions): For future parents that might be in a similar situation and trying to find answers, I thought I would share what we have learned since coming back to the US.While in the hospital, the doctor kept saying he was unconscious because of inflammation. However, as I was trying to gather medical information, his theory at the time was sepsis. He did have a UTI a month or two earlier that we struggled to find antibiotics to treat (although he seemed to respond well and quickly when our pediatrician prescribed Augmentin).Our pediatrician here suspects encephalitis because he was fully up to date on vaccines (including pneumococcal), and the timeline was so fast from a cold to eyes fluttering open but not responding to pain or voices. Hopefully we will never know, because the most likely way to be able to correctly diagnose what happened is that it happens again while in an area with better ability to treat and test.That being said, information that would have been nice to have included a blood culture and a brain scan (according to our pediatrician here). Our pediatrician at the hospital where he was admitted did not have the ability to do either of these, and I still think it was our best option, but I wish I had known that the hospital was so limited because I wish I had at least had the opportunity to consider medical evacuation. I truly believe his pediatrician at the time was doing the best he could, and quite frankly, I still completely believe he saved his life, but I have learned that there are cultural differences. Doctors in some cultures may not be as forthcoming as would be expected in Europe and the US.Although to say, he is fine now. Because of the mystery surrounding the diagnosis in December, we don't really know how likely another similar episode is. However, now he seems like a perfectly healthy, developmental normal, energetic and talkative 2 year old boy! And we have learned to ask A LOT more questions about medical care before moving overseas ;)Update: His primary care just came in. He believes it is a combination of factors. Firstly, he is fighting a virus. Secondly, his glucose level was low and he was dehydrated at admission. He anticipates sending us home maybe tomorrow. For right now, he said he just needs IV nutrition and fluids, and time for his body to kick whatever the virus is that he's fighting.My son, 2 year old male, 12 kg, 85 cm, was admitted to the hospital about 9 hours ago. Our whole family has had a virus. Both he and my daughter received IV nutrition day 36 hours ago. My daughter recovered yesterday almost completely, but my son slept all day. I think it's been several days since he stood on his own. I brought him to the hospital, anticipating needing another round of saline, vitamins, and glucose.As I was transporting him, though, it became apparent that he was even sicker than I realized. He was completely limp, and failed to respond in any way to checking his glucose levels. His eyes would flutter open and sometimes hed briefly make eye contact, but he didn't respond to his name.He has been admitted at least overnight. His glucose and electrolytes were low, as well his leukocytes. One of his liver enzymes was also high (I believe AST...whichever one, it was 42). His urinalysis came back with ammonium urate, mucus, and acetone (according to Google Translate...I am a beginner in the language here, and the doctors and nurses don't speak English, so everything I know is through Google Translate). His O2 was also a little low (94), so he is on oxygen. They have given him glucose and electrolytes and vitamins, as well as an antibiotic.Can anyone explain why he became unresponsive? His BMI was perfectly healthy. I thought fat was able to sustain through sickness like this until able to eat again, and not only that, he had IVs yesterday of vitamins, saline, and glucose. Is he going to be ok? How long is the road to recovery likely going to last? Any theories as to what's going on?I'll also attach a copy of the urinalysis, translated. I don't have a copy of the blood work, though.Edited to add: He has since woken up for brief periods. Maybe 4 hours or so on IVs, he woke up and asked to nurse. He also fought the nurse and doctor while having his nose aspirated... the doctor, nurse, and I all had to hold him. He fell asleep shortly after that, and has not woken up since. ###Output :There's not nearly enough info to say why he's unresponsive. I know youre stressed and looking for answers but you won't find them here."}
{"text": "###Input :Can adolescent anorexia have long term effects? Does it have long term effects if it occurs during puberty?26m. No known health conditions. From upstate NY.Ive struggled with my weight my entire life. At birth I was 9lbs. By the time I was 12, I was clocking in around 190 lbs. By the time I was 15, I was well over 200lbs.When I was 15, I had multiple surgeries on my feet. I had arthritis, and flat feet. I had 5 back to back surgeries to correct it. They put me on a ton of pain meds from 15-17. As a result, my appetite was severely suppressed during those 2 years. I remember losing a ton of weight, and people started to notice. I barely ate, due to the low appetite from the pain meds. I remember being 15, and thinking Wow. This was easier than I thought. This led to some pretty terrible choices. Throughout puberty, you probably couldve defined me as a textbook anorexic. I barely ate, and the weight just fell off. I really didnt notice how bad it was until I was 20. I was 20 years old and severely underweight. I was skin and bonesToday, I dont deal with it at all. Im 511 and weigh around 170-175. I dont really check. I eat well, and long distance cycle 3-4 times a week. I do strength training a couple of times a week. Not as much as I should, but I try. I watch what I eat, but definitely consume at least 2000 calories a day. Theres no question about that.But the more and more I read up on this, the more I fear how the prescription pain meds, and anorexia was detrimental to my growth during puberty. Thats such an important time for human beings, and I fear what long term effects my poor decisions caused.Can adolescent anorexia and drug use have detrimental effects during puberty? Maybe Im just paranoid. I fear it stunted my body. I fear I didnt give my body the proper chance to grow and mature ###Output :Most boys are done growing by 16. You were likely close to your adult height regardless by age 15."}
{"text": "###Input :I already take calcium/vitD combination tablets since my anti hormonal treatment started and got worse despite it. I asked my oncologist about vitamin K and she waved it off saying she had never heard of it. So I'd have to look into evidence for that if I want to have mine measured and supplemented I think. Hadn't heard about the combination with vitamine C either. Here they're just like 'oh the calcium and vitamin D don't do enough? Well guess we'll bombard with bisfosfonates then' ###Output :Possibly. But it can be significantly improved with strength training and good nutrition.It's not clearly wrong. It's a medical fact.\"Boys tend to show the first physical changes of puberty between the ages of 10 and 16. They tend to grow most quickly between ages 12 and 15. The growth spurt of boys is, on average, about 2 years later than that of girls. By age 16, most boys have stopped growing, but their muscles will continue to develop.\"https://kidshealth.org/en/parents/growth-13-to-18.html#:~:text=Changes%20in%20Boys&text=They%20tend%20to%20grow%20most,muscles%20will%20continue%20to%20develop.I didn't say ALL boys stop growing at 16.Most resources say 16. Some say 16-18.Most boys are NOT still growing into their 20s.Everybody has anecdotes about somebody they know that grew 4 inches in university. Those are mostly exaggerated, and/or outliers.Your anecdotes about your friends getting taller doesn't change what happens for \"most\" boys."}
{"text": "###Input :It is just quite frankly wrong, every countries education system and reliable sources all say boys stop growing at about 19-21 ###Output :No, they don't.https://www.google.com/search?q=average+age+boys+stop+growing&oq=average&aqs=chrome.0.69i59j69i57j35i39j0i512l2j0i433i512j0i433i457i512j0i402j0i271l3.1317j0j4&client=ms-android-oneplus-rvo3&sourceid=chrome-mobile&ie=UTF-8#ip=1You can easily see differently by simply googling this.Most resources say 16. Some say 16-18.Most boys do not continue to grow past 19. Some do. Most do not.This is why male growth charts norms plateau at 16-17 years, but weight continues upward.It might be commonly said to be 19-21 in your country's education system, but that's not accurate.If you're able to find a source that says it's typical to keep growing into your 20s, there 100 others that say it's not.This is common pediatric knowledge.You think you're right here, because lay people have told you this while growing up, but it's not medically accurate."}
{"text": "###Input :Is it unreasonable to try to ask for IV foods, or is this feasible? How else can I stop withering away? Please help.Im not sure what the technical term for IV food is, but here we go:Basic info: Male, white, 33 y.o., 6 foot, down from 190 lbs to 129 lbs. Im in the U.S. and do have insurance.Background info: for the past four years, I have had increasingly bad health issues that doctors cannot diagnose. It started with joints that felt like they were tearing spontaneously and not healing (which makes them to where I have no strength or movement) and it is literally almost every joint in my body. Then it became muscles and other soft tissue that seems to be contracting out of nowhere, and I am losing all range of motion. Then, I have other health issues that pop up and never seem to heal. Examples are erosive gastritis for the past 2 years that wont heal with medicine and prohibits much of what I eat, eyes that were hurt after being outside for 30 minutes and have now made it to where I cannot tolerate light or screens without searing pain, and weird things like that. I have seen so many specialists, and they are all baffled, think something is seriously wrong, but say they cant help. Extensive bloodwork has shown nothing but a TPO antibody, but normal thyroid levels.My main question: with my joint problems, I have not been able to close my jaw for almost a year, which means I havent been able to eat solid food in almost a year. Then, my erosive gastritis limits most high calorie foods from my diet. I stuff my mouth with the foods that I can eat, and if I try really hard, I still struggle to get 1500 cal a day. I have tried everything I personally have control over, but it is just not possible to get enough, and my nutrients are low and making it to where I can hardly stay awake. I have asked doctors if there would be any way that I could get IV food so I can get enough nutrition to, at the bare minimum, not keep getting worse and worse. Ideally, I would be able to get enough to gain weight so I can maybe improve my muscle mass. However, I mentioned this to a doctor and was laughed at like it was the dumbest question on earth. When I say laughed at, he literally said oh my god and rolled his eyes.Is this a crazy request? Is this a feasible option? If you have ANY suggestions, please help. I hate to sound dramatic, but my entire family thinks Im dying, and I feel Im on my way there as well. My stomach and colon have been torn up from all the medicines that have been tried, and I am all out of ideas. ###Output :If you cant tolerate enough oral intake for nutrition then an appropriate next step would be consideration for a feeding tube of some sort. Either into your stomach or small intestine.IV nutrition is inferior and prone to a lot of problems (also super expensive and hard to get insurance approval). Its not typically used unless you absolutely cant use the intestines for one reason or another."}
{"text": "###Input :Before they would consider IV nutrition, they would exhaust all the other ways of feeding you.IV nutrition comes with significant risks. If there is zero other way to tolerate food, it's better than starvation, but putting things in your intestines for nutrition is the safest and best in most situations ###Output :I also agree. You are not a candidate for IV nutrition. So presumably a gastroenterologist diagnosed you with erosive gastritis after an endoscopy? What was the treatment plan for that diagnosis?Putting this all together: unhealing joint injuries, muscles contracting, light intolerance, stomach and colon torn up, and extensive normal testing raises the possibility of a somatic symptom disorder."}
{"text": "###Input :Yes, I was diagnosed with an endoscopy, and I believe there were erosions in 3 places. At first I was on sucralfate 3x daily, Pantaprazole 1x daily, and dicyclomine 3x daily. That hasnt worked, so Im now on Pantaprazole 2x daily, sucralfate as needed, and dicyclomine 1x daily. That might change, however, as I have sought out a new gastro after the last one dismissed me passing a lot of blood in my stool and colon pain (likely from a large amount of antibiotics I had been prescribed).My symptoms have been strange, and I dont at all understand them. On MRIs they have seen torn ligaments, but there were no reasons for it to be torn; they have seen inflammation in my eyes, but there was no reason for it to be inflamed; and they can feel the popping/tightened muscles and described them as being constantly kicked on. But, the bloodwork comes back fine; the silver lining is that maybe Ill get something named after me? ###Output :There's a lot that remains unanswered so it's hard to say anything with certainty. I agree with my colleague - IV nutrition is reserved for people with no gut, or a biologically nonfunctional gut.However, if erosive gastritis is the issue preventing you from eating, and you have lost that much weight in 6-12 months, you may be a candidate for a feeding tube placed in your small intestine, past the level of your stomach.I don't understand why the gastritis has been this refractory to treatment (it is usually fairly simple to treat). In general the answer would be fixing the stomach problem. But a feeding tube could be used here while trying to solve the medical issues."}
{"text": "###Input :can i still grow taller? (16f)it's my biggest insecurity to the point i feel like taking my life over it, i know it sounds like i'm exaggerating but it's just been so bad for the last few years. i don't even want to leave the house over it most times.i'm 16, 5\"2, 40kg. i had a really bad eating disorder for the last few years and i'm barely eating 600/700 calories a day. i know this is making me malnourished and probably is a reason why i didn't grow that much. but i will put in the effort to recover if it means i'll grow taller. my parents are 5\"0 and 5\"9. i want to be at least 5\"4 which is only two inches but it seems impossible. i just really want to know if i can grow still because it's eating me up alive. ###Output :5'2\" is an extremely normal height. I'm sorry to hear about your eating disorder but you're a completely normal height"}
{"text": "###Input :Any fitness/wellness tips for a 29F, 4'11'', 177 pound jogger?I recently started jogging. I'm up to jogging 2 miles on a treadmill slowly and consistently at 3.5 mph speed. Did it the other day, did it again today. I'm strength training a bit, too.. I can plank for 70 seconds. I'm doing about 65 pounds on 5 rep X 5 set chest press machine routine. I can lat pull down over 100 pounds, and I can shoulder press 55 pounds on the 5 X 5's. I lost 25 pounds in the last year, but it is going so slowly. I bought a scale, and now when I look often, I just feel like I have plateaued. Any tips? Am I doing the right thing here with my routine? Will I ever lose more weight? I JUST now am getting down from stage 2 to stage 1 obesity, almost. Is there something that's supposed to be happening at this point? My blood sugar is now normal, although cholesterol was a bit high at my yearly checkup for the second year in a row. ###Output :Plateaus are common in weight loss. It'll pass with time. Keep track of nutrition, continue exercise. Look at the positives. You're down 25lbs and are increasing your activity in a meaningful way."}
{"text": "###Input :Blood work off after MTX. Should I hold the next dose until Rheum consult?30F non-smoker 147 lb 5ft 2in tall, years long history of rheumatoid symptoms and indicative blood work. My degree is in clinical nutrition which means unfortunately I understand the basics of my blood work but am not sure what to do with it. My rheumatologist is out for a week.After 7 weeks of 10 mg oral methotrexate weekly with absolutely no contraindicated medications (sulfa, alcohol, etc) my blood work has come back. I'm just hoping for clarification on if these results are expected with methotrexate, or if I may want to hold a dose until Rheumatology is back in office next week.Creatinine has dropped to 0.51 and was 0.70 prior to treatment. BUN has risen to 24 and was 17 prior to treatment. CRP at 1.4, was 1.3 prior to treatment.If I can ask for any input just to ease my mind, I'd really appreciate it! ###Output :I would not worry about these labs. They are inconsequentially different from prior.For your information - Creatinine is a measure of how well the kidneys are working. We worry more about kidney injury when it is high. BUN is not as specific and should be interpreted in the context of your creatinine. Your CRP is basically unchanged.Your rheumatologist would likely go more based off your symptoms in adjusting your meds, they are probably monitoring side effects of methotrexate so looking at blood counts for signs of low counts and liver function tests. Methotrexate is cleared through the kidneys so if there was a major change in your creatinine it may prompt a dose change. CRP and ESR are inflammatory markers that will be trended.Hope this helps!"}
{"text": "###Input :Nutritional RecommendationsHi, are there any nutritional recommendations for cancer patients? As a caregiver, I am specifically looking into any protein powders to help my dad fight weight loss. Thank you. ###Output :There are multiple factors that go into creating a nutritional plan, ranging from lab values such as kidney function, to muscle mass, desire to eat, ability to eat, etc. Id recommend speaking with a nutritionist as they are typically even more knowledgeable than physicians for nutritional advice. It should be covered under palliative/supportive care for the cancer. Youll want to consult them anyway depending on the state your dad is in physically as this point to ensure he doesnt have any nutritional deficiencies specific to the cancer he is fighting (e.g. GI cancers scan affect absorption of vitamins, minerals, fats, etc).Realistically if youre just looking for a caloric supplement, any of a number of protein drinks, such as ensure, will work. It will really come down to whether hes willing to drink them, find a flavor or brand he can tolerate and dont be afraid to switch it up for variety"}
{"text": "###Input :Failure to thrive, possible causes to consider?Kiddo born last week of October 2022 at 39+1 (vaginal birth via induction) weighed 5lb 9 oz, looked quite small for the weight and had short, withered looking legs and a disproportionately small butt. At 5 months, weighted 12lb 5.5 oz. Has consistently been 0.5 percentile although recently scraped up tp 0.6. Legs have filled out and lengthened, butt is more or a normal size. kid has been hitting motor and social developmentsl markers very well, but is deemed failure to thrive. Baby is breastfed, milk supply not the problem. Bottle is offered after every nursing, but not forced by parents, as this leads to vomiting.Mother 42 at delivery, pregnancy the result of IVF with a PG tested embryo. IUGR was first diagnosed in the second trimester, amnio and weekly placenta monitoring followed. Amnio revealed a microdeletion of unknown significance on 6p which was at length deemed unlikely to be the cause of anything by maternal fetal medicine genetic specialists - even before testing revealed the microdeletion to be inherited from the father, who has no disadvantages or disability.Mother contracted Covid in the early/mid second trimester, was fully vaccinated and fully recovered in 1-2 weeks. Mother struggled to eat during the pregnancy and after birth weighed 10lb less than she had when the embryo was transferred. Mother took diclegis, tums and omeprazole daily throughout the pregnancy to manage nausea. Mother had a UTI from week 10-20 that took 3 treatments to clear. Both the covid and the nausea were dismissed as a cause of the IUGR by both the OB and the Maternal Fetal Medicine Doctors.Currently waiting on a referral to genetics at a local hospital to investigate the possibility of skeletal dysplasia. The only visible symptom for dwarfism is a very, very slightly protruding forehead. Head circumference has always been in the 50th perventile despite the little body.So.What could be causing this, or have caused it? The final opinion from the Doctors at the MFM clinic was \"Hes just a little guy.\" For the sake of assuaging parental guilt, it would be good to know how likely it is that the inability to eat could have contributed to the problem. ###Output :If the child is growing along a percentile curve and staying on that curve, technically this is \"failure to thrive\" (also known as growth faltering) but my concern is generally low. If they're gaining weight at a lower amount than they should be or crossing percentile lines, that's where we really get concerned. How does his weight for length curve look?"}
{"text": "###Input :Thank you for responding!Weight for length curve doesn't look great, even to a layperson like me.I do think the numbers here are can in part be explained by the fact that the legs that were withered and disproportionately short at birth seem a lot more proportionate to overall body length at current time. Based on photos, I would guess that this was a visible change by 6 weeks. IUGR diagnosis was asymmetric, with normal enough head and torso with shorter arms and significantly shorter legs (legs measured for 32 weeks at last growth scan prior to birth).So ... leg length caught up a little, but weight did not rise at the same rate.WHO Boys 0-2 Percentile goes:43 at birth1.9 at 1 months3.3 at 2 months1.8 at 3 months0.96 at 4 monthsCDC Boys 0-36 months Percentile goes:60 at birth2.5 at 1 months3.4 at 2 months2.2 at 3 months1.2 at 4 months ###Output :These percentiles that you record here are for weight-for-length? Then yes, I'd agree that this needs to be worked up further.Given that all this has been post birth, this isn't from any kind of nutritional deficiency during pregnancy"}
{"text": "###Input :I [22F] am prediabetic and prehypertensive and my doctor hasn't been helpfulHi all! I am looking for some guidance here. The stats I provide are also from a DEXA scan I did just this week as a participant in a longitudinal study on my campus:22F;166.4 lb;5'8\";27.7% body fat;54.95 kg muscle mass (the form says \"muscle mass\" and idk if that's just lean body mass or muscle mass);1.055 g/cm3 bone density.Doing the DEXA scan and talking through it with the researchers was helpful because it put my weight into better perspective than just comparing it to my BMI.Summer 2021, I went for my first physical assessment living in the US and here were blood results:my A1c came back at 5.7;lipid panel all borderline high at 206mg/dL for cholesterol, 124 for LDL, 76 for HDL, but 62 for triglyceride;my blood pressure is consistently around 120s/80, including this week;my pulse is consistently in the 50s bpm, including this week at 55;I have mild anemia and take 65mg of iron daily. Over the past year my iron levels are back in normal range.I know of a family history of anemia, hypertension (my maternal uncle was also diagnosed in his 20s despite being seemingly physically healthy) and high cholesterol, but have no idea about diabetes.I freaked out at the blood work, and bombarded my doctor with questions including if I needed medication or if I should start monitoring my blood glucose. He gave the vaguest answers, saying there's no need for medication or monitoring at this time, just that I should change my diet and listed generic things I should eat that included a lot of tubers (huh?). I started monitoring my blood glucose anyway and scavenged reddit to learn what others do, but fell into a depression last year and only started picking up my discipline regarding my eating last December. I'd still been exercising throughout, though.I have a history of challenges with disordered eating behaviors and I have been working to address that and making good strides to recognize my triggers. I was overweight all my life and never learned what balanced nutrition or good regular activity looked like. I've been figuring that out for myself at college. For the past 4 years, I have been exercising pretty consistently 3-4 times/week for 45-60mins. I walk a lot, and have in the past six months increased cooking for myself to increase the protein (really just chicken, lentils, and beans lol) and green vegetables on my plate. I have been substituting rice with green banana (I don't really eat Western food) and have been successful at learning how to intuitively eat as a part of addressing my disordered eating habits.I am confident I can continue to improve my wellness habits, but need guidance on addressing my pre diabetes and prehypertension. I am awaiting bloodwork from the study at my school in a few days to see where my A1c and lipid panel's are nearly two years later. But I don't want to develop full blown diabetes and hypertension if there are things I can do now in the \"pre\" ranges to nip them in the bud.I have scheduled another physical assessment w my primary doctor in two weeks, where we will repeat those tests. I want to advocate better for myself given his last feedback. Should I ask to be put on metformin? What should I continue to do about being pre-hypertensive?I don't want to ignore my issues and don't want to be hard on myself about them either. I just want to know what I should do to live better and keep myself as well as possible. Thanks! ###Output :Relax.You BP 120/80 is normal.. and even the HbA1c is also not at a pre-diabetes level which is usually considered at > 6.0Keep exercising regularly and eat a balanced diet (which you already seem to be doing).. your cholesterol is also something that I would not worry about at this stage..no medical intervention is necessary at this time... lifestyle modification is sufficient."}
{"text": "###Input :What do these results mean?24F, 176cm 46kg. I have hypermobile ehlers danlos & likely gastroparesis, my stomach shut down just over a year ago & I rely solely on a nasojejunal tube for nutrition, hydration and medication. I've gained 8kg from my most unwell point, but my weight has been going on a bit slowly & my blood sugars are constantly low despite feeds. I've also had issues on & off with my liver and recurrent kidney and bladder infections.I had an ultrasound followed by an MRI last year, but I didn't see the results until I called the hospital & requested the results a few months ago. It seemed to suggest nutcracker syndrome, which I know can be related to SMAS. But I've also heard MALS? I don't understand the results, and no doctor has ever even told me them, let alone explained them to me.'Ultrasound: The left renal vein was not clearly visualised crossing anterior to the aorta, and the left gonadal vein appeared dilated with reversal of flow heading downwards into the pelvis. The appearances raise the possibility of nutcracker syndrome.MRI: The aortic-SMA angle is somewhat reduced, assessed at between 17 and 30 degrees on the low quality reformatted images (normal range 38 to 65 degrees).'What does this all mean? ###Output :Basically there isnt enough fat between your superior mesenteric and aorta to prevent the SMA from crushing your left renal vein and duodenum (beginning portion of GI tract). I have attached a nice diagram below.Your BMI is 15 which is waaay underweight. I understand how hard it is for you to gain weight without a functioning GI tract but weight gain can help decompress structures through fat pad support. There are also surgical options but many will have you try to gain weight before offering surgery. Its often a multidisciplinary team approach in treatment. GI or vascular surgery would be most appropriate to consult about options."}
{"text": "###Input :Thank you! Is it 'normal' given my weight & general health, or can this be a separate condition/issue entirely? Is it something I need to raise with my gastro even though they've ignored it? ###Output :Its not normal. Just low weight worsens it. Whoever ordered the imaging should be the one to make the next referral."}
{"text": "###Input :Pregnant with a pre-existing umbilical hernia. I don't know much yet, and I have questions.Age/sex: 29F | Height: 5ft 0in | Weight: 117 lbs (~105lbs before pregnancy) | Race: whiteI am 16 weeks pregnant with my first child. I live in the US.Yesterday, I had my 16wk OB appointment. We measured baby's HR at 140bpm, woo! But I have also been referred to a surgeon regarding my umbilical hernia, which, to my knowledge and limited understanding, I got in infancy (my mom watched my bellybutton \"pop out\" during a screaming fit). Yesterday, before the OB measured baby's HR, I told her about my \"outtie\" belly button and how it's already doubled in size since pregnancy; also about a day last week when I scraped a bathroom stall door against my bellybutton while opening it, which immediately caused sharp, downward shooting pains and overall abdominal discomfort that lasted for the rest of the day. She kind of wrote it off (\"bellybuttons sometimes get sensitive during pregnancy\"), until I laid down for her to get the heartbeat. She then looked closely at my bellybutton and asked me to do a sit up, then mentioned that she would be referring me to general surgery for an umbilical hernia. I asked her what the medical implications of an umbilical hernia with pregnancy would be, and she just said, \"a lot of pain that we can't do anything about.\"So that was scary, and made me question why even see a surgeon now? Just to confirm it's a hernia? But then I did some googling, and have further confused and worried myself.My consultation with the surgeon isn't for another month, coincidentally the same day as my 20 week ultrasound._________________________________Here's some more info about my experience that might be relevant:-My bellybutton has always been sensitive, even as an adult. It was much bigger as a kid and got smaller as a I grew up, but definitely still an \"outtie.\" When I was a kid, I remember it filling up and getting \"hard\" when I had gas. I would \"pop\" it and it would \"deflate.\" That stopped happening by the time I was like 7 y/o.-I have struggled with constipation on and off throughout the years, but I wouldn't say it's generally \"severe.\" I have had occasions when I'd go 4-6 days without a BM where it seemed like nothing helped, but overall, if I pay attention to lifestyle/proper nutrition, I don't go more than 1-2 days without a full BM.-Only today have I noticed a bulging under my bellybutton. And it's only when I lean back far enough so the rest of my belly/organs/fat go down so I can see it. I've never noticed this before, and I assume it's due to the pregnancy.-I've always had a pretty strong core with visible muscle tone and minimal stomach fat._________________________________I would really appreciate any comments/information about what to expect, what possible outcomes are, other experiences, etc. But some of my specific questions are:-Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)-Is it possible to not need surgery at all-- neither during pregnancy nor after?-Will a CT scan be necessary?-Will I inevitably be in a lot of pain?-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)-What, if anything, should I look out for before my consultation that would constitute an emergency?________________________________________I think that's all, I'll edit if I think of something else I should add.Thank you so much in advance! ###Output :-Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)No, I don't believe so. I'm not ob/gyn but a general surgeon, so I could be wrong on the indications for a c section.-Is it possible to not need surgery at all-- neither during pregnancy nor after?Depends on if you want it fixed, if its causing you pain, etc. Not mandatory in all cases.-Will a CT scan be necessary?No, usually not unless the surgeon is unsure of something, and a CT is contra-indicated in pregnancy.-Will I inevitably be in a lot of pain?No. Some hernias cause pain, others do not.-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)Incarceration or strangulation.-What, if anything, should I look out for before my consultation that would constitute an emergency?hard, very painful lump at your belly button that you cannot push back it and it continues to become more and more painful."}
{"text": "###Input :Scared about abnormal CBC results, history of anorexia25F, 5'0, ~105lbsHistory of anorexia and childhood asthma (used a nebulizer as a little kid, no need for inhaler/treatment now)Abnormal lab results: https://imgur.com/a/Mcg5s0kI see my PCP every couple of months at her request since I have struggled with a restrictive eating disorder since I was 13. As part of my semi-regular appointments she runs what I think are fairly comprehensive labs (I only included pics of abnormal results but she also runs thyroid, estrogen, etc.). My vitamin B12 is also slightly high (1,316 pg/mL).Im mostly concerned that my absolute lymphocyte count has been steadily declining since last year  when I first started seeing my doctor in March 2022 it was 1.26 L and in March 2023 it was 0.79 L. There are a few other results like hematocrit and mean corpuscular volume that are elevated, but those at least seem to be closer to the reference ranges. I know a small elevation/drop can be normal since were not robots, but the decrease in lymphocyte count seems pretty dramatic.My doctor didnt call/comment on my most recent labs, so I sent her a message online asking about the lymphocyte count. Her response was that a slightly lowered lymphocyte count isnt uncommon/could be due to nutrition and we could recheck at my next appointment. However, Ive actually been doing much better with nutrition since around December 2022 and am at a stable weight with normal thyroid/estrogen levels, so Im not sure that malnutrition would be a likely cause.Ive been waking up slightly sweaty/clammy in the middle of the night, usually a few nights per week. Ive experienced this before to a much greater extent in residential treatment for my eating disorder when I was going through refeeding and experiencing hypermetabolism, but that is definitely not the case now as my weight and food intake are adequate (confirmed by RD).I have a small lump on one side of my neck that my PCP ordered an ultrasound for in November 2022  result was normal enlarged lymph node, no biopsy recommended. It hasnt changed/grown, but I recently noticed another small lump on the other side of my neck. The lymph nodes just under my jawbone feel slightly swollen as of this weekend, but Im not sure whether to chalk that up to stress about this whole thing.Does my doctors suggestion to wait a few months until my next appointment to recheck the lymphocyte/other levels sound reasonable? Im worried that it will keep declining, or that it could signal a larger issue in connection with the other signs/symptoms. Thought about seeking a second opinion with a specialist, but Im having trouble figuring out how that will work with my insurance.Thank you for your time and advice. ###Output :This isn't at all concerning. I agree with your doctor."}
{"text": "###Input :Thank you so much, that helps me feel less worried about it. I know I'm a not a doctor and my current PCP has been great, but it's hard not to stress out sometimes.Really appreciate the time you and all the other doctors put into helping others out on here! ###Output :I agree with your doctor's suggestion. This wouldn't concern me."}
{"text": "###Input :How long can formula milk be run through an IV without spoiling?6 months old male Continuous feedI asked in r/nursing when milk goes bad and they immediately closed it and said ask a doctor for medical advice so here I am.Our son was in hospital for 5 months on continuous feed 20 hours a day in 4 hour chunks. We've continued that cadence now he's home and he's currently getting 180ml every 4 hours for 20 hours with a 4 hour break, but we now have a student nurse who watches him during the night while she studies. She's feeding him 360ml in 8 hour chunks which we were under the impression would be a bad idea as formula at room temperature for this long would spoil - is that correct?When I Google it it says formula can't be at room temp for longer than 2 hours which would mean he's been fed incorrectly since birth so just looking for a bit of clarity on how long you would run a continuous feed for in hospital before swapping the bags out so that we're not feeding him bad milk. ###Output :What is the actual material you are feeding? Is it formula, tube feeds or other types of nutrition?Is it going to his stomach via a tube? Or in an IV?Lots of inconsistencies in the post. Regardless best person to ask is the manufacturer of the feeds."}
{"text": "###Input :Please forgive my ignorance, this is genuine confusion and not sarcasm or anything like that but I'm really not understanding how anything is relevant behind the time at which formula milk goes bad at room temperature. Whether he's fed 10ml an hour or 1 liter an hour into his stomach or his bowel, the fact would remain that the rate at which milk would spoil at room temperature would be a constant - I'm having difficulty understanding why the answer is not straightforward that 'formula cannot sit unused at room temperature for xyz hours' as an example. Nothing unique to him or his situation would make milk sat at room temperature last longer - at least that I can think of - but if I am being ignorant to something that changes everything then please tell me so I can learn.Right now in my head I'm having trouble getting away from the concept of whether I eat chicken in 2 bites or 17 or whether I put it in a blender or I eat it fried, it would still be unfit for consumption if it were first left out for a period of time. And given that we believe the nurse is doing something we've been told is bad, it wouldn't make sense to ask her because she wouldn't contradict herself. It makes more sense to me to look for a consensus from different professionals.For his feed, that's my bad referring to it as an IV, it's in a bag that hangs up on a pole and is administered slowly over 4 hours at 45ml per hour. We give him 180ml and change the bag every 4 hours. The line runs through a kangaroo thing that pumps it into his bowel through a J port in a button on his chest. Instead of 180ml at 45 per hour for 4 hours the night nurse is feeding him 360ml in the bag over 8 hours at the same rate so just doubling the contents of the bag and leaving the bag at room temperature for 8 hours while it is administered into him ###Output :It's not milk though is it? It's some type of tube feeding. Look at the bottle, and then look on the company website.For example, Vital AF, a common tube feed formulation used in my hospital can hang unrefrigerated for 48 hours per the company website.https://www.abbottnutrition.com/our-products/vital-af-1_2-cal"}
{"text": "###Input :How do you know if you're nutritionally deficient in some way?Male. Late 20s. Non smoker. Non drug user. Non drinker.So I have a fairly basic diet. I eat a reasonably healthy mix of meat veg and fruit every day. But it is basically the same things every day. So unless there is a major health issue as a symptom is there a way to know if there's something else I need to be eating?For example I can't eat fish/ seafood. Is there a symptom that I should mindful of that means I'm missing something from my diet that fish/ seafood would normally provide? ###Output :Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.True nutritional deficiencies are almost unheard of in modern first-world countries. They are either the result of very restrictive diets, or of medical conditions that cause problems with the absorption of nutrients, such as inflammatory bowel disease or celiac disease, or surgery of the gastrointestinal system, such as bariatric surgery (weight-loss surgery) or removal of parts of the small intestine (usually due to injuries like getting stabbed or shot in the abdomen).As an aside, there is an \"epidemic\" of vitamin D deficiency currently. I use the quotation marks, as this is a controversial issue. By some measures, up to 60% of people in the United States are \"deficient\" in vitamin D. However, it is possible that the values that are considered to be sufficient are just wrong. For an interesting discussion of how this came to be you can read this interesting article about the physician who more-or-less singlehandedly creates the modern idea of vitamin D deficiency.https://www.nytimes.com/2018/08/18/business/vitamin-d-michael-holick.htmlIt should be noted that there are studies that associate vitamin D deficiency with worse outcomes of various illnesses, including COVID-19, but that large studies of vitamin D supplementation have never shown any benefits whatsoever.Finally, and to me mysteriously, despite the \"epidemic\" of vitamin D deficiency, children are oddly spared the effects: vitamin D deficiency in children produces a specific syndrome called rickets, which is very nasty, but somehow, there is essentially no rickets in the United States. The only case I ever saw was a well-meaning but utterly misguided family feeding their newborn infant home-made vegan formula."}
{"text": "###Input :Can I survive only on smoothies and fruit bowls if I make them nutritionally complete?Alright so heres the deal. Im 20, female, 119 lbs and 54. I was diagnosed with gastroparesis and IBS when I was 16 and Ive been trying to keep my symptoms at bay. However lately Ive struggled a lot with very intense pain after eating and a lot of bloating, especially when I eat at night. Whenever I eat after like 4 I have trouble sleeping because of the pain, that is if I dont throw up immediately afterwards. I started to realize that the problem goes away if I consume smoothies or smoothie bowls instead of my normal meals. I always have oatmeal for breakfast and I usually dont have an issue with it, I do become full super quickly though. I decided to replace my lunch and dinner with one big smoothie. The smoothie contains: -Spinach or kale -About 1.5 cups of fruit -Coconut oil or sugar free peanut butter -Vegan protein powder -Fortified Almond milk -Cauliflower, Celery or other miscellaneous vegetables.The smoothie is either liquid or thick and topped with more fruit, some light granola and extra nut butter. It would be my one meal aside from my daily bowl of oatmeal which is also topped with berries, nut butter and a little bit of honey. Although sometimes I have eggs for breakfast instead.In addition I take a B complex vitamin, omega 3, vitamin D and Iron supplements. I want to know if this is sustainable and something I can do long term, I honestly cannot stand the pain food causes me anymore and I figure liquid food is better than no food. Im treatment resistant and Ive been on medication for both of my conditions, somehow after I started treatment my symptoms got worse so I had to stop. I appreciate any advice you can provide. ###Output :sure. You can survive on a blended up vegan diet if you want.Just be sure you're hitting reasonable amounts of fat and protein, and supplement B12. Pay attention to your iron intake, may need supplementation too."}
{"text": "###Input :Wouldnt talking to a dietitian help or even be a good idea for anyone considering something like this? Or is that not in line with what a dietician would normally advise on? ###Output :She can if she wants. If she's not familiar with vegan diets, it could be a good idea.The intake of protein, fats and other micros could become a problem. Remember a healthy diet is first, balanced and second, a diet you can stick to."}
{"text": "###Input :What does a toddler really need nutritionally?My husband and I have 3 children. We have always had good eaters but my youngest (2 years) is becoming rather picky. I personally believe she is still eating enough and realize this is just a pretty common childhood thing. My poor poor husband is worried sick. I think this man legit thinks she will starve if he doesn't just get her to eat something and often results in caving to more snack foods, making this whole thing worse.To give you an idea of what she is currently eatingBreakfast - a full bowl of Oatmeal, banana, cup of milk. Lunch - about a quarter (plus a few bites more) of a peanut butter and jelly sandwich, bowl of applesauce, cup of water She will snack on some plain animal crackers or cheerios throughout the day Dinner - usually a small bowl of noodles and a cup of milk. Definitely her smallest meal of the day. I usually will still give her a small bowl of ice cream or a slice of pie if we have it. And I'm talking age appropriate portions. All within reason.I realize she's heavy on carbs and in an ideal world we could get more fresh foods in. I think it will all happen in time but this man really is scared for his daughter. Please help me calm him down and let me know if she will survive to adulthood on this pretty standard kids diet? ###Output :She'll be just fine. Toddlers are often snackers, and they get in a lot more calories than you'd think through this. As long as she's growing, I wouldn't be too concerned. You can always bring her in and discuss further with her pediatrician if you think your husband needs to hear it directly from them."}
{"text": "###Input :I (f21) have been losing my hair and I think its a nutritional issueMy hair used to be super thick when I was younger. As I got older, I would shed like crazy. Id be in the shower and pull out chunks of hair. My part is getting wider and it has mini parts so my big part is shaped like a stitch or spine. What kind of foods could help me grow my hair back, if possible? ###Output :This post is missing much of the helpful required information for this subreddit and contains no medically-precise information about the distribution of hair loss and medically-precise description of the findings of the scalp examination. Providing an opinion is not possible. Seek dermatology care."}
{"text": "###Input :Where to start for a good nutrition deficiency and gastro health testing29 6'1\" 200 lbs white male Fatigue last couple of yearsHey everyone. Thanks in advance for any help! I have maxed out my deductible this year for unrelated arm surgery and am looking to make sure I get the most of medical assistance that I have kinda been putting off. For the last couple of years I have felt fairly fatigued and cloudy from day to day and generally held a bit of a fog. I am in great shape physically but my diet is not the best due to very little fruits and vegetables. I was wondering about a good place to start to get a nutrition deficiency test? I would like to do a comprehensive one if possible. This has been something that I have been meaning to check off regardless of if it is the best place to start for concerns around fatigue. I have also noticed frequent black specs that look like coffee grinds in my stool. I got a take home test done with a general physician with negative results. Does this mean I simply do not need to worry about this concern anymore? I was picturing a situation where I might be able to combine the concerns and see a gastro health doctor and have a general look at my overall nutritional picture?On a side note hangovers have been getting really bad for me recently and usually lasting two days.In addition to this, I am open to suggestions on any general medical checkups that would be advised to get an idea of my health prior to the end of the year and having to pay out of pocket next year. Thanks for any help. It is appreciated! ###Output :Why get a nutrition test when you know the problem already: you need to eat more fruits and vegetables.Why are you still getting hangovers? You're 29 dude. Drink a glass of water between every drink and stop drinking so much that you get hungover. Alcohol is a literal poison. It's fun in moderation, but if you're getting hangovers for days, you aren't drinking in moderation."}
{"text": "###Input :Nutrition Response Testing21M 165lbs 5'10 I think this is not scientific or accurate but am looking for other opinions. The idea that the body responds differently depending what bottled supplement or substance someone is holding doesn't make sense to me at all. I haven't been able to find any detailed explanation online about the rationale behind this. Still, nutrition response testing is quite widespread and used by many doctors, which is difficult to understand. Do they legitimately believe it works or are they just trying to appeal to more clients/make more money? The fact that Freddie Ulan(founder of nutrition response testing) is a known scientologist is also a red flag to me. My mom is convinced that this works and wants to take me. What are your thoughts? ###Output :Removed under rule 7. Please do not post pseudoscience/pseudomedicine or other non-medical interventions in this subreddit."}
{"text": "###Input :Pediatric: Cannabis vs Opiods for pain management?My step-son (13M, 238lbs, 6'3) fractured the growth plate on the back of his ankle today. We were given hydrocodone but he has gotten very agitated/rage-y on painkillers before.Also, there is a history of opioid abuse/addiction on one parent's side and general substance abuse/addiction on the other so we're all very skeptical to give him anything. Two of us parents have used medical marijuana as a replacement for pain medication effectively.Which would be considered the lesser of two evils here? Either way we would mostly be giving it to him once a day to help him sleep. ###Output :Besides hydrocodone. Is he on any nsaids? (Ibuprofen,naproxen,etc) I assume the hydrocodone is in combo with acetaminophen. Cannabis has and is used for some pain control but it really depends on the legality in your state/country."}
{"text": "###Input :Yes, we are alternating ibuprofen and Tylenol every few hours throughout the day which is why the main concern is him getting some rest at night. Delta 8 and 9 are legal in our state. I'm mainly worried about the whole brain still developing at his age thing. ###Output :if his pain is bad enough he could get a nerve block with a catheter. would make the pain basically gone and he could keep it pretty numb for 3-5 days till a lot of the inflammation is down.You could try paracetamol and ibuprofen first. If his pain is uncontrolled with that then chat to his doctor about your concerns. Opiates can be entirely appropriate for acute pain. Im not sure of the evidence for cannabis for acute pain, especially in children."}
{"text": "###Input :My pediatric urologist wants to put my child under general anasthetics at 6 monthsI am worried about negative impacts this might have on brain development is it possible to have a successful surgery done at 3 years old instead? ###Output :3 year old kids get extremely stressed about surgery and will remember both the period before and the pain afterwards. It can be very traumatizing for them.A 6 month old will have no clue what's happening and won't remember.The available evidence suggests that a one off exposure to a general anaesthetic will not have long term implications for neurodevelopment. However your concerns are very valid and you should discuss it further with your paediatrician."}
{"text": "###Input :This! When my kid was 6 months old all he needed to feel better was to nurse. At 3 nothing worked! ###Output :It depends on what surgery your child is having on whether it can be delayed that much. What is it?"}
{"text": "###Input :Chordee ###Output :He'll be more uncomfortable after surgery at age 3 than at age 6 mo, but there's really not a solid indication to fix that early. For things like undescended testicles, those should be done sooner."}
{"text": "###Input :Was this inappropriate?26M. I recently had a flashback to when I was 15.5 y/o and had regular visits with my pediatric endo. I only have TID, no other autoimmune disorders but my pediatric endo always checked my testicle size during every 3-6 month checkup. Is this appropriate? I'm trying to figure out if this is the norm ###Output :Most pediatric endocrinologists check the testicles to see the volume and stage sexuality maturity.Endocrinologists also are heavily focused on hormones, so its well within their training to make sure youre testicles were growing appropriately.What's TID? What were you seeing an endocrinologist for?"}
{"text": "###Input :Sorry, type 1 diabetes ###Output :Well apparently high sugar levels can damage your testes, so perhaps? Hard to say"}
{"text": "###Input :Possible seborrheic dermatitis?Pediatric patient 10M, height 4ft, 80lbs, white/black, healthy and has no medical issues, no meds, etc. I was thinking it was just a serious case of dry scalp as it was starting to peel. He's been itching it quite a bit while at school. I mentioned this to the pediatrician and was told to use selenium sulfide (Head & Shoulders), so that is why the scab appears that greenish/blue color. It is raised pretty high. My concern is if he keeps scratching it could lead to an infection. Does this appear to be seborrheic dermatitis? if not what else could it be? Thank you. ###Output :1 marginal quality image. Seborrheic dermatitis could appear this way as could psoriasis, tinea capitis and many other conditions."}
{"text": "###Input :Thanks, Doc. It definitely could be tinea capitis. I'll keep treating it with selenium sulfide until my appt with the pediatrician next week. ###Output :You might consider dampening the scalp, using a salicylic acid shampoo and let it stay in place 5-10 minutes, then rinse it off. This may loosen the scale."}
{"text": "###Input :Thank you, Doc. So salicylic acid should work better than selenium sulfide? Selsun Blue and Head and Shoulders have both.Correct, I have been rubbing it in gently and washing it out after 10 minutes. ###Output :There is no evidence that one active ingredient in these shampoos works better than another for seborrheic dermatitis. I was making a suggestion to help remove the adherent scale."}
{"text": "###Input :Pediatric neurology help. Sudden onset Anisocoria (1.3mm) in 3 siblingsMy 4.5, 2.5, and 6 week old all have Anisocoria. The first 2 measure 1.3mm difference, the third has not been seen.My 4.5 year old was referred after he didnt pass the vision screen at pediatrician (they turn off lights and the kids look in the box with birds chirping.) My 2.5 year old failed same test and was referred. It is noticeable by naked eye with the 6 week old. The older two have previously passed the eye test in years prior. This is the first appointment for both that they failed.My 4.5 year old went to a pediatric eye doctor and he said he couldnt find any other issues. He said he has seen it come and go in kids and even switch eyes. I cant find anything like that on Google. Nothing about it being genetic. He said 1 in 10,000 chance that its a neurological issue because no other symptoms present. My 2.5 year old will go on 10/20. My 4.5 year old will go for follow up on 10/31.I dont know what other actions to take. It is unsettling this popped up in all of them with no answers. ###Output :I'm not an opthalmologist, but if three children in the same household developed this as a sudden onset issue in the same time period it seems reasonable to consider an environmental trigger or exposure. New medicines in the house?"}
{"text": "###Input :My 10 year old had an allergic reaction Sunday night and still has welts. Is it normal for his body to heal like this?My 10 year old son had an allergic reaction while asleep Sunday night and woke up with his trunk covered in welts. He was taken to his pediatrician and prescribed 4mg Dexamethasone, 2 tabs first day and 2 two days after.His only known allergy are peanuts (severe).He is still getting new welt outbreaks and does not seem to be getting better, but physically feels fine minus the itching.Thanks for your help. ###Output :The most common causes of hives in a pediatric population is actually a viral illness. If you don't think he's having other allergic symptoms, this could be the culprit."}
{"text": "###Input :5.5 Year Old Severe ConstipationTLDR: 5.5 year old is severely constipated, complaining of major stomach pain, trouble swallowing, and nausea. Shes waking up through the night coughing and crying in pain. Doctors are suggesting 5 cap fulls of miralax and 2 ex-lax a day - Im concerned this is not good for her. Thoughts?Hello! I feel like Im new to the constipation world, but weve honestly dealt with it for awhile now without me knowing how bad this is. My daughter is now 5.5 and we are about 5 months into a severe constipation epsiode. Its taken doctors awhile to help figure out how bad this is, but here we are. Shes struggled with constipation on and off ever since she was born (at 4 months old she would pass stool the size of hard boiled eggs), but I didnt know how bad it truly is. She has always pooped once or twice a day for most of her life, its just the consistency and size of the stool that I was ill-informed about. Here is where we are at now: Since November, she has been complaining that as soon as she eats or drinks, her throat feels tight, feels that shes going to throw up, and her stomach hurts so bad. Ive taken her to the ER twice, doctors at least once a week, and have had multiple X-rays. The X-rays consistently show tons of stool. We officially started doing a clean out method about 2.5 weeks ago doing mirilax, milk of magnesia, and ex-lax. Shes been pooping 5 or more times a day, passing lots of ribbon size or huge logs. But her complaints are continuing and shes eating less and less. She is not afraid of pooping and has no problem making it to the bathroom which is good. Weve missed a lot of school (kindergarten) for this and shes only 35 poundsI cant imagine what this is doing to her long term. The X-ray 2 days ago showed that shes still completely backed up right at the exit of her stomach, her stomach isnt digesting her food well, and her stomach is extended. The pediatric GI suggested to do 5 mirilax cap fulls a day and 2 ex-lax still, for up to 3 months. I just dont feel like this is safe for her, how little she is, how little shes eating, and how much pain this is causing her. Im no doctor, which is why Im turning here. Of course the stomach aches are now worse and shes in tears on and off all day. I, personally, have IBS with diarrhea so I have no experience on how to deal with this and asking for all the tips. We have been dairy free for a month, and Im not yet going to try gluten free because I do want her tested. We have only been talking to a pediatric GI on the phone through our regular doctor because her appointment is still a month and a half away (we had to wait almost 2.5 months to get in), so further testing hasnt started yet as to why we are in this mess. ###Output :I would agree 100% with the pediatric GI given what you say here. Long-term constipation like this causes her bowels to dilate (become larger) at baseline. That distension causes her to have less sensation of when she needs to go. Those nerves in her gut can retrain themselves, but it takes months, so it's important that she get fully cleaned out and stay that way while the retraining happens.If the dairy-free diet is helping, you can continue, but if you don't see a huge difference, it's fine to re-introduce dairy. Most pediatric constipation isn't due to a food intolerance.https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Constipation.aspx"}
{"text": "###Input :Pediatrics, please!Hello! Worried Mom here.Patient is 5 years old (almost 6). He weighs 35ish pounds and is in the 90th percentile for height. He is a picky eater, but there has been no loss of appetite.His symptoms are diarrhea. I believe this is from lactose intolerance (his dad has the same issue) because the worst episodes are after he consumes anything that could contain lactose.What I am concerned about are the dark circles beneath his eyes that have developed lately. These two symptoms (diarrhea and the dark circles) pull up neuroblastoma when I Google (I know, no Googling). I had a friend whose child had this so it hits a little closer to home, but I know its rare.He has an appointment Monday. Should I push for tests? Or is it probably just lactose intolerance and allergies/lack of sleep and I am just freaking out as a Mom?I do have health anxiety that is being dealt with by a professional- counselor and medication - but every time my children are sick I always jump to cancer.Thanks for any advice! ###Output :More concerning that he's not hydrated well, or very tired. Neuroblastoma, just...no. Not up high on the differential at all."}
{"text": "###Input :What to expect from a pediatric UTI examFemale Age 5 Weight 42 lbs Symptoms started this morning Occasional burning sensation when urinating Frequent urge to urinate No current medications Exam scheduled for tomorrow morningJust wondering what to expect by the exam. Mostly which areas will be examined and the manner in which it is done. I want to be able to protect my daughter and be able to spot any predatory behaviors. ###Output :I'm assuming you're asking whether a genital exam will happen. May depend on the physician. Some girls that age will complain of \"burning\" with urination and not have a UTI, but instead have a yeast infection or vaginal irritation that is causing the symptoms, so I do often do a genital exam unless they have symptoms like fever that make me more certain about a UTI.Genital exam in a prepubescent female would consist of often getting into a frog-leg or \"butterfly\" position while lying down or sitting back. The doctor may spread the labia majora slightly to get a view of the urethra and assess for redness or discharge. There should be no touching of other structures.If you don't feel safe with your pediatrician, time to find a new doctor. A good doctor should always welcome you asking questions and asking for an explanation before they do an exam."}
{"text": "###Input :Thank you for the very helpful reply! Im glad you specified what the exam would consist of that was exactly the response I was looking for.Its not so much that I dont feel hes safe or a good doctor, more that I want to be aware. I feel that asking someone involved in the situation with more knowledge than I puts them in a position of power where they could just claim what theyre doing is normal.But again its less the doctor and more about me being suspicious, paranoid, and protective. ###Output :No problem!"}
{"text": "###Input :Pediatric impetigo or something else?Age: 5Weight: 43 lbsRelevant health background: Hes very picky with eating due to some sensory aversions, so he ends up eating a bit of a lopsided diet and barely eats any proteins. He takes multivitamins with iron and no other regular medications. We are in the US, and he is up to date on his vaccines.Maybe relevant maybe not: We live in an area that has brown recluse and black widow spiders. I havent personally seen any. This also began his very first week of Kindergarten. A cough accompanied it, but to be honest my son has a cough 80% of his life.TIMELINESept 2 - My son comes home from Kindergarten and tells me he has a bug bite and his leg hurts. I dont think anything of it, were driving when he tells me this so I dont immediately look.That evening, I see it when giving him a bath. It looks like a bug bite. I put a bandaid on it.Sept 3 - The bug bite is irritating him. Hes scratching at it, I replace the bandaid and give him neosporin.Sept 4 - When I remove the bandaid, the wound has grown considerably. This is the first time I take a photo. Now Im wondering if this was a spider bite. I put some neosporin on and leave it without a bandage Photo: https://imgur.com/a/rB1KJ7BSept 5 - The next day, it looks a bit larger, and with some dots surrounding it. https://imgur.com/a/QdcVImZSept 6 - No change, didnt photographSept 7 - We go to the zoo and he immediately begins complaining about his legs being soooo tired. He was excited to go to the zoo so this was unusual. He whined the whole time and insisted on being carried (hes 5, this is not typical). When we get in the car, he immediately falls asleep. This is important because he had not napped in THREE YEARS. He dropped his naps when he was 2 and never napped since. When we get home, his legs look a lot worse. Not only that, the little bumps around the area have begun popping up all down his back, shoulders, everywhere. https://imgur.com/a/bbCGtFVSept 8 - We visit his pediatrician. He takes one look and diagnosis impetigo. Hes very confident in this. Prescribes topical antibiotic and oral antibiotic for a week. Said he was fine to return to school as long as the wounds werent weeping.Sept 9-16 - The rapid progression stops almost immediately and it begins to heal after about 48 hours on antibiotics. Things are looking good! All my fears of flesh eating bacteria and so on start to go awaySept 21 - Another small sore pops up on the same leg, near his hip. Im immediately suspicious of it, and dont want it to progress, so we go back to the pediatrician the same day.She says it doesnt look anything like the others, and to just keep using the antibiotic ointment, but to add a daily bleach bath (1/4 cup bleach in a tub of water) to help ward off the bacteria living on the skin. She says impetigo is just staph or strep that found its way into a wound and is irritating it, so we just need to keep his skin clean. So we start that.MAYBE RELEVANT - She notes his tonsils are large and does a rapid swab for strep, which is negativeSept 28ish - He has a scrape. Its on the OTHER leg. Hes adamant that he fell and scratched it. We believe him and leave it alone.Oct 1 - Its considerably larger but he also keeps scratching it so were not sure what to think.Oct 2 - We took a walk today and he began complaining that his legs are sooo tired (I cannot stress enough what a hyper boy he is his legs are NOT tired). We go home and that other leg looks IDENTICAL to how the original looked. I go to the urgent care and insist on a skin swab, which they do but since theres no pus, they cannot guarantee accurate results. They prescribe 10 days of Cephalexin but say theyre just not convinced its bacterial. They said it just doesnt look like anything they can readily name.https://imgur.com/a/cObh69dI am worried because it seems to be jumping around his body, made worse by walking/warmth, and hurting his legs more than topical wounds should. I also cant shake that the cough is still there.I also feel dismissed when I repeatedly ask if the cough and exhaustion could be related to his wounds.What do YOU think? ###Output :Cephalexin is unlikely to be successful at treating a Staphylococcal impetigo. Treating that requires either Bactrim or clindamycin."}
{"text": "###Input :So do you feel it looks/sounds like impetigo? If it is, would the swab they took today tell me what bacteria its originating from? ###Output :The photos remind me of a bullous impetigo in which the bullae have opened. A culture of the affected skin without fluid from an intact bulla would not show this; the diagnosis is a visual one. Non-bulbous impetigo is Streptococcal, but bullous impetigo is Staphylococcal and one must always treat for MRSA."}
{"text": "###Input :(Almost) 4yo Boy, Many Symptoms, No AnswersBorn 3/2019.Waking up at night from a dead sleep with leg pain for nearly a year now. Happens once or twice a month usually. Right leg more frequently. Chalked up to growing pains. When he wakes up, give him Tylenol, get the heating pad out and wrap his legs. Rub his back and he falls asleep. Seems fine in the morning. Sometimes has complained of pain during the day, but could be a ploy for medicine. Points to his shins, knees, and thighs as sources of pain.Complains of headaches occasionally (I've never even heard the word, \"headache\" come out of his older brother's mouth). Goes away with Tylenol.Was vomiting a lot last year. I started tracking and the average was 1.5x a month. No fever or other symptoms; would complain of nausea, boot, then be back to normal within an hour. Went to pediatrician on 8/19/22, she recommended we go to the ER because we could get all testing done rapidly and at once. Went to ER, had bloodwork done (normal at the time, no cancer markers), was diagnosed with cyclical vomiting syndrome. Debated on whether to do a CAT scan or MRI, opted to not. Has only vomited 1x since then, was this past October. Not much nausea or vomiting since.Swollen lymph node in armpit and back of neck, both on left side. Just discovered armpit one today. Neck node has been enlarged for over six months. No biopsy, superficial exams by multiple doctors, all advise this is normal and not a concern. Soft, movable, and less than 2cm in size. Hasn't grown.He often just looks pale compared to the rest of the family (we are white, British decent), but could be chalked up to recent rainy weather and being stuck indoors for winter. He also seems thinner than the rest of us, just bonier than his older brother was. Always craves sweets. Weight and height are good, around 70th percentile.I found swelling in the back of his knee four weeks ago. Right posterior, left of the popliteal fossa, about the size of an avocado pit. Puffy, not hard. Took him to the pedi two weeks ago, and she said likely a cyst, but referred me to an orthopedic surgeon for further evaluation. Have appointment this Friday to get it checked (she said probably an ultrasound). She also checked him for a wet cough that he's had for over two months. Said she heard crackling in his lungs, prescribed inhaler, doesn't seem to be helping, will have a follow up next week to check his lungs again. Cough is annoying, but not really impacting day-to-day activities. Still very active and happy kid.Went on a long walk today and he woke up again with knee pain, said only right one hurts. Did the usual late-night treatment and now he's asleep.I am debating on whether to take him to the ER again. Our firstborn was healthy as a horse, never in the ER and sick with typical symptoms. I don't want to be too overzealous with an appointment coming up, but all of these symptoms just have my mom radar screaming there's something really wrong with him. I assume the ortho won't do another blood panel at the time, so it'll be a referral if they find something wrong. I just don't know if I want to keep dragging out discovery appointments for the next few weeks vs. going to the ER and asking for the gamut of tests.Any feedback at all is appreciated. We have a PPO and are financially stable, so cost isn't an issue. ###Output :I've usually noticed that when your mom radar is screaming, it's better to take your kid to the ER. The symptoms you have mentioned could be due to a viral infection, but I'm still perplexed as to why the doctors decided against the CT or MRI and did they perform abdominal Ultrasound?. Also , cyclic vomiting syndrome can cause dehydration, lethargy , pallor, and muscle weakness. I hope he's taking his fluids well."}
{"text": "###Input :The ER doc and a random physician's assistant both advised against the CT (radiation unnecessary) and MRI (would require sedation) because it would be invasive and likely unnecessary given the results of the blood panel we got this past August. He already had the swollen neck lymph node by that point, but it was dismissed as normal. No one spoke of an abdominal ultrasound at all.He hasn't had a vomiting episode in a while, which I'm grateful for, but he is a very finicky eater. Often says he's not hungry or full, but I try not to stress because his weight and height have been increasing on the right trajectory and he's at the 70th percentile.The tone I perceive from doctors is that I'm overreacting because this is my \"baby\" and there's nothing wrong with him, but it's just such a stark contrast to his older brother. I think I'm pretty laid back overall as a mom, but this has me questioning myself. Thanks for the two cents. ###Output :You are welcome. Usually, CVS is triggered by a stressor or a food . Has your pedi advised you to keep a diary to identify it ?"}
{"text": "###Input :Nope, same deal, no mention of keeping a diary. I was essentially told that he'd probably grow out of it, not to worry if he wasnt losing weight. Based on your matrix, I would define it as mild now. He recovers fast and the issues were really confined to early/mid 2022. ###Output :Maybe he was under some kind of stress at that time , you never know with young kids. But it's good that it's resolved now. The enlarged lymph nodes , in my opinion , need to be investigated, most probably it's due to a viral or bacterial infection, and there's no harm in repeating tests so if antibiotics are needed , they can be given at the right time."}
{"text": "###Input :I'm just a layperson, but I feel like if it was me I'd 100% rather random people/doctors think I'm crazy than my child feel like I don't hear them/don't care that they're complaining of pain or sickness. ###Output :It's a very helpful matrix for cyclical vomiting syndrome. Though it's more relevant to the doctor treating the patient , I think it also provides good information to the patient or on your case parents."}
{"text": "###Input :We were prescribed Topiramate, but I haven't had to use it since October 2022. ###Output :Topiramate has a very good response in pediatric CVS."}
{"text": "###Input :I have really appreciated your responses so far! Do you have any thoughts about the knee swelling/cyst and night pains? ###Output :Night pains could be growing pains, or it could be the popliteal cyst or lymph node compressing a nerve. Usually, with an enlarged popliteal lymph node / cyst and neck ( cervical ) lymph node , I'll go for complete blood work and monospot test ( to detect mononucleosis/ Epstein Barr Virus ). Chronic bacterial and viral infection can lead to the enlargement of lymph nodes in kids ( also called lymphadenopathy ). It also happens in upper respiratory infection ( and if your pedi wants to explore further , I think they should go for a chest X-ray). Another thing that I'll always do will be the abdominal palpation to rule out enlarged spleen. In your kid's case , I'm still leaning towards the infection because he's otherwise healthy."}
{"text": "###Input :He was home for most of the covid lockdown years (we were in California and very restricted), so he was never sick or exposed to immune stressors for over two years. It seems like since he started daycare in late 2021 it's been nonstop illness. We've had head colds, stomach viruses, covid, flu, roseola, hand foot mouth, etc, you name it. Would this onslaught of viruses cause lymphadenopathy? Could it cause unexplained vomiting too? The vomiting occurred without fever and far enough from the stomach viruses and roseola to not be linked, I think.We decided to skip the ER and will see his pediatrician this week. I'll ask about the spleen/mono and push for more tests to explain the swelling nodes. Thank you so much for at least putting me at ease regarding worst case scenarios. Let me know if you'd like an update after we get results. I have no idea why you were so helpful to an internet stranger, but I sure do appreciate it! ###Output :Thank you so much for your appreciation. As a physician , it is my duty to help a patient in any way I can. You are right about the non exposure of viruses during lock down, because kids didn't have the opportunity to develop any immunity to them, and hence, the flu is more severe than before. I'll definitely appreciate an update, and I hope everything will turn out alright.Different physician, but I am not concerned about the leg pain. The lymph nodes need to be investigated at some point soon, but not necessarily tonight. You relate reassuring characteristics about them.The big tell for leg pain is whether they want them rubbed or not. Pathologic leg pains don't get better with touch, and kids flinch away: tumors, fractures, arthritis, osteomyelitic infection, chronic inflammation, all of that is not something that gets better with being rubbed. I don't think I've ever seen something worrisome in the legs causing pain that was better with rubbing."}
{"text": "###Input :This is so very heartening to hear! I opted to skip the ER today. Will see pediatrician this week to re-examine the cough/lymph nodes. I'll wait for the ortho appointment this Friday. He definitely wants those legs rubbed! ###Output :I will be thinking of you and hoping for the best. Please let us know how it works out."}
{"text": "###Input :Thank you, will do! Did you happen to see the comment above about Celiac Disease? My mother has it, I do not, but I do have issues with carbs in general. Would a sensitivity like that account for the leg pain and immune response? Vomiting and paleness? ###Output :Celiac can certainly present in a variety of ways. We used to look for a very limited constellation of symptoms, but then it became recognized that -- for example -- it can come with constipation, not just diarrhea.My comment was intended to be reassuring about pathology in the legs themselves. I think what you related is reassuring from that perspective. Whether he could have cramping from an electrolyte imbalance or nutritional deficiency secondary to celiac disease? It should be possible. Thankfully there is relatively definitive testing to rule in or out.I hope you get some answers for your little tyke soon."}
{"text": "###Input :ENT surgeons - would you do pediatric supraglottoplasty and/or remove adenoids?My baby is almost 5 months old, scheduled next week for endoscopy & bronchoscopy - the ent surgeon wants blanket consent going in for supraglottoplasty and removal of adenoids if indicated.On sleep study around 2.5 months ago, baby had a significant number of hypopneas (approx 27 times per hour) and 5 apneas (total) without a decline in O2 sats for either. Oxygen and carbon dioxide levels remained stable/good throughout duration of study. (Baby was not on supplemental oxygen during the study.)Baby has no noisy breathing, no feeding concerns (weight has gone from < 1 percentile at birth to currently 7th percentile) and is hitting all developmental milestones.Baby was IUGR, born at 5.5 lbs at 38 weeks. Released from hospital on day 3. Baby had trouble holding o2 sats at 2 weeks old, and was put on oxygen. Has remained on .5 liter since. A pulmonologist and the ENT doing the procedures both said the baby could come off of oxygen based on the sleep study, however the pulmonologist who initiated oxygen treatment in the hospital wants to continue until after the procedure.Since the study, baby is sometimes off of oxygen during the day and o2 levels hold stable. I also see significantly less startle during sleep. In my opinion, his condition is improving, and if I understand correctly a high number of babies outgrow apnea and laryngomalacia (what theyre looking for, not currently diagnosed).Looking for outside thoughts on this before deciding how to proceed. ###Output :There's not enough information to definitively say what the correct course is, and we can't look at any further evaluation that has been done. Your child has severe sleep apnea based on the reported AHI, has an oxygen requirement, and by definition had failure to thrive while being <5th percentile for weight. One thing not commented on in this post at all is how feeding has been going, if there is tiring during feeding, desaturations during feeding, and how noisy the baby is when agitated and how noisy when sleeping. These can also all point to whether laryngomalacia is a potential cause.These all indicate at the very least that an evaluation of the airway is necessary, and it is reasonable if there are significant issues to correct those issues and minimize the need for further procedures."}
{"text": "###Input :Thank you for replying!I tried to address some of those things in my post. It sounds like I wasnt clear, so Ill try again.Ive been told by 2 different doctors that he no longer has an oxygen requirement, however the initial doctor who began the oxygen wants to keep him on it until the scopes.Baby is not failure to thrive. He was born less than 1 percentile due to IUGR. He is currently in the 7 percentile. He has been growing and gaining weight consistently along his curve. Weve seen GI and several nutritionists and feeding specialists (the specialists here see in co-managing groups) and everyone is very happy with how he is feeding and how he is gaining.He does not have, and has not had, any feeding issues. No tiring during feeds. No sweating. No desats during feeds. He has a bit of reflux, which GI said is normal and needs no treatment.There is no noisy breathing when agitated. He is not noisy during sleep.The impression Ive gotten is that laryngomalacia is being looked at as a possibility due to apnea. I also understand that typically oxygen drops during these events, and his did not. I think I was seeking some opinion on this in my post, though I wasnt clear. Can apnea be the only symptom of laryngomalacia requiring treatment?I absolutely think the scopes are necessary. Im totally on board with looking. I think this is why Im feeling challenged in giving blanket consent to cutting going in, though. To me, based on the research Ive done, it doesnt sound like he has other symptoms of laryngomalacia.I was hoping I might get additional insight here, and perhaps even find other pathways to research and explore. I appreciate you taking time to respond! ###Output :Generally laryngomalacia is associated principally with noisy breathing and feeding difficulties. It is possible to have severe enough laryngomalacia that the loss of tone is resulting in the apneas/cessations of breathing, this would be called sleep-dependent laryngomalacia which is becoming increasingly recognized in the last few years.The true fact of the matter is there is a 5 month old with severe sleep apnea who is working on growing. Sleep apnea has significant impact on children and can impair development.It is also unclear if a scope examination has been done while the baby is awake (through the nose) to see if there is any evidence of laryngomalacia as this can often be apparent at bedside as well. The caveat to this would be sleep dependent laryngomalacia wouldn't be (because baby isn't asleep)When I was at a children's hospital and worked with some people that did blanket consents like that, it didn't always mean that the surgery would be performed, only if there were findings concerning enough to warrant the intervention. You have the option to talk to the surgeon and ask they call you before performing the procedure or discussing what they find. I've done that with plenty of folks. That being said, a supraglottoplasty is very well tolerated overall and those kids do tend to do much better."}
{"text": "###Input :Dr.'s office is closed but I plan to call them tomorrow to verify... but I'm curious. My kiddo, 9F 29kg was prescribed pills instead of suspension because there is a shortage here, but it seems like she was prescribed an adult dose- 875mg every 12 hours, which works out to just over 60mg per kg per day. This seems to be roughly double the recommendation for children under 12.... source here: https://www.drugs.com/dosage/amoxicillin.html#Usual_Pediatric_Dose_for_Tonsillitis_PharyngitisThe diagnosis is scarlet fever, rapid strep test came back positive. I'm considering giving her half a pill tonight, or maybe just waiting until tomorrow when I can verify dosing with the doc. Do I have other options? Is there a better site for dosing information? I don't want to be the stereotypical \"dr Google\" but I know how EHR's work and I wonder if the system goofed when the med was switched from pediatric suspension to pill form, and I don't want to give my kid unnecessary diarrhea or whatever other nasty side effects might come from too strong a dose. ###Output :They may have missed that we max out the dose of amoxicillin at 500mg twice daily or 1000mg once daily. I think it's fine for her to take a single dose of the 875mg tonight, then call them in the AM to see if you can get 500mg tablets instead.https://www.cdc.gov/groupastrep/diseases-hcp/scarlet-fever.html"}
{"text": "###Input :Please can anyone tell me what is in the predmed given before UK pediatric surgery -to help calm and sedate my 5yr old before GA. Thank youAgeSexHeightWeightRaceDuration of complaintLocationAny existing relevant medical issuesCurrent medicationsInclude a photo if relevant ###Output :I'm not in the UK but in Germany, yet I doubt the colleagues use vastly different medicines.We typically use the short-acting benzodiazepine Midazolam, which is also available as a sirup (ideal for kids). Alternatively, Clonidin can be used."}
{"text": "###Input :Can I still visit a pediatric doctor although i am 2121F. Height: 159 cm. Weight: 47kgs. South Asian. Although i am 21 i literally look like a 12 year old. I look very skinny and petite. I almost always have been since age 7-8. I won't say i eat the healthiest diet in the sense i most of the time remove onions and tomatoes out, other than that I eat ample amount of food. I literally am not gaining any body mass other than my tummy lol. I have a very thin and petite body frame. I was thinking of approaching a pediatric doctor unless it didn't improve till 18/19 but then COVID hit, can I still visit one, or that won't be appropriate given I am 21 now. Or should I visit some other doctor?PS.: I also got my thyroid levels checked and it were normal. What could be the cause? Where do I start from ###Output :If you have a pediatrician as your primary care doctor, they may continue to see you until some point. If you dont have one, setting up with a pediatrician makes no sense and most would decline to start with you. Size and appearance are not the distinction between pediatric and adult medicineas pediatricians are fond of saying, kids are not just small adults. You should see an internal medicine or family medicine doctor.Your BMI is within the healthy range. Are your parents and other relatives thin? If so, without any symptoms its very likely just genetics."}
{"text": "###Input :Was I molested by my pediatrician? / Is this normal for a pediatric exam?This is going to be all over the place so I'm sorry for that.All I remember was being 14 and being at the pediatricians. I kept saying no. My Mom was in the room and kept saying yes. So my underwear was down and my knees were bent and I was sobbing and my male pediatrician spread my labia just to \"look\" (with his hands). I was sobbing and saying no and I was ignored.I've talked to various crisis types of hotlines including RAINN and personally found them of no help. ###Output :An external genital exam is part of a normal physical exam in child. I seriously doubt your pediatrician was doing this exam for some sexual purpose. However, I wouldn't force an exam like this on a crying kid, particularly an older kid with a sense of agency, unless it was medically necessary.Many pediatricians will limit their external GU exam on older girls to simply looking externally at labia, to assess pubarche. Doing an external while spreading labia is less common a \"check up\", unless there's a specific complaint like discharge, itching, rash, whatever. On the other hand, boy will typically have their testicles palpated looking for masses, hernias, varicocele, and assessing normal testicular development.Nobody here can say if the specifics of what your pediatrician were definitely appropriate in the circumstances, but an external GU exam isn't uncommon, and isn't \"molestation\" in and of itself. But it's something where assent from a 14 y/o girl should be obtained."}
{"text": "###Input :Sorry in advance for the long post!My 8 year old son has had significant trouble with bowel training since initiation of potty training in general. What I believe started as an aversion to pooping due to distraction or not wanting to miss out on anything exciting while he was on the toilet, evolved into chronic constipation and an aversion secondary to pain. This was initially treated with Miralax and pushing fluids. However, he continued to have various amounts of poop in his underwear on almost a daily basis, and struggled with having regular bowel movements, alternating between small pebbles to impossibly large logsBecause he spends half of his time with his father and half with myself, there have been some inconsistencies in addressing this. I recently had a long discussion with his father and we decided to give an impaction appropriate dose of Miralax to encourage complete emptying and then start on a consistent maintenance dose at both houses. Admittedly, we had both dropped the ball on this. My concern now is that my son has recently had a couple of episodes of full on incontinence while out running errands. When I talked to him about always letting me know he has to go so we can find a restroom, he explained that he does not feel and urge to go, and only realizes what has happened when he feels it in his pants. I recognize that prolonged constipation can decrease urge sensation and believe this is what has happened. I do think this is still a tiny bit related to not wanting to stop what hes doing and sit on the toilet for the appropriate amount of time to have a big poop. All of that background is basically to ask, should I seek out a pediatric GI specialist? Or is this something that can be solved by going back to the potty training basics (timed toileting and having him sit on the toilet for a while). Is Miralax an appropriate choice for his age/symptoms? Does this warrant a consult with a therapist? Of note, I am aware that some of these symptoms can be a trauma response, however I am very confident that is not the case with him. Despite our divorce, my ex remains a caring father to both of our children, and neither child is left in the care of any suspicious characters. Any guidance would be greatly appreciated! ###Output :Probably appropriate to see a peds GI at this point. The starting outcome will likely be Miralax and timed toileting, but it's good to make sure nothing else is going missed."}
{"text": "###Input :what to expect at pediatrics?16yo female. went to the doctors complaining about stomach issues, they took my bloods and done a checkup and nothing came back wrong.they made an appointment in the hospital for the pediatrician and im quite nervous. ###Output :A talk with you and your parent, and a physical exam. Any particular thing youre worried about?"}
{"text": "###Input :Pediatric lower back painMy son broke his hip 4 months ago. He was non weight bearing for over 2 months. His doctor released him 2 weeks ago. His PT said his left side is super weak and lost muscle mass. He has a slight limp which the doctor said would get better with time. My question is, when he tries to run eventually his lower back starts to hurt. Could this be just from weak hip/ back muscles or some kind of muscle imbalance throwing things off? We are keeping a look out for hip AVN but OS told us that would cause hip pain and groin pain, not back pain. Any insight be help.Please ###Output :Could certainly be the weakness in his leg altering his biomechanics. That said, how did he break his hip? If there is any concern for a back injury that went unnoticed, discuss with his doctor."}
{"text": "###Input :We had a sledding accident. Im pretty sure they did a full trauma work up at the hospital. All sorts of X-rays. Couldnt they have seen something then? It all started after he started trying to run and stuff, which is why it makes me think its muscular imbalance? ###Output :Yes, I'd be very surprised if they didn't catch something more serious. The back pain should improve as his gait and running stride normalize, which PT can help with."}
{"text": "###Input :Good sub for pediatrics?The sub r/pediatrics isnt for medical questions. Im trying to find one thats appropriate.Ive got a sick four year old who has been fighting a sinus / ear infection for weeks, even after seeing four different doctors. So Im looking for a group with some potential SMEs or at least other parents who have been down this road. ###Output :Yes, there are a number of pediatricians, peds-EM docs, and a neonatal NP active on this sub."}
{"text": "###Input :Worried about my dads cardiac cath resultsMy father is a stubborn mule of a man, and I need to know if Im right in pushing this issue until he gets the care he needs. I am a pediatric ICU nurse, so adults are not my thing.My dads history: 63yo male, normal BMI, moderate physical activity 5 days a week, former smoker x 30+ years (quit in 2017 when my son was born). He takes Repatha, losartan, baby aspirin, and ambien (he works nightshift & sleeps during the day). Generally healthy and active, only pmhx is high cholesterol (we are Cuban and he eats a very high fat diet and a lot of red meat), and two stents placed in 2017. Extremely extensive family cardiac history as follows (this is tough to keep track of so bear with me):His father: quadruple bypass, 5 TIAs then full carotid blockage, heart attack = died in 10/2014His mother: quadruple bypass, years later had MI & stroke = died 4/28/2008Brother #1: quintuple bypass in his 40s... died of heart attack in his sleep 5/2019 @ age 58Brother #2: stent in his 40sSister: MI (widow maker) & triple bypass 4/2019Brother #3: 3/2023 bilateral carotid 90% blockages, persistent A-fib.And those are just his immediate family. That history extends to every branch of uncles & cousins as well. They should give us a discount for buy two get two bypass at this point.My dad recently went for his annual cardiac appt and failed his stress test (he was unable to complete it) so they had him go for a cath. That revealed 100% blockages in several areas (diagram drawn by his doc here: https://imgur.com/a/0adwYqA ) but they didnt perform any interventions. The doc said theyd have to compare this cath to the one he had in 2017 to see the changes and decide how to proceed, but that he felt ok just watching things for now. His next appt is in June, and my dad seems to think all is well. He said oh it went fine, they told me my body made other pathways for the blood to flow. Ugh.I am alarmed. Cardiac isnt my specialty, but wouldnt this warrant a double bypass? Isnt his personal and family history enough to be more proactive with intervention? I was very close with my uncle and he passed away in his sleep just months after a normal cardiac exam. I dont want the same to happen to my dad, and Im concerned that hes heading towards a major event. Any insight? Am I right to want to push him to follow up on this immediately? Thank you. ###Output :So obviously your dad has significant coronary artery disease. The family history at this point (which is ridiculously extensive) doesn't really matter since we know his anatomy.It looks like his left main coronary artery and left anterior descending artery (LAD) are open. His right coronary artery is blocked but past this it presumably backfills from the LAD through enlarged (collateral) vessels that wrap around the apex of the heart. This is why he had a positive stress test - with enough exertion the oxygen demand is too high for the left side to keep up.Almost all of the benefit for a coronary bypass procedure is with patients who have significant narrowing of the left main coronary artery or both of the immediate downstream arteries. These feed a large portion of the heart muscle, and not just your dad but anyone does poorly if they are blocked.However when these are open, which is the case here, the benefit is less clear and this is doubly true in the absence of significant symptoms. A left sided graft may not even stay patent in this setting, since there is competitive flow down the LAD. We would not usually do a bypass just for right coronary disease, the benefits do not appear to outweigh the risks in this scenario.The other blockages are being backfilled by the open arteries, and unless he develops new symptoms then medical management is at least as effective and safer. It isn't that the blockages aren't a concern, it is whether bypassing them is beneficial. In this case if it were my dad I would prefer aggressive medical management and lifestyle changes as much as possible."}
{"text": "###Input :This is an incredibly thorough reply, thank you for taking the time to explain all of that. My clinical brain cant function because all I can think about is getting another phone call and it being about him.So if Im understanding correctly, it sounds like the collateral vessels are more effective than I assumed. Hes a pretty active guy, is there danger if the left side cant meet the metabolic demands of the heart during exertion? Any risk of right sided ischemia?Ill be joining him at his appointment to take notes and make sure hes compliant with those lifestyle changes. He still thinks this is all routine and not a big deal. Your reply is helping me catch my breath a bit, so thank you again. ###Output :Yes the collaterals are presumably well-developed. The danger from over exerting himself through exercise isnt of much concern, he would be symptom limited well before there was irreversible damage. Other issues like sepsis could put some strain on the heart but unlikely to cause any sizable infarct.He needs to really maximize the medical management - strict risk factor control with high-intensity lipid lowering therapy (doesnt matter if cholesterol is high) and tight monitoring of blood pressure. If there is a hint of diabetes one of the newer agents also would be good.The medicines actually work quite well combined with lifestyle changes. CABG and stent are more bailout procedures if a lot of heart muscle is threatened by very narrow arteries, which is not the case here."}
{"text": "###Input :Pediatric low Creat level - Doctor ignoringMy 3 year old daughter went in for her check up/blood work, and has a .3 level of Creat and and 240 alphosi test results. The doctor is entirely unconcerned about this, but what Im reading on line makes me worried. Should I be concerned? If yes, what are immediate next steps I can take.Thank you in advance, Worried Parent ###Output :I cannot think of a situation in which a low creatinine in an otherwise healthy child would worry me."}
{"text": "###Input :Is there anything to be concerned about with the high level of the alkphosi? ###Output :Probably not, but thats something to ask the pediatrician"}
{"text": "###Input :NAD but I understand that higher alkphos in children is considered normal because of bone growth. Could be the kiddo just had a growth spurt. Alkphos is an enzyme found in bones, liver,kidneys, digestive tract. Def talk to your pediatrician so they can ease your worries. ###Output :Those are both normal results for a patient her age. The doctor is ignoring them because your lab likely has a reference range that's for adults, not kidsThe creatinine level roughly reflects the muscle mass. Normal for kids is always low. If it's \"normal\" for a kid, I look twice and think about things.High alk phos (alkaline phosphatase) level in kids is almost invariably correlated with a low Vitamin D level. It's more typical these days to have a low Vitamin D than not, at least for kids. Maybe it's all the sunscreen plus much less non-screen time. Fewer sunburns but lower sunshine. I don't know that we have good guidelines for what to do with vitamin D levels these days, but if you wanted to pursue something, that would be it. Or give her a multivitamin with at least 400 IU of Vitamin D and consider rechecking in the spring.I'm curious, though -- we usually don't check these labs as part of routine blood work. There's the CBC or hemoglobin level, and lead, and then lipids and diabetes (but only for children at particularly high risk). Do you know what the physician was looking for, or why they were checking extra things?"}
{"text": "###Input :Dont worry- I totally believe in them and support vaccination.Im an infant/toddler nanny, and have been working with them for over 20 years. Today I encountered something new.The Little One I take care of (18 month F) got a couple of shots today. The pediatrician advised her parents not to use Motrin or Tylenol for fever or discomfort unless her temp goes over 103.5 or she absolutely cant sleep. The reason given was having a fever and letting it do its thing means she will have a greater immune response from the vaccines. (These were standard 18 month shots- not the COVID vax, for what its worth. She has gotten the first 2 COVID shots- waiting on the 3rd next month.)I have never heard this before. Can anyone weigh in on this? Sounds crazy to me, but Im not a doc. ###Output :Current data is a bit conflicting from studies Ive read, but I generally caution against prophylactic use of antipyretics because there is some evidence that it blunts the immune response.Use of antipyretics about 4-6 hours post-vaccine have shown mixed results in terms of immune response but generally patients still gain immunity. Id rather have a happy patient and family that returns for all vaccines than tell them not to give Tylenol/ibuprofen. I try to make sure they wait 4-6 hours though before the first dose if it is needed. We have multiple doses of most childhood vaccines, so its likely there wont be an issue with immunity, even with Tylenol/ibuprofen post vaccine."}
{"text": "###Input :Thank you so much. Ive just never heard this before, and Im always open to learning! We obviously want her to get the best results she can from them, but we also dont want her to be needlessly uncomfortable. She made it through to nap time comforted with snuggles and her favorite lunch, and we plan on letting her play in the tub this afternoon to soak the bandaids off her legs.Thats another question- is there a legit reason to put bandaids on after shots? Ive never seen more than the tiniest drop of blood on a bandaid after a child gets a vaccine, but they are so hard on their legs. They stick super hard, and she tends to get little welts where the bandaids were. She also cries now anytime she sees bandaids bc they hurt so much to take off.Are they needed? Is it to prevent infection? To put pressure on the injection site? We would MUCH rather just have the tiny drop of blood on her pants than go through this every time- but if theres a legit reason Id love to know about it.Thanks for taking the time to give an answer. Its much appreciated! ###Output :No, no good reason for the bandaids other than the drop of blood and to prevent them from messing with the area immediately after.It's not evidence based. https://journals.lww.com/ebp/Fulltext/2021/03000/Does_premedication_with_ibuprofen_affect_the.19.aspxThose meds can reduce immune response but not uniformly and the immune response is still enough to be protective at minimum. There's no basis for that fever number that she picked. Delayed acetaminophen or ibuprofen given after the vaccine rather than with the vaccine appear to have a lesser effect."}
{"text": "###Input :Just to clarify your last sentence- does delaying the dose lessen the effect of the med I terms of comfort/fever reduction? Or lessen the effect of how the vaccine impacts the immune system?We try to use other methods of soothing her in general when we can, but sometimes shes uncomfortable enough that it seems warranted. (We went with her favorite lunch and lots of snuggles between the shots and nap, and are planning on letting her play in a warm bath after nap if she wants.)Thank you for weighing in. I appreciate it! ###Output :I think there was a trend to lessening the effect on the immune response, but again, the immune response was still adequate regardless. I'd give my kid the tylenol after a vaccine. In my local children's hospital they do as well. I find the evidence saying not to give it is weak and mostly refers to giving it at the time of vaccination"}
{"text": "###Input :Thanks!Edit: added question to the top. ###Output :Benzoyl peroxide is a rare allergen but a common irritant and can cause irritant contact dermatitis. As long as the latter does not occur, it is an excellent biocide."}
{"text": "###Input :Thank you. Would you have insight into how often benzoyl peroxide wash would typically be used in a situation like ours? ###Output :No examination details or images included, so no comment appropriate."}
{"text": "###Input :I hope this works for photos. Ive never used Imgur or posted a photo on Reddit before. The labeled photos are from tonight when the dots have pretty much dried up and are the best they get after a bleach bath. The other two are of times when the folliculitis is more flared up. Let me know if there is anything else for a physical exam you would want. Thanks!Edit: looks like the photos require being over 18 to view. Two are of his bottom, this is probably why, though I censored what was necessary. ###Output :Mild folliculitis present. Using the benzoyl peroxide wash a few times a week may maximize efficacy and minimize irritation."}
{"text": "###Input :Would you indulge another question? Just curious if selsun blue would be a viable option as an occasional body wash for my sons situation given its anti-fungal properties. (Im thinking the benzoyl peroxide will be sufficient, but just curious.) ###Output :Selenium sulfide is an antifungal agent but does not have antibacterial activity as far as I know. Not a good choice."}
{"text": "###Input :3 months later, doctors hypothesize TTPm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help! ###Output :It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis"}
{"text": "###Input :6 year old re-cauterized day 5 post tonsillectomyMy 6 year old had her tonsils and adenoids taken out on April 6th, she was what I thought, healing well. In good spirits, never complaining of anything more than  a little pain . Popsicles nonstop, ice cream too. Tuesday night, after a full 5 days post operation, she wakes up and starts vomiting blood. We panic, call 911, go the nearest pediatric hospital. They tell us well have to recauterize. Cue second round of fear for the night. I couldnt imagine putting her through anesthesia again in less than a week. Thankfully it went well, and the left side had active bleeding in one spot which they cauterized and the right side had some tiny vessels that the doctor recauterized too. They kept her for another 8 hours for observation and she was doing well. I guess now were all so traumatized, including her, that it could happen again. She hates the taste of Tylenol but pediatrician warned about Motrin possibly triggering the bleeding. Of course, she prefers Motrin. Im writing this terrified of it recurring and praying it wont.Im so terrified of her hemorrhaging again and I dont know how to calm myself. I was told it would be rare to happen again but it was rare to even happen the first time. Were officially 7 days post initial procedure and Im wondering at how many days post op can i be confident that shes healed?Any possible words of encouragement or advice would be so very appreciated. ###Output :Its not that uncommon after tonsillectomy actually, I agree unlikely to recur and should be ok. Did they check her blood counts to know how much she had bled?"}
{"text": "###Input :Ive got her lab results with me but unsure of what its telling me. ###Output :Fairly common , frankly not a big deal that is just bad luck. Rate of postoperative bleed is 1%, so chance it happens again very rare.You can get a rebleed at 7-10 days but rare. After that it becomes extremely unlikely"}
{"text": "###Input :Thanks for your comment. The pediatricians drilled it in our heads that it was rare that it happened in the first place, even at 5 days. But I cant help but shake the feeling that even though its rare to happen again, we were already one of the rare ones it happened to the first time around. They made it seem as its way more unlikely for it to happen to children and more common in adults. When we saw her vomiting fresh blood we thought we were going to lose her.Will the recauterization of the spot where they found her active bleeding (noted as left superior tonsillar fossa) reset the clock on healing the whole area? Diffuse oozing in the right, clots bilaterally were also listed on our discharge papers. ###Output :In 25 years of practicing ENT Ive only seen one re-bleed.The cautery sets the clock back just in that one specific spot. Theres no evidence postop bleeding is more common in adults, thats an old wives tale.Big picture here, this was a small setback your child will be fine."}
{"text": "###Input :11 month old with fatty liver11 month Male Multivitamin with iron 6 weeks premature Uncircumcised 29 inches 24.5 lbsOn March 30 he woke up with a fever. We headed to urgent care and they diagnosed him with UTI. Got a call from them a week later saying to follow up with his pediatrician. While there she said his bacteria numbers werent high enough to indicate a UTI but its possible we just caught it super early. She said she was going to do research and possibly want further testing. She ended ordering a renal ultrasound. The findings of the ultrasound indicated that his renal system is unremarkable! But his liver is showing echogenicity and fatty infiltration of the liver. What could cause this? Should I be worried about it? ###Output :Some infants have fatty liver on US or CT scans done for other reasons, as in your case. There's no consensus on what to do in this situation, but I tend to just follow it, because it often goes away. We think it's often a consequence of fetal environment, and has some association with maternal obesity, maternal gestational diabetes, and also seems to happen more often to preterm babies. But overall, the problem hasn't been well studied. In the setting of a recent infection, there's also a decent chance it's a consequence of the immune response (although it's usually from a gastroenteritis with things like adenovirus, not a UTI).These cases come to my clinic every now and then and most of the time it resolves. I usually do two things: repeat the ultrasound in a few months, and get a blood test (called a CMP) to look at the liver numbers.We don't know how this relates to long term risk for fatty liver, which has more significant health consequences. Some people have genetic causes for fatty liver, and it can start at a young age, but this is fairly rare, and not the cause of fatty liver in infants in most cases. Either way, it's worth keeping tabs on it to see if it goes away over time."}
{"text": "###Input :Should I look into dietary changes? He breastfeeds 5+ times a day and has a meal 3x a day. The meals typically consist of a protein, fruit/veggie and some form of starch (sweet potato, wild rice, veggie pasta). He drinks probably 1 cup of water a day. ###Output :Likely not necessary in the short term. But I would still discuss with a pediatric gastroenterologist."}
{"text": "###Input :Please help me understand this. Scared19, Male, 60, 180 lbs, Usually healthy, Works-out 5 days a weekHi there, I went to hematology for a low WBC count and while there I mentioned to them that I have had palpable lymph-nodes in my neck for 3.5 years and I have already been checked previously by 4 doctors including a pediatric oncologist and had multiple ultrasounds which suggest its non-concerning. However, she took an ACE level test and it came back elevated and she said something along the lines Youre ACE levels came back elevated and it could suggest sarcoidosis and if youre concerned go to a GP and get it measured again  ANYWAYS! I didnt think much of it and let it be for 6 months & I went to a Nurse Practitioner to repeat my CBC out of curiosity which showed everything was normal and my WBC was 5.6 which was great. I also asked for the ACE level test to be re-measured and they didnt know what that even was. They had me come back after they researched it and then they took a small vile of blood. They sent it off and it came back high at a 135 and cut off for that lab was 80. I am freaking out because he contacted the hematologist doc and they said I should go to a pulmonologist. I feel perfectly healthy and better than I ever have. I am freaking out because google keeps saying ACE levels being high indicates: Lymphoma, Multiple Myeloma AND Lung cancer. I am absolutely plummeting right now and nothing makes sense to me. Please give me some advice OR knowledge. Its hard to find stuff online speaking about ACE levels. ###Output :ACE level is a very nonspecific test. It is not recommended for exactly this reason. Positive tests have <25% chance of having sarcoid, especially if they aren't sent for a good reason.I would followup to make sure but this is a good example of why we don't just send off a bunch of tests for no good reason - you end up with anxiety and chasing down a number of things that are not real."}
{"text": "###Input :okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this? ###Output :Very unlikely. We dont use it as a test to look for malignancy."}
{"text": "###Input :okay thanks for the responses. my NP i seen doesnt even know what the ACE levels mean and has no knowledge on it. think i should go back and see my actual GP? or is this something i can just let be elevated ###Output :I would be hard-pressed to know how to deal with this nonspecific test without seeing you and your lab records and getting a full medical history. So again I would followup. Depending on the level of suspicion a chest x-ray, chest CT or even biopsy might be warranted.It is generally more productive to wait until there are some symptoms but I can't reassure you that you definitely don't have sarcoid or a different autoimmune disease. It does not seem like you have cancer based on the lymph node surveillance"}
{"text": "###Input :what is this rash on my toddler1.5 year old, male, 24 pounds,I just noticed this rash on both my sons feet legs and bum. theres been no change in detergent, or soap. Hes recently been on antibiotics for an ear infection but broke out in a full body rash on day three of amoxicillin. so they switched him to azithromycin and same thing happened. hes been on cipro/ dex. drops since wednesday. what the heck is going on. why is he covered in rashes? he doesnt seem to notice. acting fine, no fever, not itching. Any ideas? Picsedit: sorry the pic kind of sucks but 1. hes a toddler and does not sit still 2. the flash dulls the color of the rash ###Output :Does this rash cover his whole body? It looks like Roseola to me, which is a very common viral infection in pediatric patients."}
{"text": "###Input :no not this time. but the other 2 times it did. googling roseola - thats exactly what his rashes have looked like.i had brought him in to ER with a fever of 39.7 (went to 40.5) and lethargy, which is when they said he had quite a bad ear infection (membrane retracted with ++ pus) he hasnt been tugging on his ear or anything. could that have been an accidental finding and the fever was actually the roseola? i understand its hard to say over the internet but thought id ask ###Output :Exactly. We see this in the ER all the time. Roseola is infamous for making the ear drums look infected when they're actually not. I suspect his fever was from the Roseola, and he was falsely diagnosed with an ear infection at that time given his constellation of symptoms. The rash infamously comes after the fever breaks. It's not itchy or uncomfortable for the child."}
{"text": "###Input :that is so interesting!!! a coworker actually suggested this but i basically brushed it off, but it makes sense! so maybe hes not allergic to penicillin and azithro after all.its been about a week with on and off rashes. is that normal? i keep taking him back to the doctor thinking its the meds ###Output :I highly doubt he's truly allergic to either :)"}
{"text": "###Input :Good to know!! he doesnt seem bothered by the rash at all! He does still have a bit of a rash though and its been like 7 days since it first showed up. its kind of comes and goes tho is that normal for roseola? ###Output :Hand foot mouth is a possibility too.As an ER pediatrician, I ignore whatever urgent care diagnosis was given regarding ears. They usually suck at examining them, and think every flushed ear drum in a kid with fever/crying is infected. That, or frequently find that they're outright liars, and couldn't have possibly seen the TM, because of the enormous amount of wax (or even foreign bodies) that is in the way. The people doing these evaluations and making these diagnoses are almost never pediatricians, and usually aren't even physicians."}
{"text": "###Input :Advised by nurse line to give my 3 month old a glycerin suppository?Male. 3 months. 15 pounds.possibly milk dairy allergy. He usually goes 1 to 2 times a day but hasnt gone in 4 days. He is exclusively breastfeed. I started a probiotic 5 days ago that I discontinued since he hasnt gone. He has been having diarrhea for weeks everyday so this is a big change. Hes been passing gas and fussy starting today whenever he passes gas.I called our pediatrician hotline and was told to use 1/4th if a suppository for him. Im a little hesitant but cant get in touch with his doctor until Monday. ###Output :Exclusively breastfed infants can go up to 9 days between poos. If he is eating, not vomiting and passing wind I dont know why you would give him a suppository"}
{"text": "###Input :why does everything feel fake?history: im 16M, have no existing medical issues, nor am i using any medications, and i dont smoke, drink, or do drugs.occurrences: this has been getting progressively worse the past month, at first it was only something i could notice but it never really bothered me, but now it makes taking tests, reading (even this), and programming really difficult without full concentration. it kindof comes in waves where i can read whole chapters with no problem to having to re read a sentence multiple times to understand it (this happened in my ism test where i got stuck on a really easy problem because it felt like whenever i read one part of it, part before it disappeared). sometimes it gets so bad to where i get dizzy spells in the middle of class, and other times when im about to sleep it feels like im \"slipping\" and jump up (not the kind where you feel like your falling in a dream and wake up). also the past few days its kindof always been on very slightly.when it gets bad it feels like passing out without actually passing out, you know how you technically CAN see, but dont really understand anything? it feels like that, or like those pictures where you cant identify anything, or waking up suddenly from a deep dream, and my mind goes blank and i feel like im \"spiraling\", and it feels like im about to fall through the world? i dunno how to explain it, but i usually get jumpscared by it and it brings me back to normal, but if i focus i can point things out and describe things. another way i can describe it is it feels like im looking through my peripheral vision at all times, theres a certain lack of clarity to what everything looks like, and sometimes when im reading it feels like im being sucked into the monitor, if i really focus i can read, but it feels trying to read on a rocky boat, yeah i CAN do it, but im not really understanding it because im too focused on reading the words. sorry if im explaining this poorly, i dont really know what it is or whats causing it, im thinking its a mix of brain fog and anxiety? i wouldnt say im an anxous person but idk, and it feels kindof similar to the brain fog i get when i drink coffee, and ideas would be apreciated! ###Output :Needs detailed in person. Pediatric psychiatric evaluation."}
{"text": "###Input :3 months later, doctors hypothesize TTPIm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help! ###Output :It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis"}
{"text": "###Input :Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment. ###Output :The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation."}
{"text": "###Input :Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains? ###Output :High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes"}
{"text": "###Input :Could her delayed growth be a byproduct of the IUGR? Or is it more likely shes just not taking in enough calories per feed? Additionally, are there any questions that youd recommend I ask the pediatric GI doc? Thanks so much! ###Output :Both. IUGR babies are prone to have poor growth. Most continue to have slow growth in the months after birth, often leading to GI interventions such as increasing nutrient density of formula. This is to make up for the nutrient deficit present that an average infant's daily intake typically cannot surpass on its own.While the vast majority (80%) of IUGR and/or SGA (small for gestational age) do catch-up to reach sizes comparable to other children, this typically takes about two years. Many factors affect growth and stature, including any medical problems that led to her being small. For instance, this nutrient deficit and propensity to growth failure tend to be worse in infants who were also preterm (at 37+1 weeks, your daughter was born just two days further along than what we would consider \"late preterm\").The main things you can control and monitor at this point are her nutritional intake and feeding habits. For now, the baby's goal is to be improving in her percentiles, not worsening. I recommend working with the GI team on this goal. They will likely have you see a pediatric dietitian as well to help figure out how many calories she should be getting.Don't despair - this is more common than you would think. It doesn't mean you're doing anything wrong. You are working very hard and doing everything you can right now. Getting more hands on deck by bringing in a specialist's perspective only means more people in your daughter's corner trying to get her growing better.Most babies born with IUGR do catch up their growth by this age, so I agree with your pediatrician's concern. Increasing the concentration (\"fortifying\") her formula is a great first step, but it's worth seeing the pediatric GI to make sure there isn't something else going on. I'd suggest keeping track of about how much she eats in a 24-hour period as well, so the doctor can assess whether she's getting enough calories."}
{"text": "###Input :Pediatric question: For an 8mo baby with hypotonia and delayed gross motor milestones, how much could diagnosing the cause impact the PT/OT she is already receiving?We are talking about an IUGR baby who was born 0.03rd percentile at 38 weeks and is now 13th percentile weight, still has low BMI and diagnosed at 6mo with overall hypotonia. Currently working with PT in person weekly and OT via video-chat weekly.Skills being worked on in PT/OT include:rolling front to back (emerging, working on efficiency)rolling back to front (she never does this unassisted)weight-bearing on elbows in tummy time (often lifts arms and arches back)weight-bearing on hands in tripod sitting positionshifting weight and reaching while in prone/various seated posesbuilding lower abdominal strength with targeted exercisessensory brushing and joint compressionsimproving one and two hand grabsreconditioning oral aversion (from extensive craniosacral mouth work and tongue tie revision w/ post-surgical exercises around 4-5 months old)eating solid foods (baby will touch foods, but never bring to mouth, accepts spoon feeding enthusiastically)neck and shoulder stretches for mild torticollisIm probably leaving something out, but this is an idea of our therapy focus. We live in an area with only one pediatric neurology practice, so we cannot begin to diagnose or rule out anything until our scheduled visit in 2 months.My questions are: Is the therapy we are doing appropriate regardless of diagnosis? How could delaying diagnosis until 10 months (or later) affect her long term outcomes? Would there be any reason for us to travel out of state to a larger facility if we could be seen sooner (on our own dime, eight hours away)?TLDR: Is diagnosis of the cause of mild to moderate infant hypotonia urgent when PT/OT is already underway? ###Output :A proper pediatric neurological evaluation will better guide PT/OT, as well as if any other necessary treatments if the underlying cause is treatable."}
{"text": "###Input :UTI or Kidney Infection?My daughter 14F, 57, 150lbs, was diagnosed with a UTI at the ER on Thursday afternoon. It caused her to have hot/cold flushes and high HR, which is what brought us to the ER. She has been taking antibiotics twice per day, starting Thursday afternoon. NITROFURANTOIN MONO-MCR 100 MG CAPSULE. She has horseshoe kidney, which is why Im worried. Pediatric nephrology sent her urine from the ED for more tests and they came back this morning to MyChart.Urine Culture Your Value 20,000-29,000 cfu/ml Enterococcus faecalis Flag AUrine Culture Your Value 10,000-19,000 cfu/ml Mixed Contaminants X2Friday night she felt awful and had shakes for an hour. We called the Capital Blue nurse hotline and she said that its just my daughters body fighting the infection and she needs more time for the antibiotics to kick in.Its now Sunday afternoon and she is feeling bad again with a low fever (she didnt have a fever before). She doesnt feel well enough to get up and shower.Is there anyone who can offer help until we can call the nephrologist Monday morning?The ER doc dismissed her high HR and hot/cold body flushed as a panic attack, so now when she starts to feel bad she starts to panic. She has finals tomorrow and has an after school commitment starting this week. I need to figure out what is wrong and help her feel better. ###Output :Is her temperature over 100.4?Macrobid (nitrofurantoin) will treat enterococcus very well. However macrobid will not treat kidney infections, only bladder infections. If her temperature was truly >100.4 she may need another antibiotic. You can wait till tomorrow to call your nephrologist to check in."}
{"text": "###Input :Is a prolonged QT wave on one EKG significant? (Pill overdose)Could my incident of one abnormal EKG I received as a teenager following pill overdose need to be reported to docs 10+ years later/in the future?Or if since then I have had 2 other EKGs and a 48-hour holter monitor and only found tachycardia, am I clear? The specific abnormality was a \"borderline prolonged QT wave, poss / positive for RVH.\" Context and other lesser abnormalities to follow.I am currently 29F with sinus tachycardia, fibromyalgia, bipolar disorder. I requested hospital records of my pediatric suicide attempt because my parents and current psychiatrist are not sharing consistent information with me about my diagnosis(es) and prior care, and I would like to get more help. I was never told that I had particular diagnostic tests run or that any came back abnormal, and I want to know whether these should be chalked up to error/a fluke/exclusive to that overdose, or whether it's something I should've reported to my doctor when my tachycardia was being investigated or should report in my future medical histories or if I were to have more concerning cardiovascular complications.As a 14-year-old, I attempted suicide by ingesting 50 ibuprofen and an unknown # of Sonata, best estimate ~10 pills. The ibuprofen # could be higher technically, since I was still taking it when I lost memory/began to hallucinate. The tox screen was also positive for caffeine.14 F 110 lbs, 5'3\", on 0.5 mg Risperdal, 25 mg Zoloft, unknown if any particular mental disorder diagnosis was made at that time, \"asthma,\" white, no drug/alcohol use.I was taken to a hospital and an EKG, head CT, and labwork were done ~4 hrs after ingestion. I presented with normal exam/vitals/labwork in the first 6 hours except for visual and auditory hallucinations and ataxic gait. After about 4 hours I was transferred to the children's hospital ER. While the initial ER noted no new symptoms and stated my EKG was normal, I did see that shortly before I was transferred my BP went from 115/80 -> 114/55.Cardiac Consult:The children's hospital notes by 2 different care team providers state that my EKG by the outside hospital had a borderline prolonged QT and poss / positive for RVH. They repeated my EKG 7 days later, and the consulting cardiologist said they were happy to report this present EKG came back completely normal. He did state that I was \"admitted to [the] eating disorder program,\" so I hope misunderstanding why the EKG was being performed wouldn't affect his conclusion? He also offered to do an exercise treadmill test if they desired. Another note by a care team provider said they recommended I do an outpatient stress test after discharge, but I don't believe my parents ever had it done.Other noted abnormalities post-ER EKG after I was transferred to children's:1/6 systolic murmur, diastolic BP was hypotensive for 12 hrs (98/38, 101/35, 94/45, for example), bpm was 70 - 130, 2+ pulses on extremities, somnolence - at one point only arousable with painful stimuli and then immediately falling back to sleep - and a lot of vomiting later on. Seems like I went back to baseline by about 18 hrs post-ingestion.I think my parents and doctors were so worried about my mental state that they didn't even touch on the physical symptoms. Do I need to consider them at all? Or is it fair to assume that the EKG was a result of the overdose or emergency situation, but that it wouldn't have any long-term ramifications?Throwaway due to sensitive details. ###Output :An abnormality on an EKG one time in the context of a medication overdose is not worrisome, especially as it normalized later. This is an expected consequence of the medication overdose, as were your symptoms."}
{"text": "###Input :Im not going to lie -- between these heart rate numbers, her complaining about \"heart pain\" when she was younger, and otherwise being healthy and on-target (if slightly smaller than average) for height/weight/BMI...Im concerned. But I'm not a medical doctor. So here are my questions to those of you that are:Should I be concerned? If so, how concerned should I be?If this is concerning, what steps need to be taken? Do we need to take her back to her primary doctor and get a referral to a pediatric cardiologist? Should we insist that she be allowed to (as needed) walk during runs in cheerleading practice / school?Aditional Info and DetailsMy little sister does pee-wee cheerleading, and they start every practice by running 2 laps around a football field, which is ~1/2 mile (i.e., ~0.8 km). She is not quite \"sprinting\", but is running the whole time at (Id guess) 80-90% of her maximum running speed (with no walking breaks). When she ran it earlier tonight, at the end of the 2nd lap her Fitbit watch said her heart rate was 213 beats per minute. Her heart felt like it was literally beating of her chest, and she said that she felt like she was about ready to pass out.From what I could find online, 213 BPM for a 10-11 year old girl could be dangerously close to her maximum heart rate, though (especially at that age) maximum heart rate is somewhat variable.Ive also measured her resting heart rate a few times (e.g., after sitting down watching tv for 30+ minutes) and it has been in the 100-110 BPM range, which from what I could find online is not unheard of, but is pushing the upper limit of \"normal\". These measurements were in the evening (close to bedtime, before taking the 50 mg trazodone). I ran the numbers and, at this point, all the vyvanse from her morning dose has been converted into dextroamphetamine, which (on average) has gone through ~1 half-life (~50% has been metabolized, assuming a 1:1 metabolic conversion for Vyvanse --> dextroamphetamine).Note: to check the Fitbit's accuracy, one of these times I also measured her heart rate manually using my (surprisingly effective) homemade double-walled stethoscope. Over a 30-second interval, the fitbit pegged her at between 99-102 BPM, and I counted 50 heartbeats (meaning 100 BPM), so the measurements it takes seem accurate.She isnt the most \"active\" person -- left to her own she would sit and watch TV and play on a tablet all day -- but between cheer (3x 2-hours practices + 1 game every week), dance (2x 1-hour classes every week) and school (PE, recess) she gets at least an hour or 2 most days whether she likes it or not. And she certainly isn't overweight -- this growth chart suggests she is in the ~30th percentile for weight and ~25th percentile for height. This BMI calculator for girls puts her BMI at the 53.6 percentile (z=+0.09). ###Output :Agree with /u/muchtwojaded. Normal resting heart rate for her age/size, and the >200 HR with exercise isn't concerning to me. Sounds like she gets a good amount of healthy exercise, more than many kids her age.Nothing here sounds dangerous. If she's not complaining of symptoms with exercise, I wouldn't do any kind of workup."}
{"text": "###Input :Is it PPA or is there something wrong with my 9 week old son?I want to mention that Im not a FTM. This is my second baby. My first didnt sleep consistently through the night until 2.5. But I really feel like this isnt normal and no one is taking me seriously.Around 2 weeks he started refusing to sleep on his back. Weve had to resort to bedsharing(not what I want to be doing) and he still will only sleep in 30-60 min max increments. He breathes through his mouth a lot. And sounds like a pug when he breathes sometimes. He will stop breathing for a few seconds and then wake himself up with coughing/gagging noises. He frequently gags/chokes when breastfeeding as well. My pediatrician thinks the breathing is normal and that hes working us by crying when we put him to sleep on his own (told us to keep putting him on his back in his crib and hell figure it out. But he screams immediately).Hes had his tongue and lip tie removed a month ago. Chiropractor appointments. Hes on reflux meds. And Ive been dairy and soy free (was having green mucousy diapers) for 2 months. All of this has greatly improved his colic/fussiness- hes usually happy now. But not his sleep.My last resort is maybe an pediatric ENT. But idk what they would even do. Everyone keeps telling me his breathing is normal but I just have a feeling its not. I dont want to waste anyones time.Ill link a video of him breathing and screenshot of his owlet sock showing oxygen lvl and how frequently hes waking (orange is awake). I really really appreciate any advice. ###Output :See the pediatric ENT.The breathing sounds to me like he may have a \"floppy\" airway and could have a condition called laryngomalacia or tracheomalacia. It's fairly common, often does not require medical intervention, and typically improves with age, but you should have him evaluated particularly given the nighttime coughing and awakenings, which are likely because of the condition causing temporary drops in oxygen (as you saw on the owlet) resulting in the body's response of cough/awakening to bring oxygen back up. The pediatric ENT can use different techniques to determine whether this (or another) condition is present and responsible for the symptoms.Interestingly, children with this condition are sometimes recommended to sleep on their stomachs as it helps relieve the upper airway obstruction caused by the floppy larynx and/or trachea, so by refusing to sleep on his back, your son might just be telling you what his airway needs right now. The ENT will provide guidance on how your child should best sleep as well as any other recommended modifications to help with the condition.If bedsharing, practice safer co-sleeping techniques as much as possible as described here. Most important is firm mattress, no pillow/blankets present that could possibly obstruct the face during sleep, no smoking, drinking, or siblings."}
{"text": "###Input :NAD, but came here to say my child had Laryngomalacia as an infant. He was a squeaky breather but ceased showing signs at 18 months. I hope you get answers soon, OP. ###Output :Do not take your baby to a chiropractor. Chiropractors are not medical professionals, and they are especially not pediatric professionals. They are at best harmless and at worst lethal.I am not a pediatrician, I have no idea how reliable or useful Owlet monitoring is (I suspect not very), and that minimal video doesn't sound concerning to mebut I can barely hear and I am again not a pediatrician.This is something to discuss with your baby's pediatrician. If the doctor involved is not concerned, it's probably okay. If you're still very concerned, you could try getting a second opinion from another pediatrician, including bringing all of this information."}
{"text": "###Input :Can I ask my doctor to request pharmacare to cover Zofran?26F, 195 lbs, white, current meds are Mirena IUD, cipralex, wellbutrin, and pantoprazole. Current diagnosis of IBS.For the last four years or so have been dealing with awful and disruptive GI problems. Rectal bleeding, diarrhea, distention, nausea, vomiting, pain etc. Blood work has only ever shown anemia, which I've dealt with before, and calprotectin, fecal occult, and scopes have all been given, only finding is enlarged internal hemorrhoids but not so large to warrant a banding procedure.I saw my doctor today as nausea and vomiting were controlled by pantoprazole for almost a year, but nausea and vomiting has worsened, and I've been having increased pain localized to LRQ that will stop me in my tracks, and feels like a rolling intense cramp, or intense pressure. She wrote me a prescription for Zofran, and it was $272 for 90 tablets. I have provincial coverage, but since I'm not a pediatric patient or undergoing chemo or radiation I'm not eligible for coverage.Could I ask my doctor to petition pharmacare to get me coverage and explain that I've already been on meds that have failed to control problems? How likely is it that can be covered ###Output :Zofran has been off patent for a little while now, ask for the generic, it should be at least half that price"}
{"text": "###Input :I did get the generic , don't know what I would have done if got the name brand ###Output :Yea right, interesting. 10 wafers generic in australia is around $14 so youre still getting a solid premium over there"}
{"text": "###Input :1 year old sudden loss of visionOn Thursday, my 15 month olds babysitter noticed that she wasnt making eye contact like normal. At home, I noticed the same thing. Normally, if I look at her and smile she smiles back. But it looked like she was looking right past me. Along with that, she was not tracking objects with her eyes.I took her to the pediatrician on Friday who was concerned and wanted her to see an ophthalmologist right away. So we did that, she had a full eye exam with her eyes dilated and there was nothing wrong (like far sightedness or strabismus etc) with her eyes. The ophthalmologist was concerned too and called a neurologist who wanted us to go to the ER so we could be admitted into neurology over the weekend.The ER did a lot of blood work, a spinal tap for fluid (I cant remember the name- Im sorry.) and the doctors there just generally said they were stumped.We are on day 2 of being in the pediatric neurology unit. Shes having an EEG done for 24 hours and hopefully an MRI today. The neurologist says hes fairly confident she isnt having seizures but wants to cover everything.I hope one or both of those things gives us an answer but in the mean time all I have to do is think. What could possibly have caused this loss of vision seemingly overnight? She responds to sounds but not objects. Shes had hundreds of lights (from nurses doctors etc) flashed right in her eyes and she does nothing like youd expect. They shined a light in my eyes to show me how abnormal it was that she did nothing because I instinctively moved my eyes.Also... no falls, no high fevers, no recent illness, her birth was normal, shes developmentally normal.Does anyone have any idea of what this could be? ###Output :Sorry to hear about your daughter. It is hard to know the cause without all the test results at the current time, especially the MRI, as this seems to be something less common. If she looks well in other aspects (except for the vision loss), and has already been evaluated by a pediatrician, ophthalmologist, and a pediatric neurologist, you are doing everything you can, and it seems that everything necessary is being done. Vision requires normal eyes, normal optic nerves connecting the eyes to the brain, and normal function of the visual cortex of the brain, and of course normal response to vision requires good function of the rest of the brain. Generally most problems affecting the eyes affect only one eye at a time, and can be seen by the ophthalmologist (either anterior chamber problems such as cataracts or posterior chamber issues such as retinoblastoma). Problems affecting the optic nerves (e.g optic neuritis) are more often seen in older kids (e.g with multiple sclerosis) and are very rare at 15 months. Rarely, there can be problems near where the optic nerves come together just behind the eyes (optic chiasma) when masses (eg. craniopharyngioma)/cysts push on them and can cause visual loss. It is also rare for things to affect the visual cortex of the brain. I suspect that the MRI will be of help. If it does find something, it might need other specialists (e.g. neurosurgeon) to provide further information on management."}
{"text": "###Input :Are there different sized tools for transvaginal ultrasound?Female, Canada, 27.I think I'm expecting to get a transvaginal ultrasound sound done today, my first ever. Problem is that although I'm an adult, my body has stunted growth and I also barely have any experience putting something in there. I've only put something in there long ago that's really small and the last was like 2 days ago when I had my pap exam. She used the pediatric sized tool and even that was on the painful side. So I'm really nervous about the upcoming one because I'm worried it will damage me if they don't see where to stop at. Will they be able to see where to stop the end of it and do they've different sized ones? ###Output :The probes used for transvaginal ultrasound aren't that big, and are smaller diameter than a pediatric speculum like you would have had used for the Pap smear. Another thing you can do if you're comfortable with it is ask to insert the probe yourself, since it's more comfortable for many people."}
{"text": "###Input :13 year old athlete EKG results - Sinus bradycardia and Intraventricular conduction delayMy 13 year old is 5'11, 188lbs, was complaining of chest pain on the 29th that every time he took a deep breath it hurt. No pain when breathing normally, pain located almost directly in the middle of his sternum and a little to the left. He does play sports year-round - Football and wrestling. I cannot get an appointment until Monday with a cardiologist and I am having a hard time understanding what this means! ###Output :Would need to see the actual ECG. This may be the auto-interptetation by the machine. They are notoriously wrong."}
{"text": "###Input :1 year old Male, question about delayed passage of meconium as a newbornMy son (1yoM) has had chronic constipation since early infancy, beginning when he was exclusively breastfed. After no success with dietary remedies, ped prescribed Miralax, which has significantly improved his constipation. But it has not gone away, so ped had a barium enema performed. This test was normal, but he was referred to pediatric GI since the constipation has remained, and GI said that Hirschprung's is not ruled out and is wanting to conduct further testing.My question - part of why they're suspicious of Hirschprung's is that my son did not pass any meconium/poop at all from the time he was born until he was 4 days old. I understand this is very delayed passage of meconium. However, he was an out of hospital birth, and my mom, who was present at the birth, is sure that meconium was passed during delivery, because she said the amniotic fluid coming out as he was born was brown. The midwives never mentioned this. Obviously my mom is no medical professional, but I don't want to be raising false alarms with the doctors by reporting that he did not pass meconium if in fact he did during labor.So - if he passed meconium during labor, and then did not poop at all for four days, then passed a large volume of meconium, would this be considered normal, or still qualify as a risk factor for Hirschprung's? I've struggled to get a clear answer from his doctors, and I want to be sure that he isn't getting more testing than he needs due to me misreporting information. ###Output :Even if he did pass it during delivery, not having further meconium passage within the first 4 days after birth is abnormal. Sounds like further workup would be warranted."}
{"text": "###Input :displaced acute supracondylar humeral fracture with dorsal and radial displacement - 1/16/23My daughter fell off the monkey bars today. She landed on her back and elbow. I could immediately tell it dislocated. I called rescuer and they put a splint. I took her to the ER and they did X-rays. Based on the X-rays they said she had a displaced acute supracondylar humeral fracture with dorsal and radial displacement - the pediatric orthopedic was not available to come in but the PA said she spoke to him on the phone and they determined she needed surgery. I really dont want her to have surgery unless its absolutely necessary. Shes only 5 years old. Please help. Id like another opinion. Is there another non-surgical option? We were admitted and will stay the night in the hospital. ###Output :She absolutely needs surgery. Its a very small surgery in the realm of orthopaedics. It will be 2 or 3 pins placed through the skin and then a cast or splint applied. Theyll be able to take the pins out in the office after it heals. The only type of supracondylar fracture thats amenable to non-operative treatment are those that are non-displaced. If you elect for non-operative treatment for this fracture pattern, your daughter will have permanent, long-term elbow dysfunction."}
{"text": "###Input :I (23F) keep sleeping through my doctors appointments due to a sleep disorder.Caucasian, 95lbs, 54. Diagnosed PTSD, Anxiety, Depression, Essential Tremor, Hypoglycemia. Taking 150mg Oxcarbazepine 2x/Day, .5mg Clonazepam 1x/Day. Vape nicotine and cannabis.Im currently dealing with several medical issues but am unable to get them treated/diagnosed because I sleep all day, every day. The sleep issues have been ongoing and worsening over the past decade.I sleep 16+ hours every day, cannot sleep at night, nothing and no one has been able to wake me up (incl. medical professionals in a hospital setting, my partner, assorted alarms, resetting my sleep schedule, etc)I had an appointment with my PCP on the 26th at 8 AM that I had to pull an all nighter for to be able to go to. I got an abnormal EKG reading and needed labs. They proceeded to try to draw blood..but my veins are tiny (they used pediatric needles) and kept collapsing, so they requested I come back today (the 28th) at 10 AM, extra hydrated and rested (they said my not sleeping couldve been partially to blame for labs difficulty).Well, thats about 2 hours past my bodys chosen bedtime, so I accidentally fell asleep (and woke up at 8 PM today).Everyones getting frustrated with how many appointments Ive missed (myself included). If I continue to miss appointments (especially therapy) I could be labeled as non-compliant, which could royally fuck everything up.How can I make my appointments? How can I treat my condition myself enough so that Im able to get professional care (for this and other issues)? At the very least, how can I show/prove that Im invested in my care despite my repeated missed appointments? ###Output :Taking a sedative (clonazepam) whilst also smoking a sedative (cannabis) certainly wont help you to not fall asleep."}
{"text": "###Input :[26][F] I have moved to a new state and have WA State Health Insurance. Questions about choosing my PCP.I previously had a PCP who helped with various issues but mainly helped me with my medication management for my mental health issues. We have found what works for me (see 'Current Medications' below) but I want to have a PCP that is versed with medication for mental health issues in case changes are needed to be made (It took many years, several doctors, and many different medications to come to my current Rx and I am very thankful to my previous doctor for helping me get to such a point). But I also am 26 and am more aware of my women health needs and want to be sure I'm addressing those and staying healthy. I also have an IUD that needs removal soon, at which I will likely get another inserted.I was assigned a doctor that works at a \"Pediatrics Associates\" place with the credentials (MSN, ARNP, NP-C). I am confused as to why I was assigned to go somewhere for pediatrics, as it was my understanding that it was for children, though I am not discounting my assigned PCP's credentials. I looked into other PCPs that were on the directory and found an MD in Family Medicine and Obstetrics. Seeing this doctor would be a further drive for me but it intrigues me since I have never been to an OBGYN. Since I am getting older and leaning more into health women's health, should I request to begin seeing this PCP instead? -- Note that requests for doctor changes are allowed. -- or does the assigned doctor seem to have plenty credential/ knowledge for me to establish care?Hope this doesn't seem undermining at all, I just want to make sure I'm making a good decision since I will likely establish long term care with my next doctor!TIA :)Height: 5'4\"Weight: 110-120 lbRace: Asian AmericanPrimary Concerns: Vaginal Health & Mental HealthExisting Medical Issues: Diagnosed ADHD, MDD, GAD. Prone to overproduction of yeast leading to BV or Yeast InfectionsCurrent Medications: Venlafaxine 150 mg, Vyvanse 60 mgOccasional drinks weekly. No smoking. No drugs. ###Output :Yeah, no idea why you would have been assigned someone who works in a pediatric office. I'd switch to the family medicine MD."}
{"text": "###Input :Childs swollen elbow normal?4.5 years old 37lbs 43in.My daughter fell and hurt her left arm on Sunday evening. We took her to urgent care early Monday morning. Got X-rays and there are no fractures. They determined it was a Nursemaids Elbow and tried a few times to reset it, but they werent sure they were successful because she was resisting, even though we were (safely) restraining her (the absolute worst worst WORST for my heart omg).They told us that we should bring her to an pediatric orthopedic doctor today if she wasnt using it by the end of the day (yesterday, Monday).I did notice her using it a little bit more, though not much. She complained it hurt for the rest of the day (when she went to wash her hands and used it to push down on the soap dispenser, she screamed out in pain).Today she woke up and I noticed its a bit more swollen than her other elbow. Shes still complaining that it hurts and is using her other hand to hold her arm close to her body, but she turned a page in a book with it as I typed this, which is way more than shes done in the past day and a half.Im not sure if its just from being a bit manhandled by two different doctors trying to reset her elbow yesterday, and so we should let it be, or if its worse and I should take her to the orthopedic doctor this morning. ###Output :I would definitely take her to get checked by the pediatric Ortho. The injury is not consistent with nursemaids and these are typically very easily reduced. Worth a second look for sure."}
{"text": "###Input :Could they have seen it in an X-ray? They didnt show us the X-ray, but said there were no fractures. ###Output :The elbow can be tricky in kids. Sometimes they hide fractures very well there and we may not see them initially on x-ray."}
{"text": "###Input :Pediatric Dentist ? 5yo needs dental work.My son 5M 55lbs no medications or health concerns besides this one.Hoping theres a pediatric dentist on here? My son has a tooth thats got an abscess on the gum above it. That tooth has to be pulled and he also needs a crown on another tooth that has a bad cavity. He doesnt do well at the dentist and they suggested IV sedation for him.They do this in their office (pediatric dentist plus dentist anesthesiologist) which I found unsettling and wanted to know if thats normal? Is this general anesthesia like where hed be intubated? I always thought that needed to be done in a hospital setting.I already feel like the worlds worst mother so I know its my fault for letting his teeth get so bad. So adding this anxiety to my guilt. Just worried about his safety and if an emergency should arise we wouldnt already be in a hospital.My next question is that they didnt schedule it until mid October and thats over a month and a half wait with an abscessed tooth. Im afraid its going to get much worse in that time. They prescribed an antibiotic but Is there anything I can do at home to keep it from getting worse?If anyone has any advice for this terrified mom I would truly appreciate it. ###Output :You probably won't find a pediatric dentist on here (this is AskDocs, not AskDentists).IV sedation isn't the same as full general anesthesia where he'd be intubated. They'll use IV medication to calm him down and make him sleepy, but he'll still be breathing on his own. WIth proper monitoring (cardiorespiratory monitor, O2 saturations, etc) this is very safe. Similar to the sedation that's given for many people to get their wisdom teeth removed.Besides ensuring good brushing and taking the antibiotic, not much you can do to keep this from getting worse. Stuff happens, don't beat yourself up."}
{"text": "###Input :My 6 year old is sick every other week. I need advice.I need advice! My 6 year old is in kindergarten and has had strep, pink eye, and bronchitis every other week! He's well for a week then gets hit with a new fever, and sick again. I am not sure what to do. Care is the worst around us and we are on a waiting list for a pediatric ENT for possibly getting his adenoids out. Anything I may be missing or what I can do? It breaks me how sick he is all the time and the amount of school he keeps missing. ###Output :How are his growth and development? Every child has been getting sick constantly for about 9 months, so probably he is just like every other child. But without any information no one can say."}
{"text": "###Input :Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment.Thank you! ###Output :The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation."}
{"text": "###Input :Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains? ###Output :High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes"}
{"text": "###Input :21 year old female with GI issues for years but they keep getting progressively worseI cant remember if I always had these issues, but I remember being 12 years old and starting to have very consistent diarrhea. All throughout middle school and high school I had mostly diarrhea BMs, with a few episodes of constipation. I always assumed it was how my family ate. Around 18 it got worse. I started to become constantly nauseous and lost over 50 pounds from throwing up and diarrhea. I went to the doctor but they told me change my diet. Since moving out last year and making changes to my diet to be healthier and adding more probiotics and fibers, nothing has changed and it feels like its getting worse. Now I have constant painful gas that bubbles in my stomach and honestly smells so bad. Im embarrassed to leave the house most days in fear my coworkers will notice. My joints have started to have unbearable pain, mostly in my hands and hips. I get sick once a month and it leaves me bedridden at least one day. I feel like my body is falling apart on me.I drink lots of water and try to keep my diet to standard to help my stomach, but Im not sure what else to do. I recently aged out of pediatrics and am unable to find any doctor near me that both accepts new patients and takes my insurance. I just feel so lostIve never had a diagnosis before other than for mental illnesses. Ive considered it being stress, and while it does get worse when Im stressed, its always like this no matter what my mental state is.For family history, we have no diagnosis of IBS or Crohns, but my mother had really bad undiagnosed stomach issues and died from breast cancer. All the women in my family have had breast cancer. My sister has diagnosed rheumatoid arthritis (she is 30, was diagnosed at 26) ###Output :Have you been tested for celiac disease? You should see a GI doctor if your PCP isn't doing any meaningful work-up. There are many possible causes"}
{"text": "###Input :Is antibiotic resistance some thing I have to worry about?I have a daughter who is four years old. She has no pertinent or obvious health problems, except for a lingering cough she had for about eight months after we had Covid last year. She is almost 4 feet tall and about 55 pounds. She has been having recurring vaginal discharge for over a year now. She has been on amoxicillin, Cefdinir, and keflex. Finally, after so long of not having any answers, they finally sent her to a pediatric gynecologist. She did an internal swab and found the strep bacteria. But, after a phone call with her, she told me that all of the antibiotics she has taken so far should have killed the bacteria. Each time she took antibiotics it was for 10 days.She prescribed her another, fourth kind of antibiotic, and said that if this doesnt kill it, that she will have to have a check up inside her vagina under sedation. I am not against this procedure, but now I have become a little worried about antibiotic resistance. If these previous antibiotics were supposed to kill the bacteria and she took them for 10 days, is this a bad sign? Or is it really possible that these three different kinds of antibiotics that she took for 10 days each didnt really kill the bacteria? Id love another doctors opinion on the matter. ###Output :It's probably fine.It's not clear to me she has an infection that needs antibiotics."}
{"text": "###Input :Would a swab that shows strep not indicate antibiotics? ###Output :If you swab a human's orifice, it will grow bacteria.Whether that bacteria is the cause of an infectious pathology is a different question.Are you talking about group A or group B strep?"}
{"text": "###Input :Any pediatric GIs who are familiar with intussusception? Or something that presents as such symptomatically?Any pediatric GIs who are familiar with intussusception?My 15month old son who was full term at birth was diagnosed with a small bowel intussusception when my husband and I brought him to the emergency room yesterday, 12/21/2022. The ultrasound report read, There is a 1.1 x 0.9 cm small bowel small bowel intussusception in the left hemiabdomen near the umbilicus. No evidence of ileocolic intussusception in the right lower quadrant. No free fluid in the abdomen or pelvis.After this was found on ultrasound, after 2 hours, an ultrasound was repeated, and the intussusception was gone.I have to say I wasnt surprised by this diagnosis, and I am GLAD that it was found on ultrasound.Since my son was six weeks old, he has experienced what I intuitively thought was GI distress. He would scream inconsolably, turn red in the face, and grunt as if he were trying to bear down. This wasnt infrequent; it was all happening all the time. Every week we would visit the pediatrician and an urgent care 1-3 times. At these visits, they would tell my husband and me that it was colic or gas or fussiness. We tried different formulas with cutting everything out of my diet because he was getting breastmilk too. We tried gas drops, bicycles, probiotics, and the colic holds we were shown. You name it; we tried it.After six months of torture for my little guy, I finally said ENOUGH was ENOUGH, and I brought him to the emergency room. The imaging at the emergency room showed that he had a lot of gas in his abdomen, and it was recommended that we try a hypoallergenic formula. (Before this, my son was getting breastmilk supplemented with formula.) We switched to Similac alimentum. Once we discovered that all of the formula we had given our little guy was recalled, we changed to Nutramigen. Since being on the hypoallergenic formula, the CONSTANT crying and screaming had subsided but hadnt completely gone away.He would have bouts of inconsolable screaming that would last 20 minutes, and then he would calm down. Sometimes he would have bouts of screaming that would last 20 minutes, calm, and then crescendo into more extended periods of crying with bearing down, turning red in the face, shaking, and vomiting.With that said, I am looking for some guidance. Has any pediatric GI seen or heard of small bowel intussusception reoccurring for this time? The Emergency Room doctor said he couldnt answer this question because he sees the acute visit of patients. He recommended that we follow up with a pediatric GI surgeon and our pediatrician.I spoke with the pediatric GI Nurse Practitioner, and she said they do not perform surgeries on small bowl intussusceptions. She said that they only perform surgeries on small to large bowl intussusceptions. She also said that this should subside when he is 5 -- she said this as if I could look forward to relief for him in 3 1/2 years!!The pediatric GI Nurse Practitioner and the Emergency Room Physician told me that I should bring him to the ED anytime he presented the way he did when I brought him in when he was diagnosed. This cant is the answer. This is not sustainable for us or our child. Since he was 15 months old, we have brought him into the ED, pediatricians office, and urgent care countless times for the same issues. It just so happens that they FOUND the cause THIS time.I would like to know if anyone has guidance or familiarity with this. Some questions I have are, has anyone ever seen a re-occurring intussusception? If this is re-occurring, is our only option to keep bringing him to the ED? Could something else be missing? Who else should I talk to? What else should I do?I am so frustrated with all the conflicting information and advice I have been given over the last 15 months. I feel so discouraged and not heard.I am so worried and heartbroken seeing my son constantly go through this.Any suggestions would be helpful. I am following up with our pediatrician, and hopefully, they will FINALLY put in a referral to a pediatric GI. I am a registered nurse, so I have a general background in the medical field. ###Output :Transient small bowel intuss is a common finding in kids with belly pain or GI distress.No, it essentially never needs intervention.Kids get it all the time when they have stomach bugs. You just don't have an ultrasound on their belly the whole time.This may or may not be related to his prior issues of belly pain at all.A possible, but unlikely possibility is some sort of pathologic lead point that causes recurrent intuss. Like a Mekels, a real bad Peyer's patch, vascular anomaly, or even less commonly malignancy. I know of these being implicated more so for recurrent ileocecal intuss, but I suppose there's no reason they can't occur higher up.I think referral to peds GI is appropriate.Another possibility is Deitls crisis. It's recurrent, transient UPJ obstruction that causes episodes of pain, similar to intuss. It's rare, but also underdiagnosed, because nobody fucking knows about it. Small kids that have it are actually experiencing renal colic, but can't communicate it, and are presumed to have actually have abdominal pain. It's something to consider in the child with chronic episodic belly pain that self resolves and has no other symptoms."}
{"text": "###Input :Pediatric Psych patient dosage9 F Caucasian 93 lbs 4ft 6?My daughter was prescribed Lexapro 5 mg and everything I'm reading online says it's not for children under 12. I reached out to her pediatrician and he says to contact them because it's their expertise. I've been trying but am not getting through. In the mean time, is this something I should hold off on giving her or is the dosage small enough? ###Output :Its likely safe but there is limited evidence to show efficacy (limited number of trials). Id hold off until you speak to psych, 1-2 days while you wait to speak to a psychiatrist for more clarification wont make a difference. It takes 6 weeks of consistent use before you really start to see much in the way of improvement to begin with, for most patients."}
{"text": "###Input :Thank you for your reply! She was given it starting on Saturday and seemed to do fine. I did end up getting through to someone and they said it was fine to give because she had been monitored while on it. I can't find any info as to why it's not recommended for children under 12 but they seem to find it appropriate, so I'm going to assume it should be? ###Output :They dont recommend against it. Its just the lack of evidence and a strong benefit/risk analysis that prevents them from recommending it in patients under 12 at this point."}
{"text": "###Input :(Pediatrics) 24 month old white female with discordant bone age. 31\" tall, 21 pounds. No meds, no surgeries.(Pediatrics) 24 month old white female with possible short stature. 31\" tall, 21 pounds. No meds, no surgeries.My 2 year old hasn't been getting very tall as she's gotten older. She's dropped to the first percentile for height. Her first pediatrician wasn't overly concerned, but we saw a new pediatrician and she was concerned and had her x-rayed. I got the report back, but the doctor is out of the office so I won't be able to talk to her until next week.The radiology report says:FINDINGS: A single radiograph of the hand was provided for evaluation of bone age. The patient's chronological age is 24 months. The hand bone age according to the tables of Greulich and Pyle is approximately 2 years. The wrist bone age most closely approaches that of 1 year and 3 months. The standard deviation for the patient's chronological age is 4.64 months. No structural abnormalities are identified.IMPRESSION:Discordant bone age between the hand and wrist, but both are within 2 standard deviations of chronological age per the age and gender matched standards of Greulich and Pyle.Is the discrepancy worrisome?https://flic.kr/p/2nS9y6S ###Output :Worrisome probably isnt the right term. It isnt indicative of anything dangerous.It can sometimes indicate a hormonal issue that requires endocrine referral.But will also say that pediatric endocrinologists and radiologist often disagree on bone ages.Bone ages are pretty subjective. Basically they x-ray the hand in a specific way and then compare it to a book with known bone ages and say eh, I think it looks like this one the most."}
{"text": "###Input :Disagree in what way? Just generally, or does one group tend to say bone age is more/less advanced than the other? ###Output :Just generally. I dont do bone ages but have heard a few endocrinologists say I never listen to radiologys reads on bone ages. Then they proceed to do it themselves."}
{"text": "###Input :6 year old with hallucinations currently hospitilized. Is this autoimmune encephalopathy?Age: 6Sex: MaleLocation: New England, USAMy child has been in the hospital over the last week for suspected autoimmune encephalitis. I brought him to the ER on 4/11 per instruction from his pediatrician due to visual hallucinations. He was admitted after neurology came to the ER for a consult. The hallucinations have not been improving with treatment as of yet (4 days of IV steroids & 1 day of IV IG, see below for more specifics). I've been advised 90% of the labs will take a couple of weeks to get back. Is there anything else we should be considering? He's the happiest kid, he absolutely loves school and his friends and teachers and he can't wait to go home. He knows what he's seeing isn't real and I wish I could make it go away. Any insight/advice would be so appreciated. He's been a trooper throughout this process but it's not easy wondering every day what is going on. I can provide additional information if needed/requested.Assessment/Plan: Child is a 6 y.o. 5 m.o. male with PMH of hypnagogic hallucinations and asthma who presents for evaluation of 2 days of daytime hallucinations. Given acute onset of worsening visual hallucinations that started with nighttime awakenings on 4/7 and then progressed to daytime visual hallucinations on 4/10, we are concerned for autoimmune encephalitis. LTM EEG with left parasagittal and temporal spike wave epileptiform discharges, suggestive of underlying brain irritability. However, patient is very well appearing with no other classic features of autoimmune encephalitis- no encephalopathy, no weakness, no abnormal movements. Given that he is very well appearing and is not demonstrating significant decline from day to day, we will plan to first obtain CSF and brain MRI with contrast prior to starting immunosuppression. If CSF is bland, we would likely still recommend treating with immunosuppression given clinical concern and patient meeting diagnostic criteria for autoimmune encephalitis.EEG is abnormal but no definite seizures. Frequent and sleep activated left temporal and parasagittal spike and wave epileptiform discharges. Brain MRI normal. LP overall bland with 1 nucleated cell in tube 1, 2 nucleated cells in tube 2. Other labs pending but does have ANA positive at 1:320.Has been on IV steroids since 4/14 with no improvement in visual hallucinations. Will plan to continue steroids for total 5-day course and discuss case with our neuroimmunology colleagues. (This plan changed after neuroimmunology consult, began tapering steroids after 4th day to begin IV IG)Treatment:s/p 4-days of high dose IV methylprednisolone (30mg/kg daily)prednisone taper: 1mg/kg (max 60mg) prednisone tapering over 6 weeks (can roughly cut in half every 7 days) Week 1: 30mg daily Week 2: 15mg daily Week 3: 10mg daily Week 4: 5mg daily Offstart IVIG today for 2-days- IVIG 2g/kg divided over 2 days. Started on 4/17 treatment was well-toleratedResulted workup:EEG abnormal with frequent abundant spike wave epileptiform dischargesEEG continued to demonstrate frequent abundant left parasagittal and temporal spike wave epileptiform discharges -EEG from 4/12 -Frequent to abundant left parasagittal spike wave epileptiform discharges that occurred both independently and in brief 1-3 Hz runs lasting <10 seconds (BIRDS) -Occasional to abundant left temporal spike wave epileptiform discharges that occurred both independently and in brief 1-1.5 Hz runs lasting <10 seconds (BIRDS)quick brain MRI normalsedated brain MRI with contrast normal, incidental finding of likely arachnoid cystReassuring CBCd, BMP/Mg/Phos, LFT'sESR and CRP normalTSH elevated to 7.44, free T4 normal at 1.1B12 and folate normalRPR non-reactiveRhinovirus positiveCeruloplasmin normalUrine tox negativeUA normalANA positive 1:320, speckledSerum copper within normal rangeCSF opening pressure 15CSF cell count and total protein normalAnti-TPO antibodies negativeHIV 1/2 negativeCollected and pending: [] CSF culture [] CSF HSV PCR, CSF VZV PCR, CSF VZV IgM [] CSF oligoclonal bands, IgG index, beta-2 microglobulin, flow cytometry, cytology [] CSF autoimmune encephalopathy panel [] CSF anti-Glycine-R antibody [] Serum Glycine Receptor IgG [] Myelin oligodendrocyte glycoprotein [] 24 hour urine copper [] 24 hour urine porphyrins [] Double stranded DNA antibodies [] Antiphospholipid antibody panel [] Thyroglobulin antibody [] Serum MaTa Autoantibody test [] SPEP panel [] MS profile, serum and CXF [] IgG index/synthesis rate, serum and CSF [] EBV serology [] VZV IgG, IgM [] HSV PCR, HSV type 1,2 antibody [] Serum encephalopathy panel [] Mycoplasma IgM, IgG [] Lyme screen with reflex to immunoblot [] HSV PCR, serumMENTAL STATUS EXAM: Appearance: appropriately dressed Behavior: cooperative, eye contact good and pleasant Psychomotor Activity: normal Musculoskeletal: moves all extremities; no abnormal movements Station/Gait: normal Speech: regular rate, regular rhythm and regular volume Language: normal comprehension Mood: happy Affect: full range Thought Process: logical, linear and goal-directed Associations: no loosening of associations Thought Content: no delusions and no obsessions Perceptions/Experiences: visual hallucinations Orientation/Sensorium: alert Memory: immediate recall intact. Attention/Concentration: intact to observationImpression: Child is a cheerful and pleasant 6 yo boy, from X attending Kindergarten at X. He has a hx of mild OSA, hypogogic/hypnopompic hallucinations since early on, asthma, no prior past psychiatric history, presenting for worsening hallucinations since 4/10, admitted for medical work up on etiology. Psychiatry consulted for diagnostic clarification, support and medication management.4/14/23: Patient continues to be calm and cooperative, behaviorally appropriate for a 6-year-old boy. Continues to experience visual hallucinations, yesterday night described as \"monsters,\" which patient is understandably afraid of. Most of patient's hallucinations are visual, vivid, and neutral with minimal emotional involvement. No auditory hallucinations. No clear seizure activity on EEG, other than minor blinking, clinical signs of seizure disorder not noted on physical exam. Pt age, onset, and symptoms are not typical of a primary psychotic disorder or normal development. We agree with pediatric neurology and primary team that the origin of hallucinations are organic. No emotional or behavioral dysregulation. Thus, we do not recommend scheduled psychotropic medications at this time. Pediatric neurology assess patient has underlying brain irritability from EEG findings (left parasagittal and temporal spike wave epileptiform discharges), likely secondary to encephalitis, as opposed to seizure disorder. ###Output :What were the CSF cell counts, protein, and glucose?"}
{"text": "###Input :3y(f) Seeing Pediatric Pulmonologist - What to Expect and Genetic TestingMy (37F) daughter (3F) will be seeing a pediatric pulmonologist next week for suspected asthma. Her pediatrician has diagnosed it as \"mild or intermittent\" but from my observations, it is not mild and is getting worse. It was thought she had recurrent croup but we now suspect those croup episodes have actually been asthma attacks/flares. They only occur during viral illness, but each time she is sick she ends up in respiratory distress and needs an ER/hospital visit. She is prescribed albuterol, flovent, and decadron. Pediatrician agreed to allow us to only use flovent at onset of illness so it is not daily use.I don't know if there will be genetic testing performed, but I did sign a form agreeing to genetic testing.My question is, should I be thinking this is something beyond asthma and possibly genetic? Should I push for imaging and/or genetic testing? ###Output :Peds ER doctor here, sounds very much like asthma. No, genetic testing is not done routinely at all, i suspect they make everyone sign that form before coming in so that they can streamline the process if they need to test patients for anything."}
{"text": "###Input :Pediatric Abilify weaning schedule?Hi Reddit Docs, My 8yo (9 in April) son has been on Abilify for about a year, up to 15mg. Long story short we dont feel that it is making a difference and in fact hes getting worse, more physical/aggressive, even violent at times. Especially since we added clonidine again. (In addition hes being treated by a physician who specializes in ADHD, not a psychiatrist. He was diagnosed by a psychologist with ADHD, depression, and motor coordination development disorder. I had to see this Dr because he was diagnosed during the height of the pandemic and no psychiatrist was available. Basically threw different combinations of Vyvanse, guanfacine, clonidine, and Adderrall at him, hes currently on Adzenys, Abilify and just came off clonidine. Finally got him some Lexapro a few months ago and his baseline mood has improved but the outbursts are worse. Ive been trying again to get a psychiatrist with no luck. I currently have an emergency intake visit scheduled in 4 days with a social worker who is supposedly going to get us a faster referral visit.) What is the recommended taper schedule to come off the Abilify? Wanting to make sure current provider is giving us accurate info. Thank you! ###Output :I am not sure what the guidelines for treating children are where you reside but to me this seems like a hodgepodge of medication. I would personally be very concerned to write out so many medications (some of which counteract each other).My first question would be what was the main problem with your son before he got medicated? Why did you seek help? Is there family history of psychiatric illness?The tapering really depends on the patient and the symptoms experienced. One could recommend to reduce 5mg every week (so 15mg, 10mg and finally 5mg before stopping). This can be further adjusted depending on any side effects. This can be also adjusted more finely if you have an oral solution instead of tablets."}
{"text": "###Input :Pediatric4 y/o female, turning 5 next month. No significant PMH. Complaining of pin point pain around umbilical area that hurts more when I breathe in and out. Also complaining of GERD symptoms described it perfectly without knowing obviously when I eat my food and drink too, it goes down to my belly and then comes back up and I have to swallow it again.Started complaining of both these symptoms over the last 24 hours.No bulge can be noticed or palpated, even when coughing or taking deep breaths.What could this be? ###Output :Gastric or duodenal ulcer, GERD, constipation. Would talk to pediatrician about it. Can do a trial with famotidine if it sounds like reflux to them with a more thorough history. If its a one off episode its unlikely to be anything to worry about if it self resolves. Look for food triggers and anything that helps or makes it worse in the mean time."}
{"text": "###Input :Pediatric burnsMy daughter is 4 years old and was burned with hot water earlier today. She was taken to our local emergency room within about 20 minutes of the accident. The burns are on her chest/belly area covering approximately 65% of the front. The doctor did not specify but I believe it's 2nd degree burns as the top layer skin has came off. The er gave hycet plus gave her a prescription for hycet and silvadene cream. They gave some thin blue towels of hold over the burn area with instructions to not begin the cream or put anything else on it until it stops leaking fluid from the burn. Now she has blue towel fuzz stuck to the burn area and I was told not to wet the wound nor cover with anything else. I don't want to go against the er doctors instructions but I just have a bad feeling that this is going to end up infected. Do these instructions sound correct? Is there anything else I should be doing? Given the burn is on her chest I'm not sure I'm allowed to include a photo but if the mods allow it. ###Output :This burn would likely meet criteria for inpatient management based on the described size and severity of the burn. Im surprised they would send you home. You should be able to lightly rinse the fibers off but every time you rinse it and if you have any abrasion, you risk destroying the epithelialization of new skin. There is a balance between dressing changes and allowing time for healing. Additionally moisture can increase the risk of infection. Generally speaking the fuzz is likely harmless, so you would have to use your judgement as to whether it needs to be removed based on the amount attached and any soiling or other factors present.If there is a significant amount, Id recommend a return to the emergency room for further management and discuss admission to the inpatient service or transfer to a burn center for further care. Burns often require more significant care than just the initial skin damage, especially if a significant portion of the trunk has been burned. In pediatric patients it is even more imperative to get proper care to ensure proper healing and limit future difficulties secondary to poor healing.They can be managed at home for minor burns, but if you are not comfortable with the care and it has not been described in enough detail that you feel comfortable, return to the ED. Your child will thank you in the future if you get proper care now. Its unfortunate that this may require an additional trip to the emergency room, but I wish you the best and hope your child has a speedy recovery.You may wish to try a different emergency room for a second opinion if you did not feel like you received adequate care at the first one."}
{"text": "###Input :Pediatric lupus?My 11 y/o daughter had three weeks of low grade fever, headache, body ache, fatigue, nausea and low appetite. Multiple negative tests - covid (including antibody), mono, strep, flu, RSV. Had a positive urinalysis for bacteria and blood - did a round of Bactrim but the symptoms remained. Current meds for asthma - symbicort, xopenex as needed, singular.Doc ran some more blood tests - looks like some were autoimmune tests. Can I get some interpretation of these ANA titer results? Recommend seeing a pediatric rheumatologist? ###Output :That's quite a high ANA titer (means very positive). Time to see a peds rheum.This is not the place to push Lyme pseudo-medicine."}
{"text": "###Input :Definitely in a tick borne illness area - Lyme tests are in these results too - but she was only reactive on one of the bands. I think that means shes negative? ###Output :That means she's negative. Please don't listen to the internet panic about Lyme disease. It's easy to test for and straightforward to treat."}
{"text": "###Input :Pediatric Wellness Exam around PubertyI am trying to find a new pediatrician for my daughter (11y/f). We went to a local female pediatrician, who was nice, albeit a little rushed and pushy. We talked for a little while, and the pediatrician did ask if she had her period yet or not. She has not. Upon physical examination, with little notice (hey I'm going to do this, and then did it) the doctor pulled up my daughter's shirt and bra, and then pulled up her pants at the waistband to look at her vaginal area. My daughter was struggling to not let her do this and is now traumatized by the interaction and felt like she could have given a little more warning. I know that physicians are very busy and have many patients to see, but I feel like I've failed to protect my daughter from this. I would think a conversation asking if she is developing breast tissue or pubic hair would have been just as efficient without stressing my child. Or even saying what she is going to do before doing that kind of exam. Is this a normal practice on a wellness exam? My daughter will not be returning to this doctor. ###Output :It is normal practice to check these areas, yes. Sounds like the doctor could have explained the process a bit better. At this age, I generally talk to the patient about what I'm going to do and why, then ask for their assent before proceeding."}
{"text": "###Input :7yo old with Hashimotos and Lichen SclerosisMy apologies for such a vague request but Im searching for any answers of how these two are connected or if we should be traveling out of state for second opinions. My daughter was diagnosed in the past year with both conditions. We live in the US (Nevada). She currently sees a pediatric endocrinologist and a pediatric urologist (we do not have a pediatric gynecologist where I live and our pediatric dermatologist is a male and my daughter wasnt comfortable seeing him).My issue is that everywhere we take her they comment on how rare her conditions are or how they havent treated it before. To me, that doesnt mean they are incompetent or she is receiving poor treatment, I just wonder if there are people who do treat these conditions more frequently and if it is worth our time to seek second opinions.Definitely not rich, but could most likely cover basic assessments if need be.Thank you in advance! ###Output :If someone has one autoimmune condition, they are at increased risk of developing other autoimmune conditions. These are both autoimmune conditions but unrelated except for the autoimmune diathesis. No comment on the thyroid disease, but skin biopsy results are definitive and treatment of lichen sclerosus is usually straightforward."}
{"text": "###Input :For my son.Age: 8 months old Weight and height: 20 pounds and 2 foot No medications being taken No smoking No current medical issues Location of complaint: headIll start with saying we took him immediately to the ER and got seen by a neurosurgeon at a pediatric hospital afterwards. They said he was good to go after observing him for a few hours and said his CT scan was clear of any bleeding or fractures by both the ER and neurosurgeon at at the pediatric hospital.I was at work and my wife called me and told my son fell back off of the couch, which is about a foot and half up off the floor (which is hard tile, there is a rug there as well about a quarter of an inch thick if that.)She picked him up and then said he was crying but then he stopped and his eyes rolled to the back of his head, he started bubbling at his mouth and got stiff. Wasnt responding to anything. I work at the hospital where we brought him into the ED at and I saw him, I was moving him but he wasnt responding either so they called in a code and gave him 2.5mg diastate to help him out. After they gave him that, I saw him start moving and making noises. Afterwards they took a CT scan on him which, at that point, I was informed by one of the doctors there it was clear from any fractures or bleeds. However, I was also told that since there wasnt a radiologist there the doctor told me she couldnt say for sure. At this point, they send us to the pediatric hospital where he was seen by the neurosurgeon, who told us she didnt see anything either and it looked clear to her as well. Afterwards we were three from about 10:30-5:00 pm. During the time we waited he fell asleep and ate like normal, didnt throw up or anything. Neurosurgeon came back and did some other tests, he grabbed some keys she had and played with them like he normally does with things. From there, they discharged us and said to watch him over the next 48 hours for any changes in behavior or anything out the norm. Neurosurgeon stated she doesnt think he had a seizure but doesnt know for sure since the scan was done about 20-25 minutes after he arrived and wasnt sure if it was done too early. For a bit of a better timeline of events, he fell about 8:59 a.m. and arrived at the hospital about 9:05 a.mSo after we got home hes been completely normal. Even today hes been fine. He has a regular check up in about two weeks but I want to do a follow up and wanted your alls advice due to the fact of how he was immediately after the fall, since that seemed to be the part that had most of the providers a little stumped. I did on searching on google (I know) to see if I could find anything similar to the situation but found nothing that seemed similar to it. They way a nurse and the neurosurgeon explained what it was, that it couldve been he had response to the trauma of the pain and that his was reaction was what made him go into that state. I apologize for the long read but there was no short version that had enough info. But, if theres a question that anyone needs answered for more context please let me know. ###Output :t's hard to say if he seized or not. Seizure after head injury isn't super rare. You can have seizure in absence of bleeds or fractures. The timing or findings of the CT has no bearing on whether he seized.He may have been concussed. Concussion is a clinical diagnosis, and is not something that is diagnosed by imaging.I frankly would be shocked if he had seizures or concussion from the fall, as described. I've seen >100 babies with falls like this, none have had serious injury.I've seen many infants and toddlers with falls from 2nd story window/balconies. I don't recall any ever having serious head injury.But yeah, likely either a weird pain response, or concussion. Or there is more to this story than an 18\" fall onto carpeted floor."}
{"text": "###Input :Trans (FTM) invasive exam at endocrinology visit *repost **is this common practice??4 years ago i had visited a pediatric endocrinologist for my first dose of T after 2 years of therapy. i had done everything i needed to, i was excited, i was desperate the endocrinologist did everything routine blood tests, usual physical examinations during the physical, it was quite apparent that i did have excess hair and signs of hyperandrogenism. the blood work even indicated that my cholesterol was high. the day of my follow-up he had asked me to wear a gown so he can check down there i dont remember ever getting a reason why but he did let my mom stay in the room and brought a chaperone. i was desperate so i let him do it. it haunted me for a while.4 years later. i had learned that that examination apparently isnt routine via my friends and this examination was never reported in any of my records so i decided to give him a call about it to express my concerns. he told me that people who have hyperandrogenism, their clit grows so he wanted to check for signs of that and anything that can indicate for signs of a tumor, that is causing it so that he would order a CT scan if he suspected iti still dont know how a physical examination can make that clear but i felt pressured today so i just agreed just like i did 4 years ago he even admitted to checking several patients clits for a baseline for T but he said he doesnt do it anymore because its uncomfortable or has a (female) nurse do it if he feels its necessary.i still dont have an answer im afraid i gave consent that day under false pretenses i feel strange just leaving this alone even though i dont think he had any ill intentions.should i ask for another opinion? or am i making this a bigger problem than it is? ###Output :Sounds like they were assessing for clitoromegaly and they werent very sensitive to your needs or reading the room. I dont think this is common for FTM physical exams, especially when youre displaying signs of hyperandrogenism.What I can say is that my guess is a pediatric endocrinologist is definitely more likely to assess genitalia because they are the ones that first pick up on hormonal imbalances caused by tumors or abnormal genitalia so it may actually be within their scope. I think they were being thorough during a time when trans care was evolving given that they brought a chaperone. If they did a full pelvic exam then that would certainly raise some red flags.I think your being uncomfortable was warranted and I dont think what they did is standard practice. However, Im not sure Id pursue it anymore given that a genitalia exam in some cases might be appropriate. Again, if penetration occurred then Id be more worried. Today, this would typically be monitored by a Gyn as part of a multidisciplinary team."}
{"text": "###Input :What exactly do percentiles mean for pediatrics?I took my two year old for his appointment today he weighed 32.2 lbs/90th percentile and his height was 34.5/63rd percentile.I know this might sound bad, but does this mean my child is on the short and chunky side? Only asking because I didnt mention his diet and the doctor never brought it up except to cut out juices and switch to 2% or 1% milk for him.. but didnt seem concerned with his weight and said his teeth were great.I shouldve asked, but my son was trying to get into everything, it got hectic and it completely slipped my mind to ask ###Output :He's on the heavier side for kids his age. He's still taller than average, though, so in general he's just a bigger than average 2yo.Switching to low-fat milk and avoiding sugary beverages are standard things that we suggest at this age, so I wouldn't read into the pediatrician talking about those. That's the recommendation for every kid!"}
{"text": "###Input :The only time percentiles posed a problem for my kiddos was when they were used to detect a head growth problem in one of my kiddos  extra imaging was requested and there was an actual reason for the extreme jump off of the datum points off of the growth curve.Would it be fair to suggest that growth curves and percentiles are used to detect changes in growth? ###Output :Yes, that's a good way to explain it. When we're watching from visit to visit, we're looking at the trend in percentile over time.50th percentile would be exactly average, 90% percentile means in a room of 100 kids his age hes heavier than 90 of them."}
{"text": "###Input :low neutrophils high lymphocytes pediatricMy son is 3 years old. Got a ton of blood work for his weight I guess. He's 27lbs. He has high energy and no concerns other than occasional constipation. The blood work came back with low neutrophils 21% and high lymphocytes 71% (which has me sick to my stomach thanks to Google. WBC, RBC and hemoglobin is normal. Hematocrit is low 32.9% with the range min of 34%. His neutrophils absolute is 1.56 which is in range but on the low end of the range that says the min is 1.50. Lymphocytes absolute is in range. All morphology is normal. His ferritin is low at 23 with the standard low being 36. Everything else is normal. They did a lipid panel which I didn't have him fast as no one informed me. And his triglycerides were pretty high at 238mg/dl. He had half a sugar cookie an hour before and I was feeding the other half during his blood draw to distract him. VLDL was high at 48mg. Everything was normal on lipid. Carbon dioxide was low at 17.0mm. ###Output :First off keep in mind the percentages always have to add up to 100. So either the neutrophils are low because the lymphocytes are high, or the lymphocytes look high because the neutrophils are low. So he's got one problem, not two. Based on the other values my guess is that it's probably the low neutrophils but I'd have to see the absolute numbers.His iron is a little low but otherwise everything else is normal. Do you have a hard time getting him to eat meat? Because it's likely just dietary.In general, I really recommend against googling labs because it always comes up with scary stuff. Those aren't cancer values if that's what you're worried about. Could be he's fighting off an infection, could be related to a malabsorption issue or dietary deficiency, could just be normal for him.If it were my patient or my child I would think it's not likely a big deal, but would want to recheck at some point in the next few months to see if it changes. Keeping in mind I'm a family doctor and not a pediatrician, so they may have a slightly different plan."}
{"text": "###Input :Neutrophils Absolute Your Value 1.56 103/uL Standard Range 1.50 - 8.50 103/uL Lymphocytes Absolute Your Value 5.26 103/uL Standard Range 2.70 - 10.50 103/uL Monocytes Absolute Your Value 0.44 103/uL Standard Range 0.10 - 1.10 103/uL Eosinophils Absolute Your Value 0.15 103/uL Standard Range 0.00 - 0.90 103/uL Basophil Absolute Your Value 0.00 103/uL Standard Range 0.00 - 0.20 103/uL Bands Absolute Your Value 0.00 103/uL Standard Range 0.00 - 2.10 103/uL ###Output :Honestly that doesn't really look awful. Mild neutropenia. Not particularly scary."}
{"text": "###Input :Ascites 4 weeks post-op, acute renal failureUpdate: Over 5L of fluid was drained from my dads abdomen today. The fluid was high in creatinine and consistent with urine. He initially felt much better, but then started experiencing extreme pain, likely from muscle spasms due to the drastic change in his body over the course if only 2 hours. His O2 dropped to 86 due to the pain. He is now medicated for pain and sleeping on and off. We are hoping that his status will improve over the next few days. Thank you to everyone that commented.70M, 6ft even, 205 lbs, Barrett's esophagus, eczemaHistory of heavy smoking decades ago that was reduced to once or twice per day in the 1980s. Uses edibles/microdosing to manage anxiety and depression.Regular medications include acid reducers for well-monitored esophagus and fish oils and supplements for controlled eczema. Very active lifestyle for age including managing half acre yard, frequent 15 to 20 mile bike rides when weather permits, strength training at gym multiple times per week.January 12th, dad underwent robot assisted prostate removal. Lymph nodes were clear and there was one area where cancer had spread one millimeter into outside tissues. No radiation is recommended at this time. He was disharged home with a catheter. The catheter was removed one week later, but about 18 hours after it was removed, he was having trouble urinating and developed severe pain. He went to the ER cathed again. He was determined to have continued swelling in his urethra.A few days later, a cystogram with his surgeon revealed a small tear in his bladder where his bladder and urethra meet. His surgeon said that he expects the tear to heal on its own.My dad was admitted to the ER today for increasing discomfort in his abdominal area with pain and diarrhea. When I showed up, I noticed that his abdomen was visibly distended. CT confirmed ascites. Nothing else to note other than a 2 mm calcification in a kidney and cirrhosis. He is a recovered alcoholic that hasn't touched alcohol in 37 years. Labs shows some RBCs and WBCs in his urine. Also indicated acute kidney failure. BUN 56 mg/dL, creatinine 4.54 mg/dL, eGFR-Cr 13 mL/min/1.73m2.It is a lymphatic leak? Maybe urine leak caused it? If so, what next? ###Output :In a patient with cirrhosis and new onset renal failure with swelling by the prostatic urethra, your dad appears to be at risk for urinary retention because of how much inflammation and swelling there is by the pelvis at the neck of the urethra. A simple noninvasive bladder scan can be done at the urologist's office after he voids or is allowed to empty his bladder completely , called a \"post void residual\". If there is more than 300-450 cc (every doc has their own cutoff) after a reasonable attempt to empty every last drop, he is considered to have urinary retention. This can cause urine to flow backwards and cause backpressure into the kidneys, effectively causing hydronephrosis (which can be picked up on a renal ultrasound (ultrasound of kidneys), or CT scan of the abdomen. Obstructive uropathy is this condition and can be source of renal failureAlso, ascites is not uncommon in decompensated cirrhosis. Make sure your dad is on a low salt diet. Also it is important to check a Complete metabolic panel or hepatic function panel to see his albumin level. Low albumin can contribute to ascites. Your dad could be in what we call hepatorenal syndrome if his cirrhosis is not under control and can lead to renal failure and death."}
{"text": "###Input :What would cause someone to spiral into acsites when they have not touched alcohol in 37 years? He quit drinking when he was only 33 years old and hasn't had a drop since. He has never had any issues with his liver before.I will put his CT impressions, but I don't recall seeing anything about hydronephrosis. ###Output :low albumin levels coupled with changes in portal pressure can cause this too, as can increased salt in diet or from IV fluids he had received during surgery. You mentioned the CT had findings of cirrhosis. Cirrhosis physiology is complex and would need complete liver function panel, INR, Tbili, serum albumin, Na levels to fully evaluate severity"}
{"text": "###Input :Thank you. I just got off the phone with his surgeon, and we were able to talk for about 30 minutes. He feels that there is a continued bladder leak and that we are likely to find that the fluid collection is high in creatinine. They are putting a drain in tomorrow and they'll test the fluid. If this is the case, his kidney function is likely not as poor as it appears, as his body is reabsorbing creatinine through his peritoneum. I did ask him to run a liver panel out of an abundance of caution and he agreed. ###Output :If that's the case, then this is a Urinoma I believe. Still though a creatinine of 4.54 and BUN of 56 is quite high but you're dad's urologist is right that creatinine can be inflated in this rare but unique scenario. BUN would be expectedly a bit higher if his creatinine were that high but not always. Cystatin C measurement can be another surrogate used to indirectly measure his true GFR. That hole wont repair itself unless the urologist diverts the urine elsewhere and hence the drain is needed. Bladder wont heal if there's continuous flow of any liquid, in this case urine, through the hole."}
{"text": "###Input :Thank you for your input. I feel significantly more at ease. Hopefully, this is truely just the continued leakage. When my dad's labs came through electronically, I was initally shocked and alarmed. Now I feel cautiously optimistic.His urologist us going to mess with catheter sizing and try to inflate the balloon a bit more to put a bit of a stretch and seal up that leak. He'll give it two more weeks to see if the fistula can repair itself before going in for a corrective surgery. ###Output :I'd be worried about a bladder leak given the bladder injury. Need to aspirate and sample that fluid before writing it off as simple ascities, imho."}
{"text": "###Input :They are putting a drain in tomorrow morning, so we will find out what thr fluid is then. I feel extremely frustrated right now that there isn't more of a sense of urgency. ###Output :Either the fluid is persistent leak from the tear which seems somewhat likely. The other possibility is obviously cirrhosis with ascites. As a prior heavy alcohol user, long-term smoker likely some degree of poor lifestyle habits (ie dietary) and his age he has more than enough risk factors to develop cirrhosis.Either way, sampling the fluid will give the necessary info"}
{"text": "###Input :My husbands diagnosis. Please help. I posted a few months ago about this and you were all so helpful.Pt: 41 y/o male, former marine, non smoker, very occasional drinker, 170 lbs 60.My husbands official diagnosis is Metastatic renal cell carcinoma, which spread to his lungs. They went in and took the tumor off the kidney (he has horseshoe kidney so he only technically has one) and he was very optimistic about getting it all from that area. Said his body encapsulated the tumor and they didnt see anything else on his kidney. They said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.No chemo, no radiation, no immunotherapy yet or maybe at all. Is this normal?His lymph nodes have been so swollen I can see them under his collar bone, and in his neck. Im worried. Is metastatic a automatic stage 4 diagnosis?Is his prognosis good? His oncologist and doctor seem to think so, but they wont really speak on anything early on. They said we would meet in December and talk more then. What do I do now?My husband isnt able to work, and is taking time off from getting his degree. He can barely walk around without being winded. I have picked up extra shifts at work, so I dont get to see him and how hes doing. I just want to know if I should trust what they are telling us, or ask for them to check him again since hes so weak. Help? Im losing my mind.Thank you. I appreciate you all so very much. ###Output :Dont wait, call the oncology office now and let them know these concerns, they may need to start other treatments sooner.See a palliative care doctor ASAP. They are experts in cancer pain. Some cancer treatment centers also have anesthesiologists or rehab doctors who are experts in cancer pain.Oncologists are experts in the extreme complexities of treating cancers. There is a lot more to having cancer, and it's best to have an interdisciplinary team."}
{"text": "###Input :He definitely needs to be checked out sooner rather than later, so if the oncologists cant see him urgently then he should still see primary care, or failing that, go to ED where they can check him over and perhaps even do a CT to establish whats going on with his nodes / progression. ###Output :Yea an ER doc can check to make Sure he hasnt developed a PE (blood clot in the lungs) which is common and cancer and causes shortness of breath. The CT will also see if the cancer is bigger. Just be sure to go to an ED thats affiliated with his oncologist so they can see the images"}
{"text": "###Input :Pts horseshoe kidney would handle it better than an. NSAID for, say, minor pain. But metastasizing cancer pain is of a much higher order. Hell be initially given Norco, probably transition to higher-order opiates via a learned palliative oncology Al pain specialist. ###Output :That is an outrageously inappropriate pain regimen for a young person with advanced cancer."}
{"text": "###Input :I agree. I was shocked. Its hard as his wife to watch him suffer. The man never complains, and if he says in hurts, it hurts. ###Output :I'm seeing a lot more tylenol/NSAID management for post operative patients (c-sections, hernias, hysterectomies, etc). However we always give narcs for breakthrough. The cancer patients are the exception, particularly the stage 4 ones. They still get non narcotic pain alternatives but that's in combination with narcs."}
{"text": "###Input :Based on all of your comments it truly sounds like its time for a second opinion. Your current oncologist doesnt sound effective nor compassionate and you and your husband deserve a doctor who will listen to your concerns, treat symptoms, and treat his cancer rather than wait another few weeks which could be crucial ###Output :Im a urologist and I've treated cancer like this.So he should definitely be in some type of therapy if he has metastatic renal cell cancer. Typically this is immunotherapy which is typically not too hard on the body (this is significantly easier than something like chemo). There are many medications out there that all have pretty good effects on cancer. It sounds like your husband had a cytoreductive nephrectomy\" where the kidney is taken out even though we know the cancer is spread. The goal is to just get as much cancer out as possible. Typically if there is remaining cancer (in the lungs for example) we then give immunotherapy however you do need to wait about 6 weeks after surgery for recovery. I'm not sure where he is on his recovery from surgery. Bottom line, I would talk to your oncologist about starting treatment, especially immunotherapy.Yes stage 4 = metastatic cancer. This is true of essentially all cancers.i will be blunt his prognosis is not good. With appropriate treatment his chance of living another 5 years is probably ~20%. This doesn't mean he'll die tomorrow but his time is limitedMore worrying is how young he is - 41 is incredibly young. You mentioned he is a veteran - he should see someone asap at the VA. If he had any exposure during combat he may be able to have all his medical bills covered. This is incredibly long and bureaucratic process but would be something I'd strongly suggest looking into.I am sorry but I hope this helps"}
{"text": "###Input :It helps me, as you are being honest and upfront and thats what I need.So theres really not a good chance hes going to walk away from this? If you personally had to put time on it, can you tell me about how long?Thank you for that well thought out and honest reply. His doctors told him that he was going to be fine, but everything I have read online (I know Dr google isnt good, but I have scoured so many articles)Maybe thats why they want to wait until December? He is recovering very slowly. Hes also in a ton of pain and nothing I do helps. His doctors wont prescribe things as they claim its too hard to get around the red tape. I dont understand. Im treating him with edible THC as well as CBD because he wasnt eating. I was honest with them about this, and they didnt seem to see a problem with it.My heart is broken, but thank you for telling me your opinion here. It means a lot. ###Output :Cancer related pain is one of the major indications for opioid pain meds. Im not sure what red tape these doctors are on about. I think its time for a second opinion."}
{"text": "###Input :NAD, but both of my parents had metastatic lung cancer. There was literally zero red tape in getting them pain meds. My father passed 7 years ago, and was getting fentanyl patches, morphine, and Norco. My mom just passed 3 months ago and she had morphine and OxyContin. Your husbands pain should be treated. ###Output :Is he getting medical care through the military or civilian hospitals? There's a huge difference in quality as well as the fact that you cannot sue if a practitioner has dropped the ball."}
{"text": "###Input :If he has a positive Virchow node, they need to see him like right now ###Output :This is all (unfortunately) correct except OPs husband didn't get cytoreductive radical nephrectomy but partial nephrectomy, due to having only one kidney to start with."}
{"text": "###Input :That doesnt sound good. ###Output :Yes, this partThey said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.doesn't sound good at all. Sounds like his metastases are growing pretty fast when he's already noticing bulging from lymph nodes and trouble breathing from lung metastases. But we don't really have enough information to make this determination right now. Missing information:The exact histopathology (is it clear cell renal cell carcinoma or something more exotic?)Imaging reportsThe date of imaging and surgery to get a feeling for the timeline and progression dynamicsWhy his treating physicians said that \"his body encapsulated the tumor\" when they also said he has lung metastases, and why they didn't indicate systemic therapy and why they seemed to think his prognosis is good.Taking the most likely case based on incomplete information: In metastatic classic clear cell renal cell carcinoma, no chemotherapy is indicated ever, because chemotherapeutic agents don't help, which has been tried and demonstrated over and over. Effective medications are immunotherapy (checkpoint inhibitor antibodies like pembrolizumab), TKIs (tyrosin kinase inhibitors that can be taken orally, like sunitinib, pazopanib, cabozantinib or axitinib) and as probably less effective alternatives medications that inhibit vascular growth (e.g. bevacizumab or lenvatinib) or mTOR-inhibitors (e.g. temsirolimus).What's indicated precipitates on your husband's other medications, comorbidities, performance status (overall health) and other stuff.Also, in oligometastatic renal cell carcinoma, locally ablative therapies can be used to kill all the metastases you can detect at the moment, for example radiosurgery, microwave ablation etc., but your husband's case doesn't sound like that from the very limited information we got.Edit: As /u/Porencephaly already wrote, your next step is to contact his oncologist's office. They need to determine what the problem is right now (maybe it's even an infection and not metastatic progression) probably with new CT imaging and formulate a plan of action.His trouble breathing could be due to anemia, or a number of infections, or heart problems, or lymph node metastases compressing blood vessels or a bronchus, or pleural effusion, or whatever else... this is all more probable than trouble breathing due to lung metastases themselves, which surpisingly rarely are symptomatic in this way."}
{"text": "###Input :Thank you!! Ill get him in ASAP! ###Output :Heme/Onc fellow here, agree with everything youve said.Ill add my two cents and say that in addition to immunotherapy, VEGF inhibitors such as axitinib, cabozantinib, and lenvatinib are options as well. Many of the first-line treatment regimens are a combination of immunotherapy (either pembrolizumab or nivolumab) + one of the VEGF inhibitors. Combination immunotherapy (ipilimumab+nivolumab) is also an option as well for many patients. If someone has non-clear cell histology, the preferred regimens change a bit (and clinical trial is much preferred) but a lot of the same treatments are used.For someone who has a large burden of disease and is symptomatic from it, a combo of VEGF inhibitor + immunotherapy might be better than immunotherapy alone, just because the response rate is faster. But ultimately the choice depends a lot on factors like what other medical conditions someone has and what side effects theyre willing to tolerate, because we dont have any head-to-head trials showing that one regimen is better than the other."}
{"text": "###Input :Seeking information regarding dads renal cell carcinoma. Any urologists here?My dad has been having serious issues with vomiting, nausea, and weight loss. They ended up doing abdominal CT because colonoscopy and upper GI scope were normal. There was an incidental finding of a 2 cm heterogenous(I think???) lesion on one kidney. Per radiology report, it says renal cell carcinoma until proven otherwise.Today we saw the urological surgeon who said due to size of tumor and my dads age, hes a candidate for ablation and theyll give him a referral.The appointment was very rushed and I (29 F) went in with my dad because he has a history of TBI and has a hard time remembering/relaying medical info. We basically were just told that its cancer (which I figured from reading rad report) and that it can be ablated very quickly and the doctor then basically told my dad to drop his pants for a prostate exam so I made a swift exit.My questions lie in whether more imaging needs to be done on my dad to make sure theres not other cancer somewhere? The doc said most likely stage one but theyve only done the abd CT and nothing else?? I understand its a small tumor but does that automatically mean theres no metastasis?? I dont understand how they know that its only stage I without additional testing or imaging? Can anyone give me insight here about this process?We will be following up with that physician where I will be asking for clarification. It was such a whirlwind of an appt and I just didnt feel prepared to ask necessary questions. ###Output :From the information provided, this is not standard of care - but giving us the image files (upload to e.g. dicomlibrary and CT report would be very helpful.Here is NCCN's very helpful patient guideline for kidney cancer.A suspicious 2 cm lesion on a kidney often, but not always is renal cell carcinoma. A 2 cm renal cell carcinoma that's confined to the kidney is usually pretty harmless and very unlikely to relapse or metastasize.The problem is that 1) staging is incomplete and 2) you won't have histology going along with this to confirm that it is indeed renal cell carcinoma and 3) your father has concerning symptoms that are as of yet unexplained.Initial evaluation and staging vitally includes comprehensive labs (CBC, metabolic panel, LDH), abdominal CT with and without contrast, chest CT (or at least, but that's discouraged in the guidelines, chest X-ray) and a thorough physical examination and history.If there are any alarming signs on history or examination, additional imaging must be done. I'd consider vomiting, nausea and weight loss to be alarming. At least brain imaging (preferably MRI) should be done to exclude brain metastases imho.Also, when not performing a partial nephrectomy, which would be preferable to ablation if possible, an initial core needle biopsy to secure histologic diagnosis is recommended. Otherwise you won't ever know what kind of 2 cm mass they burned. The NCCN guidelines stateBiopsy of small lesions confirms a diagnosis of malignancy for surveillance, cryosurgery, and radiofrequency ablation strategies. Ablative techniques may require multiple treatments to achieve the same local oncologic outcomes as conventional surgery."}
{"text": "###Input :Distended abdomen, fatty liver, enlarged spleen and left renal fullness?Hi everyone!Just wondering if anyone has any ideas as even my GP seems to be stumped!I'm female, 32, MODY diabetes on insulin and high blood pressure (on nifedipine). Have a history of colon polyps but most recent colonoscopy in June was clear.The last few months I've been struggling with swelling in my stomach (photo) I look heavily pregnant and it is so uncomfortable, and the few weeks I've started having pain around my right rib area and into my back. Also have extreme fatigue.2 different GPs examined me and both were certain it was fluid so referred me for ultrasounds.I had these last week and had the results today - there is no fluid! The ultrasound did confirm moderate fatty liver, an enlarged spleen and left renal fullness.GP has referred me to haematology to look into the spleen, but said the fatty liver is only moderate and wouldn't cause the pain etc. He also doesn't know what the left renal fullness means but I do have a repeat enal ultrasound tomorrow.Full blood count was normal, kidney function came back normal but GFR had dropped from 85 in April to 62 last week, ALT on liver function only slightly raised to 62, cholesteral high at 6.3 with triglycerides at 7.3mmol.Anybody have any ideas at all as to what could be causing the swelling etc?Thanks - sorry it was such a long post! ###Output :An ultrasound cant tell the difference between fat and fibrosis. Your labs and imaging findings of enlarged spleen are concerning for possible liver disease. You should see a gastroenterologist for further work up."}
{"text": "###Input :Dont you think a gynecological exam is warranted? ###Output :I honestly dont know if abdominal fullness is a reason for a gyn exam. I wouldnt think so though if youre not having other symptoms (bleeding), but not my area of expertise"}
{"text": "###Input :That's doodoo. If fibrosis is significant, US can easily tell the difference between cirrhosis and fatty liver. ###Output :An ultrasound can show other signs of cirrhosis and can give an idea if a liver is cirrhotic appearing but it doesnt actually measure fibrosis/scar tissue. Sono it doesnt show fibrosis. Youd need a biopsy or fibroscan for that. Or an mri with elastography. 97wrongggggff"}
{"text": "###Input :You said if it can tell the difference. Measure is another thing. Ultrasound can tell the difference between a fatty liver and a highly fibrotic one/cirrhotic. But yeah, it can't measure the amount. Unless you do an ultrasound fibroscan. In that case. Ultrasound can measure the amount  ###Output :You can have an ultrasound that just shows fat and that liver can definitely be a cirrhotic liver even if the ultrasound doesnt call it. Thats my point."}
{"text": "###Input :My sebum creatinine level is 5.7 and I want to reduce it by following a renal diet. Is it possible?I am 23F, 55kgs and 5'1. I had high creatinine level of 17, then went through dialysis for 2 sessions and reduced it to 5.7. I do not want to go through dialysis again as it made me feel very weak and made me vomit blood and feel sick. Instead of dialysis, I want to follow the renal low protein diet and take my meds (ketosteril, iron supplements because of my low haemoglobin and antacids). Is it possible to reduce creatinine by this margin without dialysis? ###Output :I suspect the answer is no, but it's a better question for your kidney doctor. My understanding is that the renal diet won't restore renal function, but reduces the amount of things that don't dialyze well (certain dietary proteins, phosphorus, etc). If you have been started on dialysis I suspect that your kidneys have failed. Your kidney doctor is the one tell give you prognosis if there is a chance of you regaining kidney function or if dialysis would be a long-term thing.I would strongly caution against trying this on your own or skipping dialysis sessions without first discussing with your kidney doctor. It's very possible that dialysis is literally keeping you alive.I'm sorry but this needs more info."}
{"text": "###Input :I'm willing to give any info. What should I add? ###Output :I'd add the history: what doctor did you see, why was your creatinin so high/what was the reason for your kidney failure, did they tell you doing dialysis twice was enough? This post is very confusing"}
{"text": "###Input :Would bladder or ovaries be checked on a CT scan for renal stones?A few months ago I (24f) was in the ER for gross hematuria and the doctors there did a CT scan, suspecting renal stones. Nothing showed up, and its now suspected to be related to my endometriosis as its having a cyclic presentation around my period.The doctors also noted a 4 cm ovarian cyst on my right ovary, which makes me think that the CT scan wasnt just focused on the kidneys.Anyway, all this to say: Im pretty sure the gross hematuria is from bladder endometriosis (which my doctors believe it to be), but Im a bit worried its something more serious like a tumor or large cyst. Would my earlier CT scan rule out these possibilities, or should I maybe make an appointment to do more imaging? ###Output :Would have been seen on the CT."}
{"text": "###Input :Potential Renal neoplastyWent to er for massive dehydration and what I thought was a intestinal blockage. That issue resolved itself but during CT scan for blockages, etc, noticed something on my kidney.\"Indeterminate lesion in the lower pole of the left kidney measuring 1.7 x 1.5 cm. This is suspicious for a possible renal neoplasm. A follow-up non emergent dedicated pre and post-contrast renal CT would be recommended to further evaluate.\"Not asking for medical advice, going to get it further checked asap, but anyone with experience here - how concerned should I be? It's the weekend and I can't call pcp and I'm trying to keep my wife from panicking, honestly. The er doc seemed fairly concerned. ###Output :Based on CT results it's literally indeterminate. You need further imaging which will likely happen rather quickly."}
{"text": "###Input :potential kidney/renal issues? or maybe something else?Hi,I really need so advice, I'm 27 male from UK, bmi within range, slim/average build,Over a year ago now I had a dull ache in my right mid back side which radiated down my flank.I saw my Dr who did a urine sample and a ultrasound, both were fine.. a year ago, however the pain has still persisted.I've gone back and forth to the Dr's who are now being quite stubborn and won't do anything else apart from constant urine tests which come back normal, they won't assist or try other avenues.This pain has continued to plague me, sometimes I have zero pain, live normally, and a hour or so later or the next day I could get the pain back which feels like a deep ache, (like I've been kicked in the testes) this hasn't got any better by itself for a year. And now it's starting to worry me as now when the pain happens, I now get a tender testicle on my right side.At first I thought maybe my underwear are a bit tight, so I've spent a lot of time not wearing underwear to give them space, it's made no difference, as soon as that back pain starts it moves down my flank, and eventually in my testicle where the pain can last 1hr to 5hrs and if like magic completely disappears until the next episode which is usually that same day or the next.I dont know where else to turn, I'm considering going private for gp , who could push me back onto the nhs and refer me. Bypassing my nhs gp. I'm starting to be concerned it could be something more serious which is not being detected and could get worse.I just want the pain to go.The pain severity out of 10 can range from a 2, to a 8, it makes me feel nauseated if it's bad.Thanks in advance. ###Output :Sounds like a ventil stone in the right ureter, can be seen easily with a native CT scan of abdomen/pelvis.The ultrasounds and urine analysis were done to rule out the most common causes which are hydronephrosis and pyelonephritis.A ventil ureter stone doesn't always cause a hydronephrosis to be seen in the ultrasound. And a microhematurie although is present in most cases of urolithiasis but not always.The next logical step is a native CT scan. Book an appointment with your urologist"}
{"text": "###Input :Thank you this sounds similar, I will have to ask my Gp as in the UK we can't book direct with specialists, you need a gp to do so if they feel it's necessary.I cant find anything on ventil stones, but have found a lot of info on ureter stones which sounds very similar. Thanks again ###Output :Ventil stones are rare, i have only 2-3 cases per year. I don't know if the name in english is same as in german, we call them ventil stones because they act as a ventil or imagine as a Gate, the ventil stone moves a bit=blocks urinary tract causing hydronephrosis and massive pain, then a bit later this stone moves again and opens the way so to say and then urine flows normally and hydronephrosis dissappear so pain goes away. The native CT scan can 100% detect it. If you experience fever with the pain you rush to the Er, otherwise go to your gp as you said."}
{"text": "###Input :I have a secret IUD and need to undergo a non-invasive pelvic ultrasound, will it be detected?Hi! I'm a 22 year old woman who lives in a conservative Muslim society and I need to undergo a pelvic ultrasound to test for PCOS. I secretly got an IUD while living abroad, never thought I would have to move back to my home country so wasn't prepared for this situation. My mother accompanies me wherever I go because I'm never allowed out of the house alone.I recently had my blood checked and the test report includes: levels of FSH, LH, estradiol, progesterone, testosterone, renal function tests, liver function tests and a lipid profile. Can a doctor come to a conclusion about whether I have PCOS based off my hormone levels, or is an ultrasound mandatory? ###Output :Yes, they will 100% see it on an ultrasound.Often the hormone results are all theyll need for the diagnosis, but in some cases doctors will recommend the ultrasound to get information on the size and appearance of the ovaries. Its possible to decline to get the ultrasound. If you really dont want one, the doctor may be okay with skipping it.Or is there a way you can go to the ultrasound with another family member who you trust to know about the IUD?"}
{"text": "###Input :Could they slip a written note to the tech or doctor to not verbally mention the IUD in front of mom? ###Output :In conservative Muslim countries, it's not uncommon for doctors to share information about adult children with their parents. It would not be safe to send this type of note/email and risk it being shared with the parents.Read more here. (Excerpt from \"Factors influencing sexual and reproductive health of Muslim women: a systematic review\" below)\" Unmarried women seemed to be concerned with healthcare providers informing family members about their visits and expressed worries regarding providers sharing information discussed during consultations. For some single women, family members often accompanied them during health visits, making it impossible for them to discuss any issues privately.A study in Egypt revealed that although patient records were stored securely in filing cabinets in the family planning clinics, a number of healthcare providers stated that they allowed family members to view womens health records. In addition to providers lack of respect for confidentiality, another contributing factor is that in the Egyptian family health model, womens medical records are a part of the combined family health records and could be easily accessed by any family member \""}
{"text": "###Input :Thank you so much for your answer! I was not aware of this! ###Output :#1. PCOS can be diagnosed by simply having irregular or absent cycles plus excess hair growth. Ultrasound is definitely not necessary. #2. Unfortunately, if a pelvic ultrasound is done the IUD will be quite obvious."}
{"text": "###Input :NAD, but is it possible for you to call your doctor on your own? Explain the situation, I'm not sure if that is feasible where you are or not, but they really do need accurate medical history ###Output :You don't need an ultrasound to diagnose PCOS. It's clinical history + exam + hormone levels.If you have a hormonal IUD, though, this can affect diagnosis and treatment plan. Hormonal contraceptives are the first line treatment for PCOS, anyway."}
{"text": "###Input :In Australia you wouldn't need it because you already meet criteria. That being said the treatment doesn't really change wether you label it as PCOS or not - it's to go on hormonal contraceptives. ###Output :In your case, you still don't need the ultrasound tbh. You need clinical OR laboratory signs of hyperandrogenism (in your case, hirsutism) Coupled with absent periods, you have two features. As long as they don't suspect another etiology (which can be tested for via blood), you can be diagnosed."}
{"text": "###Input :Sorry to piggyback this comment but just out of curiosity, can PCOS ever be a possible diagnosis even if hormonal blood test results indicate otherwise? I have always some of the physical symptoms (long periods, cystic acne, mild hirsutism), and my consultant gynaecologist diagnosed me with having PCOS after observing that my ovaries were enlarged and pearly during a laparoscopy to excise endometriosis. But bloods I had taken when I was much younger, and further bloods I had taken 2-3 years after this surgery showed that my androgen & testosterone levels were within normal ranges, so my GPs opinion is that I dont have it (regardless of my consultants observations). Ive never quite known what to make of this difference in opinions. Any thoughts? ###Output :Yes, if hormonal blood tests are normal and there's no obvious signs of hyperandrogenism (in your case, the hirsutism seems subtle), then that's when ultrasound comes into play. Your GYN did a laparascopy and visualized the ovaries directly, which would replace the ultrasound in this case. Also, women with PCOS tend to have skipped or absent periods, not prolonged periods. So, I can see why your GP would be skeptical."}
{"text": "###Input :MRI Renal ResultsAbdominal Wall: Umbilical defect approximately 9mm TRVCan someone explain this to me? Is this a hernia, if so how is this possible?Also originally I received the mri for a renal mass that was first discovered in 2017 of 3.6 cm and on my recent MRI exam is now 1.1 cm? Does this mean it could still be cancerous or most likely benign? ###Output :Tiny (presumably fat-containing) umbilical hernia which is so common that half the time we don't mention it.Can't conclude anything about the renal lesion without the full description. If it's one complete thing that has decreased in size, then yes it's benign. If there was a 3.6 cm cystic lesion that has gotten smaller but now has suspicious features, that's a different story."}
{"text": "###Input :Respiratory rate while sleeping?Age: 26 Gender: Male Weight: 170 lbs Height: 510I do not smoke or drink.Hello! I have been monitoring my sleep with my apple watch and have seen my respiratory rate be pretty low which from what Ive seen isnt good.Occasionally I see it between 10-11 and apparently last night at 9.5?I dont know if you guys can offer if the apple watch is even a good indicator or accurate. Which is why I rather ask yall.Thank you for helping, wishing you the best. ###Output :That's normal"}
{"text": "###Input :Thank you so much!At what point would you consider it to be abnormal? I obviously have no knowledge other than the vagueness I see which is 12-20. ###Output :It's more abnormal to be tracking your resp rate while asleep."}
{"text": "###Input :68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6\" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important? ###Output :Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding."}
{"text": "###Input :I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions ###Output :It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother."}
{"text": "###Input :Myasthenia gravis and respiratory infectionHi my first language is not english so please excuse any mistakes. I (24f) have Myasthenia gravis and even though I take several immunosuppressants such as Prednisolon, Azathioprin and weekly Efgartigimod alfa infusions my symptoms are quite severe.I had multiple myasthenic crises the last few months. The last time I was in the hospital was this January because my symptoms worsened due to a covid infection and I was treated with intravenous immunoglobulins and nirmatrelvir/ritonavir. I was released 10 days ago.Two days ago I started to notice that I have symptoms of a respiratory infection (coughing, runny nose, sore throat, breathing is difficult and so on) and the symptoms of my MG worsened too. I am really afraid to call my doctors because they work at the hospital and when my symptoms get worse they admit me to the hospital. I can't stand hospitals anymore. I had several plasmapheresises, was intubated, had a feeding tube, a thymectomy and so on. I am very thankful for all their efforts and they saved my life several times but everything in me has the urge to be as far away from the hospital as possible...Do you think I should be admitted again or is there any possible solution to treat this at home? And if I contact my doctors would it be irresponsible of them to treat me at home? ###Output :Sorry, but I dont think your question can be answered over the internet. The decision to treat for an MG flair requires a thorough physical exam. It may be worthwhile to note that MG can be very difficult to treat, and its reasonable for your doctor to be conservative and bring you into the hospital. If left untreated it can be rapidly fatal, especially if youre at home."}
{"text": "###Input :(26F) If a breathing pattern disorder is corrected (respiratory alkalosis/chronic hyperventilation), how long does it take for serum bicarbonate to return to normal levels?I developed chronic hyperventilation due to tachycardia. Sustained low CO2 dropped my bicarbonate levels. My heart rate is now under control and breathing pattern disorder in the process of being corrected. How long can I expect it to take for my bicarbonate levels to return to a normal range? ###Output :Bicarbonate levels will usually normalise within days once CO2 levels are corrected. The kidneys are very good at what they do - I wouldnt worry too much about your bicarb levels if all else is well/improving."}
{"text": "###Input :Viral respiratory infection fever not getting better.22M, 5'10, 157 lbs, no drug use, no known health conditions or allergies. I got sick early in the morning on January 7th around 1 AM or so. Instantly got hit with fever, cough, sore throat, headache. Jan 9th I developed severe ear pain and pressure as well as ringing and echoing. NP looked and said it was an ear infection and prescribed amoxicillin. On January 7th my fever peaked at around 101.5-102. I took Tylenol to reduce it and it worked well. On the days after that my fever fluctuates from around 99.5 F to 100.5-101 F. It hasn't gone down from there. Doctor's office didn't detect fever today but they were using a forehead thermometer. At home my thermometer once again showed 99.5 which has now increased to 101 in the evening. My oxygen levels, HR, and BP were all fine. I cough a lot with mucus and sometimes it hurts but nothing crazy. Should I be worried? How long does fever typically last and when should I seek out help? I took a covid test today and should be getting results tomorrow as well. ###Output :That's fine. Nothing to worry about"}
{"text": "###Input :M19 70 kg . Possible influenza but no respiratory problems.Hi . So my sister got influenza, and got diagnosed. And then I got the fever and the dizziness.So here are my concerns. I a barely coughing (I had like 10 painful coughs the whole day) but other than that I am breathing fine. I am feeling kind of itchyich in my trachea but nothing more.I am also concerned by my dizziness that comes and goes for 5 seconds.Thoughts? ###Output :Im not sure I follow your question. Influenza has a spectrum of symptoms. Sounds like you have influenza."}
{"text": "###Input :How do you clinically distinguish a Viral Upper Respiratory Tract Illness from a Bacterial one?Medical student here, year 2Well I've been reading about respiratory pathogens and found out that while viruses are the most common cause for these, bacterial infections can have terrible sequelae when not treated (RHD), so how does a doctor clinically determine if the person presenting to them has Viral or bacterial infection so that right measures can be taken?I'm assuming throat swabs for every single person wouldn't be very economical and just or would they be? ###Output :Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.Streptococcal pharyngitis is a fairly distinct clinical syndrome compared to a garden variety viral respiratory infection. Classically, the symptoms are severe sore throat and fever, and the signs are exudative tonsillitis and tender anterior cervical lymphadenopathy. While sore throat is common in viral infection, exudative tonsillitis is less so, and viral syndromes are often accompanied by cough and coryza, which strep infections do not produce.These distinctions are codified in the Modified Centor Criteria, which can give you a pretest probability for the presence of strep throat, and guide your testing and treatment decisions. Here is a link to a calculator that can help you.https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitisBacterial infections of the respiratory tract typically refer to pharyngitis, tracheitis, sinusitis, or pneumonia depending where along the tract you are worried about. Each will have their own physical exam findings, risk factors and severity that over time, you learn to distinguish.Since you're mentioning throat swabs, testing for EBV, flu, RSV, COVID, or Group A Strep can quickly be done with rapid point-of-care testing if they have risk factors (we can use clinical decision making tools like Centor criteria to help us as well)."}
{"text": "###Input :Are there these associations like, if pharyngitis is bacterial in etiology the person most likely presents with fever, while viruses produce a runny nose, are any such associations there and are these correct? ###Output :Not that simple. Viral infections can also cause fever. Runny nose tends to be more viral than bacterial."}
{"text": "###Input :M25 215lb viral respiratory infection and low body tempHello Im M25 and weigh 215 lb. I have been recently (yesterday)diagnosed with a viral respiratory infection and have been experiencing mostly coughing (for a week) and sinus drainage; however, my body temperature has remained consistently lower than normal. Im typically at 98.6 F but Im currently approximately at 96.4. Im using a thermometer under my tongue. Is this drop in body temperature normal? ###Output :This does not sound concerning. Try a blanket."}
{"text": "###Input :Thank you for your comment. What worries me is that Im wearing a jacket and am using a blanket in bed right now. ###Output :Throw away your thermometer for an easier life."}
{"text": "###Input :Can you get an outer ear infection from upper respiratory illness?~2.5 weeks ago I caught a mild illness  sore throat with swollen lymph nodes on left side only. Negative COVID tests.My left ear felt a little clogged afterwards but seemed to be improving.Yesterday, it rebelled. Lots of pain inside, worse today. Jaws a bit sore too and sometimes the pain spikes when I turn my head left.Diagnosed with outer ear infection, prescribed Ciprodex drops.After curiously reading up on it (only had an inner & middle one before), Im feeling confused and wondering if this makes sense.- How does a throat illness/infection end up in your outer ear? Are they unrelated?- Can you get an outer ear infection if your ear hasnt been wet recently?- If it isnt an outer ear infection, will the drops still work?Most of what I read talked about swimmers ear and there being water involved, but embarrassingly between the illness and some other stuff I havent showered in like 2 weeks so it's been dry.I've had past vestibular issues so am extra concerned about addressing this right/quickly so it doesn't start causing other trouble.Thanks! ###Output :This is a common thing that gets referred to me, and as an ENT this issue slowly kills me inside. Differentiating between an outer and middle ear infection should be quite simple.If you can answer yes to the following questions, then you may have an outer ear infection (aka otitis externa):Is there white/yellow/brown/red stuff draining from my ear?Does the physical ear hurt when I pull on it or press on it?Did it hurt when they stuck the otoscope in my ear canal (more than it may usually if you have sensitive ears)?When they examined the ear, did they see redness, inflammation, drainage in the ear canal itself?If no, then you don't have an external ear infection.If you have a middle ear infection and they gave you drops, the only time this is useful is if you have a hole in your eardrum, and this will often also lead to drainage from the ear.A middle ear infection can be quite painful as well, but you shouldn't be able to really touch the pain in the same way.What is very common post-cold and what you may likely have is Eustachian tube dysfunction. This can result in fluid in the middle ear space, but doesn't necessarily mean an infection. This is treated from the nose side with either short course afrin, sudafed, oral steroid (low dose, short course), Flonase, saline irrigations, or any combination of the above.This all comes with the obvious caveat that I have not examined you and cannot specifically comment on your case or rule out an otitis externa, otitis media, or whatever else."}
{"text": "###Input :can cutting off sugar cure an upper respiratory infection?20F, 5'4, 116 lbs., do not drink, do not smoke/drink/use drugs, USAI got sick around October 29, 2022, after going to the doctor, I was prescribed a 10-day antibiotic dose that was finished around November 11. Although my harsh symptoms were gone afterward, such as tiredness, body ache, and congestion, all of a sudden after the antibiotics I got this harsh cough that was productive with green mucus. The cough was not a dry cough like I had before/during my antibiotics but rather came from my chest and is very loud. I have trouble breathing with this cough. Knowing its been around 40 days and I haven't stopped coughing so much so my back is killing me from the constant coughing, 4 days ago I went to the doctor. He basically told me to cut off sugar from my diet, no junk food, and eat only vegetables and soup for 20 days and I should feel better. (I was a little confused about this suggestion because he never asked about my diet beforehand, previously, I didn't eat junk food every day and I include veggies and fruit in almost every meal. I am quite active and have been consistently healthy.) I was not prescribed anything that can help my mucus but was prescribed cough syrup and an inhaler.I am not sure if a change in diet is a solution and I'm wondering if I should ask for a chest x-ray because I have difficulty breathing.Also this doctor didn't even check my breathing until I had asked him to. He said my lungs sounded fine but did hear mucus in my bronchi.Side note: after finishing my antibiotics I took probiotic pills and drank kombucha, could that have caused this? ###Output :Generally speaking, eating less sugar and increasing plant-based food is a good thing for your health; but you shouldnt expect this change to make any real difference with an acute infection. I expect in 20 days youre going to feel a lot better regardless of a change in your diet."}
{"text": "###Input :My (35m) heartrate is not going down after recovering from a respiratory virus.I'm 35, male, 5'11 and 215lbs. I was fighting a respiratory virus for the last 2 weeks. My symptoms are basically gone at this point, but my RHR has not recovered. It is normally around 62bpm and has been stuck around 92bpm for the last few days. I understand that it can be elevated while fighting an illness, but I expected it to return to normal as I got better. I do not drink caffeine, alcohol, or take any medications that could raise it. I have an appointment to get a Holter monitor for an unrelated sinus arrhythmia in a couple weeks and I'm concerned it might skew the results. The only thing I can think of is I haven't been eating much in the last couple weeks due to a sensitive stomach so I don't know if the lack of nutrients might be causing something to be going on. I've been drinking lots of water as well. ###Output :Give it a few months to reset"}
{"text": "###Input :26F - little streaks and spots of blood in phlegm but no symptomatic respiratory/sinus/throat illness and no coughing26FWhen I brush my teeth, I suck the mucus in my throat out into my mouth and spit into the sink. For the past few days, I've noticed bright red spots and streaks within the mucus. Not too much but it's there. I have had no recent infections or illnesses. No recent coughing or sore throat either. Everything sinus or respiratory has been normal. I used to vape and smoke between 18-23 years of age, and the volume of air I can take in during a deep inhale has shortened as a result of the smoking/vaping based on my subjective, highly inconclusive observations.Have been experiencing noticeable and moderate ongoing fatigue as well. ###Output :Not concerning. Congratulations on being nicotine free though! your body thanks you."}
{"text": "###Input :My disease may have caused respiratory involvement.Hello, I am 28 years old male 165cm 22kg Malay. I have been diagnosed with rare disease named Congenital Fiber Type Disproportion Myopathy in 2010. I also suffered Combined Scoliosis and Lordosis and has to use wheelchair. The scoliosis made my left lung smaller than my right lung. I refused spine surgery as I deemed the risks outweighed the benefits. I discontinued medical checkup in 2011 as there's no other treatment available. My skeletal muscles is progressively weaken over the years. Since last month after recovered from a flu, I've been having daytime sleepiness despite 7-9 hours of sleep. I also frequently woke up from a dream with a headache. Rarely, I woke up choked or gasping for air. I also has multiple awakening at night. My Gp prescribed me with 0.25mg Alprazolam few days ago to help me sleep better. I did get uninterrupted sleep, but it did not help with daytime sleepiness. I stopped Alprazolam after I read about the withdrawal symptom. I planned to schedule an appointment with sleep specialist. I'm afraid my disease has respiratory involvement. ###Output :Your post raises concern for chronic hypercapnic respiratory failure  basically you skeletal disease causing chest wall restriction leading to hypoventilation. A benzo (such as alprazolam) would acutely worsen this, not surprised things got worse. Strongly recommend you see a pulmonologist asap. You probably need something like nocturnal BIPAP to blow off CO2 and improve your symptoms."}
{"text": "###Input :Can someone explain \"respiratory failure\" to me?30F, persistent pneumonia and shortness of breath. Sp02 sits at around 88 but as low as 50 on exertion.I have been treated at an outpatient clinic and visited by nurses daily, I have been given oxygen to use at home. My doctor said I have respiratory failure but I am unsure if this is just a general term, or if it means my lungs are dying, or something else?The term \"failure\" makes it seem serious/life threatening but I have not had anything explained to me.Should I be worried? ###Output :Respiratory failure usually has a different meaning than being used here - what's the clinical situation causing this?Respiratory failure is often technically defined as either low oxygen levels or high carbon dioxide levels due to your lungs not working as well as they should. You can have acute respiratory failure, like if you get pneumonia or have an asthma attack; you can also have more chronic respiratory failure where your lungs dont work as well in generallike with emphysema.Its hard to know whats going on in your exact condition and what the prognosis is without more informationbest thing to do is ask your doc.In your case respiratory failure is defined by your need for oxygen -- chronic hypoxic respiratory failure. \"Failure\" in this situation means your lungs aren't working well enough on their own to sustain your life, so you need the oxygen. If your lungs weren't failing you wouldn't need oxygen.Should I be worried?That's a very common question on this sub, and often it's not answerable over the internet. In your case I'd certainly be worried. It sounds like you are quite young for having developed chronic respiratory failure, and it doesn't sound like you have a clear diagnosis (probably meaning there isn't a clear treatment plan going forward). You should keep asking questions to your doctors until you get answers; and if you haven't seen a pulmonologist yet you should seek one out ASAP. \"Persistent pneumonia\" isn't a diagnosis."}
{"text": "###Input :27F Overweight  dizzy, nauseous, weak, sleepy, and seeing some black spots from time to time  respiratory acidosis?It's been a month since I've been having these weird symptoms  headaches, dizziness, nausea, weakness (specially on the legs), faintness. I feel confused some times as well.I also have bad GI problems such as bad absorption, diarrea, and/or constipation depending on the date.After 5 trips to the ER with pain on the left part of my chest, and confirming that my heart was fine, all I got diagnosed with was anxiety and POTS.But today I did some blood tests and my Bicarbonate levels were low (20; normal range is 22-29).Could I have respiratory acidosis although my oxygen levels are 95% and up?Or is this more a metabolic thing?I do feel like I can't breathe properly recently. ###Output :Your bicarbonate level is fine. It was maybe outside of the lab reference range, but it's nothing to worry about at all"}
{"text": "###Input :Sorry for doubting, but  Are you 100% sure? I have my doctor's appointment on Monday. I just want to know if this is something treatable, or if I should go to the ER. ###Output :Yeah it's fine, not at all urgent."}
{"text": "###Input :I don't have kidney problems that I know of.But do you think my lungs are alright? Could it wait till Monday to check? I feel I can't breathe properly, but just because I'm terrified of not breathing properly. ###Output :Youve been to the ER 5 times. I would assume they checked your oxygen levels and someone listened to your lungs."}
{"text": "###Input :Yes, they have listened to my lungs several times, but they have never said anything bad there. My oxygen levels are always 95%+.I just had an abdominal ultrasound scan and aside from some fat in my liver and some bile salt in my vesicle, they didn't find anything. No comment on any acid in my stomach whatsoever.I also had a chest X-ray plaque and they didn't say anything bad was going on in my lungs.I have high uric acid  9.0 (limit is 5.7).Is it safe for me to sleep today and tomorrow and wait till my Monday appointment? ###Output :Do you have kidney problems? Did anyone suggest baking soda or tums? Do you eat a lot of meat?"}
{"text": "###Input :Getting circumcised. What else can I say was done at work as an excuse?EDIT: Wow thanks for all the replies!TLDR: whats a fairly minor procedure with a ~2 week recovery time that I can say I had done instead of a circumcision?  Im a 34 year old male and I have to get circumcised for medical reasons (phimosis and frenuloplasty that didnt work)I have a physical job as a Paramedic, so will be on alternate duties in the office for a couple weeks. Ive done so before with a busted ankle.However Ill be working around people who are medically trained to various levels, and theres always ice breaker conversations about how you ended up in alternate duties. Well Id rather not tell Carol from accounts about my dong, so is there another procedure I could say I had done that isnt as embarrassing?I could say its none of your business or similar, but that might make things awkward and probably make it obvious its dick related.Im thinking of saying an inguinal hernia repair? Seems like a similar recovery time, a bit tender below the belt kinda thing??Any other ideas?Thanks docs! ###Output :Tell people you had macropenis and that you had to have a surgical reduction, since it was just too big."}
{"text": "###Input :Doesn't HIPPA protect him from having to tell his work anything more than that it's a medical issue ###Output :No, thats not HIPAA. HIPAA prevents healthcare providers from telling anyone at work if they ask. Your employer does have limited rights to information for sick leave and I think most privacy is under the ADA."}
{"text": "###Input :Yes, that you're having surgery not what the surgery is for.The point was that their job has no right to ask specifics ###Output :No. HIPAA is concerned with covered healthcare entities not disclosing your medical information to other people without your information. It doesn't address your coworkers asking about your surgeries."}
{"text": "###Input :O I get that but that not the fkn point I'm trying to make. ###Output :HIPAA does NOT protect him from his employer asking about medical conditions. This is more of an ADA issue if anything.HIPAA has nothing at all to do with this situation."}
{"text": "###Input :It does if they call my doctor to ask. Hippa protect any thing about my health being shared ###Output :HIPAA says your doctor can't disclose that info. It doesn't say they can't call and ask.I can call and ask your doctor. If he tells me, he's committed a HIPAA violation. Not me.HIPAA has nothing to do with OP's responsibility (or lack thereof) to disclose medical information to his employer. Neither are HIPAA bound entities."}
{"text": "###Input :Inguinal hernia seems like a good excuse. Same region, common in men, not very invasive surgery similar to circumcision ###Output :No, OP doesnt need an explanation, they said as much. But OP also said they would rather have a simple excuse on hand that doesnt raise any eyebrows rather than tell someone its none of their business and invite scrutiny. Some people are more comfortable with that than others."}
{"text": "###Input :I'm not sure, my dad had one and was advised no heavy lifting for six weeks post op ###Output :I would say testicular torsionNo guy is asking any questions after that"}
{"text": "###Input :I disagree. If I didnt already know what it was, Id definitely ask what it is haha ###Output :I think hernia is fine"}
{"text": "###Input :One of my sons had to have surgical repair for penoscrotal webbing, sounds somewhat similar, and I also didnt feel comfortable blasting private details about that around casually. we made similar jokes about it being a penis reduction. But usually I just said he had a urological surgery/procedure and left it at that. If some asshole really tries to pry about details after that then they deserve the nunya response. Edited to add- he was about a year old when he had surgery, so different in that regard but still not comfortable telling people details about my babys private part situation ###Output :Hernia repair is fine.However honestly if it was me, I would just be up front about it.You're having a medical procedure to correct a problem with your health, and your coworkers are healthcare workers.If carol from accounting gets nosey, just offer to show her before and after photos! (But don't really, because you would totally get in trouble.)"}
{"text": "###Input :Dont tell them you are getting circumcised. Medical co-workers can be the worst. ###Output :Thats your approach which is fine. But OP made it clear theyd be more comfortable if they just had an easy excuse that doesnt raise eyebrows. OP shouldnt have to explain themselves, but not everyone is comfortable with that.Id go with hernia.Is there a reason why you have to give the info in the first place?\"I'm on alternate duties for medical reasons\" should be more than enough for anyone who isn't your doctor. Honestly \"I'm on alternate duties\" with no further details whatsoever is a complete sentence already.You can say hernia repair if you want, not saying you can't, but it's a bit bizarre to me that you've been put in a position where you feel like you have to reveal more than you wanted to or make something up just for an ice breaker with Carol from Accounting. An ice breaker should be, like, \"what tv shows are you watching recently\" or \"what's your favourite meal\"! Not \"please explain something potentially very personal\"."}
{"text": "###Input :NAD ... Tell'em you had a hysterectomy, and then grin and walk away.I get that you'll need to say something because people are like that. But it's not up to you to tell. I, personally, head for \"humor\" to shut it down. ###Output :Since this has nothing of an actual repercussion medically, you could try saying something in line of abscess drainage or an excision of lipoma/sebaceous cyst, etc.,"}
{"text": "###Input :Honestly, just say that you had to have a procedure done that you'd rather not talk about. I work in the medical field too and I have never had anyone push after saying that. ###Output :Vasectomy, cord lipoma removal.Where I am, hernia repair earns you 4-6 weeks of light duties."}
{"text": "###Input :respiratory/co2/bipap/desatrespiratory/co2 retention/bipap/desatsHello everyoneI am a caregiver to my 47y male [5'11 155lbs, Caucasian, no alvohil quit smoking in 2020 after 22 years of cigarettes and lots of cannabis, on 60mg sildenafil 3x a day; inhaled treprostinal, b1, Folic acid, vit d, calcium, o2 and temporarily prednisone after hospital] partner with CHF, pulm hypertension, and copd emphysema. DX in 2018. Was put on 3L of o2 24/7 in 2020 and then May of this year began having frightening symptoms which turned out to be CO2 retention. He's been to the hospital 3x in 5 weeks, been intubated once and on hospital bipap twice. We have our own bipap bit it's part of the philips recall so until we became aware of this co2 problem, we weren't using it. The dr recommended we do as it was riskier without it.However everytime I would put him on it, he would desat 10-15% and hold there. I thought it was the machine, the mask, the toxic fumes from the recall, etc. I have now rented a machine, have a new mask, and when he got out of the hospital o2 sats were good while on it. However its now been 2 weeks, although using it every day and trying to keep him out of the hospital his CO2 has built back up judging by his symptoms.Been trying to use the bipap anyway and just fight to keep o2 sats up, had a mask leak the other day , finally got the new part and it doesn't seem to be leaking anymore but still he desats 30%, it seems like it takes some time (hr , hr and a half) to burn off the first layer of co2 before he can stabilize o2 sats so just been trying to get him over that hump.When o2% drops it seems to get stuck like airway is closed or diaphragm paralyzed! If I crank the o2, sometimes it works to help his sats cycle up, but mostly not. I haven't been able to keep Bipap on more than hhr at a time the last day as it drops under 80, and a couple times under 70. Trying to do some research and my theory was a bronchospasm but his inhalers (prosir snd combivent) and/or breathing treatment of a Ipratropium bromide/albuterol seem to make his sats worse than before use.Last night it cycled down to mid 70s on the bipap for the 5th or 6th time but wouldn't come up and I pulled him off, put him back on the cannula. However the spasm continued once he was off it, no matter how much I cranked the o2, it would cycle down to 70s or low 80s and sit there awhile. Then it might cycle up but fall right back down. He was making efforted breaths, with a high respiratory rate. Took ages before this cycle stopped and his o2 sats stabilized in 90s.My question is does this sound like a bronchospasm? Hypopnea? Paralyzed diaphragm? Just recently got a wellue o2 ring and have noticed so me drops to 78% out of nowhere, when he's just sitting and it will hold there for 10-30 seconds and then go up. I've actually noticed on the chart a couple days ago, it happened 3x, almost exactly 10 minutes apart while on bipap so was wondering if it was related to the heart cycle. Don't know if these events are even related/the same thing.Any insights? I can't keep him on the bipap/can't get out the co2 when I can't keep his o2 up!! I was gonna leave in the cannula and just hold the bipap mask up to his face tonight so it's easy to remove if o2 starts falling but still may help trigger some deep exhales to blow off co2? Is this a good idea or not? To kind of spot treat without strapping everything on that's difficult to get off, switch over to cannula if sats drop?I'm at the end of my rope, haven't slept more than 1 hr increments for months, i really don't want him going hmback to the hospital they always seem to break something else on him!! The drs cant understand the anount of damage to his lungs for his age/history. Are there diaphragm exercises to strengthen? Does it sound like a spasm? Any theories or information helps! ###Output :Most likely the oxygen supply is decreased due to high pressures inside the mask during inspiration. Do you have a second oxygen supply and nasal cannula? If so, put on a nasal cannula under the BiPAP mask and run it at 8-15 L/min. This will help provide a higher amount of oxygen during inspiration."}
{"text": "###Input :Yeah one of the doctors suggested that, we did try that a couple weeks ago and it didn't help, we didn't have a proper dual ventilation setup so the mask didn't seal as the cannula was in the way. When his CO2 is low he's able to stay above the 90s, even a few days ago when it was high but not too high, as long as I held the mask on when there was a leak he was staying in the 90s but given that this happens desat after the BiPAP is off I feel like there's some other explanation like his lungs are freaking out ###Output :I have to disagree. I would try to find a dual ventilation setup to try."}
{"text": "###Input :I will try anything but respectfully how do you account for the desat cycle to 70s for an hr and a half after thr bipap is off? ###Output :Could be entirely unrelated to the desaturation when putting the BiPAP on."}
{"text": "###Input :Yeah I'm wondering that, bc it just happened, just not as long or as low and he hasn't had the bipap on for 12 hrs. I'm wondering if the bipap exacerbates it but there's another issue like diaphragm or bronchospasm. ###Output :I wouldn't think bipap would exacerbate it. I do think there's likely another reason for his desats, like bronchospasm. Not likely a diaphragm problem. Follow up with his doctor."}
{"text": "###Input :If it is a broncospasm should the Ipratropium bromide/albuterol nebulizer treatment and/or proair albuterol inhaler and/or combivent inhaler (Ipratropium bromide/salbutamol) make it better or worse? I've read some conflicting things and the neb used to help his o2 sats , I would use it before bipap but now with the heavy co2 , all those treatments seem to make his sats worse by 5%+. ###Output :It should make it better. It sounds like he's needs to see a doctor"}
{"text": "###Input :I (63m) was diagnosed with ALS about 8 weeks ago. Needless to say, this has been a devastating diagnosis for me and for my spouse. Symptoms started 2 years ago with diffuse cramping, and minor dyspnea upon exertion. The cramping continued, then I developed more dyspnea, and then fine motor skill weakness in left>right hand. An EMG in March of this year showed major motor neuron issues, and the suspected MND was confirmed as ALS by two specialists. I am 5'9, 170 lb. I am on riluzole and Relyvrio, still waiting on the Radicava because the fucking insurance company is taking its sweet time and would probably prefer that I die in the meantime so that they don't have to pay for it. Here's my issue: my main symptom, which has slowly progressed, then more quickly starting in Feb of this year, is respiratory muscle weakness (diaphragm and chest wall muscles). I cannot breathe lying flat, and have to use a BiPap machine at night or I get hypercapnia. I am increasingly fatigued during the day, and often short of breath even just moving around the house or doing simple chores. I can walk a mile slowly, but have to take a break halfway, and it's taxing. I understand from my voluminous reading about this shitty disease that most people die from respiratory failure at the end, and that that is usually the last set of symptoms they get. Respiratory muscle weakness is more rare as a presenting symptom. Given that it's really the first major problem I am having, my fear is that it's going to be the thing that takes me out, and that it could happen rather quickly. I am trying to get my affairs in order, have an advanced directive on file with my PCP and am doing all other estate planning and power of attorney, etc., as fast as I can. I do not want tracheostomy or gastrostomy under any circumstances, I do not want to simply exist hooked up to machines. Quality of life is paramount, and my spouse has agreed to all of my wishes. We do not have children. How will it end when it ends? I am still relatively mobile and can use my limbs and hands, no real issues with voice or swallowing. I imagine that at some point I will simply not be able to breathe any more without the NIV, and that even that will not work at some point. What I am unsure of is what it looks like getting to that point, and what happens when I simply can't breathe any more and an NIV doesn't work. I want to go quietly and easily, without struggle. Do I state that I want continuous deep sedation at some point, and if so, when? Any guidance or feedback at all is welcome. ###Output :One of the worst diseases. I'm so sorry OP.I can promise you that there is no reason you should in any way be suffering physically at the end of life. You will not stop receiving treatment. We cannot treat ALS but we can treat pain, shortness of breath and anxiety/fear very very effectively. Your ALS neurologist or pulmonologist should be able to put you in touch with a hospice program and I think talking to them may reassure you.Opiates for instance are almost always successful at relieving shortness of breath and pain. Benzodiazepines are sometimes used for anxiety. These are given in doses of whatever you need to be comfortable. With a good hospice plan you should have nothing to worry about as far as untreated symptoms.The setting is also a consideration. Home hospice can be challenging mostly from a care standpoint. Often patients with ALS already have in place a high level of care at home and can stay there with a few hours a day of hospice nursing. If the nursing needs are significant or can't be met, the other option is to choose to do what is called inpatient hospice. This is in a setting that is more like a hotel than a hospital, visitation restrictions are (in general) quite relaxed, and there is 24 hour nursing care. They are very focused on quality end of life treatment.You are dealing with your own mortality and grief. This is more than enough. What you shouldn't be fearful of is feelings of pain or shortness of breath. I suggest meeting with the hospice people in the near future even if you are not yet ready for this. They can answer questions and plan about how you want this to be done."}
{"text": "###Input :Upper respiratory culture came back and the results are confusing.I am a 33 year old female. Weight: 160 Height: 53 Medications: Modafinil Smoking: Yes, about a pack a day.Was seen at walk in clinic on the 9th of October for what appears to be a Virus. Swollen lymph node on the left side of my face, under my jaw and just to the left of my chin. Sore throat, dry cough, lethargy, headache, muscle pain, and fever that sticks around 101 and comes down occasionally. OTC wasnt really helping. On the fourth day of this now. Chest discomfort started today.Covid pcr came back negative. Rapid strep test came back negative.My upper respiratory culture came back today and these results are what is confusing me. I cannot get a hold of anyone at the clinic who can tell me something so attempting to get an idea of if I should continue to call or if its nothing.This is the only information on the culture.TEST: Upper Respiratory Culture1COLLECTED DATE/TIME: 10/9/22 8:30 PMFINAL REPORT: MANY MIXED RESPIRATORY FLORAINTERPRETIVE DATA: 1ALI Microbiology uses MALDI-TOF mass spectrometry on the Bruker Microflex as its primary method for identifying bacteria and yeast. This test was developed and its performance characteristics determined by ALI. It has not been cleared or approved by the FDA. The laboratory is regulated under CLIA as qualified to perform high-complexity testing. This test is used for clinical purposes. It should not be regarded as investigational or for research. ###Output :Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.MANY MIXED RESPIRATORY FLORAThis simply means that the bacteria found in your culture are typical bacteria found in everyone. No predominant pathogen (disease-causing organism) was found.Generally speaking, respiratory cultures of outpatients are not useful. Rarely do they produce actionable information."}
{"text": "###Input :My asthma is so badly controlled and my specialist isnt giving me other options, is there anything else I can try?Im 28F and Ive tried so many different asthma treatments and I constantly sound like this https://imgur.com/a/RkAF2MC , right now Im having no real bad coughing fits or terrible difficulty breathing, it gets worse but I really dont know what else I can do to just breath normal. This is what Ive tried with my pulmonologistVentolin Symbicort Spirivia Montelukast Xolair (stopped this bc side effects were bad) Dupixent (taking bi weekly)I take prednisone probably once a month at this stage.Ive seen an allergist and use all hypoallergenic products/bedding etc. I have an air purifier in my room. I wear a mask out doors because of air pollution in the city. Ive tried taking anti histamines and they dont make any difference.I dont or never haved smoked. I try to keep active and live a healthy lifestyle for the most part.What else can I do? My doctors not really giving me any more optionsHonestly all tips or advice is welcome. ###Output :Asthma mimics need to be ruled out (vocal cord dysfunction, tracheobronchomalacia, ABPA, etc). If all else fails there may be some benefit from bronchial thermoplasty (but the overall benefit is somewhat unclear)."}
{"text": "###Input :Add Chrug strauss syndrome to the list too ###Output :Sarcoidosis as well. Basically needs a full cardiac, pulmonary, and upper airway workup if youre failing this many treatments. I presume they had one if an allergist got Xolair approved, but you never know."}
{"text": "###Input :How does diaphragmatic breathing differ from typical respiration in an individual without underlying respiratory conditions?To my understanding, the lungs expand and contract as a function of the diaphragm/transverse abdominals contracting, as well as the contracting of the inner/outer intercostal muscles. As a musician who plays brass instruments, there is this phrase, \"Breathe with your diaphragm\" that gets passed around quite often, but I never really felt like I fully understood what that means from an anatomical standpoint, because wouldn't that imply that it's possible to breathe without the diaphragm, or that an otherwise normal breath is done without the diaphragm?I am aware of diaphragmatic breathing as a form of physical therapy for individuals with chronic obstructive pulmonary disease, but what benefits, if any, would it offer for an individual without such medical issues?Follow-up, would such exercises expand an individual's vital capacity/is it possible? I believe a person's TLC cannot be changed. All in all, there is a lot of information about breathing in the world of music education that is shared and taught without citation or concrete scientific basis and I wanted to get to the bottom of it all. Thanks! ###Output :I am not in the world of music but you are correct. Inhalation is done with the diaphragm and accessory muscles as needed. I would guess that breathing with your diaphragm is more of a cue to take a solid expanded chest, stomach out breath as opposed to a weak, chest only inhalation. Again, basically a cue to get maximal amount of air in your lungs.And yeah I think it would be a stretch to say that exercising can increase total lung capacity. Maybe, but I cant imagine it is in any appreciable way."}
{"text": "###Input :Does routine respiratory flora mean Im strep free?Age: 48Sex: femaleHeight: 5 8Weight: 150Race: whiteDuration of complaint: weekLocation: throatAny existing relevant medical issues: StrepCurrent medications: noneInclude a photo if relevantI was treated for strep but still felt a little sick so I asked for a other culture. The results came back routine respiratory flora. I cant get anyone at One Medical to respond/explain so I thought Id check here and see if that means Im ok or if something else is going on. ###Output :It means you have the normal bacteria that grow in your mouth. As for whether or not you are improving from strep throat, the culture has no bearing on that."}
{"text": "###Input :please help, ive been having weird respiratory problems for 10 days and idk whats going on.25f smoker hi, for 10 days ive been coughing up THICK GREEN phelgm and/or blowing it out of my nose, especially at night. i wake up every 2 hours unable to breath until i clear it out. my throat is also sore at night but just from the phelgm irritation. its so much phelgm i go through 2 boxes of tissues a day. the first day i was sneezing a lot and then my nose was running for a few days and now the last couple days it seems worse, as its turned into a lot more coughing/occasional wheezing even in the day time. i have a post nasal drip too. sometimes my nose feels clogged and sometimes it feels dry. the mucus production has only increased with time. during the day its not very bad but at night its hell and the mucus is much darker and thicker. im only relatively comfortable if im completely standing. weirdly enough i have no other symptoms like fever or pain. just various respiratory issues. im worried i may have a bacterial infection because it has only gotten worse. what could this be? please helpEDIT: went to urgent care, had bacterial infection, on antibiotics now ###Output :You are having a bad cold my friend, sounds like it might have progressed to sinusitis. This will get better on its own, use decongestants at night, aspirin and lozenges for throat pain."}
{"text": "###Input :Can anyone recommend some blood pressure medicines that dont cause respiratory issues?Im 25, Male, 6 and weigh 180lbs. Ive been taking Metoprolol since I was 13. I wasnt overweight, no heart defects or anything, just a genetic issue. My usual blood pressure without medication is 150/100. 25mg of Metoprolol ER brings it down to 120/80, and when Ive taken it in the past, 10mg of Lisinopril brings it down to 110/70.Ive always had bad allergies and congestion issues, and recently theyve been getting worse. Im seeing an ENT soon, but before then, I also have an appointment with my primary doctor. I suffer from pretty bad post-nasal drip which causes me to constantly clear my throat. Through research, Ive found that Beta blockers, as well as ACE inhibitors, are prone to cause asthma symptoms, congestion issues, and dry cough. Since my congestion and post nasal drip have become more problematic, Im looking to eliminate anything that might be contributing. Since there are so many different blood pressure medicines, I thought Id ask for some recommendations that are less prone to cause those side effects. So far Im leaning toward Losartan, and Ill be discussing these changes with my doctor this week. Thanks! ###Output :Beta blockers can cause bronchoconstriction in people with asthma. You havent mentioned asthma, just congestion. Those are unrelated problems.ACE inhibitors like lisinopril increase bradykinin, which can produce a dry cough. Again, unrelated to post-nasal drip or congestion.Calcium channel blockers like amlodipine are often first line and dont have any respiratory effects, and ARBs like losartan dont increase bradykinin, so thats reasonable, but it doesnt sound too likely that your problems are related to medications."}
{"text": "###Input :I previously had an inhaler because I was waking up in the middle of the night not breathing. Did a sleep study and no apnea. I also go through episodes where I feel like theres so much mucus in my throat I cant breathe, but I always attributed that to anxiety. ###Output :At that dose, metoprolol specifically is selective for the receptors in the heart and should not affect your lungs at all. At doses above 100mg/day is when I'd be concerned. (Other beta-blockers vary in their effect on asthma but metoprolol is a better one).As for Lisinopril I echo what the physician above said. It only causes dry cough and that would usually appear very early on when you take it. No effect on congestion.I personally had bad post nasal drip and congestion. Seeing a specialist helped so I'd suggest waiting for the ENT appointment."}
{"text": "###Input :Can someone be more prone to respiratory infections?Almost every year without fail, I get an upper respiratory infection. Every spring it starts out seemingly as allergies, an itchy nose and throat, sneezing, etc. then it slowly makes its way down and I get a respiratory infection. I dont know why but it just always happens without fail. One year it got so bad that I started to have fluid buildup in my lungs and had to have a lot of antibiotics. This year its quickly getting bad but I just moved recently so I dont have a doctor, barely productive cough that tastes like blood/nasty and some chest heaviness along with fatigue and a hoarse voice/white spots on tonsils.No one else seems to have problems like this, so I was wondering if some people are just more prone to stuff like this? Ive gotten them constantly no matter what environment Im in, and it always quickly gets really bad. Even during my childhood I got them really bad, and I had RSV as a kid. Usually I dont get any answers, its just yeah you have an infection, heres antibiotics.Other than this Im a completely healthy 21 year old female, no existing conditions and no medications other than melatonin. ###Output :Note: I am not a pulmonologist.Having had pneumonia in the past, you are more vulnerable to getting pneumonia recurrently. You might want to consult a pulmonologist to see if there's something else going on. Asthma, chronic bronchitis, reactive airways disease, and a few other less common causes of seasonal/recurrent respiratory illness might underlie your problem. Also, because you've had recurrent respiratory illnesses, you should get annual flushots and update other immunizations. If you smoke or vape, the best thing you could do is quit. Inhaled substances are not prudent if you are prone to respiratory illnesses."}
{"text": "###Input :Morphine and breastfeeding21f, in Ontario Canada, breastfeeding a 8 month old. Is there any safe amount of morphine I can take for pain while breastfeeding? ###Output :Morphine is generally safe and has low transfer through breast milk.However, make sure youve maxed out your Tylenol first. 650 mg every six hours can go a long way towards pain relief."}
{"text": "###Input :Thank you for this! Is 650every six hours the max dose for Tylenol? I do not want to take narcotics but sometimes it seems like the only wait to get the pain to a point I can function. ###Output :Max dose is 1000 mg every six hours, but I think you have diminishing returns after 650 mg. Plus, wouldnt go too much higher with breast feeding."}
{"text": "###Input :Can I wait this out? I dont want to go to urgent care35F 140lbs. Been having what I assume is an upper respiratory type infection for like 3 days. Coughing up green mucus, from sinuses too. Its thick and sticky. Taking mucinex daily and drinking a lot of water. No fever.My husband insists I go to urgent care because of the green thick mucus situation. I have no fever, can I just wait this out and see if it gets worse in a few days? I dont want to be put on antibiotics by a doctor if its just a virus. ###Output :If only 3 days in and not having fever or really bad facial pain, I have no reason to think that you have a sinus infection instead of just a viral upper respiratory infection. I don't think urgent care is warranted in this situation."}
{"text": "###Input :No bad facial pain. Just coughing up mucus from the chest. Im assuming from dripping down my throat ###Output :Yep, sounds like a nasty virus. Hydration is going to be key."}
{"text": "###Input :Ongoing respiratory issuesLast week I started coming down with what felt like a cold. But my chest was aching very bad (under left breast and into back) and was having a hard time breathing. Gave it a few days to sort itself out but it got worse, ended up in the urgent care with a fever, cough , chest pains. Was coughing up brown, green and blood tinged mucus. Did X-ray.. doctor said they saw bronchial cuffing but radiologist stayed X-ray was all clear (confusing..) doc put me on a zpac and Im on day 3 of 5. Im still having chest pain, low grade fever and coughing up blood, and green mucous. I am a smoker and noticed after I smoke I feel horrible with chest pains and sweating.. going to ride it out another day if I am still unwell tomorrow should I go to er for another chest X-ray? Nervous about lung issues/as a ct scan awhile back showed partially collapsed lung and lung nodules. I dont feel that the antibiotic has been helping Much. Im a 27yo female so I feel Im sort of young for any serious issues ###Output :Another chest x-ray this soon is probably not going to show anything different. Infections take time to clear, at this point I would recommend continuing the antibiotic and waiting. If your symptoms haven't started to improve after the last day of the antibiotic, then consider going back in for a reassessment. Also, smoking really diminishes the lungs ability to fight infections. I would recommend quitting smoking."}
{"text": "###Input :My neighbor (36M) dropped dead in front of me. I failed to resuscitate him. Hoping to get better understanding of his cause of death.This happened a month ago and Im sorry if this isnt the right place but it was a traumatic event for me and I think having some potential logical explanations might help me move on.My neighbor (who I didnt know at all really) was a 36 year old male, slightly overweight. He worked construction I believe. I was out front of my house when his truck drove down and he kind of pulled into his parking space a bit erratically but I didnt think much of it and was busy with my daughters. After what felt like a couple minutes (but was actually 12 mins according to my security camera), another neighbor screamed and said hes not breathing and asked me for help. I called 911 and immediately helped get him out of his truck and onto his back. He was blue. Me and another man took turns doing chest compressions until rescue arrived. They were able to get a pulse back but he ended up dying a week later.He and his wife had a brand new baby. They dont speak English and so when I asked her what had happened she told me as best she could that it was not a heart attack. That it was respiratory arrest. That he had a form of syncope.I actually have syncope myself (neurocardiogenic syncope and take beta blockers) and didnt want to ask any further questions. Just wondering how such a young guy can go from driving one second to just not breathing the next. As far as I know, my doctors have never told me I might just faint one day and stop breathing as a result. Im guessing this is a different kind of syncope. Just wondering if anyone knows of any possible reasons?Edit: I wasnt expecting so many responses and am so grateful. There are so many potential causes of death I hadnt thought of. Its really moving hearing so many doctors and paramedics share their own stories of losing patients and the emotional ramifications. Thank you. Im going to absolutely pursue counseling.Ive had a couple people message me about his widow and baby. I wanted to update that Ive been doing my best to help them. I got a fair amount of baby gear donated and my husband and I bought her enough groceries for a month as well as a $200 gift card to the grocery store. I also printed photos (which I got from her sister) of him and his baby on archival quality paper and framed them as a gift for them. They were already struggling before he died and both out of work. It seems like since his death, a lot of family has arrived to help her out too.And lastly, it wasnt covid (luckily). Its been a month and I already tested negative. ###Output :Just chiming in to reinforce what has been said. We can't tell you exactly what happened, because we can't know without a lot more information. However, we can say a few things.Seeing someone die is always a hard thing to deal with. The first death we all saw in our careers stay with us, even when doing CPR becomes a routine thing, and if you ask the majority of us we'll be able to tell you what happened in detail, even after quite a few years. It does get easier though, once you realise that the person you were trying to resuscitate needed resuscitation in the first place; they were dying without your intervention and you did all you could to try and change the outcome from what was already going on. In your specific case, the fact that you kept pumping his blood for him well enough for paramedics to get a return to circulation means you did a good job of it.You should consider talking to a counselor about this. It is definitely a big thing to process, and it's normal to struggle with it. We usually get a debrief from our seniors after a death, and getting to talk it over with someone who can help you unpack it all is quite helpful.Also, know that there are various different kinds of syncope, and the kind you have doesn't cause an increase in your risk of sudden death."}
{"text": "###Input :I cant like this enough.I havent been authorized by the mods of this sub, but I want you to know that every death is a tragedy to medical professionals. Regardless if youre prepared for it or not, its hard to deal with losing someone. Even if you know your patient is terminal, it still hurts to have it end in death.You did everything you could, and MORE than most would do.Im so sorry you had this experience, but please know that you reacted stronger and better than a huge majority of people would. ###Output :every death is a tragedy to medical professionals. Regardless if youre prepared for it or not, its hard to deal with losing someone. Even if you know your patient is terminal, it still hurts to have it end in death.Truth. As an oncologist, I have just grown numb to losing a patient. It still feels like a stab in my heart every time."}
{"text": "###Input :Hey man, just wanted to let you know that youre a great person for venturing into such a difficult field. Take care of yourself. ###Output :Thank you"}
{"text": "###Input :That's totally how I felt reading this. OP, you did amazing. I knocked myself out at work last year and all people could do was run around screaming. You were nervous but composed and did an amazing thing keeping him as best as you could until the paramedics arrived.OP, I am really proud of you, not only for your quick action but also for your caring. We can't save everyone but the people who try make me proud to be human. ###Output :Know that you did everything that you could. Don't feel guilty. He might've had cardiac issues that resulted in cardiac arrest. Likewise, things such as OD cannot be ruled out either.When I was a resident, events like this often triggered me to have a meltdown. I'd feel guilty. Why couldn't I have saved that man or woman during that code blue? At the end of the day, we have to realize that death is a part of life. Of course, I learned this over time as a young doctor. Sometimes we cannot resuscitate an individual no matter how hard we try even if there is a crash cart with all the emergency supplies right next to us."}
{"text": "###Input :I go to therapy once a week for a different reason, but the one thing that helps with closure with traumatic instances is EMDR. Its like what op said, but instead of writing the event out, you work with a therapist and say the event until you feel safer. I always hold these things in my hand, as we go through the event little by little, hell ask me one to ten how do I feel (about what I just talked about) and tell me to just focus on that and well do a set. The thing in my hand (dont know what its called) will start vibrating in my hands (think like hand held massagers that were popular in the 90s ish. Its not big, but it buzzes and vibrates in your hand. Does that make sense?) Its so soothing, and I always feel like I am slightly floating and turning. Absolutely not in a way you would high. Then he would stop and ask what I notice now? I would explain the next part and repeat. When we had to stop for the day (or week, depending how often you went) he would ask 1-10 how I was feeling, do a set and I would gently open my eyes. We would do this until I felt comfortable enough to feel like the incident was more safe in my mind.ETA: I forgot to mention, in the beginning of the session, he would show me a list of emotions and ask which one could best describe my feelings of the event at that moment. Then ask 1-10 of my emotion. We would then do a set before he asked me what I noticed from the event.Every appointment, he would ask if I felt like processing that session. Sometimes you need a break, and thats okay. You still have someone to share anything you feel comfortable sharing who is a third party. He also started the processesing session showing me emotions, asking how I felt 1-10 and I could share starting with the beginning from last session, or where I left off. The whole point is to talk about the event on your terms and process how you need to. ###Output :Realized I havent let myself process what happened.It will take time; don't be afraid to seek help from a therapist. Just know that you did everything right. Thank you.I just wanted to thank you for doing CPR on this guy. You did a good job, it's so important that people try to resuscitate a patient in this situation. Sometimes it wont work depending on the underlying disease. But that's not your fault. You guys did the right thing!"}
{"text": "###Input :NAD, Im a 911 dispatcher. The fact that EMS was able to get a pulse back means you and your neighbor did the right things and did your absolute best to give him a fighting chance. Unfortunately, sometimes no matter what you do, its not enough and its too late. So many times, cardiac arrest calls we take end with EMS doing CPR until getting to the hospital, and the hospital calling it shortly after. Perhaps your quick action gave his family time to see him a last time and say goodbye. I hope you find peace and comfort... and even just a few sessions of therapy can provide such a huge benefit toward professing things like this. ###Output :Echoing all that was said here.First off, thank you for trying to help. These kind acts keep society alive despite political posturing and divisiveness in social media.As hard as it is to imagine and as difficult it is to go about your routine, inaction would be far more paralyzing. You did everything that you could in his time of need. I have had similar instances in my career in the ED and this same message was relayed to me early in my career: We can only do everything we can do and nothing more. At the end of the day, you gave him a chance. If no one did anything, he would have died. You gave him a chance.I cant speak to exactly what happened, but respiratory arrest is essentially saying that he stopped breathing. That could imply severe asthma, anaphylaxis/allergic reaction or even cardiac arrest (eg, I had a 42 yo MI in a patient just today). Or pulmonary hypertension.I wouldnt rule out overdose. Narcotic addiction has almost never been higher and is one of the leading cause of death of young people. I pulled someone out of their car unresponsive, cyanotic last week for the exact same reason.I trained in one of the most severe areas of narcotics in the US, Kensington in Philly. Its everywhere and a daily occurance. An opioid addicts life has been replaced with daily struggle to obtain narcotics or suffer debilitating withdrawal that few ever want to experience in their lives ever again. Its said that alcohol withdrawal can kill you; narcotic withdrawal makes you wish you were dead.Fortunately, there is help. Suboxone and other treatments can help to replace their addiction with an extremely safe and effective alternative. Its unfortunate that this happened and likely could have been well known by the family. I have had this converation far too often in my career. Parents who performed CPR on their child as they were holding their grandchild in their lap on christmas morning, the daughter who could no longer struggle and overdosed on every pill in the house and the 15 year old who is going to gift of life after found in the rear of the bus. Family are expecting that someday that they will get a phonecall - they just dont know when.The carfentanyl that is used in place of heroin is deadly for anyone who cant fight their addiction and relapse, only to find that the ford taurus of narcotics was replaced with a tractor-trailer. And its often too late. Methadone can be used, and maybe used by some on the street or for pain control, but its hallmark is that your breathing is stopped often before pain control. And it has some of these cardiac effects that were mentioned regarding hydroxychloroquine.Narcan is a medication that is widely utilized. It reverses their apnea (lack of breathing/respiratory arrest). But its temporary. Sometimes ingestions can rebound and the effects can wear offI trust that you did everything you can.If this continues to haunt you, in addition to asking your family doctor for a referral to someone to speak to regarding your experience, ask for a prescription for narcan. Even our local libraries carry some. Keep some in your bag. Speak out, see if there are groups in your area that you can support financially or otherwise. Reach out to the family that was involved. Addiction is often a genetic process. Finally, if you have your own kids, be aware that opioid addiction can happen...especially those with addiction tendencies. It can happen with as few as 12 pills.Best of luck. And again - thank you for all that you do!"}
{"text": "###Input :Its said that alcohol withdrawal can kill youHow can it kill you? That's insane!It can happen with as few as 12 pills.It's seriously that addictive? I was on codeine cough syrup for three months and I had no problem putting the bottle away when my cough was gone. Maybe it helped that I genuinely hated every single thing about it except for the cough relief. ###Output :How can it kill you? That's insane!Since you don't appear to have gotten an answer. Two main ways. Alcohol withdrawal can cause seizures, which can be deadly, and alcohol withdrawal can cause something called delirium tremens. Delirium tremens is more of a form of withdrawal characterized by quick and varying changes in someones heart rate and blood pressure in such a way that it can kill (through irregular heart rate called arrhythmias) or a person can become unable to \"protect their airway\" so to speak and choke.Alcohol withdrawal isn't a pretty thing. BUT the good and bad news is that it varies a lot from person to person.https://emedicine.medscape.com/article/166032-overview"}
{"text": "###Input :I'm not a doctor so I can't say much on what happened but I went through something similar.An elderly man that walked past my house every day to go to church collapsed in front of my house. I have no idea how long he was there. But I heard a woman screaming for help so I went outside to look. He had no pulse. I gave him chest compressions until ambulance arrived but i knew he was already gone. I could hear air going in and out of his lungs from the chest compressions. I'll never forget that sound and how sad I felt doing it to him when I knew he was gone and feeling his ribs crack. This was 5+ years ago and I still remember it like it was yesterday. I still wonder if i had looked out my window sooner if he would have survived and wonder how long he was there before the woman saw him. I also remember how the fire fighters arrived first and stood around me and told me to keep going rather than take over. It was definitely traumatic.I feel so sorry for your neighbors family. So young and so much life ahead to live.Life really sucks sometimes.I will always remember the experience and it was hard to process at the time but it did get better as time went on. ###Output :This probably doesnt really add anything, but I just want to reiterate, THANK YOU. You did something that is incredibly hard both physically and emotionally. You kept your cool and did what needed to be done, and what each of us hope that someone would do for us or our loved ones. The causes of suddenly death make a long list, and include things like congenital or acquired arrhythmias, vascular issues including aneurysm rupture or clot in the brain or lungs, and among many many others drug overdose which is sadly probably the leading cause in this age group these days. Im sorry that we cant really give you an answer here. As others have said, please seek help if you need it to process this event. Its a trauma and not something that many people have experienced. Remember that you did everything right, there is likely little that would have changed the outcome, and that you helped give his family a week to say goodbye."}
{"text": "###Input :To respiratory physicians: is length of time of holding breath an indication of lung capacity?Im a 24M, light smoker, on no meds, weighing 71kg at 175cm.For a smoker who is hypersensitive to the effects of smoking on his body, I am often testing my lungs, usually while exercising (swimming), to see how long I am able to hold my breath. Am I making a false conclusion when I see that my ability to hold a longer/shorter breath correlates to better/worse lung health?Side note: Ive heard that lung capacity can only deteriorate, and is rather stubborn in improving, or all together impossible.. so what gives?Ps: if there is a better sub to ask this question, please do suggest it! ###Output :The other comments here are correct that breath holding time is not an accurate reflection of total lung capacity (TLC).But to unpack your question a little further, TLC is just one of many variables important in lung health. Chronic lung disease from smoking is predominantly obstructive (COPD), which is measured by a decrease in the forced expiratory volume in 1 second (FEV1), often also expressed as a ratio to the forced vital capacity (FVC), or the total amount of air you can blow out at once.If anything, smokers tend to increase their total lung capacity as their disease progresses because they are trapping air, unable to blow it out."}
{"text": "###Input :Respiratory sinus arrhythmia or sinus pause ?? EKG (sorta) included20M, 52, 150lbs, hypothyroidism, anxiety disorder, depression, .5mg Xanax, 25mgc levothyroxine, 12.5mg metoprolol 2x dailyHi again !! So I have one of those at home 1-lead ekgs and whenever I do one and take a deep breath I notice my heart rate slows down and it looks like it skips a beat...... can anyone tell me what this is ?? I have a lot of anxiety around my heart and bought the ekg to monitor my heart rate and I know these things arent 100% accurate but this is worrying me. Sorry if this is asking a lot but im not seeing my cardiologist for a couple weeks so could someone tell me what this looks like ? https://imgur.com/gallery/wjuAjvy ###Output :100% normal - this is respiratory sinus arrhythmia. Stop checking."}
{"text": "###Input :Update to Previous Post Regarding Cough Up Blood After Workout. Results Were SurprisingAge: 31Sex: MHeight: 6'6\"Weight: 250 AthleticRace: White/CaucasianDuration: 4 1/2 MonthsLocation: Lungs/Upper Respiratory, Upper G/ICurrent Diagnosis: Stage 4 Aggressive Gastro-Intestinal CancerCurrent Meds: Pain Killers, DiureticsAs needed Meds: Lidocaine Patches, Anti-Nausea, Melatonin sleep aidOriginal: https://www.reddit.com/r/AskDocs/comments/c2ls61/chronic_cough_and_now_coughing_up_blood_after/?utm_medium=android_app&utm_source=shareSo after spending some time at an Urgent Care, getting some scans lined up and trying to be patient, I woke up one morning to pain and compression over my chest. Urgent Care Docs had advised me that any escalation of symptoms should mean I go to the Emergency Room. Once there they almost immediately checked me into the ICU for observation and began running every test you could name. For the next 4/5 days I did just an unreal number of scans, 2 biopsies, and they drew enough blood to fill a small pool. Pain escalated daily while there so finding a solution was a running theme. So after a lot of trails here's what they found:Current: Stage 4 Aggressive Metastatic Gastrointestinal Cancer ( Adenocarcinoma )Previous: Disseminated Intravascular CoagulationAfter doing a Lymph Node & Bone Marrow Biopsy they found my marrow filled to capacity with dead cancer cells. This pointed them in the right direction. My platelets were crashing daily (20,000 at admission) and I've got inflamed lymph nodes throughout my chest cavity which is one source of my (significant and at time escalating) pain. Its infiltrated my lungs and several vertebrae along my spine (causing vertebrae to show signs of Osteopenia) . Weirdly enough there's no noticeable tumor/mass/lump they can trace it back to. It's kind of just spread throughout (described as Adenocarcinoma) , though they were finally able to locate a small ulcer in my stomach that allowed them to finally be able to classify it. I've currently just completed my 3rd (now weekly) round of chemo (we started asap when other options such as clinical trials were deemed a non-option) and we've been able to stabilize a number of things (blood factors such as platelets, hemoglobin and the like) along the way. Many of my blood counts are still in the trash so clinical trails are not currently an option. In early stages of my 3 weeks hospital visit I was in a state called **DIC (**Disseminated Intravascular Coagulation) which caused me to act like something akin to a blood squirt gun if i bled. Essentialy it screws with you clotting factors and any bleeding event is an issue. Any procedure became an issue and many my numbers were artifically raised in order to attempt anything that would cause me to bleed. Fortunately after a week of treatments and what felt like several wheel barrows of infusions we kicked my body out of D.I.C and am more or less clotting normally. Fun story: early one morning after the vampires took their daily does of my blood a CNA came in to do a routine vitals check. This particular morning they took 2 unique sets of blood samples plus a rather large sample for testing against infectious disease. This was also kind of at the height of my \"he's not clotting\" phase. During the blood pressure check it popped open all the fresh holes in my arm, causing them to bleed and freaked/surprised the CNA. Made me laugh. (end of story). Immunotherapy is what my Oncologist are banking on right now so crossing my fingers. Chemo is causing reasonable progress (numbers are low but stable) so we're staying the course for now. My personal mid->long term goal is to find an alternative to opiates for pain management (who the hell knows why a person tolerates opiates for a buzz cause constipation sucks!!!) so looking at alternatives (THC pills potentially or preferably resolving the issue that's causing me pain) I've been discharged from the hospital after 3 weeks so now I'm working to find a routine that works. Losing weight so a short term goal is stopping that (I'm rather tall and (was) muscular so my bodies nuking whatever calories I put in and I'm not putting in a lot due to general nausea, but smoothies have been my friend. Please let me know if you have any questions or advice.. I'll answer what I can and absorb what reasonable advice I read. ###Output :Man, that was not high on my list of possibilities after your original description. Sorry to hear. Give it hell."}
{"text": "###Input :Fortunately I do, and they've been a tremendous help. Would have been very difficult without their aid. However , things have mellowed out enough, now that I've been discharged, that most everyone has been able to return to their routines, which is nice. Their support was invaluable but I was eager to get everyone back to their normal lives as well for their own sakes and health. ###Output :Thanks for the update, OP, though I wish it were better news.I will leave this up for now as OP has a specific follow up question regarding pain and symptom management. However, if this thread becomes off topic (including an excess of well wishing in relation to actual advice being given), we will lock it.We all want OP to do well. Stay on topic so we don't bury good advice that may come forward."}
{"text": "###Input :My significant other's health has sharply deteriorated and after months we have no idea what it is.Hello. My (24F) boyfriend, Paul (29M), and I are fairly active. We go on road trips every year with our main stops being prime hiking spots. Paul is 5'7'' and 230 pounds. Due to his southeast asian/pacific genetics, his entire family is on the heavier side, but Paul is just as active as I am and eats well.Recently, we have gone long distance. Paul returned to live with his parents due to the pandemic while I stayed where I was. I visited him in June 2021. At this point, Paul had few symptoms, but some new minor health issues. We went hiking around Lake Tahoe and Paul was a little more out of breath than usual. He hasn't needed to use his inhaler since he was a kid, and he had to use it on this trip. We attributed this to recent wildfires in the area and poor air quality.However, Paul's health continued to sharply deteriorate. We went to Edinburgh, Scotland, in July. While hiking Arthur's Seat, Paul had to use his inhaler so many times he emptied it out. He could not get it refilled as we were out of the country. Until the end of the trip, Paul's breathing became more and more labored and he developed a persistent cough.I did not visit Paul August-November 2021. We spoke on the phone and Skyped regularly. During this time, Paul would sometimes leave the call or mute for a few minutes. He'd come back and apologize, saying he'd had to cough pretty violently and didn't want me to hear. I was concerned. I overheard one wracking, moaning coughing session and knew it was not just asthma or an irritated throat. By October 2021, the air quality in his area had greatly improved.I persuaded Paul to visit his general practitioner. His GP dismissed all of his concerns and cited Paul's being fat and asthmatic as the source of his issues, and that the issues would disappear with rest and exercise. I had to fight doctors for years to get them to take my chronic pelvic pain seriously, and was finally diagnosed with an ovarian cyst that was 8mm long and about to burst, so I have experience with self advocacy in the medical space. I helped Paul see new doctors.In mid-October 2021, Paul developed abdominal edema. Paul's feet, legs, and lower stomach were swelling up like crazy. He gained 40 pounds. He could barely move at all, even to go to the bathroom. He couldn't sleep lying down without suffocating, which only worsened his exhaustion. He went to the doctor again and was prescribed diuretics. The diuretics helped with the swelling and extra weight and within 2 weeks he was back to his regular weight, but the coughing and weakness persisted.About a month after regularly taking diuretics (November), Paul started feeling intense nausea on a weekly basis. This nausea would prompt coughing fits. Paul couldn't eat or focus while nauseated. Our calls became more and more infrequent as Paul's nausea and headaches grew. He told me sometimes the nausea would get so bad that he would vomit. There were no patterns to the vomiting--it didn't happen at a certain time of day or after meals. Sometimes it was foamy. He got a CT scan to look at his gall bladder and all results were within normal ranges. Blood tests, including labs for liver function, all came back normal. His doctor referred him to a gastroenterologist for more testing, but due to increases in COVID-19 cases, they haven't even processed his file, let alone scheduled appointments, which would be months out. A nurse anticipated he wouldn't be able to go in until February 2022, but at his rate of decline, this has me concerned for his mental wellbeing and life quality.This week, in late December 2021, I visited him and his family for Christmas. I had heard from Paul about his issues and was following closely with his medical updates, but seeing it firsthand was another thing altogether. I have never seen human suffering and sickness like this up close or cared for another human being in such an intimate way.Every single day, he has intense coughing fits and bouts of nausea where he makes vocalizations and gags, usually every few hours. At least once a day, these coughing fits are so bad that he spends 5-30 minutes vomiting in the sink. The vomiting has increased drastically. After this, the nausea alleviates, but Paul feels exhausted and has migraines. He barely eats. He barely sleeps.Today, he had three different nausea/coughing bouts that induced vomiting. One developed rapidly and he threw up in a restaurant bathroom. The last one, which just happened this evening as of writing this post, also caught him by surprise, and he vomited in the kitchen sink. The vomiting was so physically taxing that his nose bled profusely and he lost control of his bowels and peed himself. He was not strong enough to make it down the hall to the bathroom. Eventually, I assisted him into the shower. I am writing this before bed, and he is still coughing, and has a migraine. He hasn't gotten up from where he sat after taking the shower.I would appreciate any medical advice about what might be causing what Paul is going through, as well as tips for how to navigate the medical system to ensure this gets treated in the best way possible. I would like to reiterate that while neither of us are marathon running body builders, Paul (before all of this) was physically active and monitored his eating habits. He was also mentally active and had returned to school to pursue a degree in a new field. We both have families that are reasonably well off and are good support systems.Paul is one tough puppy, and reassures me that it \"isn't so bad,\" but after seeing it firsthand, I know this is not something that can continue the way it is. I am extremely worried, and caring for him is beginning to wear on me mentally. Sometimes I feel sympathy nausea when I hear the noises he makes in the bathroom.Please help in any way possible. I appreciate any and every tip, and can provide additional information if needed. Thank you very much.UPDATE 12/26:We went to the ER at 4 AM right after Christmas. Luckily, it was almost completely empty. I was not allowed to go back with him, so for the entire five hours I was sitting in the waiting room, I was only ever accompanied by one or two other people at a time.Paul's shortness of breath, fatigue, and wracking coughs got him seen quickly. He texted me updates as things progressed. He got every test I wrote down from these comments--BNP test, pulmonary work, chest x rays, GI work. An echocardigram is scheduled for next week.They found out right away that Paul's BNP results were seven times higher than usual. They said this was indicative of heart failure. They also tested Paul for COVID 19. He tested negative, but did test indicating he had some kind of viral illness.Paul's doctor concluded that he was suffering from chronic RSV that was made worse by poor genetics, asthma, and obesity. Paul did confirm he had what felt like a respiratory illness in Scotland in June, then after going to a wedding in October, then this week when he got severely ill and we found out his mother had a cold.There is no cure for RSV, but a vaccine has reached human trials. The only things Paul can do to alleviate his own suffering and avoid a heart attack is to make significant lifestyle changes and live like an immunocompromised person. I believe in his ability to achieve the former, but the latter is more difficult because of his emotionally overattached mother who brings the entire extended family out for lunches, movie nights, shopping, etc. several times a week. I'm concerned she won't take it seriously or will be in denial to avoid feeling responsible and will therefore continue to expose Paul to colds that could kill him.Paul is currently resting. He was given medication for his nausea and a new inhaler. He is doing better but still coughing. We have already started on his new food regimen. I am hoping for the best, but the pandemic has proved that people rarely take precautions for others' goodwill. Thank you for all your support. Paul might never have gone to the ER if I hadn't visited and reached out to this community. ###Output :He needs to go to the emergency department. It sounds like he has some sort of heart failure causing the shortness of breath and swelling. The nausea and vomiting could be anything, though Id be concerned about electrolyte abnormalities or increased intracranial pressure. Heart failure can cause it too but not this severe Id imagineDont have a great answer tying them together thoughThis was pretty much exactly my thought process as well. Hard to tie all of these symptoms together until we start a work up, which should definitely include an Echocardiogram. Go to the emergency department to get started, then will probably need to stay in the hospital until a diagnosis and care plan is made, as well as symptomatic improvement."}
{"text": "###Input :What about ruling out lung cancer? You dont have to be a smoker or old to get lung cancer and unfortunately Asian/Pacific islanders are at higher risk? ###Output :Lung cancer is almost unheard of in your 20s. Also none of the symptoms other than cough fit"}
{"text": "###Input :Disclaimer: Not a doctor.With Paul's history of being active outdoors(I also wonder if he has any pets?), I also wonder if the hospital should be checking for Lyme Disease? Depending on his other symptoms not sure how high up it would be on the differential?I know that coughing is pretty rare in it, but from the sounds of it whatever he's had has been going on for a prolonged period of time, and it kind of sounds similar to this patients story, but also maybe not entirely?I guess it could be something for the OP to ask the doctor about that they're talking with. ###Output :It is something I thought about though I dont know Lyme prevalence in the UK and more importantly Lyme is more associated with heart block than with heart failure. Something worth thinking about though"}
{"text": "###Input :When you look at intracranial pressure, how does that affect how someone breathes?I know it makes you work harder to breathe but not why. ###Output :Theres the Cushing reflex which makes you breathe shallower but Im not 100% sure the nausea/vomiting and breathing troubles are relatedGood lord this is a hospital visit.As a physician these symptoms would spark a large battery of tests in my primary care office, but it sounds late for that. He needs to try a hospital. Make sure he tells them exactly what you wrote here."}
{"text": "###Input :I dont mean to be rude with this question but I know as someone with chronic illnesses I am generally reluctant to go to the ED when they flare up because of the whole history of being told theres nothing doctors can do for me, or its just because Im fat, anxious, whatever. If hes been dismissed by doctors before what should he say now to make sure he actually gets the care he needs? ###Output :Its always hard to say what another doctor saw or thought when someone got care. Miscommunication between providers and patients are extremely common with chronic illness. With flares of chronic illnesses there is often not much that can be done outside of the norm, and brief emergency care is frequently not enough to solve the flare but hospital care is frequently not indicated, which can make one feel very much dismissed.In this case, OPs BF has several huge red flags that suggest he should go to the emergency room for evaluation.Severe worsening nausea and headachesLoss of bowel/bladder controlProgressive coughing and shortness of breathFluid buildup requiring diuretics (this is VERY unusual and requires a significant evaluation that I dont see written about here)"}
{"text": "###Input :How can we determine which ER around us is the best/most advanced? Paul's insurance is considered good (Kaiser Permanente) but his doctors barely listen to him, infrequently order tests, and weren't overly concerned/in emergency mode over the fluid buildup. ###Output :If he is a Kaiser insured patient he will only be able to seek care at Kaiser facilities. This is a situation of the squeaky wheel getting the grease. He needs to go to the biggest Kaiser in the area and be on his doctors ass every single day until he gets help."}
{"text": "###Input :There is a Kaiser ER near us. Hopefully they listen. ###Output :Kaiser is generally a good system, but weird things can be harder to diagnose in the system because they are much more conservative in general with testing"}
{"text": "###Input :Ideally it should be an academic / teaching hospital. They're more used to seeing unusual cases and thinking outside of the box. ###Output :This will not be possible with Kaiser insurance, they will simply send him to a Kaiser hospital from the academic hospital ER, and he will get a large bill for it"}
{"text": "###Input :Im with Kaiser and Ive gone directly to the ER for an emergency by ambulance. I just paid my co pay. ###Output :It can happen, but you cannot be admitted to a non-Kaiser hospital unless you are too unstable for transfer or the Kaiser is on diversion for some reason."}
{"text": "###Input :I agree. He should go straight to the most advanced ER/hospital local to him. A lot of things are probably going on.Once the more acute and scary things are sorted out I'd look into a sleep study to find out if he has sleep apnea since it can cause a cascade of serious problems.Also I do not mean to sound insensitive (and of course doing this is a very personal decision) but if obesity is a big problem for him he may want to consider weight loss surgery after he recovers from whatever is going on now. I was obese my entire life, once my health started failing I had gastric bypass surgery and I can't tell you how much it has helped me and probably saved my life. ###Output :I agree he needs urgent evaluation with his worsening symptoms. The differential is broad for his various symptoms and will likely need cardiac, pulmonary and GI workup."}
{"text": "###Input :The most important part is that - while you may have a list and such, an ER visit isnt going to find the exact diagnosis right there and perform all those tests at your request. The goal of this visit is going to be to assess for any acute abnormalities OR to get him admitted to an internal medicine team that can take the time to work these things out. ###Output :Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."}
{"text": "###Input :As the physicians here have responded, go to ERnow. And please update! Very curious to hear his outcomes. Best of luck to you ###Output :Does he use drugs, specifically marijuana?Food allergies? It would be a bit drastic, and may not explain the swelling, but you can develop them at any time.A bit young for cancers, but maybe he is genetically predisposed, getting at least a CT scan with contrast of his abdomen would be good.This is concerning for his heart too, as mentioned.He needs quick workup, as mentioned. Worrisome is not eating and what his electrolytes are like.Not that being obese is the sole cause of his symptoms, but he should lose weight. Almost every physician you will run into will say this as it is important for his health, just as they would tell him to stop smoking if he was smoking."}
{"text": "###Input :He doesn't use drugs and has no known food allergies. He was able to eat breakfast today, and so far it hasn't come back up, though he is coughing. I feel overwhelmed by these responses but appreciative. I'm worried about going to the ER because our area is having a huge COVID surge and hospitals are at capacity. Is it safe to wait? Where is best to go? ###Output :As tough as it is right now, you might have to take him for emergency care. If he is coughing/vomiting so much that he loses control of bodily functions and is unable to eat and generally take care of himself, he should be seen sooner rather than later.Are the headaches coming before or just after the other symptoms? Bad migraines can present with nausea and vomiting, and sometimes neurological complaints, as well.It's hard to tell more without seeing full labs and imaging, again, pointing to getting some answers quicker by going to an ER."}
{"text": "###Input :They were probably wondering if cannabis hypermesis syndrome could be contributing to ten vomiting ###Output :Yes, cannabis hyperemesis syndrome, or cyclical vomiting syndrome, as mentioned. Usually people who have been smoking daily for while, 10-15 years, but can happen with less."}
{"text": "###Input :[25m 175lb 61] Post-Concussion Respiratory IssueI suffered a mild to severe concussion on Dec 10th after flipping my car. Jan 13th I began to get sick. I mention this because I know it affects the immune system.So, 1/13; It started with a sore throat & a lump by my adams apple. For the first week It progressed to wheezing, headaches, extreme fatigue and as much mucus and snot that the body can produce. By Jan 22nd I felt better, but the mucus and sinus pressure was still there. Today is Jan 28th. The past 4 days Ive had mucus that began as lime green color the first two days, and the past 2 days (including today) has been the color of an egg yolk. I also coughed up blood a little while ago today. I have never had a sickness last me this long. Not even covid. Im concerned. What should I do? ###Output :It sounds like you have an upper respiratory tract infection.It could be that your symptoms resolved and you got a second infection.It could be that you've got a bit of congestion or post nasal drip. You can treat this with a mucolytic agent that can help the body break down and clear the mucous.It could be that you've developed a bacterial infection that is taking longer to clear and may require some antibiotics.It is likely that these symptoms have nothing to do with your car accident.Given how long your symptoms have been going for, I'd suggest seeing your GP or PCP for further treatment options."}
{"text": "###Input :Undiagnosed respiratory illness.32M177cm77kgEuropean whiteI've had an ongoing illness with no diagnosis for 2 years. Main symptoms are respiratory; sore chest, flu-like symptoms, no energy, coughing up blood and mucous, shortness of breath, exhaustion at the slightest of exertion. Numb nose, inflammation all in nose.I've had a CT scan abdominal and there was nothing too abnormal. One thing stated was large lung volume, but no signs of COPD, fibrosis. I also did genetic test with Ancestry which stated I have a significantly increased risk (although stated it could be a mistake) for lung diseases. I would like to know is there any clinical significance to increased lung volumes with no other symptoms? It's just something I am curious of but can't find answers online, like is it a precursor to getting COPD or something. Can someone explain if it means anything?At this stage due to the CT abdo scan coming back mostly normal, I am beginning to suspect some sort of nasal infection, but I would like someone explain to me what increased lung volume could mean, so I can move forward and narrow down my illness and eliminate all other possibilities whilst also understanding what it means. ###Output :There's honestly no real clinical significance to just noting large lung volumes."}
{"text": "###Input :For 19 days, My wife has had fever and muscle soreness to where I have to help her stand up and get out of bed. She is convinced she is dying. Please help.We have been to the clinic twice since this started but since she has no respiratory problems they did not test for covid. She had a chest x-rayMe and our 1 year old are fine. Wife did not get the flu shot this year so we think it might be related but for 19 days seems outrageous.She has been prescribed antibiotics and tamiflu which she finished two days ago.She gets fevers around 2pm and closer to bed time around 9pm. They've been around 102 on average and peaking at 102.9 a few days ago.We're scared because this hasn't let up for 19 days. Are there side effects if your body stays at fever temperature for long periods of time?Is 19 days unheard of for the flu?? Is it likely something else?31 F 5'9 188 lbs. Caucasian.Taking Tylenol regularly to fight fever and achesUpdate: Wife is in hospital. Thank you for the help.I can't be with her yet. All of our normal sitters and family are either out of town, unavailable or also sick.They would not let us bring the baby in so I'm just home waiting for info. She is at least in good hands. ###Output :She'd almost certainly have a headache though and I see no mention of that."}
{"text": "###Input :Headache can sometimes manifest as neck pain if its referred pain, I just wouldnt rule out. ###Output :Right, but I've never heard of neck pain without headache. It's referred from the meninges so it'd be very strange to present like that. It's always possible but the likelihood is maybe < 1%? Additionally, symptoms typically start improving within 7-10 days.Any answer on the mono testing? If shes never had mono it can be pretty brutal. Comes with neck pain and fevers for sure."}
{"text": "###Input :How severe is the neck pain? Look up Kernigs sign. Its a maneuver you can do to test for meningitis. Meningitis is the inflammation of the lining of the spinal cord and meninges in the brain. It can be caused by both virus or bacteria. Shed be positive if she has extreme pain and cant extend past 90. If thats positive, you need to call the doctor/ED. Also, meningitis can cause a pinpoint rash. If shes darker skinned, you could see it more easily on the palms and soles of the feet. Rashes May also appear with prolonged fever. You can do the tumbler test where you take a clear glass and press it against the rash. If redness goes away when pressed, then its negative. If you can see the rash still through the glass, then its positive. Its sounding more like Mono. If possible, see if the doctor can test. Mono needs to run its course, but it can have some complications. One of them in enlarged spleen, so no sports and if she has sudden upper left abdominal pain go straight to the ER. It also can cause liver issues, so watch out for jaundice which is yellowing if the skin. I hope she starts feeling better soon OP! ###Output :I'd be careful about posting medical advice like you are without fact checking.Kernig's is actually a pretty bad test for meningitis. It has a sensitivity of only 5% and a PPV of 27%. That's pretty awful. I also wouldn't recommend for untrained people to test it on themselves or their loved ones.Not all types of meningitis causes a rash. I believe you're referring to meningococcemia. I think this diagnosis is extremely unlikely as she has been having symptoms for 19 days. She would be dead by now. Symptoms of meningococcemia progress very rapidly. Also, the tumbler test is also a pretty bad test and all it does it to be able to differentiate petechiae from other blanchable rashes. It's not specific to meningococcemia and can also just be done with a finger.\"Prolonged fever\" do not cause rash. I am not sure what you are referring to here. Yes, a lot of diseases that can cause fever are also associated with rashes but it's not the fever itself that leads to a rash.I don't think Mono is likely here. While some of the symptoms would match, it would be unlikely to have persistent fevers for 19 days with simple mono.OP, I believe that at this point a visit to the hospital is warranted if your wife is as impaired as you are describing it."}
{"text": "###Input :THIS. NAD but same symptoms I had and it was sepsis. I was also sent home from doctor/ER twice before they realized it. Need to have blood taken for dx (in my case anyway). ###Output :Please read our rule on claiming credentials"}
{"text": "###Input :I wouldnt worry about COVID right now. As your wife is probably septic and requires urgent care to live and prevent death.Spesis KillsSorry to sound blunt please update us ###Output :This is your final warning on claiming credentials without verification."}
{"text": "###Input :Ok. Can you please send me the information so I can send through my information. Kind regards Rachelle. Sorry I have never done this before. ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."}
{"text": "###Input :Exactly. Ive seen a couple cases like this. Id still recommend for OP to have her checked in the ED. Would rather not miss another explanation such as underlying infection and like others have mentioned possibly sepsis. Id suspect an infectious source will need to be ruled out first as it can then be treated with antibiotics and is more lethal. If nothing is identified from labs/imaging maybe further pursue labs to rule out rheumatoid arthritis. ###Output :This sounds like it could be mono. It's possible she's septic from various sources but I'd think they would have been ruled out by the clinic you went to.Has she been getting worse or does it seem like she was bad at first and has stayed at that level?What does she doe for work? Has she had any sick contacts?"}
{"text": "###Input :Can the flu be misdiagnosed as an upper respiratory infection?M14Height: 5'3\"Weight: 145 lbsRace: WhiteComplaint: Very flu like symptoms; fever, aching body, being hot cold hot cold, chills, dry cough, the whole nine yards. Doctor did 15 minute flu test (nose swab) that came back negative and prescribed an inhaler and cough syrup for an upper respiratory infection.Existing medical issues: None to my knowledgeCurrent medicine and doses: Prescribed Fluticasone nasal spray; 2 sprays in each nostril and Poly-tussin liquidSmoke? No but secondhand smoke from parentsDrink? NoRecreational Drugs? NoAny help is greatly appreciated. I am happy to answer any questions.tl;dr Flu symtoms, got diagnosed with upper respiratory infection. Doesn't sound right. ###Output :Flu technically is an upper respiratory infection (in general, though it can cause lower respiratory infections). The false negative rates of the rapid flu swab are pretty low, so while it is theoretically possible, I would just assume that it's true that you do not have the flu. The flu is just one of many, many related illnesses that all act similarly. Our rapid nasal swabs only test for that one specific virus (influenza), but there are tons of other viruses that we cannot rapidly test for and which could cause similar symptoms. You could have parainfluenza, human metapneumovirus, RSV, etc.The treatment is the same for all of them, inhaler, cough syrup, Tylenol/ibuprofen/naproxen and time."}
{"text": "###Input :Ok. Thank you for answering! I do have a question though. How long should I stay out of school? I was planning to not go tomorrow, and have a doctors excuse to go back on the 5th. Is that good or should I stay out longer. A lot of kids have influenza but go anyway and the school won't shut down to prevent infections. On a sort of related note, I had RSV as a baby and have had bad lung function ever since I can remember. ###Output :Just stay out of school until you're feeling better. The 5th sounds reasonable to return. Ideally people would not be in school when they're sick, but the reality is if you're in school you're going to get sick in the winter. Lots of babies have RSV, I don't know that it predisposes you to having it more as a teenager."}
{"text": "###Input :My dad had an upper respiratory infection and now I am nervous from being around him.Age: 44Sex: MHeight: 6'3Weight: 202lbsRace: WhiteDuration of complaint: NALocation: TennesseeAny existing relevant medical issues: NoCurrent medications: NAMy dad and sister went on a vacation trip to Peru roughly two weeks ago. About a week after returning from the trip he developed runny nose, chest congestion, probably a fever (never took his temp), and a bad cough. He is in his late 60s and already has a weakened immune system from a bone marrow transplant he had a few years ago, so he just chalked it up to the common rhinovirus cold that he seems to get every year. I went to visit him this past weekend (about a week after his symptoms started). He didn't have a fever or anything, but had a pretty bad cough the entire time I was there. All in all, he was healthy and out doing stuff the entire weekend. However, with so much coronavirus in the news, now I find myself contemplating whether or not its POSSIBLE he had it (I havent seen Peru in the news, but ya never know) and if I now possibly have it (I am currently observing no symptoms and was at his house from Friday to Sunday morning). He was not observing very good hygiene protocol with his coughs, and I had to chastise him numerous times for coughing into his hands or not covering up at all. Again, he had zero symptoms at time of visit other than a lingering cough. I guess my question is, should I be dedicating any real estate in my mind right now to worrying about this corona virus? It should be noted that my sister was in close proximity with my dad the entirety of the trip as well as a week after the trip when he started getting symptoms, and she has shown zero signs of anything. With all this panic in the news, I just find myself silently listening or observing my body for the onset of symptoms and its interfering with my daily life. ###Output :You do not need to worry about 2019-nCov at all. There have only been 2 imported cases in Brazil and 1 imported case in Ecuador in all of Latin America. Even if there had been cases in Peru, the odds of him coming into contact with it would be very slim, and the Futher odds of you being at any sort of risk would be neglegible.Stop panicking about this, and get your flu shot every year."}
{"text": "###Input :81 y/o female- respiratory distressMy grandmother got pneumonia this time last year. Currently she is achy, having trouble speaking, her throat hurts very bad. We went to the Doctor a few days ago, they took an X-ray of her lungs and said there was one area with fluid they wanted to keep an eye on but werent too worrisome. Today I call her and she can barely speak and is wheezing while breathing. Do we need to go to the emergency room? ###Output :Yup"}
{"text": "###Input :Post-Respiratory Illness - Cardio -- persistent elevated heart rateI have been sick with a respiratory illness for several weeks. I tested negative for the flu, the doc didn't think it was COVID-19 and would not test me. I have been on several antibiotics and I take the last dose tomorrow. It was mostly chest tightness and inflammation. I felt better today so I went for a run. I shortened the distance and intensity by half.About an hour after my run, my heart rate spiked to 99 bpm and my hands began trembling . It's varied this evening between 80-120 bpm all night at rest. My baseline is around 66 bpm. I have tested my temperature several times - no fever.Could this be something serious? It has me a bit concerned. Thank you41M5\"10180 lbsSmoke (occasionally)Duration - 6 hours ###Output :No way for us on here to tell you wholeheartedly whether this is serious or not. If it is bothering you then it is serious. Does this typically happen when you run? Cause I know for a fact when I run my heart rate shoots up as well. Very normal for this during physical activity. I would recommend stopping smoking if you are worried of respiratory illness."}
{"text": "###Input :Acute Respiratory Failure from strong scentsAge27SexMaleHeight194cmWeight104kg 14% BodyfatRaceCaucasian, Irish/DanishDuration of complaintLifelongLocation (Geographic and on body)Ontario Canada. Lungs, esophagus?Any existing relevant medical issues (if any)AsthmaticCurrent medications (if any)Salbutamol Turbuhaler, Ventolin, FloventInclude a photo if relevant (skin condition for example)N/AThis question is going to be short, and concise; with examples.When a strong smell is present, my airway cuts out completely. I have theorized that it it may have something to do with what I call \"thick air\".Examples: Diesel exhaust scent, frying greasy or oily things, the smell of certain algae (like near a pond), occasionally with foul smells (this will seem odd, but it's innocent in my exposure((a day old corpse, animal or otherwise)).It's not particularly tied to smoke, cigarette smoke does not bother me, and I use an E-Cigarette. This has been something I've dealt with my entire life. It is quite painful when my airways suddenly close, and I can only breathe again when I place a cloth over my mouth (if the scent is still present) or move to fresh air. My doctor has told me he thinks it's something called laryngospasm, but this doesn't seem exclusively correct, as from my understanding, this is caused by your vocal chords... and that doesn't quite make sense to me.Edit: I should mention that once I am able to breathe, I typically uncontrollably cough, and sometimes vomit because of my coughs. ###Output :Throat tension, hoarseness, and/or voice changes shortly before, during, or shortly after these episodes?My first thought is along the lines of your docs. Look up vocal cord dysfunction or paradoxical vocal cord motion and see how well that matches your experience.(Edit: also, Id not consider this acute respiratory failure unless you became hypoxemic/needed supplemental oxygen or needed to be mechanically ventilated in some way. These things can happen due to vocal cord dysfunction in fairly severe cases of it)"}
{"text": "###Input :Tension and Hoarseness, definitely. My voice becomes gravely and it tends to hurt to speak.Only one instance a few weeks ago, I couldn't get fresh air and from what I've been told, I blacked out. That was strangely because of some smells from a Kernels popcorn stand.I apologize for the mis-identified title. I understand the difference now. Thank you for your response! ###Output :I see laryngospasm occasionally in my clinical practice, and one is usually unable to breath to the point of turning blue. It occurs when a physical substance tickles your vocal cords: saliva, blood, water while drowning, etc.. not generally fumes. Rarely lasts more then a minute.What you're describing sounds closer to bronchospasm for which you're at high risk: asthma, smoker (yes I know it's e-cig... It doesn't make it harmless : https://www.ncbi.nlm.nih.gov/m/pubmed/29847989/). My advise is to get better control of your asthma depending on the frequency of these symptoms and, well, you know this is coming: stop smoking. For standard cigarettes smokers, it can take 2 months for your body hyperreactivity to return to normal, not sure what the data says for e-cigs."}
{"text": "###Input :How can I avoid respiratory problems with the flu shot?I know the importance of getting my flu shot, so I intend to get it. However, I always get breathing problems accompanied by dizziness and fatigue for a couple days after getting my shot. It presents the day after the shot, not the day of, so I don't think it's an allergic reaction. I guess it's just my immune system freaking out. Anyways, is there a way to avoid the respiratory issues, or should I just get my shot on a Friday so I can let everything play out over the weekend?22F, 5'2, 120lbs, no meds, generally healthyThanks! ###Output :This could be an allergic reaction, although it doesn't sound typical. It's worth discussing with your doctor before getting the shot. Some people shouldn't get the flu shot, it's possible you're one of them.If it's not an allergic reaction then I don't have a good alternative explanation. I would suggest Tylenol and rest."}
{"text": "###Input :If it's an allergic reaction, do you think taking Benadryl would work? ###Output :Maybe, but then you would be even more tired. Better to know for sure than guess."}
{"text": "###Input :UPDATE: [26F] recommended for termination of pregnancy in a country where I don't speak the languageOriginal post here: https://www.reddit.com/r/AskDocs/comments/ici7ez/26f_recommended_for_termination_of_pregnancy_in_a/First of all I want to say thank you, thank you, thank you not only to the physicians who responded but also to everyone who upvoted and comment-bumped me for visibility. Obviously the physician responses helped on the medical end, but the simple comment bumps helped so much emotionally. I'm in this country without family (except for my husband and toddler) and sometimes it honestly gets really lonely so having even the tiniest bit of online support meant the world to me. I even want to thank the user who posted anti-semitic comments because your comment specifically helped this hella Jewish woman connect with other Jewish women on this forum who offered hands-on support, validation, and rescoures.I had a meeting with the specialists in the termination committee today and they diagnosed the pregnancy with cystic hygroma in addition to other serious physical (nasal, respiratory, heart) malformations that would make the fetus 100% incompatible with life. They made it pretty dang clear that I could basically miscarry at any moment, which sounds about right to me as a layman given all this info. We asked about genetic testing/probability of this happening again and they said it's very unlikely, the occurrence of this situation is less than one percent overall. So I've decided to forgo any additional testing like CVS or amniocentesis as a chromosomal defect would just be another issue on the list and not a defining factor in my choice.So unless nature takes it course, I'm scheduled for an inpatient termination this coming Monday. I can't really find anything online about inpatient terminations, but they gave me the choice and explained that the outpatient procedure would be started with dilation by osmotic dilators and move quickly while the inpatient procedure would use slow, supervised dilation with less trauma over 48 hours. I'm not 100% sure if they meant physical trauma or emotional trauma, as they mentioned some people find it very uncomfortable and impeding (especially with childcare) to do the outpatient dilation and return to the hospital for the procedure. I'd read about osmotic dilation earlier and it really freaked me out so I was super happy to have this previously unknown option offered.I'm feeling a lot more secure after hearing from everyone in this community, my doctor, and today's specialists. I never in a million years thought I'd be terminating a wanted pregnancy for any reason but I still have thousands and thousands of chances to have another baby just waiting in my ovaries so I'm going to focus on that and also on my toddler who is already my whole world. And I'm thankful in that I've experienced this and can hopefully help women who are in this situation in the future. Thanks everybody!*Edit just to add that all the doctors and social workers on the committee and at the hospital we went to spoke near perfect English which was a great relief for me and we did not have to spend money we don't have on an interpreter.*Later edit to update that the genetic blood test came back early and indicated 1:5 for down syndrome and trisomy 18. ###Output :I'm glad you got the answers you needed.Regarding the inpatient termination if you are wanting clarification I think it would be which route are you going:will you receive osmotic and/or chemical dilators and then go on to have an evacuation procedure?will you receive osmotic and/or chemical dilators and then go on to have an induced delivery? Just an fyi with this, people not infrequently require manual removal of the placenta, so they end up having the 'evacuation' portion anyhow (but it would just be the placenta).Both are safe. Some \"feel better\" about the second option because they feel like they are just inducing labor rather than actually \"terminating\". Fetuses in general, but especially a compromised one, have high rates of passing before delivery anyhow though.Also, you could choose to have genetic testing of any remains (and not do CVS or amniocentesis). But it is one of those things where it's optional and it may not truly change anything for you. This being said, many people like having a more solid answer.Good luck with everything. You have very good odds of having normal babies in the future."}
{"text": "###Input :From what I understand, I'd be going route 1 with chemical dilators and then the evac. The chemical dilators seems to be their reason for inpatient treatment though and honestly I'm fine with 1 or 2 in that case. Something about the osmotic course just innately makes me uncomfortable. Buuuut if I'm being super duper honest, I'm fine with anything inpatient because I just want the time and space to decompress about it all without the stress of toddler, chores, work, etc. But yes we asked about genetic testing of the remains too but the specialists said they'd only show \"academic\" results and nothing impactful after the fact or for the future. My husband and I are both just really onwards and upwards kind of people so if the doctors don't need it after the fact and say everything's okay, then it's okay for us. I wish I had the rescoures to gild your posts for the rest of forever, you really deserve it! I'm so truly thankful for all of your responses you have no idea.*Edit to add that I did however have the basic chromosomal blood test done that goes hand in hand with the nuchal translucency, so if anything comes back abnormal with that I will of course satisfy any curiosity with an update here! ###Output :I did however have the basic chromosomal blood test doneThat test is pretty accurate so that should likely give you the information you need. Good luck with everything."}
{"text": "###Input :NAD, but a nurse and in general was worried for you! Glad to see your update! Im sorry you are feeling so isolated, but glad you found resources! Hang in there. ###Output :I'm locking your thread since you don't seem to have additional questions. Thank you for the update though, and we wish you all the best."}
{"text": "###Input :30F, 55kg, 160cm, Asian, Singapore, upper respiratory tract infectionLong story short, somebody i know was diagnosed with upper respiratory tract infection bu a licensed doctor, 2 night ago. Her symptoms were cough, fever (38 degrees), headache and muscle aches. No runny nose. She refused all the medication provided by the doctor. The doctor gave her 1 day sick leave.Last night, about 24hrs after the initial diagnosis, she claimed that she has been hospitalised for her illness. Is this possible? Isn't \"upper respiratory infection\" just a fancy term for a common cold? ###Output :We will not be able to tell you if your acquaintance was hospitalized, as that seems to be your question."}
{"text": "###Input :Alkaline \"medicine water\" healing reflux, colitis and upper respiratory infections.In my country (Hungary) we have this medicine water called Salvus which is drawn from a thermal bath. It has bold claim such as healing GERD, colitis, upper respiratory infections while also treating diabetes and peptic ulcers.I 31M have GERD and my doctor switched me off of PPI's to Salvus water and a low dose of famotidine. Since then I have pretty much non-stop diarrhea and my heartburn got much worse.My question, based on the ingredients, is this medicine water bullshit?Ingredients (mg/l):- Sodium: 5800- Lithium: 2.0- Chlorid: 2020- Bromide: 13.9- Iodide: 2.08- Fluoride: 3.0- Hydrogen-carbonate: 12810 ###Output :Surprised a doctor is scamming you. Is it a real doctor? Alkaline water is a scam. Go back on the PPI."}
{"text": "###Input :Heart rate increases every time I inhale. Respiratory sinus arrhythmia.Male, 27. 70kg. Relatively healthy, I do running and hit the gym.Is it normal? Does everyone have this? ###Output :Very normal. Nothing to worry about."}
{"text": "###Input :Respiratory restrictive pattern, unknown cause please help.I am 21 years old male.I have started having bad shortness of breath the past 4 months. I have seen so many doctors and this is the results so far.The originally test to prove there is something going on is the respiratory function test, I cant interpret all the results but the pulmologist said my breathing shows a restrictive pattern with 65% of expected lung capacity and velocity. This test has been repeated every month with similar results. Gas transfer was 95-100% not indicating lung disease.Got a ct scan of chest with dye to rule out lung disease or to see if anything else is on my lungs but it came back clear other than enlarged thymus gland.They thought it might be respritory muscle weakness although the neurologist said unlikely as when I am lying down the respiratory test shows similar results as to standing.Cardiac possibilities cleared by cardiologist.The cardiologist, pulmologist and neurologist are at a loss and have determined to just hope it doesnt get worse. Please help. ###Output :Restrictive pattern on PFTs essentially fall into three categories, unfortunately you've had them all investigated. It can be the lungs themselves (i.e. fibrosis, or stiff lungs), chest wall noncompliance (think of terrible scoliosis, severe obesity, etc), or neuromuscular disease. The first two are typically pretty easy to diagnose, neuromuscular disease can be very difficult. There is no gold standard for how to determine if restriction is related to neuromuscular disease, but the sitting/supine spirometry is often done as one piece of data (as it appears you have done).Have you done a MIP/MEP (maximal inspiratory pressure and maximal expiratory pressure)? A low MIP tends to indicate diaphragmatic problems, and a low MEP indicates problems with chest wall strength. Like the sitting/supine spirometry, these must be interpreted with caution, as they are not truly gold standard for anything.If all else fails, there is always the Cardiopulmonary Exercise Test (CPET). It's basically a test that measures your heart and lung function through maximal exercise to determine where exercise intolerance may be coming from. It's not always available in all places and can be very difficult to interpret.All in all, with your story I would put my money on a neuromuscular issue. I think the neurologist ruling it out based on the positional spirometry alone is premature. Bring up the MIP/MEP and CPET to your pulmonologist and see what he/she thinks.Mind if I ask where you are being evaluated? You would likely benefit from going to a tertiary care center, such as affiliated with an academic or university medical center. Depending on where you are located I could suggest some places to find docs who'd be interested in you."}
{"text": "###Input :Can visual processing issues stem from 1) respiratory infection or 2) stress and anxiety?I am 30F, relatively active lifestyle, diagnosed with ADHD and treating it using Vyvanse and regular therapy.I am on the tail end of a two-week cold. Still have a bit of congestion and fatigue but no sore throat or cough etc.Something I've noticed over the past couple weeks/in the past is that I feel like I have difficulty processing visual information. E.g. if I'm walking in a forest, the amount of visual information seems overwhelming. I can't really \"see\" what's in front of my unless I really stop and focus on one thing at a time.My last eye tests showed I had 20/20 vision and I have no issues reading on screens or seeing things far away, it's just that when I'm presented with a lot of visual information, I have issues processing it all.I've also notice this happen in the past when I've had depressive episodes. Does this sound like an actual issue with my eyes, or could it be linked to my mental state? ###Output :Simple answer is yes. Fatigue and illness affect sensory processing and cognition, usually transiently. That's a good thing, since it forces you to rest, slow down, let your body recover. The more complicated question is whether there's something different about your experiences as compared to people without neurodivergent states.Your description suggests that you might have visual snow, though maybe you are just overwhelmed with information during higher stress?"}
{"text": "###Input :Muscle, Respiratory, Heart, and Mobility problems: Is this just obesity or something more?I am 29 y/o , 6ft even, and probably 400lbs easy, probably more, i can't afford a scale so idk.For about a year up until March when my job shut down for 7 weeks, i was very capable of doing the physically demanding work at the Auto Plant i worked at.. I was not fit, but it was doable for me. During shutdown from Covid, I started to notice that moving became harder and harder. My lower back would struggle to stay up and that caused breathing to get harder, which caused the heart rate to skyrocket. It eventually progressed to the point of complete muscle failure after about 50 feet of walking.When I got back to my job, I collapsed in front of my supervisor and his boss. Everybody freaked out and I was forced to go home and get tested for Covid 19. It was negative. Even when coming back after a few days out, however, I still could not walk more than 50 feet without sitting and gasping for air with the muscles in my back completely giving out causing collapse.Now I cannot even mow my lawn completely without resting 3 times. It is a tiny lawn that my roommate mows in about 10 minutes. It takes me 30-40 minutes with resting.I cannot walk 50 feet without gasping for air, I have regular heart palpitations, there are huge numb patches in my legs (oval shaped, upper thigh above the knee on the front of the leg), I cannot sleep more than 40 minutes to an hour at a time, and when walking I feel like I ran a marathon when it is only trivial distances. (heart rate, breathing troubles, back and leg muscle failure)Lastly, this morning at 4:30 am up until about 8:00am, I had these horrible feelings of doom, despair, anxiety, and panic, all wrapped up into one horrific attack for those many hours. Along with this, my heart rate was so high I literally almost called 911 many times.In the opinion of the people in this thread, are my issues likely 100% obesity related, or could there be something neurological going on in my back and legs as well? I dont know when the numb patches in each leg started.I'm scared of death, so I'm making what life changes I can (eating better, cutting caffeine down to reasonable levels of moderation, etc) but this is preventing me from functioning as a human being. I do not have insurance so I dont know what to do. I probably need to see a cardiologist, neurologist, or some sort of skilled orthopedic person. Please help, reddit. I dont want to die. I have dreams of owning my own I.T. business for security consulting.If more information would help, please please please ask and I will be 100% open about everything. I'm trying to change my life and contribute to society. I'm hoping to not have to go on disability or anything like that. My father was upper executive branch of a major telecommunications company so I hope to do something that would make him proud as he watches me from the heavens. ###Output :Do you smoke?Obesity can cause a great deal of damage. Think how much more your heart has to pump. Think of your belly compressing your lungs decreasing how much they expand making it difficult to breath. Think of the extra weight your back has to carry. These are just a few things. I know this sounds tough and maybe harsh but Im saying it because Im confident you can make changes. Youre young and if you put in the work, you can definitely make changes. There are many free resources online.From the sounds of it, you might be having some heart failure symptoms. Do you have any swelling in your legs? I say find a PCP. Get worked up and get the studies you need. Maybe start off with an EKG and some labs and go from there. You might need an ultrasound of your heart if your PCP recommends it.Biggest recommendation I can make is lose weight by changing your diet. Preferably something you can live with whether its intermittent fasting or the Mediterranean diet or whatever.You got this"}
{"text": "###Input :I do not smoke, and actually had an EKG at the Emergency Room today which came back normal. Could a normal EKG mean heart failure is off the table? Your positive words mean the world to me, friend. ###Output :Well, heart failure is a clinical diagnosis. An EKG may help but doesnt give you the answer. For example the EKG can tell you there might have been a heart attack or signs of decreased oxygen or clue you in that one side of the heart is enlarged but thats about it.We usually use a combination of symptoms and labs to say someone has heart failure. Again, your PCP will be able to help. Again there are a few diet threads on here were guys your size have dropped a bit of weight."}
{"text": "###Input :Here is an image of what they actually did test wise https://i.imgur.com/7fMucgv.png. I have covered all identifying information as well as the weight because I am embarrassed. They checked my blood for Diabetes i guess and said that while my pancreas is compensating and I'm not even pre-diabetic, I do need to stick to the positive life changes I've implemented. If you have time to look at that image, would any of those tests have revealed the existence of Heart Failure? ###Output :No. A proBNP would be helpful and if youve had recent leg swelling that would also be helpful. Otherwise seems like everything looks good from this numbers"}
{"text": "###Input :51F (pulmonary) under what circumstances should I take mom to the ER? She has chronic respiratory failure - hypoxia of unknown origin being worked up - but over past 3 days she's gotten worse51F, 59, very thin, getting thinner fast, white, USA. non-smoker, non-drinker; no prescriptions. On supplemental oxygen for chronic respiratory failure - hypoxia. Undergoing workup to figure out whats wrong but its taking taking forever. (This is for my mom.) (x-post)Very long story short: formerly vibrantly healthy moms been deteriorating since January. Shes lost over 25lbs since then, has been having daily oxygen desaturations down to as low as 80 whenever she started walking for months and is now on supplemental oxygen. Exhaustive pulmonary testing (including RHC and shunt studies) and cardiac testing (echo with bubble study) all inexplicably normal. The doctors are puzzled, as you can imagine. She looks awful. She does have a few \"good\" hours in the morning, but it slowly diminished til afternoons she crashed. As of now, \"good\" morning hours aren't lasting as long and she's crashing earlier in the day when she hits a wall, becomes totally sapped of energy, becomes very weak.At first her oxygen only went down when she was up and about and moving, down as low as 80, thats when she got the order for supplemental oxygen. But past 3 days, it's going down much more often, even at rest. (But it IS intermittent, not constant.)Heres why Im here today seeking advice: What would be a scenario that would mean we should take her to the ER? As of the past 3 days shes feeling worse, now has oxygen desats at rest, and it also is dipping down more and more often than ever before, and something very new - her heart rate keeps dipping a few times a day down into the 50s and occasional 40s (not necessarily when her oxygen is low - sometimes yes thats the case, sometimes when shes on oxygen it happens too. In the past few evenings shes been having severe shortness of breath even when her oxygen is at 100. Although shes been ill for months w/no answers yet, these worsening signs and symptoms have only been happening for about 3 days.Blessed to live in a city with a nationally known excellent medical center. The head of one of the lung hospital lung centers shes been seeing wants her to come back in to see him again for further investigation since the last study (shunt) was normal and they still dont know whats wrong (what the hell else can they test for???), but that conversation with him was last Thursday, before things suddenly got even worse on Friday til now - and who knows when that appt will happen. He's in high demand of course.In the meantime were in a holding pattern, so please can someone give advice on if there are certain signs or symptoms that would trigger us to take her to the ER? ###Output :The desaturations at rest are concerning, it would be reasonable to take her into the emergency room now. Given your post it seems that she would have very poor reserves, so if things worsen even a little bit she may have profound effects.Another option is to get ahold of her pulmonologist or the person whom is on call for the clinic. He/she would be able to give a more informed opinion based on her unique situation."}
{"text": "###Input :Thank you so much. I begged her to let me take her to the ER last night, it was pretty bad - but she refused - she said she'd \"feel stupid\" since her oxygen/heart rate go back up to normal in between the bad episodes and she \"doesn't want to waste their time.\" With your advice I think she will listen (she appreciates my asking things here).With her permission I reached out to her regular long-time pulmonologist via her patient portal to ask if she should come in to see him soon. I did mention the low heart rate in that message. Hopefully will hear back soon. If her heart rate goes down that low again I'll remind her of an actual physician's advice (thank you thank you!) and she will listen. ###Output :Assure your mother that she's not wasting anyone's time! Also, it's not her job to know if something is an emergency, s it's okay to go the ER and find out everything is fine."}
{"text": "###Input :I have an upper respiratory infection. Been to the doctor for it. When will it end? It's been 8 days now.25f, 120lb, white, asthmaticI was tested twice for COVID and both came back negative. When it got worse the doctor gave me 4 days of steroids to take, cough medicine, and mucinex.Day 1-3: bad congestion, fatigue, sore throat, voice loss Day 4-7: began coughing. Had to increase use of my rescue inhaler Day 8: began to cough up disgusting green phlegm.Does the green phlegm mean I'm near the end? Or that I should go back in? ###Output :Probably just a viral cold that needs to run its course which is usually 10 days - 2 weeks. I would add some Sudafed/flonase for your congestion. Hopefully you start feeling better soon."}
{"text": "###Input :38 yr old femaleHistory of bronchitis/pneumoniaI was recently babysitting my nephews who were unknowingly sick with an upper respiratory infection both have been tested for coronavirus several times coming back negative. However, in the meantime I got the upper respiratory infection also. Unfortunately, I have a very long, bad history of bronchitis/pneumonia with a hospital stay of two weeks in 2019 with double pneumonia and only an inch of air flow. So my question is how long does congestion last before I should be concerned? I've had this cold since last weekend. I'm on amoxicillin, my inhaler, Albuterol, nose spray etc. But still congested and wheezing but no fever or chest tightness. The congestion however has not improved should I be concerned? ###Output :Assume you've got tested?Most URTIs are viral so I'm not surprised if its not improving quickly with antibiotics, likely they will do nothing."}
{"text": "###Input :I haven't been tested because my nephews came back negative and they were the only people I've seen. Also, if I'm not improving on antibiotics what do you suggest? Er visit PCP visit? Just wait it out? My chest congestion and wheeze is bad but I'm not running a fever, no chest tightness, I'm not getting worse but at the same time I'm not improving. ###Output :You need to isolate and test regardless.No, congestion is normal with a viral URTI and doesn't usually need a doctors visit, you can self manage at home. If it is not improving over time or worsening yes definitely."}
{"text": "###Input :what is wrong with me? respiratory problems and oedema doctors baffled need ideashi I know this is a long shot and I'm not looking for a replacement for a diagnosis by a \"real life\" doctor - I have been having a long series of tests and scans etc etc and been in and out of hospital for months. It's just a matter of curiosity really.I became ill with what I thought was asthma in roughly june last year. It started with terrible chest pain that I woke up with and called an ambulance when I was no better after 4 hours. The pain was roughly central and felt like I'd been kicked by a horse and I was very short of breath. In hospital my O2 was measured at 71% which they blamed on my smoking habit. I had an x ray and ecg and everything seemed fine.I went home and continued to have terrible breathing problems which I thought was asthma for about a month before I was referred to minor injuries by my GP. They did an x ray and freaked out and got all the students to listen to them tapping my chest because one side was almost completely full of fluid. I got rushed to hospital in an ambulance and admitted. I had a chest drain put in and then had to go to a specialist hospital to have a heart drain put in as I had fluid on both lungs and around my heart. After a couple of weeks I was allowed to go home.Unfortunately the problem has persisted and I've been in hospital 3 times now, with my chest no better. I also had a.broken rib which I think was the result of coughing after I caught a cold at christmas. That's healed up now but I still have swollen legs and a swollen tummy and trouble breathing that has me gasping after a few steps. I'm on a diuretic for the swelling and it's been increased twice.I've had all sorts of scans, x rays, blood tests, ecgs, and most recently had a broncoscopy with a fine needle aspiration biopsy of swollen lymph nodes in my lungs. None of the tests have shown anything and the consultant says he is baffled and they are going to have a meeting about me. I have to go back in to hospital soon for a few days to have my chest drained and a thoracoscopy (?) - camera between my ribs and a biopsy.I've given up smoking but it hasn't helped. My O2 isn't as bad as it was in june/july though - tends to be high 80s or low 90s. I also hit menopause at the exact same time that my health took a nosedive and haven't had a period since june '22. I was also diagnosed with diabetes type 2 and high cholesterol when I was hospitalised in august and have been taking medication for that.So far tests have been negative for cancer but he says it can't be entirely ruled out.Does anyone have any insight at all or any ideas as to what might be wrong with me?age 51sex femalerace whiteweight 230lbslocation ukdiagnoses: schizoaffective, type 2 diabetes, asthma, high cholesterol, bilateral pleural effusion and cardiac effusionmeds: furosemide (? diuretic tablets), statin, a tablet for diabetes that is supposed to increase insulin after meals, folic acid, salbutamol inhaler. Supposed to be taking metformin but it makes me have an upset tummy and I found that difficult as I am living in a hotel at the moment and don't want to have an accident so I haven't been taking it. Up until august last year I was on paliperidone injections 75mg (invega) for schizoaffective disorder but they stopped those in case it was making me ill. ###Output :I would have a CT scan of the chest and abdomen to get a more detailed image of the fluid collections and any other abnormalities. I would get a culture of the fluid obtained during the thoracoscopy procedure to determine if there is an underlying infection, and then a biopsy of the pleural and pericardial tissues to determine the cause of the effusions.Shortness of breath, swelling, and fluid accumulation can be symptoms of congestive heart failure. Your history of high cholesterol and type 2 diabetes increase your risk for this condition."}
{"text": "###Input :Can I fly on a plane with weakness of respiratory muscles?(neuromuscular disease)Male, 24 years old. Live in Canada. 100kg, 200 Cm tall.I have an unknown neuromuscular disease that weakens my diaphragm, throat and skeletal muscles, and affects my cognition. I also have Ehlers-Danlos Syndrome.I want to know if my daytime oxygen is normal, and my Co2 levels are normal, is it safe to fly in a pressurized cabin on a plane? It's quite hard to breathe at times but I had a sleep study a couple weeks ago and it was fine. ###Output :Can't answer that over the internet with the limited information. Would recommend talking to your doctor about a test called a High Altitude Simulation Test (HAST), where they used oxygen blenders to simulate a lower pressure with a lower partial pressure of oxygen. A lot of airline companies require it for people with lung disease to fly."}
{"text": "###Input :Is a low respiratory rate a problem? (Bradypnea)Is a resting respiratory rate of 5-6 breaths per minute indicative of a problem? Online it seems there are some sites (non medical...) which think a low breath rate is healthy. But on medical sites I find references to the medical problem of bradypnea.40M, caucasian, 178cm, 90kg, drink alcohol. Resting heart rate of approx 55-60BPM. Blood pressure normal to slightly elevated.Existing conditions: anemia - taking iron supplement. Possible IBS. Have done little exercise over the past 12-18 months due to fatigue caused by anemia. ###Output :low RR with self measurement without other symptoms is not a problem."}
{"text": "###Input :COVID-19 FAQ #2Updated 6th AprilThe below comes from multiple sources as well as the direct experiences of myself and my colleagues.If you would like more information I highly recommend this free e-book written by two German physicians, it is available in multiple languages and is very up to date: https://covidreference.comIs it really as bad as they say?Yes. This is the most serious public health crisis of the last hundred years. By the time this is over many thousands will have died before their time. Do not underestimate the effect this will have on global societyThese are my symptoms, do I have COVID-19?Right now (assuming you live in an endemic country) any infective symptoms are COVID-19 until proven otherwise. Such symptoms may include any or all of:FeverCough (productive or dry)FatigueMuscle aches (particularly chest pain)Sore throatSwollen glandsLoss of sense of taste or smellDiarrhoeaThis is not an exhaustive list. Take home message: if youre not sure assume you have it and quarantine appropriately.When should I seek medical attention?Any breathing difficulties should be discussed with a doctor. This may be breathlessness at rest or on exertion, such as climbing the stairs. If youre struggling to do the things you normally do then seek assessment.You should have a low threshold for seeking assessment if you are at high risk of exposure, for example if youre a healthcare worker.I have no symptoms, should I stay at home?Yes.At this moment you must stay at home. You must only go to work if your job is essential for the running of the country or your local health service (although I accept not every country has introduced income support for those who have to stay at home.Dont see anyone socially unless you live together.If you do go out for work or supplies then stay at least 2m away from other people. Do not touch each other. Wash your hands religiously.What treatments are there?So far nothing.Either you get it and your recover, or you develop ARDS, in which case you will need to be admitted to ICU and ventilated.Chloroquine/hydroxychloroqine inhibits the ACE2 receptor in your cells, this is the path the virus takes you infect you. There is, to my knowledge, no published data at this time suggesting that it makes any difference.There are multiple trials into antiviral medications but again nothing has been published to my knowledge (please correct me if Im wrong).Am I high risk?The majority of people who get C-19 will have a mild disease. A minority will develop severe disease that requires ventilation and may lead to death.The biggest risk factor for developing severe C-19 is age. Below the age of 50 the disease is rarely severe. In children it is almost always mild. The groups most at risk are the over 70s and over 80s.As mentioned earlier there is some suggestion that higher viral exposure (such as experienced by healthcare workers) may lead to a more severe disease course.In terms of other medical problems some people should take extra precautions. Those receiving cancer treatment or taking immunosuppressants are at greater risk. Asthma seems to convey greater risk but mainly among those with more severe disease (such as those on biologic treatments, daily prednisone or those who have previously been admitted to intensive care).Men seem to be at higher risk of severe disease. We dont know why.Other conditions may have implications. If you are curious about your personal risk due to a comorbidity there is lots of useful information on patients charity websites, for example asthma UK.I have elderly relatives, what should I do?Everything you can do to facilitate them staying at home away from others. If you live with them avoid them as much as possible.Talk to them now about what they would want if they got COVID and got sick with it. Would they want an ventilator? Would they want ICU? Over here hospital inpatients arent being allowed visitors. Admission may mean dying alone, on an intensive care unit with no one allowed to see you. Its a hard discussion but better that everyone knows what everyone wants now.What is it?COVID-19 means coronavirus disease 19 (as it was first reported to the WHO on NYE in 2019). It is caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2).Why is it spreading so fast?COVID-19 is very contagious. Current data suggests an R0 (that is the number of people an infected person will go onto infect) of 2.5-3. By comparison your average seasonal flu with have an R0 of about 1.3. To put this into perspective, if you start with 10 people infected with seasonal flu, over ten infection cycles youll end up with about 138 infected people. With COVID-19 over the same ten cycles youll end up with tens of thousands to hundreds of thousands of infected people. Bear in mind this is not what is going to happen, only what could happen if the a disease was left to spread without effort to slow it. Public health measures to contain it can massively reduce the actual transmission rate.Can I find out if Ive had it already?Right now no. There is a test in development.What can I do to minimise my risk?Wash your hands. Regularly. Avoid large gatherings. Follow local rules and guidance. If you have symptoms then stay away from other people.To my knowledge there is no evidence that wearing a surgical mask in public will be of any benefit.Should I stop taking my medication?There have been media reports that people taking certain types of mediation, specifically ACE inhibitors/A2RBs (eg ramipril/losartan) or NSAIDs (eg ibuprofen) are at higher risk of catching or complications of COVID. To my knowledge there is no good data to support this. You should continue to take your medication as normal unless instructed otherwise by your doctor.Is tickle in throat same as a dry cough? Two days ago I woke up with chills, diarrhea and pounding headache. Headache is gone but now have tickle in throat that makes me want to cough. Could that be corona virus?? ###Output :If you aren't coughing, you don't have a cough, do you? You could still have the coronavirus, infections can have very variable symptoms."}
{"text": "###Input :Are you no longer contagious when your symptoms disappear?Ive tried reading through the comments but couldnt find any direct answer. A friend of mine was in contact with someone who tested positive and Im worried. He said his symptoms were gone after two weeks of being sick but he got tested the week they hung out and got the results two days after the handout. ###Output :Not thought to be, but not confirmed.We are recommending you wait until at least 72 hours after your symptoms have resolved to end self-isolation (and symptoms resolving while you're still having tylenol around the clock doesn't count)"}
{"text": "###Input :NYC, immuno-compromised. Delay medical appt's? Better or worse? ###Output :Depends if time critical or routine"}
{"text": "###Input :Ive been sick with some Covid19-like symptoms for 25 days now and Im 90% better now. I cant get tested where I am but my GP and I have been assuming thats what it is so Ive been isolated and all that good stuff.My question is, if my respiratory infection was by some chance NOT Covid19, am I now at increased risk of complication if I do contract it now that Ive just experienced pneumonia or something like it? ###Output :No"}
{"text": "###Input :Would a motorcycle helmet protect against virus? I know I'll look silly, but I don't want to buy face masks so that they are saved for the healthcare professionals. ###Output :No"}
{"text": "###Input :If you have a cough, but no fever or fatigue, are you okay? Can allergies cause a sore/itchy throat AND a cough? ###Output :Any cough right now is covid until proven otherwise."}
{"text": "###Input :What should you do if you develop the symptoms? They're so generic, and the hospitals are being overwhelmed, plus it IS allergy season. Advice online seems to suggest you should only seek treatment if you have a pre-existing condition, or one of the more serious signs like shortness of breath. However, my whole city went under a 2-week quarantine starting a week ago after a woman had a coughing fit in a store in a neighboring county, and she did test positive! I don't know any other details of the case though. Right now I'm worried if someone even so much as clears their throat near me. I haven't gone out since the quarantine stated, but my mother (who I live with) has been going to work (she's only one of like 4 or 6 people who are, and she has to go to work because she can't take all her paperwork home with her, its just too much), and she claims the idiot locals are completely disregarding the quarantine even though we HAVE had at least four confirmed cases in this city alone! This has made me really paranoid. The local community isn't exactly known for being healthy, and the whole city seems to be overrun with Trump supporters too which doesn't bode well with him denying its a problem. ###Output :If you develop symptoms you stay at home. If you develop breathing difficulties you seek medical assessment - follow local protocols."}
{"text": "###Input :Are swollen lymph nodes involved with the virus at all? I woke up today with VERY swollen and sore lymph nodes on my neck underneath my jaw, both sides. ###Output :Not typically, but possible"}
{"text": "###Input :Where are they at with antibody tests? Internet says they exist but are hard to get. ###Output :Lots of companies are touting these but to my knowledge none have been proven to be reliable yet."}
{"text": "###Input :I have been experiencing fatigue lately: my RHR is higher (~55 instead of ~45-50); I get really tired when I try to run, even though I am a runner that does 50 mpw; I feel dizzy for a few seconds when I stand; etc. I have felt fatigued for the past 5-10 days and none of the other symptoms of COVID-19 have appeared. I think the fatigue is potentially from not being as hydrated as usual, the weather getting warmer, or my different eating habits with this whole quarantine situation.However, I am worried that it could be COVID-19. I am wondering what the actual chances of this being COVID-19 are; how many people actually only get fatigue without any of the other symptoms? I get the FAQ states any of the symptoms should be conservatively assumed to be COVID-19 but I am looking for a more statistical response. Thank you! ###Output :Sorry I am unable to give a statistical response based on your vague set of symptoms."}
{"text": "###Input :Do the fevers fluctuate? I've been tested and will get my results with 24 hours. I've been exposed to a covid + person and have had fatigue, mild cough, body soreness (as if I worked out). My normal temperature is around 97.4 it raised to 99.8, 100.5, and the back to 98.5 . ###Output :Yes. Sounds like possible covid."}
{"text": "###Input :My wife tested positive for COVID-19 several weeks ago and has now had a fever for over a month, while I am asymptomatic. We have been quarantined for the entire month and have not left our house. Her doctor recently gave her antibiotics as she believes my wife has a secondary infection that is causing the fever to linger. Is it safe for me to see family (while maintaining 6 ft/mask/etc of course)?Edit: My family has also been self-quarantined, they are relocating to their vacation home which is close to me. ###Output :We are still treating people as infectious if they have a fever so you should continue to quarantine. You cant prove that your wife isnt infectious or that you arent asymptomatically carrying it. Check your local guidance on whether you should be socialising with others regardless of your Coronavirus status."}
{"text": "###Input :There has been some mention of pinkeye being a possible symptom of the virus. Is there any potential truth to this or is that likely a symptom of something unrelated? ###Output :Not to my knowledge"}
{"text": "###Input :31F, ~125 lbs in NYC (a hard-hit neighborhood in Brooklyn). Pre-existing conditions: classical EDS (with ID'd genetic mutation) and mild dysautonomia. In 2018 I had a very bad case of mono and by early 2020 was just getting over the fatigue from it.I've been sick with suspected covid-19 for almost a month now and just can't seem to get 100% over it. Week 2 was the worst, couldn't eat and lost almost 10 pounds (was originally at 130 lbs and now starting to gain a little of it back) and had chest pain. I had ordered a pulse oximeter, which arrived halfway through Week 3. Readings are mostly normal, it once dipped to 94 briefly. Have had persistent low-grade 100-degree fever (99.5-100.3) that lessens a little at night and worsens in the afternoon, comes with chills and sweats. Pretty fatigued and get winded doing normal things in my apartment like cooking (I live alone.) I have swollen lymph nodes (two that have bugged me since the mono that swell with any infection since then, one on the back of my head and one in my thigh [?!], other lymph nodes affected through this were the ones in my armpits and groin).After 4 weeks of fever, my PCP asked me to come in for a physical and bloodwork. Lungs sounded fine, temp measured 99.4 in the office (morning), throat was red, lymph nodes in armpits were felt by her but didn't seem unusually large. Metabolic panel and CBC came back normal -- not even elevated white blood cell count. Dr was a little concerned about the buggy lymph node in my thigh and said it should be imaged when the pandemic is over....but that will probably be months from now. I was diagnosed with \"fever of unknown origin.\" Tylenol and Aleve relieve some discomfort, but don't bring the low-grade fever down. It just likes to stay put at about 100. (I normally run in the 97s-98s.)I am starting to worry about lymphoma because of that lymph node. It was imaged (ultrasound) when it first appeared in 2018 and was deemed large but noncancerous. Since then I've caught some more bugs than usual but attributed that to recovering from mono and a particularly bad cold/flu season in the city.My PCP is getting harder and harder to reach since she is now working in the ER to help those that are in dire need of help, and I don't want to bother her too much since I'm not dying...I'm just mildly ill and not getting better.Are there cases of mild covid19 that just seem to linger on and on and on like this? I had some friends who had mild cases around the same time as me and recovered in 2 weeks and are completely better now. I'm nearing 5 weeks and still sick. Is this just how covid19 is in some people, or do I need to be worried about cancer? I'm sorry, just really scared and won't be able to get regular/thorough medical help for the time being. ###Output :Most likely prolonged recovery. Lymphoma very very unlikely, but review with your primary doctor when theyre back open."}
{"text": "###Input :Does anyone know if taking antibiotics for a bacterial infection while potentially being infected with coronavirus is dangerous?Ive had a fever the last couple days with sever headaches, however I dont fit the criteria for testing where I live. This morning I noticed what seems to be a times flare up on my left foot. A couple hours later and my toe has swollen and there is a redness spreading slowly up my foot. I spoke to a doctor over the phone and mentioned the fever, and gave my other symptoms. The doctor prescribed me with some antibiotics for my foot and said theyll fax to the pharmacy for me.Im just worried that the antibiotics would be detrimental to my immune system if I do have covid-19. ###Output :No benefit but doesnt seem to worsen things either. Current agreement is to give antibiotics if any suggestion of a bacterial infection instead of/in addition to COVID."}
{"text": "###Input :I and my mother just came back from England 10 days ago (flew to Romania). We're in self-isolation, haven't gone out even for shopping. When we were at the border the doctor told us to call our GP or 112 (emergency number) if we get symptoms. I have just heard Mom properly cough, very loudly and persistently, and it lasted a while. The airport and plane were very crowded so I wouldn't be surprised if we have it. Mom doesn't want to call our GP because she is afraid of a hospital quarantine. 112 seems a bit drastic for some coughing. There's a national covid19 information hotline. Should I call them? Should I just talk to her and we agree to continue self-isolating for a month beyond the government enforced period? If I am honest, I'm kind of scared of a hospital quarantine too because I feel like it might make her (and maybe me) worse. I'd much rather just self-isolate at home, but I feel like if we don't know she/I are positive she'll really want to go out grocery shopping and stuff. She's also probably going to want to meet with my Dad (who is 64, has diabetes, hypertension, liver problems, is overweight and has had a benging tumor in his intestine for which he's been operated). She's 49 and I'm 17. Should I not call anybody and just talk to her? Call the hotline? Call 112? ###Output :I dont know what measures Romainia is taking but I would encourage you to follow all local guidance. If the cough lasts more than an hour then call."}
{"text": "###Input :I heard her, she had breaks but it was very very loud and it was about an hour, she was trying to silence it and go to sleep. Im not sure how seriously they mean call 112 though. Ill call the information hotline in the morning and see what they say. ###Output :There is a strong chance she has covid. Follow all local guidelines"}
{"text": "###Input :I'm trying to find an answer to this because the CDC released conflicting information.How much benefit is there to cloth/homemade masks? My understanding is they don't help much, they don't block coronavirus, and if anything they increase risk because people are constantly touching/removing/adjusting them.Surely there isn't much benefit in wearing a homemade mask at work if I have to remove it for lunch and then put it back on. I'm just touching my face more. ###Output :The benefit of the public wearing masks is really going to be in prevention of transmission from folks that are asymptomatic but spreading the virus. You could be spreading it right now. Please wear a mask so that you don't get others sick. We don't know exactly how much benefit this will have, but it's a simple enough thing to ask people to do.You shouldn't be touching your face at all when removing a cloth mask."}
{"text": "###Input :An article mentioned that hypertension is a significant risk factor.Does this refer to untreated hypertension or treated, or both?If someone had hypertension that has been successfully treated for years or decades, is it still a risk factor? ###Output :Hypertension seems to be a risk factor. Whether that is because of the hypertension itself or because of the associated micro and macrovascular damage cause by untreated hypertension we do not know."}
{"text": "###Input :Allergy season is coming up, which means sneezes and sniffles. Currently I take a steroidal nose spray to cope, I also have access to non-steroidals if needed. Will a steroid nose spray have any negative affects vis-a-vis covid19? I do not have it, but dont want to make things more difficult than it needs to be. ###Output :Nasal steroids safe to continue"}
{"text": "###Input :I keep hearing \"I had the virus back in November!\"In November of 2019, there wasn't a surge of deaths and hospitals becoming inundated with ill people.The virus didn't just decide to start becoming highly contagious in March 2020.I find it hard to believe these people actually did have it already months ago. ###Output :Unless these people were living in Wuhan then it is phenomenally unlikely they had covid in November."}
{"text": "###Input :Someone told me it was a matter of controversy that COVID-19 is transmitted via breath.Is that controversial like it is controversial to say that smoking causing lung cancer? :-). ###Output :Theyre talking nonsense"}
{"text": "###Input :What is a good source of news about the progress of the pandemic?I tried MedCram on youtube, but it goes off on tangents.People keep recommending web sites teenagers built.I would like a news source that would tell me the numbers, the trends, what has been learned, and what the recommendations are. ###Output :In terms of hard stats on numbers of cases/deaths etc http://worldometers.infoIn terms of everything else the ebook listed at the top of the FAQ"}
{"text": "###Input :Can someone who was sick in Feb with what they thought was the flu, now test positive for Covid-19?Or in other words, is the virus similar to Hep-C where you can still test positive weeks after recovery because of antibodies? ###Output :There is no reliable antibody test yet available.Once one exists it should be able to confirm exposure within the last year, perhaps longer. The immune response still not fully understood."}
{"text": "###Input :Age 23. Female. North Colorado. 55. Maybe 105 pounds. I have Ehlers Danlos Syndrome with Vascular Complications, Gastroparesis, and an AVM in my dueduom that bleeds periodically ( started bleeding again yesterday) (currently anemic because of this). My father recently told my family that he tested for antibodies of covid. I lived with him from Feb 29- April 3. He was sick from March 23- April 1. I developed a low grade fever last night as well as a headache, and have been very lethargic. Would I be able to be tested without proof that he has antibodies? He and I arent on good terms and I am very concerned. I am also concerned as I lost health insurance April 1st and havent secured a new plan yet. ###Output :Current antibody tests (particularly the home testing kits) are not accurate and of no diagnostic use."}
{"text": "###Input :Is it safe to go outside for walks? I'm obese and therefore more likely at risk due to my condition, so I'm trying to lose weight. I would get a mask obviously. ###Output :Yes walks alone in open spaces should be fine. That said follow local guidelines - some countries forbid anything but trips out to collect food."}
{"text": "###Input :Many sources earlier this year kept stressing that the flu was worse than covid19. The flu has been around for a long time. covid19 was new and no one knew much about it yet people kept saying the flu was worse. Now we're where we are now. Why didn't people take it more seriously? ###Output :Those sources were probably not scientists or doctors. This was never not worse than the flu. This is what bad journalism does to our society"}
{"text": "###Input :Hi guys, this might be a bit of a stupid question, but four weeks ago my ear temperature hit 38 degrees, naturally it scared me so I self isolated, I tried to go on my PC again after 10 days and the same thing happened again. Skip forward another 20 days to today, and it's happened again (37.8 this time)... Can headsets make your temperature rise by like a whole degree? My temp was 37.1 when I went on my PC. I've felt fine for almost three weeks until today. Also can anxiety cause this? cos I am very anxious/stressed basically constantly atm and do suffer from diagnosed severe anxiety. ###Output :I would certainly suggest taking off your headset for an hour then rechecking."}
{"text": "###Input :Whats the deal with NSAIDs? Are we able to take them? I dont have covid, just being cautious. Specifically looking to use topical voltaren gel for chronic neck pain. Any advice is appreciated! ###Output :Recent review found no evidence that NSAIDs worsen covid. Youre definitely okay to use NSAID gel such as voltarol."}
{"text": "###Input :Why cant blood and organ UV radiation be a treatment for Coronavirus?Okay, I know how stupid that sounds, but I didnt want to jump on the bandwagon so I did a couple of minutes of research and I just want to hear from people who know better why this thinking is wrong.I know external UV radiation would not do anything, however:Uv radiation and high humidity has been found to be very effective at killing the coronavirus :https://www.google.com/amp/s/www.aljazeera.com/amp/news/2020/04/sunlight-humidity-kill-coronavirus-fastest-scientists-200424065853466.htmlUltraviolet irradiation of the blood used to be used to treat diseases like pneumonia before antibiotics in the 1950s :https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122858/Ultraviolet radiation has been used or suggested before as a way to sterilize organs during organ transplants:https://www.jhltonline.org/article/S1053-2498(18)30378-4/abstracthttps://www.efe.com/efe/english/technology/brazil-develops-technology-for-sterilizing-organ-transplants/50000267-3933369So what is stopping doctors from, in the worst case scenarios, treating critically ill coronavirus patients by irradiating their blood and/or a lung? ###Output :Beware quackery."}
{"text": "###Input :F23 Respiratory Sinus ArrhythmiaHi, I was recently diagnosed with Respiratory Sinus Arrhythmia and prescribed an inhaler. I was only told to use \"as needed\" but I have been having trouble figuring out when \"as needed\" applies. Do I only use it when I feel like I'm having an onset attack? Or at night when I lay down to sleep and my symptoms seem more noticeable? Are both situations applicable? Also any advice on lifestyle changes to ease my symptoms? Thank you in advance. ###Output :A \"respiratory sinus arrhythmia\" is an absolutely normal phenomenon and doesn't need to be treated, as it's normal. What was the inhaler prescribed for?"}
{"text": "###Input :I was also confused when the physician said she was prescribing an inhaler, the main things I complained about was a feeling of pressure in my chest and my heart feeling as if it was beating faster, but too softly, then skipping a beat and beating harder as if to compensate for the lost beat. I also mentioned how a little over 2 weeks ago I had a severe attack that was causing my muscles to twitch and spasm and i was sweating. The papers from my discharge say asthma but asthma was never mentioned during the visit. ###Output :Agree with above post. Your doc may have prescribed as a diagnostic/therapeutic trial for some symptoms, but ran out of time to explain it all to you. I'd get in touch with the person who prescribed it to you and ask them, as inhalers aren't typically used in this situation."}
{"text": "###Input :30 F Not feeling fully recovered 1 month after a Myasthenic Crisis and Acute Respiratory failure30 Female, medical conditions: Myasthenia Gravis, Chronic MigraineMeds: Mestonin 60mg every 4 hours, Cellcept 2x day ( 1st month on medicine)It's been a little over a month since I had a Myasthenic Crisis and was hospitalized in the ICU. I had three days of high-dose steroids and plasmapheresis for 5 days. I was feeling better respiratory-wise but still felt very tired and not back to 100% of where I was before the crisis. I was put on Cellcept by my neuro immediately after release and so far it has made me have less droopy eyes and mouth but I haven't noticed much difference.( Note: I have been diagnosed since late 2019 and on Mestonin, they did not put me on other meds since I responded well at the time. It has since been suggested that the mestonin alone was no longer able to handle the disease and that is why I went into a myasthenic crisis)The past week I have felt the shortness of breath from the Myasthenia come back, and at times I have gone on my CPAP to help reduce the strain and it has made me feel better. I'm starting to feel fatigued again, but not at myasthenic crisis level, so I'm pretty sure the benefits of plasmapheresis wore off. My main concerns are:Is it normal to take a while to recover from a Myasthenic Crisis?Is the reemergence of shortness of breath a troubling symptom?Should I ask my neuro for another treatment or medication? ( I was warned it could take 2-6 months for CellCept to fully work)I do see my neuro early next week, but I'm not sure if these symptoms are troubling enough I should seek medical care sooner or if there are other suggestions I should bring up to my doctor when I see her. ###Output :Yes you really need to contact your neuro doc. You are at risk for another crisis because you had one already. You may need ongoing weekly plasma exchange until you are on stable immunosuppressants. Your docs are the best ones to advise you, you aren't bothering them."}
{"text": "###Input :Found out I have convex chest at 40 after years of respiratory issues, now what?I am a 40 year old white male. Recently I had some issues with what I believe to be acid reflux (possibly aided by too much coffee) and it made me vomit several times. After telling my doctor this he decided to do a chest x ray and so far has only told me I have a convex chest.As an aside, I have been trying to find answers to joint issues I've had since puberty. My knees feel like they pop off and back in, even when that hasn't happened they swell up and hurt severely if I'm on them too long.Tgis applies to other joints to a lesser degree, I also have scoliosis and severe back pain.What should I ask my doctor to do? What to test for? Sometimes I feel like I have to ask for things with him and I'm worried about my future health.Anyway, thank you for reading and kind regards. ###Output :Chronic dyspnea and chest wall deformities make me think it might be worthwhile to be assessed by a pulmonologist. These lung doctors have a series of tests that can evaluate how much the chest wall deformity may be affecting your overall breathing, and if substantial have different ways of treating it."}
{"text": "###Input :Need ideas from as many medical minds as possible please! Chronic respiratory failure - hypoxia. Worsening. Low BMI. Ruled out pulmonary and cardiac causes, whats in your differential?51F, 59, thin, white, USA. never-smoker, non-drinker; no prescriptions; unintended weight loss of now 28lbs since January, oxygen desats started in January w/ exertion, suddenly worsening in the past few days and now on continuous oxygen. Exhausted and weak. X-post for visibility. (This is for my mom)ETA see bottom of this, someone mentioned cervical spine issues, my mom has those, found in MRI in 2020!Ive posted about this a couple of times but need as many ideas as possible, and casting as wide a net as possible as weve hit a dead end and its looking bad.All pulmonary and cardiac testing done. Normal. (Only abnormal test so far has been an elevated 5-HIAA ordered bc hours-long intense hot facial flushing episodes began at the same time as the oxygen desats). Follow up with GI in 2 weeks.Over the past several days oxygen desats started coming on faster and going lower so after respiratory therapist consult now on continuous oxygen. Follow up with the pulmonary doc tomorrow but after 6 months of pulm/cardiac testing - and now sudden worsening of symptoms over the past few days - it seems like its time to look for other causes.What other specialist besides pulmonology or cardiology would you recommend? What would be in/on your differential list at this point?ETA: someone mentioned cervical spine issues causing this - here's her MRI of cervical spine and brain brief notes from neurologist about this from 2020:Her MRI of the C spine shows degenerative changes but most notable for disc protrusion at C6-C7 narrows the spinal canal to 5 mm. She is nearly asymptomatic at this point, but still encouraged her to discuss with neurosurgery for opinion given the findings.MRI of the brain shows multiple punctate foci, estimated at 30. ###Output :I've been thinking about your mom since you posted last week about her worsening symptoms.The typical differential diagnosis for hypoxia is pretty simple to workup -- decreased partial pressure of oxygen (altitude), hypoventilation, decreased diffusion, VQ mismatch, and shunt). I would expect any reasonable pulmonologist could pretty easily work through that differential diagnosis, and I suspect if your mom got a shunt study that has gotten a thorough workup.There are some additional, rare causes of hypoxia/dyspnea that do exist. They are things that we predominantly see in the ICU, as they are typically acute causes. I categorize them as histocytotoxic and competitive. It's a bit complicated:Histocytotoxic causes do not exactly cause hypoxia. An example is cyanide. It uncouples the electron transport chain (ETC), which is the process of how cells utilize oxygen to make energy molecules). When the ETC is uncoupled/blocked you can not process oxygen, so physiologically it's like your body experiences extreme hypoxia. It's an immediately fatal process, so I can pretty much assure you your mom isn't dealing with cyanide toxicity. Perhaps you could bring up the idea of histocytoxic hypoxia to your mom's pulmonologist, though. She may have a chronic exposure to a substance that is causing hemoglobin dysfunction.Competetive hypoxia/hypoxemia is related to something that either outcompetes oxygen for hemoglobin binding or changes the hemoglobin conformation so that it no longer binds oxygen as well. There is something called methemoglobinemia (pronounced \"met-hemoglobinemia\", not meth-hemoglobinemia). It's also something we see on an acute setting in the hospital. There is a congenital/hereditary form, but it usually presents pretty immediately after birth. I wouldn't expect it to arise later in life like with your mother. There are plenty of acquired forms, but these usually happen acutely. It could also be worthwhile to bring up the idea of methemoglobin or other competitive forms of hypoxia/hypoxemia to your mom's pulmonologist.These are super rare and unlikely things, but it sure sounds like your mom doesn't have a common or simple problem. Hope this helps!"}
{"text": "###Input :Can coronavirus present as a cough and shortness of breath without other severe symptoms?I know you guys get a stupid amount of these posts, but I'm trying to figure out if I should go to a doctor to get tested, and I figured you guys might be able to tell me if my mild symptoms have any chance of being caused by the coronavirus.Me: female, age 20 (21 in a few days), 5'10\", 160 lbs., no comorbidities, mentally and physically healthy and fit, no drugs/alcohol, no medications. Possibly came into contact with someone sick.A few of my distant coworkers have tested positive for coronavirus. Two days ago, someone I share a desk with (who works the opposite night shift as me) went home sick with severe symptoms - it really sounds like he has the disease.Now, four days ago, before hearing about these cases, I had a headache, some body aches, a very mild sore throat. I'd explain it as, like, the most mild cold you can have. I popped an ibuprofen and went to work.For the next two days, I continued to have the same very mild symptoms. No fever, no runny nose. I thought it was allergies. But I started developing a cough. At first, it felt like when you exercise too much and can't breathe properly, but with a little chest pain to boot. But these symptoms have gotten progressively worse, to the point where I can't take a deep breath without coughing. My chest burns like someone rubbed some mild capsaicin cream on the inside of my lungs. My heart rate is higher than normal, and I have some mild body aches/fatigue. When I move around, I get short of breath way too fast. Additionally, today I think I may have developed the mildest of fevers (though I have no thermometer on hand).The feeling in my chest really reminds me of that one time I accidentally mixed bleach and ammonia and breathed in some of the fumes, but a little worse. It's not comfortable, but it's not bad. I am NOT coughing nonstop. I can speak, breathe, and sleep normally. But I undeniably HAVE a cough, and I'm tired. However, the other symptoms are so mild that if it wasn't for the cough, I'd think it was allergies/psychosomatic symptoms.I did call out of work and am keeping myself at home. I feel HORRIBLE about it because my symptoms are so blasted mild, but it's not worth the chance. I will go to the doctor and get tested if it doesn't go away, but I just figured I'd ask here beforehand - just in case my symptoms in no way match the coronavirus. I've read about people's symptoms, and most people talk about severe upper respiratory symptoms, which I do not have. Everything in me is screaming \"you're being dramatic,\" so I thought I might be able to get an opinion here on whether I am, indeed, just being dramatic.Thank you so much for reading through. I appreciate your time.Edit: I called and asked for a test. They don't want me to be tested because my symptoms are pretty mild, so I will just be staying home for a bit (5 days) to see if my symptoms get worse at all. That's how much ATO I have. If they go away, back to work. If not, I'll talk to HR and risk my job rather than other people's lives :( Thanks for the help.Edit 2: reports of positive tests in my area have been rolling in today, including in my boyfriend's workplace. Yikes.E3: I guess my birthday present is probably going to be unemployment because I'll be doing a full quarantine.E4: happy news! I talked to my employer and I won't be fired if I quarantine! Woot woot! 14 days of bored coughing, here I come.E5 03/20/2020: yeah it's getting worse. Chest is on fire. Hopefully this really isn't the coronavirus, because that would suck. Stay safe guys. This shit fucking hurts :)E6 03/22/2020: bedridden now and they won't test me. Breathing is hard. I hate this.E7: 03/26/2020: finally getting better. I am still extremely short of breath and can't do much or walk far. My lungs still ache, and going out in the cold is the worst. I can't taste or smell very well. However, I am extremely grateful that the worst of the sickness is through. That was probably the sickest I've ever been in my life, and it sure wasn't fun. I'm so glad my employer granted me paid leave; I spent four days in bed and will be self-quarantined for a while yet. Yeah, this was probably the coronavirus. Thanks for your help guysE8: 04/04/2020: I am much recovered. However, I am still very out of breath. I ended up calling the covid hotline again (long story involving my now sick roommate) and NOW they want me to get tested - AFTER I HAVE RECOVERED - because I am still very short of breath. The test was this morning (very uncomfortable). Let's watch this test come back negative now XD ###Output :Yes"}
{"text": "###Input :Thanks. Appreciate it. I will get tested. ###Output :You may not be able to get tested, given the limited supplies in most of the US right now. Please assume you have it and STAY HOME and away from family members who are at risk."}
{"text": "###Input :Same here i have cough and burning throat and can be hard to breath. I do also have random fevers and the first time it went away but now its returned. And my job flat out refuses to pay unless we are confurmed to have it. ###Output :Don't take ibuprofen!"}
{"text": "###Input :Not so sure about that. Heard a doc on on of the networks today saying there's no evidence to back this up. Hard to know with a lot of unconfirmed advice going around. Best wishes to those feeling unwell. ###Output :Yeah I'm not sure either, but it's better to be safe at this point. I'd go for Tylenol."}
{"text": "###Input :Overnight the cases doubled in New York where I GREW UP and my father still lives. ( Mind you he is late 60s something he's as stubborn a mule and won't go inside ugh) It may not have hit us yet but It will. I don't give two shots if he's from Kiribati or Myanmar or even Jupiter. I'm concerned with folks taking it seriously.As for you if you reread my message I clearly state that this guy didn't offend me, to which I'm not making a snarky remark I'm stating \" oh man that fucking sucks what's happening in Italy that shots for real over there, it's gotta be difficult. In which I then go on to wish him well. At NO point in my reply did I ever curse him or put Ill will upon him just the opposite.I APOLOGISE if it came across another way that was not my intent.As for you maybe in the future you might stop and consider the gravity of what's going on. I may personally live in the Midwest for now but I'm shipping out in a week and I have family all over the East coast. Lastly good luck hopefully we can do this again some time, this nothing quite like a decent discourse  ###Output :Please read our rule on claiming credentials"}
{"text": "###Input :23M I was prescribed Prednisone after getting symptoms of upper respiratory infectionI went to an urgent care yesterday after having a sore throat the night before, I took the prednisone yesterday as well. Now my sore throat has turned into horrible nasal and chest congestion and an even more sore throat. My sister is just finishing up a bout with bronchitis(thats what she was diagnosed with). Is this the right medication for me? My body is telling me its not based on my infection getting worse it seems. ###Output :These things are likely unrelated. Despite the prednisone you would likely have gotten worse anyway. It just seems like cause and effect because of the timeline. You also likely have the same viral infection as your sibling. You really dont need the prednisone unless youre wheezing. You dont really need any medications specifically but can take things for the symptoms such as Tylenol/Motrin for aches, pains, or fever, OTC cough suppressants, etc. drink plenty of fluids. I assume the urgent care swabbed for flu/covid? If not that would be something that could direct treatment plan more."}
{"text": "###Input :Do I have some sort of respiratory infection22M, 5 ft 20, 235lbs. 2 weekends ago went to a family party and we were all drinking and started sharing a bottle that was passed around between like 5 people. The next morning I had a sore throat and just thought it was nothing. It continued for a few more days and after the sore throat went away I got really congested and got a really bad cough that I still have to this day almost 10 days later. My mom also had the same symptoms plus her sinuses were bothering her so she got a covid test that came back negative. I just assumed I wouldnt have covid if my mom didnt if we were both sick. The doctor at the clinic she went to said she had a sinus infection. I havent seen a doc yet but my sinuses havent been bothering me at all just my chest snd a cough. The cough is the worst in the morning then kind of slows down a little then picks up again around the time I want to go to bed. I get in nasty coughing fits to the point where I can barely even breathe and I cough up a ton of green phlegm. Ive had an upper respiratory infection before but it was never this bad. Ive barely been getting any sleep because of this cough. Ive taken mucinex dm, robutussin, and dozens of cough drops but nothing is working. ###Output :Sounds like either COVID or an enormously long list of alternative upper respiratory viral infections. Just because your mom tested negative doesn't mean you don't have COVID as well."}
{"text": "###Input :Why did urgent care send me home to fight an upper respiratory infection that has put my husbands coworker in the hospital?Age: 28, race: Caucasian, sex:FIve been dealing with an upper respiratory infection these last few days. went to urgent care Wednesday, no fever, sore throat. Negative for Covid, strep, flu. Doc told me to take time off work, could not due to previous attendance issues so Ive been doing half days. Sore throat went away and it feels like my chest is chock full of mucus. I already have mold in my house, so yay. Ive done a nasal spray and taken a decongestant but Im so nervous. I dont want to wait for this to get as bad as Hs coworker did. Urgent care doc struck me as one of those its not a big deal people and denies my illness could get worse ###Output :I mean... we didn't put everyone with covid into the ICU or even admit them all.Illnesses hit different people differently, we base treatment recommendations on your illness severity, not based on what happened to an acquaintance.If you decided to go to work afterwards, it sounds like the urgent care doc 100% made the right call."}
{"text": "###Input :Contracted respiratory symptoms from my childMy son (10 months old, male) was fussy, with runny nose and coughing between Friday and Sunday last week. Now he's not longer fussy, the runny nose decreased to less than a half and he caughs once or twice a day. He's very active and with good mood.As of Tuesday I started having an itchy throat that led to a sore throat and a runny nose the next day. On Thursday I had elevated temperature (37.8 C) and cough. Friday the cough went on, but temperature was normal. Today the cough feels coming from deeper in my chest, but no fever. I've taken two sars-cov2 antigen test (Thursday and today), both negative.Tomorrow I have an appointment with the family doctor. My partner (41yo female) and her daughter (13 yo female) are starting to develop similar symptoms as I did.Since apparently my son caught an infection and then passed onto us, plus the covid antigen tests came negative for all three (partner, daughter,me) I'm not sure if covid could be ruled out.Could you please share your thoughts? I'm not really sure what to ask specifically, just want to get some opinions and maybe suggestions.Cheers! ###Output :Sounds like the easier solution would've been to get your son tested first, instead of everyone else.Remember that there are plenty of viruses besides COVID that cause similar symptoms. More likely that you have one of those given the negative tests."}
{"text": "###Input :My best friend died suddenly, and Im trying to figure out what happenedIm sorry if this isnt an appropriate question for this sub - if you have any other relevant sub recommendations, please let me know.29 year old white female, 58/315lbs, frequent drinker, non smoker, no medications other then OTCs, no known health problems.On December 13, my best friend (we work together) went to her sisters company Christmas party. Towards the end of the night, they got into a fight, which continued until they got home (they lived together). During this fight a shard of glass or mirror punctured her trachea (still dont know the truth as to how this happened, but thats a different story).They had her in the ICU for two days. While in the ER, her lungs stopped working and they put her on a ventilator while in the ICU. Her kidneys started to act up, so they kept her for a full week. I visited her and gave her a care package, we walked around the ward a bit, and she was in pretty good spirits although she got winded easily. Externally, it looked like her injury was healing well.On December 23, she came back to work for a half day. She had subcutaneous emphysema and was retaining water weight for some reason. We took a walk and she got very lightheaded at one point. She was supposed to leave at 2, but she got lightheaded again and said she was going to wait a few minutes before driving, I gave her some water and pretzels. About 10 minutes later, I heard strange gurgling noises coming from her desk (we sat across from each other with a divider in between) so I ran over. She was bent over her desk shaking and barely breathing, her pupils were dilated and she was unresponsive. She also lost bladder control at one point. She fell out of her chair as I was calling 911, and when on the ground she was only breathing 1-2 breaths per minute (agonal breathing?), her face and tongue turned blue and then grey, and she was clenching her jaw. I stayed on the phone with 911 while two of my coworkers started chest compressions. Once the paramedics arrived, they took over, started manually breathing for her, and hooked up an AED (I think), and the first time they stopped CPR she flatlined and wasnt in a shockable rhythm. It took them forever to find a vein that worked, but they finally got one and gave her epinephrine 3 times that I noticed along with sodium bicarbonate. They also intubated her. I dont know if this is standard, it seemed strange to me, but they worked on her for over an hour, maybe even an hour and a half - every time they stopped compressions she would flatline, but after the first time her heart was in a shockable rhythm so they shocked her several times. They were unable to resuscitate her, and told us that she died of kidney and respiratory failure.If any additional information is required, Ill do my best - not sure if I covered everything. I requested a copy of the autopsy report from the county ME but they said the case was referred to a justice of the peace, so I have to contact her directly (and if theres an active investigation she may not release the report). If anyone has any ideas as to what happened here, I would really appreciate it. Thanks in advance. ###Output :Wow, those are quite some tragic events to happen to everyone involved. My condolences.At this stage I guess you will have to wait for the autopsy.My first guess would be a large pulmonary embolism (immobilized in the ICU).A primary cardiac cause seems unlikely. A respiratory or airway cause (suffocation or serious bleeding in the upper airway) I'm not so sure about either, because it wouldn't have such an extremely acute onset and your friend would typically run over in case she was suffocating for instance. A very serious and sudden arterial bleeding (ruptured aortic aneurysm) doesn't make sense either considering her age and history.A major intracranial (subarachnoid) hemorrhage is a second possibility.Again, pure speculation. You would have to wait for the autopsy report."}
{"text": "###Input :Yea I watched my son die of a PE we knew it was eventually going to happen and the gurgling made me immediately think of that. Sorry for your loss. Please consider some counseling as it can really help work through dealing with unexpected deaths. ###Output :Sorry for your loss. If she actually had SQ emphysema when you saw her that day, I would be concerned that she may have had an air leak and may have developed a tension pneumothorax. A tension pneumothorax can potentially lead to progressive shortness of breath and cardiac tamponade which would drop her blood pressure. In that situation, I would have expected her to be having some chest pain prior to the event and for symptoms to build up. If this happened very suddenly, then I agree that a pulmonary embolus is more likely."}
{"text": "###Input :Do you think there will be charges brought against her sister? I could see an Involuntary Manslaughter charge for someone where I live happening. ###Output :Sorry to ask, but did the ems people work on her for an hour and half or did they transport her and the docs worked on her for an hour and half?"}
{"text": "###Input :Ems from op ###Output :Why on earth would EMS work on someone in the field for 1.5 hours instead of transporting?"}
{"text": "###Input :Depending on the area, sometimes med command directs EMS to stay on scene with an unstable patient. Ive heard them be instructed to stay up to 2 hours before med command calls it, but its so unusual Ive only ever encountered it once. Does seem very very strange, but it also very much depends on rural vs urban settings. A lot of different possibilities. ###Output :Ive heard them be instructed to stay up to 2 hours before med command calls it, but its so unusual Ive only ever encountered it once. Does seem very very strange, but it also very mMakes no sense honestly, intubate, start acls, go."}
{"text": "###Input :Depends on your area and protocols. Study's have shown improvement in survivability and neuro out come of obtaining ROSC in the field prior to transport. Field terminations are becoming more common in EMS on medical arrests. Mainly in part you're unable to properly work an arrest in a moving ambulance.Requirements in my area for field term are 30 minutes of basic ACLS. Epi, fluids, ET/ laryngeal airway, bicarb/ calcium on renal pts. If the patient remains in asystole med controls is contacted for any additional orders, with no change we terminate. ###Output :Yes, improved survivability if ROSC within a certain time frame, 1.5 hrs?"}
{"text": "###Input :This varies a lot with the culture of EMS agencies, transport distance, etc. I work with some agencies that work it on scene and only transport if they get ROSC or if theres something obvious the hospital can do that they cant. To be fair, unless its a known STEMi that can be cathed, or a cold water drowning, or trauma were just going to do to ACLS too. ###Output :Define what \"we're\" means, you are ems or em?"}
{"text": "###Input :My particular Emergency department. Things might be different elsewhere ###Output :Your ER Doctors do not use ACLS, nor should any board certified EM physician. It is a backburner protocol that can be implemented while thinking but is ultimately a protocol created for non resuscitationists. Your ED should not be doing \"ACLS too.\" There is also a significant difference in the number of available hands for CPR, med pushing, and ultrasound machine, a pharmacist, a respiratory therapist, etc etc. I know I don't know all the details, but a young person who arrests in the field should be brought into the ER ASAP."}
{"text": "###Input :If critical care paramedics use thrombylitic agents on scene it requires an additional 90 minutes of CPR, at least in UK guidelines. ###Output :Those don't really exist here. And if they do, they are in remote academic areas where transport should have been quick."}
{"text": "###Input :Where do you work? A lot of EMS protocols around the world are \"No ROSC = no transport\" except maybe in some extreme cases that can't be treated in the field (ie. PE in some places, or intrapartum cardiac arrest). ###Output :I am so sorry for your loss, it seems you got into a very tough situation but did all you could to help her and gave her and the EMTs the best chances; you're a good friend and person. I would agree with the colle ague that a PE or another clot of some sort (intracranial bleed/occlusion) comes to mind as a plausible possibility, and that waiting on the autopsy results is the best step. A serious underlying reason would also explain why the resuscitation was unsuccessful."}
{"text": "###Input :UPDATE ABOUT MY MOM: Chronic respiratory failure - hypoxia w/o pulmonary or cardiac explanation.51F, 59, thin, white, USA. never-smoker, non-drinker; no prescriptions; unintended weight loss of now 28lbs since January, oxygen desats started in January w/ exertion, suddenly worsening in the past few days and now on continuous oxygen. Exhausted and weaker every day. X-post.This is just an update for anyone interested. Ive posted about this several times on the various medical subs here out of desperation and have been blown away at the helpful advice and input. I wanted to post an update in case anyone remembers spitballing about this and might be curious about new developments.Today mom had her follow up with her pulmonologist following the normal shunt study. He spent a solid hour with us going over everything shes been experiencing the last six months with a fine tooth comb, reviewing prior records in the hospital system from the past year before the oxygen issue, and doing a thorough physical exam - we knew something crucial might be in those clues.Very long story short - its not a happy update but it unfortunately makes sense given a lot of other problems mom has been having during this same timeframe that just seemed insignificant or unimportant compared to the chronic respiratory failure. Things she thought could sit on the back burner til that was solved, but have been accelerating in just the past 2-ish weeks along with the worsening oxygen desats.Basically, there are several observable, objective signs and symptoms that seem to point to some kind of neurological/neurodegenerative process/disorder.He ordered a lot of tests that will be happening next week, and she will be seeing a neurologist for further evaluation on Tuesday.The more we read, the more huge lightbulbs are going off on this kind of process being a possibility. Not going to assume anything, and not trying to be negative, it is just undeniable that a lot of the puzzle pieces fit and we want to prepare for the worst mentally/emotionally. It's a long way from here to final answers (if we ever get any, we are well aware we might not ever get this figured out, that there are limits to medicine), but I just thought Id update since my moms situation is such a very odd, even bizarre, case. Thanks so much to all of you who have pitched in. ###Output :Glad to hear you've found yourself a solid pulmonologist. Might I ask what institution he/she is working at? I like to know where there are good folks if I ever need to reach out."}
{"text": "###Input :I (27F, 65in, 125lbs) was recently prescribed propranolol (20mg twice a day) for migraine prophylaxis. As I was reading through the information, I saw that multiple occurrences of past bronchitis are a significant contraindication. I have had pneumonia several times, and am not sure about bronchitis because the several pneumonia cases I had, I put off going to the doctor until I had to go to urgent care (less than ideal, I know. poverty can really be a bitch.) The last time I had pneumonia I ended up with cracked ribs from coughing so hard.Is it safe for me to be taking propranolol, and are there early warning signs I can look out for if my respiratory system is being negatively impacted? Would I develop a cough?I would call the prescribing PA but not only was it the first time I had an appointment with them, it was also their last week at that job, and they also were a little bit dismissive when i asked if there could be any interactions with my psychiatric medications (bupropion xl 300mg & concerta xr 27mg.)Thanks for your help! ###Output :Previous infections shouldn't affect you today, I wouldn't worry about it too much but yes you are correct, they would be signs. The main sign would be an asthmatic sensation, in which case you should not take any more propranolol and seek help.It's very hard to give good medical advice you seem to have shared lots of pertinent information, I can only suppose, but I suppose there's no problem taking this beta blocker at this moment."}
{"text": "###Input :Thank you! Would asthmatic sensation feel much different than respiratory symptoms from sickness? I noticed today that drinking very cold things makes me cough and feel like i have an itchy throat/need to clear my throat. This isnt completely unusual for me, but its been more extreme than normal. ###Output :Not really, shortness of breath, is shortness of breath.Allow me to advise you not to drink very cold things."}
{"text": "###Input :Is brain fog/cognitive dysfunction in sleep apnea caused by sleep fragmentation or intermittent drops in SpO2?24M, 176cm, 78kg, mild sleep apnea (AHI = 10), not on any meds, non-drinker, non-smoker.I have had mild OSA for the last 2 years and was only recently diagnosed in March; during this time, my main symptom is brain fog/cognitive dysfunction which was bad enough to impede my ability to study. I have since been treated with CPAP and I have noticed mild improvement even though I am still not 100% used to the machine and the mask and am hence sleeping only for 6 hours at a time. I still feel sleepy on days where I sleep this little, but the brain fog is improving gradually nonetheless. This makes me wonder: was the brain fog caused by the oxygen deprivation while my OSA was untreated, or was it due to the sleep deprivation? If it was caused by sleep deprivation which occurs as a consequence of the OSA, then why am I experiencing improvement in the brain fog even though I am feeling sleepier than most of the days before I began using CPAP? ###Output :They are both tied in together, as the low oxygen level triggers an awakening response that fixes the low oxygen level but results in sleep fragmentation. Disorders that are associated with frequent awakening but not hypoxia, such as restless leg syndrome, are also associated with \"brain fog\" and other symptoms of poor quality sleep so it isn't really just the oxygen.There are two possibilities here for you.Cognitive dysfunction and daytime sleepiness are not affected equally by quantity/quality of sleep though they are related. It is possible that 6 hours of higher quality sleep is helpful for your cognitive symptoms, but isn't enough to pay off the sleep debt you've accrued especially since total sleep has decreased. Increasing comfort over time with the CPAP is the rule of thumb, and eventually it tends to become a sleep cue.The other possibility is your cognitive improvement is a placebo effect. Your OSA is mild by AHI, depending on the rest of the picture including nadir oxygen and other symptoms (snoring, high blood pressure etc) this may or may not be causing your symptoms. I think this is less likely.There are some other possibilities with persistent daytime sleepiness when you have started treatment for sleep apnea, including a mixed sleep-disorder, and if it persists may warrant testing in the sleep lab if this wasn't done already."}
{"text": "###Input :Thanks for the comment. This is more comprehensive than I expected.But what I meant is, without the sleep deprivation/fragmentation, could the SpO2 drop still cause cognitive dysfunction? My nadir oxygen (lowest Spo2 recorded in my sleep study) was 88% (for a total of 9 minutes, not continuously but distributed across the night), and usually the drops are to the levels between 90-94%. If it was the sleep fragmentation caused by the Spo2 drops that is the culprit, then it doesn't really explain why I have been feeling sharper and yet I am feeling sleepy. I have had insomnia in the past and the sleep deprivation have never given me \"brain fog\" neither, I simply felt so tired that I can't continue with my day anymore subjectively but I wouldn't notice a \"fog\" over my head. One way to illustrate the difference would be the comparison between the times I had to do an all-nighter before I had OSA and when I had to do an exam after having slept say 6 hours the night before while having OSA: I still found it harder to think on my feet in the latter case even though theoretically I should be more tired in the first case due to the acute sleep loss.I don't think that my cognitive dysfunction is a placebo effect because the difference that I have noticed is a bit too big. I have taken anxiety medication (atarax) and followed the advice of a psychologist to just take it easy and relax before as well when my clinicians thought that the brain fog was caused by stress and anxiety, but even though I convinced myself that the it was psychological and even layed off my studies for a whole year, I did not experience any improvement as significant as that which I am experiencing now.I know why I am still feeling sleepy: it is from the simple fact that I get woken up by the sunlight in the morning easily, since the CPAP mask is making it hard for me to put my eye mask on and I haven't learnt to sleep under my duvet yet due to the heat underneath (the CPAP mask is making that a possibility as an added benefit anyhow). ###Output :I don't think that there is a distinction between the SpO2 drops and the sleep awakening here. They aren't really separable since you are treating both.To whit, treating sleep apnea with oxygen supplementation isn't really effective at improving symptoms, and other causes of sleep disruption that don't cause intermittent low oxygen also result in cognitive dysfunction.I see that you are trying to separate these things out but no I don't think it is just that you are recovering from a hypoxic injury to the brain."}
{"text": "###Input :Right, so basically you're suggesting that the fact that I am noticing improvement despite feeling sleepy can be accounted for by my sleep deprivation being nonetheless less severe in comparison to before I got started on CPAP, even if I haven't been sleeping well for other reasons recently? That can make sense.Are Spo2 drops to the level that I described harmful to the brain? How about the effects of CO2 buildup itself (independent of the fact that it causes you to wake up periodically)? ###Output :Your respiratory drive is related to things other than just low oxygen levels. There is a pacemaker in your medulla that integrates a bunch of data, including carbon dioxide levels, strain, airway narrowing, lung expansion etc.For instance with OSA there are often respiratory effort-related arousals (RERAs) caused by partial airway obstruction. These increase the effort needed to take a breath, but do not cause hypoxemia. They do cause awakening because of the increased work of breathing and the muscle strain sends and alarm signal to higher centers involved in the sleep-wake cycle.So oxygen doesn't cure sleep apnea because this isn't the only reason that there are awakenings. In addition if there is complete airway obstruction then no amount of oxygen is going to help."}
{"text": "###Input :Is a full neuro-cognitive recovery guaranteed with full compliance with CPAP treatment? I am still finding it hard to focus and think and I've been dead tired today... I was in bed for more than 8 hours... The CPAP is working as intended because my AHIs have only been at around 1.2 on average since I got started on it. ###Output :We don't really deal in guarantees in medicine. Also I don't know if your symptoms are due to your sleep apnea. If they are then good recovery would be anticipated."}
{"text": "###Input :Well I guess I'm fucked judging by how it feels. I don't see how bouncing back is possible to be honest. If I would think about how I felt at the start of this I was certainly sharper than now so there has been a deterioration over the last 2 years. As far as I know intelligence is supposed to be quite intact/stable and if that has experienced a gradual decline then I would guess that full recovery is quite unlikely as well. I say this because if I would think about a topic that I know from experience wouldn't have difficulty thinking about before, my train of thoughts stop earlier than it previously does. ###Output :This kind of went from a question about sleep physiology to diagnosis of neurocognitive decline, for which I don't have any information to say that you are or are not \"fucked\", but would be very shocked if you had some sort of irreversible neurodegenerative disorder at age 24.I would continue to give the CPAP time - this is usually the most treatable thing and as you get more accustomed to it the benefit will increase. You had a one-day setback. Depression/anxiety are the other common causes of these symptoms in a young person."}
{"text": "###Input :Can chronic CPAP use reduce the natural respiratory strength or capacity?Age: 32 Sex: M Height: 510 ###Output :No"}
{"text": "###Input :3 months sore throat. Urgent care seemed very concerned about oral cancer.https://imgur.com/a/m7onRtJThroat pictures.21 Male. 61 165 lbs. athlete and healthy most of life. Dont smoke and drink on any regular basis. Vaccinated for HPV.Ive had a sore throat for 3 months that began right after a fever but has stuck around. Symptoms include some difficulty swallowing time to time, lots of mucus every morning, and very occasionally pressure near ears, but I wear earplugs every night to sleep right next to train tracks.I visited 1 month into sore throat and was given antibiotics, didnt change anything after full course.Saw them again recently. Negative for all STDs, strep, mono, no growth on culture. Blood work normal as of 1 month ago.This time at urgent care the nurse seemed very concerned it could be oral cancer and urgently referred me to an ENT. Im waiting on that visit on the 28th of April and Im freaking out in the mean time.Thoughts? Thank you for your time. ###Output :Theres nothing in the images youve posted that appears cancerous.Follow-up with a primary care physician, or at least a midlevel PA/NP who have examined more than a few throats and knows what a normal pharynx looks like.Id probably try to treat your chronic sinusitis with daily flonase in each nostril and a daily allergy pill like zyrtec. Do that for at least a month. Considering you obviously have post-nasal drip, your chronic sinus congestion likely explains the daily morning mucus, sore throat, and ear pressure. And yes, this can cause symptoms that last for weeksespecially if you havent been treating the actual cause.The only person who throws out a diagnosis of cancer in a 21 year old for a sore throat that lasts for three weeks is someone who doesnt know what theyre doing."}
{"text": "###Input :What are your thoughts on possible differential of acid reflux (respiratory reflux, LPR)? ###Output :Possible, but sounds like OPs describing a lot of upper respiratory symptoms. And if youre in the northern hemisphere right now, its the start of spring allergy seasontheres a lot of people with chronic congestion/cough that lasts for weeks and is not infectious.I advise my patients frequently who start developing similar symptoms at the change of seasons to grab their antihistamine of choice along with a nasal steroid and use for at least 4-8 weeks."}
{"text": "###Input :Thank you. It has been 3 months however, not 3 weeks. I definitely agree and appreciate all the info. Im definitely considering acid reflux as a possibility too, though I dont have heart burn. I have been eating pretty late dinners and spicy foods lately. ###Output :Ok so what did the doctor say? Because it would be extremely weird for you to have throat cancer at your age."}
{"text": "###Input :Have yet to meet doc, it was a Nurse Practitioner that examined me. I agree. After I mentioned Id performed oral sex before symptoms, she suddenly became very alert and mentioned oral cancer and HPV multiple times. I told her I was vaccinated. She still seemed very concerned even after that. She definitely spiked my anxiety more than necessary. ###Output :HPV doesnt cause oral cancer in weeks or even months, but years and decades."}
{"text": "###Input :I had a bad experience during a procedure and want to make it right.56 yr old female with chronic pain. I had a knee RFA with a new doctor. My most recent previous ones were under deep sedation ( propofol, ketamine, midazolam) in a surgical center because of problems in the past with pain and panic attacks. When I went for the consultation I was told I would be completely sedated with propofol and would not be aware of anything. I asked for an injection of torodol after the procedure as this has what has worked wonderfully for my 3 previous RFAs to control post procedural pain ( I have had gastritis in the past so taking ibuprofen is a no-go for me). The PA said no problem. We discussed in detail previous bad experiences that has lead to a formal diagnosis of PTSD ( anesthesia that resulted in me being conscious of pain, but not being able to tell them to stop the procedure). She took notes and said \" I will be fine\". I am also diagnosed as immunocompromised with a primary IgA, IgG immunodeficiency. They were aware of this.When I got to the procedure they wouldn't let my husband wait with me. This has never happened before and I was not prepared. Then I was notified that I had to be awake for some nerve testing ( my previous 3 RFAs did not do this, I was out through the whole rhing). I asked if it would hurt. I was told there would be \" tingling\". Then I asked about the torodol injection and was told \" we dont do that\". Then they took me back and refused to put the nose canallula under my mask like the other times at the surgical center. I was caught off guard. They shamed me, they raised their voices at me, they made sarcastic jokes. At this point I almost left.I ended up going through with it as I felt trapped because I needed pain relief. The \"tingling\" was short term burst of pain at a level of 7 or 8 for two of the three nerves tested. I was completely unprepared. The last nerve was okay, just weird.My question is how do I make this never happens again? Why didn't they tell me ahead of time that I would be awake. Why did they say \" tingling\" instead of \" maybe pain, it differs among patients\". Why was I refused the torodol after being promised it? Why didn't they tell me about removing my mask at the consultation knowing I'm extremely high risk for all respiratory illness?I have lost trust in this provider and I'm supposed to have another different procedure in two weeks. Botox injections, where I just found out they won't let my husband be with me and I dont understand why. It's hard to find pain doctors and I dont want to change unless I absolutely have to. I just want to try to reestablish trust.Am I overreacting? Is it usual to not let a spouse be in pre-op and I've just been lucky in the past? I've already have had awful experiences in the past, which they know, and I felt trapped yet again. Im considering what to do with the scheduled botox injections as im not sure I can trust them without my spouse being there. I feel like they are going to spring something on me the last minute again when I'malone and vulnerable. Is there any advice you can give me to help me out so I can repair this relationship? I do see a psychiatrist and a therapist for the PTSD. Thank you. ###Output :Sorry you had to go through this.In regards to the Toradol, I understand why they didn't give you Toradol as if you have gastritis from ibuprofen Toradol is almost exactly the same thing which can cause gastritis so shouldn't be given.I've been at hospitals that allow family in the preop area, I've also been to hospitals that don't allow it. Especially after COVID the rules and policies have changed drastically.Some doctors will tell patients there might be some tingling or pressure or something without using the word pain because some people will actually cause themselves more pain by thinking and dwelling on it, a negative placebo effect. It's a personal practice type of thing.The best thing to prevent things like this happening again to be up front with all the staff you are interacting with about your previous experiences such as this. You can talk to the doctor directly and let him/her know about your negative experience as well."}
{"text": "###Input :Thanks for taking the time to respond. Your comment about torodol is interesting. My PCP, the previous anesthesiologist, my previous pain management doctors and the new PA all agreed I could have it, all knew my medical history. My PCP said it bypasses my stomach so it's safe. What in the world is going on here? I see your a pharmacist so I am now going to ask some more pointed questions from my providers. They nurse just said, \" we don't do that here \" when I asked for it, nothing about my specific history.I have a hard time believing not allowing my husband back with me was a COVID policy as they don't require masks on staff or patients at this practice. In fact the doctor gave me a snarky comment about me wearing one in pre-op. He said, \" I should take some deep breaths if my mask will allow it\".You may be right about them wanting to avoid a nocebo effect and so they underplay the pain component. I've had the same experience with previous doctors. I always thought consent was a big deal though and knowing what pain you may be in seems to be a part of giving, or not giving, consent for a procedure.I informed them of my negative experiences in detail in order to avoid all this, they knew. I guess I just have to decide if I want to use the mental energy to try again with them.Again, thank you for the response, much appreciated. ###Output :The stomach bypassing actually doesn't affect the mechanism of action that it works. The reason why NSAIDs like Toradol and Motrin cause issues with the stomach is due to the inhibition of COX-1 which happens whether it's taken orally or given IV/IM."}
{"text": "###Input :You literally just have to leave and reschedule if you dont feel heard. Its not worth the medical ptsd in my opinion . My rfa for my back I asked for sedation at the center they blew 4 veins and got blood all over, (which triggered my thoughts of cutting i suppress as much as possible), then told me I didnt need sedation anyways and told me my only other option was to leave if I didnt want to do it with nothing . Feeling trapped and not wanting to seem like a wimp I did it with no Iv line of any kind.Ive never heard of them having someone completely out where they cant test the nerve . You can ask for a medrol dosepak tho to help inflammation /post op pain or go into any urgent care for toradol . Ive done the urgent care option often .Sedation isnt used for like anything injection or nerve burning wise anymore and idk who got the idea to torture patients , cheap insurances not wanting to pay most likely, but it makes me sick . 15 years ago you got sedation even if you didnt want it. We were treated like humans . Oh what a time .Im sorry you experienced this. Therapy has helped me in dealing with some medical ptsd issues . At least the anger and feeling violated . ###Output :We dont sedate all the time because sedation has very high risks and can result in aspiration, inability to ventilate, and death. Sedation is taken very seriously and is a very high risk thing to do."}
{"text": "###Input :Any respiratory therapists or pulmonologists on here? I feel like I'm getting no support in weaning my 4 month daughter off her home oxygen and my anxiety is through the roof.4 month female15.5 lbsWhiteLow oxygen saturations is the main concernFlovent, bactrim, iron, vitamin d, recently discontinued diuril.My 4 month corrected has been off daytime for months, always 97 and above, usually 99 or 100.Nightime weaning has been more difficult because of her periodic breathing. Its usually the most extreme when she first falls asleep. She will go up and down from 97 to 89/88/87/86 sometimes low 80's every 10 seconds or so. Down 5 seconds, up 5 seconds. This happens over and over again for about an hour, then she comes out of it and sits at 97/95. Then she goes back into it, usually not dipping as low as the first cycle.The first time they tried to trial her off nighttime they told me to \"watch her\" the night before her appointment. I tried to get more info. When do I put the oxygen back on? What is concerning? \"Just watch her\". So I stayed up as late as I could and tried to peek intermittently. Lowest I saw was 89. This didn't seem like the most accurate sleep study but whatever. She had been tearing out her oxygen every single night at this point for weeks. After me relaying what sats I saw, they decided to wean the diurul first, then check back in in Feb.I reached out this past week because its been impossible to keep her oxygen in. I'm using the works, the strongest adhesives, using mittens, socks, swaddles, and she still manages to get it out. She's also started trying to eat her tegaderm and I am certain she ate some at least one night. And a really problematic rash has been developing on her cheeks from the duoderm. I decided to leave her oxygen out since last week after the tape eating incident and to give her cheeks a chance to heal. I let her NP and NEO follow up know and they are in agreement that we should just leave it out indefinitely and \"see what she does\". But what does that mean exactly! Shes definitely going lower than usual the past couple of days, as low as 83 so far.TLDR: WHEN DO I PUT THE OXYGEN BACK ON WHAT IS SAFE/NOT SAFE. I have asked her NP time and time over what her parameters are and she never gives me a straight answer. I understand that dips to 80s are fine. But how many? She cycles like this for at least an hour every night, probably a total of 2 or 3 hours. Are these dips cumulatively an issue? We've never gotten an alarm when her oxygen is out (alarms at below 90 for longer than 10 seconds). Should I just based my concern off of that? I have to go back to work in a couple of weeks and will no longer have time to stay up late watching her monitor and watching her naps. ###Output :How are you positioning the NC? Dont tighten it under her chin like an adult would wear it, instead put the prongs in the nose, and adhere the cannula up by her eyes - not level with her nostrils, keeping it up higher will hopefully reduce them coming out, then tighten the cannula up by the top of her head.Tegaderm is pretty weak, I place douderm down on the skin, place the cannula on top, then secure with 3M multipore tape. Taping the cannula to the douderm not to the skin, that way if it is tore off, the skin isnt being torn. Hope this helps."}
{"text": "###Input :Im doing all of the above but will look into the 3M tape, thank you! ###Output :Hey there. Patience is key. Helping your 27 weeker who needs home oxygen is a marathon, not a sprint. The impact of BPD/CLD is going to take a while for her lungs to get to the point where she can be off oxygen entirely, and will affect her lungs for the rest of her childhood and to some degree her entire adult life.That being said, trust what your team is saying here. The alarm parameters are perfectly fine as a level for concern. In the NICU, we would only care about desats longer than 10-15 seconds; momentary dips are much more likely to mean nothing. If your team thinks shes ready for room air overnight, particularly given her vigorous attempts to pull the cannula off, I think thats a good sign.Let her alarm do the work. You shouldnt have to be staying up next to her like this. The alarm can tell you when shes going longer than 10 seconds in the 80s. These short blips dont matter as much. If it alarms, just keep track of how many alarms overnight youre having, how long, and the low number reached during the desat. The monitor should be tracking this for you.Its okay. You are doing so much hard work for your daughter right now and are asking a lot of really important questions about how to give her the best treatment and recovery; that shows me that you are taking great care of her. Just keep talking with your team and dont be afraid to ask to speak with them in between appointments if you feel like things are changing."}
{"text": "###Input :Opinions on posterior tracheopexy for 2.5yr old?My son, 2.5yr old male, 32lbs has severe tracheobronchomalacia and moderate bronchomalacia and a type 1 laryngeal cleft. The bronchomalacia goes deep into the bronchi. Hes had multiple hospitalizations and 2 PICU stays. Most recent in December. His sleep studies always come back as mildly failed. His baseline o2 overnight is 94 with multiple dips into the 70-80s when healthy. Im in Canada and our doctors feel that surgery is too aggressive since he is generally healthy but struggles with respiratory viruses. They also feel that because the bronchomalacia goes deep into the bronchi it cannot be fixed and therefore correcting the tracheomalacia may not do much and they cant correct the bronchomalacia. Doctors at John Hopkins in Florida feel he is possibly a good candidate for the tracheopexy and would like to see him and run tests however that would be all out of pocket (5-10k$ for tests, 100k$ for surgery). When he is sick, his overnight o2 stays in the 80s. I dont even bring him to the ER anymore because often hes fine otherwise. He may sleep more. When he gets lethargic is when I go in now. Doctors here say he will get stronger as he grows. He sleeps around 15hts per day and does get winded easily. Ive pulled him out of daycare as the risk is just too great to his health. Sorry this is all over the place. Opinions? ###Output :My opinion is 100k is a truck load of money when you have a team of doctors telling you it isnt necessary. But my other opinion is multiple 02 dips to the 70s isnt great. Have you tried anything less drastic like home oxygen? I would want to even ask about cpap before pursuing a surgery OOP your doctors dont think you need."}
{"text": "###Input :Freaking out about my echo results. PLEASE advise.27f 5'3\" 280lbsPLEASE can someone look over my echo results and tell me if there is anything alarming? I am so scared.. (Yes, I have called my cardiologist who is out until Thursday and I truly cannot wait that long)Left Ventricle:The left ventricular chamber size is normal. There is no leftventricular hypertrophy. Global left ventricular wall motion andcontractility are within normal limits. The estimated ejection fractionis 55-60%. Normal left ventricular diastolic filling is observed.Left Atrium:The left atrial chamber size is normal.Right Ventricle:The right ventricular cavity size is normal. The right ventricularglobal systolic function is normal. TAPSE measures 2.2cm.Right Atrium:The right atrial cavity size is normal. The interatrial septum is notwell seen.Aortic Valve:The aortic valve is trileaflet. There is no evidence of aorticregurgitation. There is no evidence of aortic stenosis.Mitral Valve:The mitral valve leaflets appear normal. There is no evidence of mitralregurgitation.Tricuspid Valve:The tricuspid valve leaflets are normal. There is trivial tricuspidregurgitation. Unable to estimate the right ventricular systolicpressure due to incomplete spectral Doppler waveform.Pulmonic Valve:The pulmonic valve appears normal. There is trace pulmonicregurgitation.Pericardium:There is no pericardial effusion.Aorta:There is no dilatation of the ascending aorta. There is no dilatation ofthe aortic root.Venous:The inferior vena cava was not well visualized; unable to accuratelyevaluate size and respiratory change.______________________________________________________________________MeasurementsName Value Normal RangeIVSd (2D) 0.93 cm -IVSs (2D) 1.19 cm -IVS % thickening (2D) 28 % -LVPWd (2D) 0.98 cm -LVPWs (2D) 1.46 cm -LVPW % thickening (2D) 49 % -IVS:LVPW ratio (2D) 0.95 ratio -LVIDd (2D) 4.21 cm -LVIDs (2D) 2.86 cm -LV FS (Teichholz) (2D) 32.1 % -LV FS (cube) (2D) 32.1 % -EF Teichholz (2D) 60.6 % -Ao root diameter (2D) 2.84 cm -LA dimension (AP) 2D 2.47 cm -LA:Ao ratio (2D) 0.87 ratio -Name Value Normal RangeLA ESV SP 4CH (MOD) 44.1 ml -LA ESV SP 2CH (MOD) 38.7 ml -LA ESV BP (MOD) 42.7 ml -LA ESV BP (MOD) index 22.1 ml/m2 -LV EDV SP 4CH (MOD) 93.7 ml -LV ESV SP 4CH (MOD) 32.5 ml -EF SP 4CH (MOD) 65.4 % -LV EDV SP 2CH (MOD) 66.8 ml -LV ESV SP 2CH (MOD) 30.2 ml -EF SP 2CH (MOD) 54.8 % -LV EDV BP 81.9 ml -LV ESV BP 31.9 ml -BP EF (MOD) 61.1 % -Name Value Normal RangeMV E-wave Vmax 0.91 m/sec -MV deceleration time 185 msec -MV A-wave Vmax 0.76 m/sec -MV E:A ratio 1.2 ratio -LV E:e' septal ratio 9.1 ratio -LV E:e' lateral ratio 7.6 ratio -Name Value Normal RangeAV Vmax 1.26 m/sec -AV VTI 24.25 cm -AV peak gradient 6 mmHg -AV mean gradient 4 mmHg -LVOT diameter 1.91 cm -LVOT Vmax 0.92 m/sec -LVOT VTI 17.68 cm -LVOT peak gradient 3 mmHg -LVOT mean gradient 2 mmHg -SV LVOT 51 ml -AVA (continuity Vmax) 2.1 cm2 -AVA (continuity VTI) 2.09 cm2 -Ascending Ao 2.86 cm -Name Value Normal RangeMV PHT 54 msec -MVA (PHT) 4.07 cm2 -Name Value Normal RangeTAPSE 2.2 cm -Name Value Normal RangePV Vmax 0.87 m/sec -PV peak gradient 3 mmHg -RVOT Vmax 0.63 m/sec -RVOT VTI 10.41 cm -RVOT peak gradient 2 mmHg -FindingsLeft Ventricle:The estimated ejection fraction is 55-60%.Thank you so much! ###Output :This looks like an extremely normal echocardiogram. Like boring normal, nothing interesting or remarkable at all.The regurgitation is described as trivial and trace, which is like saying I saw it so I gotta document it, but its clinically meaningless."}
{"text": "###Input :8 year old F, 4'1\" - Undiagnosed Condition / Continued dry cough - 2.5 years ongoingMedicines: Zyrtec (Switched from Claritin recently due to no positive response), Albuterol, Symbicort 160, pre+probiotic, antacid, - Has had adnoidectomy 2 months ago.My daughter has been going through an extremely long period of troubleshooting and we're still not at the end. What started out as a chronic cough and getting fevers and flu like symptoms were passed off as Covid towards the end of 2020.Then as the months went by it was passed off that she was getting sick at school. Various antibiotics and not getting better.Then in mid 2021 it was passed off as chronic sinusitus and told to use saline solution and more antibiotics.Then a few months later it was allergies and to take Claritin.Then after seeing the allergist it was Asthma because after 60pt test she's not allergic to anything but clearly decrease in breathing capacity so Albuterol.After seeing the cardiologist it was lower respiratory and take Symbicort with Claritin and Albuterol.After seeing ENT it was adnoids. After adnoidectomy she is to keep taking all of the above as well.Here we are two months later my daughter is home from school coughing just as she did two years ago. I have given her antacids and childrens pepto, along with pre+probiotics (largely because of the antibiotics) including all of the above mentioned medicine, and while she's no longer getting the flu-like symptoms she coughs so much she doesn't even realize she's doing it anymore. I don't know what's next. All ideas are welcome. ###Output :Have you seen a pulmonologist? Or was that wrapped in with the allergist?One consideration would be tic cough or somatic cough disorder which would require behavioral therapy. I would especially think about this as you say she doesn't even realize she's coughing. Usually chronic cough is very noticeable to the child. Is she up all night coughing?"}
{"text": "###Input :1: It really seems like he should have been diagnosed and started treatment for MDS after the bone marrow biopsy/aspiration in July 2021, not 11 months later given the fact he has tried so many therapies for ITP with no response. It also notes that patients \"typically have mild-moderate thrombocytopenia.\" He has always been below 50K, surely that's not moderate?What is your opinion on his history/diagnosis?2: I believe the nurses screwed up with premedicating him for his tranfusions during his last hospital visit. He had negative reactions on the two days I know they deviated from what is clearly on his chart AND on the request from his hematologist/oncologist which tells them what medication he needs when. Then, units aren't even ordered for the following two days, a man who is recorded as transfusion-dependent in his chart. Prior to his hospital visit, the premeds were followed almost exactly with no negative reaction, and after noticing his head bleed, the nurse followed the premeds exactly with no negative reaction. I am going off of his medical history acquired from the hospital which notes exactly when the medication is administered (not being confused with when they charted it). His cause of death is noted as acute respiratory failure due to PNA, but its only because we took him off the oxygen due to the head bleed which I believe they caused.Am I looking at this wrong? Did they mess up?THANK YOUI know, it's a long one. I really appreciate it if you took the time to read through it and give your thoughts and opinions.I know he had a rough disease, and I believe I could accept his death, but something in these hospital notes stinks... ###Output :Having treated many patients like this, these cases are often very difficult to manage. They sent off clonal hematopoiesis of indeterminate potential (CHIP) which is helpful in identifying mutations that may be causing cell abnormalities in MDS and sometimes garners targetable mutations eg IGH, del5q, ringed sideroblasts. However many of these we do not have detailed data given rarity so their effects on treatment are still unclear. In February 2023, that loss of chromosome 7 confers a very very poor prognosis along with refractory thrombocytopenia. I believe getting palliative care involved at this point may have been warranted. I do not believe any treatment wouldve changed his course by this time.I dont think a mistake was made by not treating him since signs of transformation to AML were not evident on the marrow from 2021. A score we use to predict transformation would also predict that prognosis was good with low chance of AML transformation in the next 10 yrs. Your father also has an extensive cardiac history and the drugs we use to treat MDS to AML have significant side effects including heart failure which Ive seen happen before from anthracycline. He had too many comorbidities so Vidaza was appropriate when it was given which is used to treat AML. Wed classify him as medically unfit but not frail and these patients are typically very hard to treat. Patients also become refractory to transfusions over time because their body starts making antibodies towards platelets. I do not think the mix up with premeds made a difference.Watching a loved one die from a hematologic malignancy is not easy, especially MDS. Please make sure you take care of yourself as well. I am very sorry for your loss. You did the right thing letting him go like you did. There was no meaningful way out of his situation where he would go on living a quality life. Please know that his medical team did everything they could."}
{"text": "###Input :19 month old has had fever since end of JanuaryAge: 19 monthsSex: MaleHeight: 33 inchesWeight: 27lbsRace: CaucasianDuration of complaint: just over three monthsLocation: Southern United StatesAny existing relevant medical issues: Dominant Dystrophic Epidermolysis Bullosa with recessive traits. This is a genetic skin disorder. When googling this disorder, you'll find very bad cases. My son's case is very mild compared to some other children. My child's father also has the same type.Current medications: Tylenol and Motrin as needed.Include a photo if relevant: noneI'm on a mobile app, please forgive me if this looks awful as far as formatting goes. My son and I got COVID back at the end of January. We both seemed to recover okay. We both ran fevers throughout the duration, never above 102F. After recovering, we then noticed a new fever and took him to the doctor where he presented with a high pulse, left ear infection, and an upper respiratory infection. Dealt with that with antibiotics and the fever came and went. Never above 102F. About a month later, still not better. Back to the doctor with a right ear infection and strep throat. Antibiotics once more, different one this time. Two or so weeks later after antibiotics were finished, back to the doctor where he had a double ear infection and still had strep. My husband and I double down at this point and begin sterilizing everything this child touches. We clean his toys and play areas every evening after he goes to bed, sterilize common areas, threw away toothbrush and bottles and sippy cups, wash every single stuffed animal and pillow and change sheets. We went over the top to try and keep the germs at bay. They had him on the strongest antibiotic they could give him at this point. He finishes the antibiotics and we take him back to the doctor to ensure all the infections and strep are gone. They are. Relief, right?No. He still has the fever. He's had a fever of at least 100F nearly every single day since he got COVID at the end of January. The last appointment he had at the doctor where they confirmed ears looked fine and the strep was gone, the doctor said his fever was from teething. A nearly 102F fever from teething? For that long? I'm not buying it. I had another doctor we took him to (before all this) while his regular pediatrician couldn't see him tell me that it wasn't normal for a baby to have that high of a fever while teething.He goes back to the doctor tomorrow. I don't even know what to ask them to test for. I don't know what to even do. They're blaming it on teething. It doesn't seem normal for a toddler to have a fever for this long even when his sickness is no longer there. He doesn't currently have any infected sores from his skin condition, either. Nothing open and nothing oozing or bleeding, so that's not it. It's something else and I have done so much googling to try and figure out what it is he has or what's wrong and I don't know where to turn anymore.Please help. Thank you. ###Output :Hi, wondering what happened with your little one"}
{"text": "###Input :Pediatrician ordered blood work at the insistence of my husband after trying to say the fever was due to teething. Again. The CBC with differential came back normal, so they said. But in his medical records, it literally says abnormal in the comments. They also did a blood culture and when I asked about that, they said his preliminary results are fine and they were monitoring for the final results. For some reason, I cannot view this in his patient portal.We found something called PFAPA and are wondering if that's what we are dealing with. ###Output :You can post the cbc here if youd like. Its not uncommon for a lab result to flag as abnormal but actually be fine. Blood cultures probably dont appear in your portal until 5 days, but if its negative at 1-2 days then it will almost certainly remain negative. PFAPA is certainly possible, or HIDS, but doesnt really fit the fever pattern.Chronic subtle skin infection was my first thought but sounds like not the case. Could just be back to back to back viruses especially if there are intermittent fever-free days, or mono. Can I presume he doesnt have a central line? I wouldnt be surprised if the doctor tomorrow wants to admit him to the hospital to expedite more testing. We typically send blood for lots of less common infections and non infectious conditions, and sometimes ultrasound and/or mri looking for signs of a site of infection. Please update here if youre comfortable doing so."}
{"text": "###Input :I've been concerned about mono. But there's no other symptoms. And wouldn't it have already gotten worse after three months if it were? I would be very surprised if the doctor does anything more than try to blame it on teething again. If I could switch doctors, I would do so in a heartbeat. We haven't had the best experience with her as far as caring goes...He does not have a central line, no. What types of things would the blood work be looking for? ###Output :Viruses can cause fever and no other symptoms in little ones. 3 months is a long time though for one virus. But again if he has had any fever free periods it could just be recurrent normal infections.Testing could look for general inflammation, bone marrow function , mono and other weird infections, autoimmune conditions which would mostly be JIA in a toddler, immunodeficiency, malignancy which seems unlikely here. Many of the diagnoses which cause 3 months of fever do not have a specific test and are tough to diagnose.Im sorry about your experience with your doctor. In my hospital if you showed up in the ER reporting 3 months of fever especially with an underlying condition youd probably be admitted. If it was me and I was unsatisfied with the visit tomorrow Id consider going to the ER at a Childrens hospital if you have one near."}
{"text": "###Input :2 year old respiratory distress?27 month old female, 27 lbs. Meds: duoneb, albuterol sulfate, epi pens. History: born at 31 weeks, required extensive oxygen support including ventilation for a few weeks. Allergies to eggs, peanuts, coconut, sunflower, dogs.2 year old is on day 3 of a relatively minor cold. She is covid negative as is the rest of the family (we tested for Christmas.) Over night started having a little trouble breathing. Resting resp. rate was between 36 and 40 breaths per minute. Grunting occasionally, minor retractions in rib cage and clavicle. No fever, no vomiting, normal energy all day prior. Normal appetite, normal diaper count. Gave duoneb breathing treatment and noticed slight improvement. (Resp rate went from 40 to 36 bpm.)Does this warrant an ER visit? With covid surging Im hesitant to bring a not yet vaccinated former preemie anywhere she could be exposed. My Childrens hospital offers an e visit option but I feel like this is something theyd need to see and or hear for themselves in person. ###Output :That resp rate is close to normal for her age. The concerning part is the grunting and retractions. That signals she's working hard to breathe. Given her medical history it would be a good idea to have her seen by a doctor. She may need a change to her baseline inhaled medications if she's dealing with a cold."}
{"text": "###Input :Thank you for your response, and happy holidays. Shes one of three preemies for me so this is not uncharted territory for us. This pandemic makes all of my decisions twice as hard, though. Risk of exposure vs medical treatment  Im calling her on call Ped now. ###Output :Very stressful, I hear you. It's hard to recommend that you dont have her assessed by her pediatrician given the signs of respiratory distress. That's why there are docs on call on holidays, don't feel bad contacting them."}
{"text": "###Input :COVID-19 FAQNote the information below may well now be out of date. If I get a chance I will update.READ THIS FIRSTIve written this to try to answer some common questions about COVID-19. I will try to answer any other questions you may have.Do not ask what your personal risk is due to whatever medical condition you might have. We simply dont know. Read whats written below - age is the most important factor in determining someones risk of severe disease (ie needing hospital admission) or death.Do not list your symptoms and ask if we can tell you whether you have COVID-19 or what precautionary measures you should take - we cant. You should follow you local public health guidance. If in doubt, isolate and only go to the hospital if absolutely necessary. Read below for more information.Clearly people arent actually reading this and just asking the above anyway, Im no longer going to reply to these questions. I generally reply to all questions, if I havent replied to yours its because youre either asking the above or your answer is contained within this post.What is it?COVID-19 means coronavirus disease 19 (as it was first reported to the WHO on NYE in 2019). It is caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2).Why is it so bad?COVID-19 is very contagious. Current data suggests an R0 (that is the number of people an infected person will go onto infect) of 2.5-3. By comparison your average seasonal flu with have an R0 of about 1.3. To put this into perspective, if you start with 10 people infected with seasonal flu, over ten infection cycles youll end up with about 138 infected people. With COVID-19 over the same ten cycles youll end up with tens of thousands to hundreds of thousands of infected people. Bear in mind this is not what is going to happen, only what could happen if the a disease was left to spread without effort to slow it. Public health measures to contain it can massively reduce the actual transmission rate.How come more people dont have it?We only know how many confirmed cases we have. For every one person who is ill enough to be tested theres a large group who have mild symptoms only and arent tested. This number varies wildly but seems to be about 1 in 10 (ie for every confirmed case theres another 9 people out there who have COVID but arent symptomatic enough to get tested.How do I know if I have it?The most common symptoms are a fever and a persistent cough. Other flu like symptoms may be experienced. It will be very variable from one person to another. The only way to know is to be tested - access to that depends on whats being done where you live.Can I find out if Ive had it already?Right now no. There is a test in development.Am I going to die?About 1 in 8 of the KNOWN cases (ie only those who are confirmed to have COVID) will end up being hospitalised. About 1 in 6 of this group will become critically ill and need to be managed on an ICU. Of this ICU group about half will die.For the 7 out of 8 cases who arent hospitalised the symptoms are mild enough to be managed at home. Remember for each of these people theres another 8-9 who arent even aware they have it. Some people have no symptoms, for others its the same and a bout of flu.The good news is if youre young youll probably be fine. Young adults and children have excellent survival rates with deaths very rare. Older people on the other hand are at much greater risk. Amongst the 60-69yr age group mortality is around 3%, whilst in the over 80s its approaching 15% (again of confirmed cases).I have a co-morbidity!The biggest risk factor for higher mortality seems to be cardiovascular disease, followed by diabetes and hypertension, then chronic respiratory disease such as COPD.Age remains the biggest risk factor by far, if youre young and you have one of these that doesnt mean youre going to die. It would be sensible to minimise your exposure.Can I go out?All these restrictions on movement are about slowing spread. The big problem for hospitals now is a sudden tsunami of critically ill people that the usual ICU capacity cant cope with. Think of it like taking a train - go rush hour on a week day and its packed and you cant get a seat, much quieter in the middle of the day. Go on a weekend and theres no early morning peak so the passengers are divided amongst more trains thus everyone sits down, even though a similar number of people travel over the course of the day. If we can slow the rate if infection ultimately therell be the same number of cases but they wont all come at once so the hospitals will be able to manage them. Make sense?Every country is different so you should follow your local guidelines. Doctors on this forum come from all over the world, what is right where they live may not be right for you.What can I do to minimise my risk?Wash your hands. Regularly. Avoid large gatherings. Follow local rules and guidance. If you have symptoms then stay away from other people. Take this seriously, because it is.Do not ask if we can tell you whether you have COVID based on your symptoms alone - we cant.Should I stop taking my medication?There have been media reports that people taking certain types of mediation, specifically ACE inhibitors/A2RBs (eg ramipril/losartan) or NSAIDs (eg ibuprofen) are at higher risk of catching or complications of COVID. To my knowledge there is no good data to support this. You should continue to take your medication as normal unless instructed otherwise by your doctor. ###Output :Follow local guidelines regarding social contact.Mild can be no symptoms at all to a mild flu like illness.Safe to go out on your own.We cannot comment on individual risk.https://jamanetwork.com/journals/jama/fullarticle/2762130 URL to a paper out of China - the 80% mild figure includes those with viral pneumonia not requiring respiratory support - this will absolutely be the worst viral illness many of us have had"}
{"text": "###Input :Are things such as a mild sore throat/ fatigue early signs? ###Output :Possibly yes. Could also belong to another virus. When in doubt, assume you're infected and stay away from others"}
{"text": "###Input :What about sore throat caused by swollen lymph node? I can see it on one side inside my mouth and my neck is sore to the touch behind that ear. :( Temp has been slightly above 99 Fahrenheit this evening but its my understanding that body temperature fluctuates throughout the day. ###Output :If it's just a node it seems unlikely, but I have no way to tell for sure"}
{"text": "###Input :Is throat clearing the same as coughing? My coworker has been doing it all day and we share an office. ###Output :not the same, but can be a sign if infection. Im not clairvoyant though."}
{"text": "###Input :How can I tell if I have new onset of asthma vs. COVID-19? I've had low fever, had to clear my throat but not cough, and have tightness in my chest / difficulty breathing and occasional pain in my lungs. There is no wheezing at all, no runny nose or congestion, my airways feel dry. I have no history of asthma, I'm 26 and exercise regularly (been recently training for cardio). The symptoms started in earnest about a week ago and got slightly worse the last few days. I'm trying to figure out if it could be just sudden onset of asthma or if I should be concerned that I have COVID-19. Any thoughts on to what extent these symptoms may resemble asthma? ###Output :New onset asthma in adults rare Infection common"}
{"text": "###Input :Is it possible that there was a different strain of coronavirus that was non lethal circulating in the US this winter? I got quite sick in December 2019 and the main symptom was sore throat/persistent cough. Many people in the community were sick as well. It was definitely not flu, I did get screened and was negative and I also get flu vaccination annually. Also the period of fever was short and not particularly high. ###Output :There are a variety of respiratory viruses that cause essentially the same upper respiratory symptoms. This includes other strains of coronavirus but most commonly it's rhinovirus or others. You can't really tell them apart without viral PCR test."}
{"text": "###Input :Glad you asked this. I also have stage 1 or 2 sarcoidosis which is largely asymptomatic. My brother, however, has fibrosed lungs due to severe sarcoidosis. I worry more about him as he is currently on an immunosuppressant which seems to be helping him. ###Output :Not to my knowledge.That would come under the classification of pulmonary disease so I think would suggest higher risk of severe symptoms, but depends on age and severity of the sarcoidosis."}
{"text": "###Input :Anti-inflammatories and steroids and COVID19I have seasonal allergies and I take albuterol, nasonex for symptom relief. I read that anti-inflammatories and steroids aggravate COVID19 symptoms. I'm not sick with any symptoms of COVID19, but should I stop taking these just in case?I also take antihistamines (Zyrtec/loratadine) and a daily inhaler Ventolin (I don't believe that is steroids). ###Output :Good question.This has been widely reported after comments from the French health minister.As I understand is there is no good evidence suggesting any increased susceptibility to, or severity of COVID amongst those taking non-steroidal anti inflammatory medication such as ibuprofen.People who regularly need steroid such as prednisone should absolutely keep taking them as normal unless directed otherwise by their doctor.Ill add a section to the post."}
{"text": "###Input :Shortness of breath muscle pain I wish they would define and describe these things, I am confused as to what they really mean.I have a persistent feeling that I need to yawn but cant- is that shortness of breath? Im not wheezing, I just feel tight. I had this a week to 2 weeks ago as well but attributed it to being on prednisone at the time.I have localized muscle pain, is that muscle pain? or does it need to be full body?I had contact with two people recently returned from Beijing 19 days ago. There are a few hundred confirmed cases in my area ###Output :Needing to yawn is different from feeling like you can't catch your breath. The latter is shortness of breath. Generalized muscle pain is what you should expect with COVID-19, simmer to a flu or some bad colds."}
{"text": "###Input :came into this thread looking for the same thing. I had a slight tightness in my chest/throat without pain. intermittent chills, feeling feverish (but i dont think i actually have a fever), and no coughing.i have no difficulty breathing persay, but taking a deep breath requires more effort than it used to. I dont know if this qualifies as a \"shortness of breath\" because the definition is so vague.. is it considered having \"difficulty breathing\" even if you're not gasping for air?I've had no known contact with anyone with COVID19, been indoors since last Friday. But I live in NYC so I'd say my risk of having already caught it is pretty damn high. ###Output :The feeling you are looking for is if you cannot catch your breath.We'll use this as the new COVID-19 question thread.We can't answer every question, especially those about whether you might or do have a case yourself. For general questions that we might be able to answer and that aren't explained in government and international websites, ask here. If you're asking a lot about your or loved ones' individual risk, look at the resources from reputable sources, like the sites linked in the original post here. We don't know better than the information provided, and we can't provide individual consultation to everyone.What is my risk?We can't answer that. The data available aren't thorough and granular enough, and we don't have full information, and that can't be calculated accurately even for the best-characterized diseases. All that we can say is repetition of the guidelines from the CDC and WHO websites, or other major organizations. Some comorbidities increase your risk. We can't say anything more individualized than that.What should I do [especially with individual risk factors]?There are no secret super-precautions to take. The recommendations are the same for everyone: wash your hands, don't touch your face, practice social distancing. It's more important for you, personally, if you have higher risk, but it's good advice for everyone. It reduces your risk of getting COVID-19, and it reduces your risk of spreading COVID-19 to someone who is higher risk than you.Previous megathreads:"}
{"text": "###Input :Prediabetic and COVID-19So I know that if you have diabetes and you contract COVID-19 it could be bad. I was diagnosed with prediabetes and was wondering if that carries the same risk if I contract COVID-19 ###Output :No evidence of this to my knowledge."}
{"text": "###Input :I'm in the same boat, I really can't tell if I have shortness of breath, or if it's just anxiety. It's been persistent for about two weeks now, with very few other symptoms like extremely mild cough now and then. ###Output :Top of the FAQ under read this first.Do not seek medical attention unless you are so unwell that you need to go to hospital. Use online resources or call 111."}
{"text": "###Input :In kind of a difficult situation with my children. 50/50 weekly custody split. Their mother got them yesterday and tells me 4 hours later that I need to pick them up because she has covid symptoms. It takes everything for me to not go get them but as I understand, conventional wisdom right now is to assume they are infected and not to spread it (leave them there). Youngest is 9 both children healthy. My girlfriend is also immunocompromised. Am I taking the appropriate precautions or is it better to get them out of there? ###Output :Majority of guidance is that the children should be isolated for 14 days if they live with someone who is infected. You should follow local guidance."}
{"text": "###Input :have an academic question about asymptomatic carriers of covid-19.people who are infected but not showing symptoms - does that mean their body is not responding to the infection, and not creating antibodies to destroy the invading virus?If that's so, does that mean they will be able to infect other people way past two weeks? ###Output :Absolutely they are having a normal immune response."}
{"text": "###Input :thank you for the response. Quick follow-up (and sorry about the dumb questions): do you mean an asymptomatic carrier will have a normal immune response, therefore will still create antibodies to fight the virus despite being asymptomatic?Or do you mean in spite of having a normal immune response, their body couldn't detect the virus (therefore asymptomatic and won't fight the virus)? ###Output :The former"}
{"text": "###Input :Hi, hopefully someone can ease my anxiety a little, we have our wedding planned for July of next year, there's still a lot of planning to do, and I'm worried that even though it's over a year away this virus could get big enough that large gatherings will still be banned by then. Is this realistic? Is there enough research going into the virus that we should be able to get on top of it all with vaccines and treatments within a year?I know that there are people out there who's health is on the line, and they have more right than I do to be anxious, but... I'm worried about it too. Basically I just need reassuring that I can keep planning and we won't be living in a post apocalyptic society by then. ###Output :Sorry I cannot predict the future.I will be surprised if this has not settled down in 16 months"}
{"text": "###Input :What exactly is the difference between the names COVID-19, SARS-CoV-2, and 2019-nCoV? ###Output :Covid19 is the name of the disease,sars cov2 is the name of the virus. The last term isn't used anymore."}
{"text": "###Input :Is it safe to take anti-histamines if you think you might have COVID? I think I am also experiencing seasonal allergies based on runny nose, sneezing, and dry eyes. I just don't want to suppress my immune response. ###Output :Yes"}
{"text": "###Input :What are the chances of it spreading through a hvac(forced air) heating system? I live in a basement suite. When my upstairs neighbours get a cough or virus. I seem to get it a few days later. ###Output :We don't know. It's possible."}
{"text": "###Input :Any potential issues taking albuterol through an inhaler for asthma symptoms if the symptoms are actually being caused by COVID-19 respiratory infections? ###Output :No continue you usual meds"}
{"text": "###Input :There is a post online circulating by someone who says that she has been in pediatrics for 8 years. Her post indicates that she believes that Covid-19 has been moving through the United States for several months. She describes symptoms, cases she has had come into the practice she works at, and says that she would send samples off for testing if it was possible.Her post has been shared almost 300,000 times. In most of the local posts, there are about 30-50 likes. That means that this is reaching upwards of 15 million people.I am also in the medical field, but as someone who helps make decisions for at-risk patients. In my small town in Florida, this nurse's post has been shared by half of my town. The comments are all in agreement - they've all had this before. It's utter nonsense, shared by people who simply don't understand the first thing about medicine or pandemics.I contacted this nurse this morning and informed her that her post is spreading through my community as well as others, and that it is being used to suggest that people don't need to take this seriously, do not need to socially isolate, etc. I asked her to recant and print a retraction. She threatened to sue me for stalking her. She then went and put a disclaimer on her post telling people to take Covid-19 seriously. The issue is - her words are being copy and pasted, and not shared, so people are still reading her post without the disclaimer. And they're taking it as gospel.I decided this afternoon to call her office, only to find out that there was no way to bring this to her doctor's attention without going through her. She already told me that she manages the Facebook page. Apparently she also screens the emails to her doctor, according to the receptionist. There is no way to contact this doctor directly, and I have tried every way possible. I am hesitant to report her to the board of nursing, and even if I did, I don't have her information.Should I let this be? All I want is for her to print a retraction and remove her original post - I don't want to personally be involved, I just don't want the locals in my town to buy her conspiracy theories. I don't know what to do from here. ###Output :Well youre correct its clearly rubbish but as a physician I have no idea what to suggest"}
{"text": "###Input :My dad is a domestic US pilot, and he's going to be in my city this week. Would it be a bad idea to still meet up (in a non-public place)? I'm 24, he's 55, we're both currently healthy - as far as we know - without any comorbidities. Feeling like I should cancel but I really want to see him. ###Output :If youre both free of symptoms you can certainly see one another. Large gatherings or unnecessary social contact for those at high risk (elderly, co-morbidities) should be avoided. As always follow your local guidance."}
{"text": "###Input :12 days ago my father wasn't feeling well (after a week of feeling unwell, with symptoms of common cold), he went to hospital because he was suspected to be infected with coronvirus, he had a chest CT scan and blood test (I think for CBC and CRP), the doctor said his CT scan showed lung infection but it was not coronavirus, they prescribed her some medication and he's got very well and back to normal life.7 days ago or so my mom got sick too with symptoms like fatigue and cough. he went to our local clinic, got some medication and the doctor prescribed her a blood test. she got well too but 2 days ago she went to doctor to check and show her blood test, the doctor told her \"you were close to get coronavirus but the danger has passed\" (excuse my language but I don't know what the fuck he meant!) my mom then has asked her if a lung image is needed and he's replied that it's not needed and her lungs are fine (he's checked her breathing pattern with Stethoscope apparently). he then has prescribed Vitamin D and acid folic in addition to her previous medications such as Amoxicillin. My mom is alright and her illness is mostly gone but I looked at her blood test, these are the numbers:W.B.C: 3700 /ulRBC: 4.09 (10*6/ul)Neutrophilis%: 64Lymphocyte%: 36CRP: (Positive) 48 mg/lShould I be worried? what's the right thing to do? as I checked with test references, her CRP is so high, normal level should be less than 6 apparently. Is it possible that she suddenly and silently get very sick without symptoms, now that she's quite fine? ###Output :Bloods consistent with non-specific infection.Cannot tell you if they have/had coronavirus without a test."}
{"text": "###Input :I live my aunt and her boyfriend. They refuse to let me leave or open windows thinking it will make me 100% safe. Does that ensure safety or are there any other things they should o ###Output :You are minimising risk but nothing is impossible."}
{"text": "###Input :The UK released last night that anyone whos routinely offered a flu vaccine on the NHS due to a chronic condition is now classed in the high risk group Ive got digestive tract paralysis, an ileostomy, dysautonomia, chronic joint pain, chronic fatigue and urinary retention as my main conditions None of these affect my heart or lungs so I accept that I may be higher risk to catch it but in my eyes I shouldnt be higher risk of getting complications except maybe my potassium dropping lower than usual if I struggle with oral intake/get the rare diarrhoea Do you think Im right in my assessment of my risk or would you consider someone like me high risk for complications too ? Im a 24 year old female by the way who does have a history of being hospitalised with chest infections ###Output :Cannot comment on individual risk.As in the above post age is the biggest risk factor for severe disease."}
{"text": "###Input :Highly probable that I have Covid 19 and I was wondering if I should continue nursing my 12 month old daughter. She is also feverish but much milder than myself and I was curious if there is any literature or recommendations in regards to breastfeeding. I know other illnesses can pass on antibodies and wasnt sure if this was the same or if I could make her more sick. ###Output :To my knowledge no evidence passed on breast milk.Illness generally very mild in children.QuestiomThank you for the information! This is indeed a pandemic of a lifetime, but i just wanted to clarify the overall death rate: 1 in 10 people are sick enough to get tested, of those 1 in 8 get hospitalized, of those 1 in 6 are critical and of those half die. So the death rate is 1/10/8/6/2 which is about 0.1% (probably understated a bit because some COVID deaths are misattributed). Is that correct or have I missed something? These numbers seem much lower than what usually gets reported (2% i believe).Data very rough, dont extrapolate from it.Mortality rate quoted for confirmed cases. Far more out there undiagnosed so probably lower than initially thought in the whole population. Mortality rate amongst elderly is horrific."}
{"text": "###Input :Why dont doctors give people antivirals early on in a cough to prevent lung damage. Why are public health authorities waiting until people need or are close to needing ventilators to test them. ###Output :Multiple studies underway to see if antivirals effective Public health decisions are local and political"}
{"text": "###Input :I understand social distancing well enough to understand the message. Stay home. For my own mental health, I was wondering if fishing, alone, on a river close to home is something thats still feasible. Is this a situation in which even while alone, in a quiet place in the woods, Im still putting myself or others at risk? ###Output :Close contact needed for transmission."}
{"text": "###Input :Why isn't thorough nose and face washing being advised with hand washing if the end goal is to keep virus from face (entry points). Thanks. ###Output :People tend not to touch things with their faces, apart from their hands"}
{"text": "###Input :My doctor found a shadow on my liver in an ultrasound. Im scheduled for a ct scan on Monday and a follow up doctor appointment Friday. However, should this wait? What if Im exposed to covid by going to the dr. On the other hand what if I have cancer and should be seen....what would you recommend? ###Output :Continue normal medical care unless advised otherwise by your doctor"}
{"text": "###Input :I have about a 28ish BMI so I'm overweight but not obese. Am I at higher risk because of that? ###Output :Government guidance. High risk BMI >40"}
{"text": "###Input :I have probable covid-19 but dont meet travel/contact requirements for testing. I am a 28 year old female with no comorbidities, however my lymphocytes are consistently low and neutrophils high in various bloodwork throughout the years. Not sure why.Severe cough for about a week, fever for past five days, influenza A and B negative, virus panel also negative. Chest X-ray shows no pneumonia, but Ive read that covid-19 pneumonia can only be seen on a CT scan. Coughing up frothy sputum almost constantly, pain when breathing, and getting lightheaded with light activity around the house.Naturally I am quarantined with my family however:-should I be concerned about developing pneumonia?-when they talk about the possibility of convos-19 patients developing long-term or permanent fibrosis, what exactly does this mean? What symptoms would one have, and how would one get tested in the first place?Thanks! ###Output :If your symptoms worsen and you are concerned seek reassessment.Given this virus was only identified less than three months ago anyone whos talking about secondary fibrosis or any other long term effects is full of shit."}
{"text": "###Input :What sort of things should people use disinfectant on?Should they use it on surfaces other people people touch because Covid-19 can live on surfaces? ###Output :Data still emerging about how long it persists on different materials.You cant be too clean"}
{"text": "###Input :Does Covid-19 just live on people's skin and then gets transmitted by touch?Is it transmitted through bodily fluids? ###Output :Most aerosol spread from coughing onto external surfaces or other people. Coughing onto hands then touching other people also spreads. Hence hand hygiene and social distancing essential"}
{"text": "###Input :w.r.t the last FAQ point, I have tried to dissect the Lancet letter in question, and am wondering if my interpretation is correct;https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltextBasically what I understand is that if you are taking ACE Inhibitors, and you encounter a drug interaction with a different drug, there may be additional risk/complications.However, this is only off investigating dead bodies with comorbidities, so it's not necessarily an accurate representation of the facts.Thanks ###Output :As I understand (DOI I have not read the paper relying on others interpretation) the lancet paper is hypothetical not hard evidence. European society of cardiology has an excellent position paper on the use of ACE- inhibitors/A2RBs that is available on their website."}
{"text": "###Input :Can you contact COVID19 by eating food that has the virus? Let me give you an example. You order a take out pizza and the cook sneezes on the pizza so virus droplets are on the food. Are you able to get the virus by eating it or would you have to get the virus on your hands and then touch your nose/eyes in order to get the virus? ###Output :If someone with covid sneezes on something and you then eat it then yes you could contract it that way.Of course if your local pizza chef has a habit of sneezing on food then serving it Id advise finding a new pizza restaurant."}
{"text": "###Input :I keep hearing that a large a symptomatic portion of the population spreads the disease because they dont know they have it. If this virus is try spread via droplets, then how do asymptomatic infected people spread it? Wouldnt they need to be coughing, sneezing, etc for it to spread easily? Otherwise wouldnt chances of spreading be super minimal from an asymptomatic person? ###Output :You could also get it from them touching their face then touching a doorknob."}
{"text": "###Input :I read it can survive 3 hours in the air. Is this true? For example, if you go into an elevator that was previously ridden by someone infected, how likely are you to get infected? ###Output :No, the virus is not likely to be randomly aerosolized as far as we currently know. It's droplets, which can survive on surfaces. The air problem is mostly in the hospital during high risk respiratory procedures."}
{"text": "###Input :I don't know if this is the right place to ask this, I can post it elsewhere if it's not.I'm 23F, 5'3 117lbs, in canada. drink occasionally and very rarely smokeI've never had the flu, and I hardly ever get colds. The most I'll get is the sniffles, sore throat and a headache in winter. The only times I've been sick with something that I can remember was a stomach bug 2 or 3 times and I think I had strep throat at some point.I've had the flu shot maybe once when I was a kid but I can't remember another time since then. There's no real reason to it, I know I should be getting it but my parents never enforced it so we all just forget out it (my family is like this too, I could count on one hand the times one of got really sick with something.) I know I should because it hurts other people but that's not the point to this. My question is this, from what I understand having a flu shot and getting the flu builds immunity to the virus, right? If I've never had the flu or the flu shot, and I get the COVID19, is my body not gonna take it well? I know you probably don't have an exact answer to this since we are all still learning about it but maybe theoretically could you tell me what you think? or how would I react if I get the seasonal flu? ###Output :Having had seasonal flu or the flu vaccine has nothing to do with how you may react to this covid virus"}
{"text": "###Input :Low respiratory rate and possible Bradypnea?M35, 57, 190lbsHi all. Ive been tracking my breathing rate using a Fitbit Sense, and it has been fluctuating between 10-11 every night. In addition I snore, occasionally wake up throughout the night, and get lightheaded occasionally (maybe one brief spell once per week), but that often goes when I eat. Otherwise feel fine. I was diagnosed with vertigo a couple of years ago when my dizziness was particularly bad and the medication cleared that up.Is this something to be concerned with? I keep reading that below 12 is abnormal but I cant find much more than that. Is that below 12 when awake? Is 10 ok when sleeping? ###Output :Yes, it's totally fine. It's a pretty useless thing to track."}
{"text": "###Input :Thank you! My hypochondria gets the better of me sometimes ###Output :So why have a device that gives you too much information with no real need/ability to analyze it usefully? Get rid of that smart watch thing and move on with life."}
{"text": "###Input :Can the cause of a respiratory infection be determined by listening to a patient's lungs?Patient is 33F, 5'3\", 105 lbs, has a history of psoriatic arthritis and gerd and takes humira, methotrexate and pantoprazole.Patient has had wheezing and chest congestion for three weeks. PA listened to patient's lungs and said the diffuse rather than focal crackling/wheezing sound ruled out bacterial and fungal infections. Can these infections truly be ruled out based on sound? No tests were performed. ###Output :No. Classical \"typical\" pneumonia tends to be localized to one part of the lung. \"Atypical\" bacterial pneumonias can be diffuse. I would be very concerned about a patient with an autoimmune condition on multiple immune suppressing medications (especially the humira). Three weeks is a long time to infectious symptoms -- typically if something hasn't gone away in 10-14 days we look into it further. I strongly suggest you seek out another opinion, probably from an MD or DO who will likely have more training and experience than a PA."}
{"text": "###Input :Results of blood tests show abnormal for a lot of things and I was randomly scheduled to see a respiratory therapist. Please help me understand25 year old male 62 181 lbsNo alcohol ever, no smoking ever, no drugs everActive duty MarineOver the last 2 months, I started having severe stomach pains and have been unable to eat or drink very much which resulted in me loosing 25 lbs. I started vomiting what appeared to be reddish brownish stuff last Tuesday with coffee ground looking things in it that smelled like rotten metallic feces. I went to the ER and had blood work and a CT scan. The scan showed my small intestines were inflamed in some areas, and the blood work that was available immediately showed my bilirubin and coagulation levels are high, which they already knew because I appeared to have jaundice.I checked my online tricare portal for the results of the blood test and UA that took a few days to come back and I learned that my Lipase level is low (66), BUN is high (21), sodium is low (105), Glucose is high (105), bilirubin total (2.7) and direct (.40) are both high, UA RBC is high (67), UA spec gravity is high (1.041), and that Ketones, blood and protein were all moderately present in my urine.I did my best to google what all that meant and all I learned is that there is possibly something wrong with my liver, kidneys, and pancreas. The reason I am extremely confused is that someone at the naval hospital scheduled me to see a RT? This was not communicated to me. I just happened to see it on my patient portal. I knew about the GI doctor referral but why would I need to see a RT? Also, based on what info Ive given, what seems the most likely to be wrong with me? ###Output :Gastritis or esophagitis. PPI should help. Follow up with GI doctor. Can't comment on rest"}
{"text": "###Input :Thank you for responding! The surgeon also said he is thinking Gastritis. The ER doctor prescribed protonix for home until follow up with GI on the 8th of March ###Output :Omeprazole . Good luck"}
{"text": "###Input :I have respiratory sinus arrhythmia in my late 20s, is this still normal? RHR is 54bpm and BP is 110/7026 male, when I breathe in my HR goes up, when I breath out it drops drastically. Most devices clock my RHR at mid 50s bpm. Now it goes up no problem, when I workout it goes up quickly but it also drops fast too. I can go from 160 running a mile and sit down and 40 seconds later its 59 bpm (verified by the good old fashioned finger) I do get lightheaded occasionally but its very much tied to anxiety when I do so not really something that I relate to a heart related issue. Im just curious if this is worrisome? I read respiratory sinus arrhythmia usually goes away in early adulthood but I certainly still have it. Ive had a echocardiogram a few years back (unrelated screening) and it was totally normal. A holter monitor as part of the same screening was fine beyond a few hundred PACs a day and a few dozen PVCs which doc said are normal findings.Anyway is anything worrisome about my heart rate and the breathing affect the HR? ###Output :Nope, not worrying."}
{"text": "###Input :What kind of viruses cause respiratory and gastric symptomsSo my poor baby, (M, one year old, 28 pounds, no underlying conditions) has been sick for 2 days. 101 fever, diarrhea, vomited once, runny and stuffy nose and a slight cough. I also believe his throat may be sore but it's hard to tell. He just tested negative for flu and covid so I'm wonderimg what types of virus cause these diverse symptoms. I'm not super worried because Hes holding down his drinks, and still being playful through out the day. Hes just napping a lot more and not really eating. Any idea what kind of bug he got? No one else in the house is sick and we don't leave the house other than for work. ###Output :Usually in this age either RSV, adenovirus or rhinovirus"}
{"text": "###Input :They didn't test him for RSV but now I wish I asked! My 3 year old had it at his age but he was REALLY sick. My little guy is just really run down but still acting fairly normal. Whatever the diagnoses is, won't really change the treatment though so I'm not gonna stress too much :) thanks for the response! ###Output :Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."}
{"text": "###Input :COVID19 megathread #4READ THIS FIRSTthis was written by u/nowweareall to try to answer some common questions about COVID-19. We will try to answer any other questions you may have.Do not ask what your personal risk is due to whatever medical condition you might have. We simply dont know. Read whats written below - age is the most important factor in determining someones risk of severe disease (ie needing hospital admission) or death.Do not list your symptoms and ask if we can tell you whether you have COVID-19 or what precautionary measures you should take - we cant. You should follow you local public health guidance. If in doubt, isolate and only go to the hospital if absolutely necessary. Read below for more information.Clearly people arent actually reading this and just asking the above anyway, Im no longer going to reply to these questions. I generally reply to all questions, if I havent replied to yours its because youre either asking the above or your answer is contained within this post.What is it?COVID-19 means coronavirus disease 19 (as it was first reported to the WHO on NYE in 2019). It is caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2).Why is it so bad?COVID-19 is very contagious. Current data suggests an R0 (that is the number of people an infected person will go onto infect) of 2.5-3. By comparison your average seasonal flu with have an R0 of about 1.3. To put this into perspective, if you start with 10 people infected with seasonal flu, over ten infection cycles youll end up with about 138 infected people. With COVID-19 over the same ten cycles youll end up with tens of thousands to hundreds of thousands of infected people. Bear in mind this is not what is going to happen, only what could happen if the a disease was left to spread without effort to slow it. Public health measures to contain it can massively reduce the actual transmission rate.How come more people dont have it?We only know how many confirmed cases we have. For every one person who is ill enough to be tested theres a large group who have mild symptoms only and arent tested. This number varies wildly but seems to be about 1 in 10 (ie for every confirmed case theres another 9 people out there who have COVID but arent symptomatic enough to get tested.How do I know if I have it?The most common symptoms are a fever and a persistent cough. Other flu like symptoms may be experienced. It will be very variable from one person to another. The only way to know is to be tested - access to that depends on whats being done where you live.Can I find out if Ive had it already?Right now no. There is a test in development.Am I going to die?About 1 in 8 of the KNOWN cases (ie only those who are confirmed to have COVID) will end up being hospitalised. About 1 in 6 of this group will become critically ill and need to be managed on an ICU. Of this ICU group about half will die.For the 7 out of 8 cases who arent hospitalised the symptoms are mild enough to be managed at home. Remember for each of these people theres another 8-9 who arent even aware they have it. Some people have no symptoms, for others its the same and a bout of flu.The good news is if youre young youll probably be fine. Young adults and children have excellent survival rates with deaths very rare. Older people on the other hand are at much greater risk. Amongst the 60-69yr age group mortality is around 3%, whilst in the over 80s its approaching 15% (again of confirmed cases).I have a co-morbidity!The biggest risk factor for higher mortality seems to be cardiovascular disease, followed by diabetes and hypertension, then chronic respiratory disease such as COPD.Age remains the biggest risk factor by far, if youre young and you have one of these that doesnt mean youre going to die. It would be sensible to minimise your exposure.Can I go out?All these restrictions on movement are about slowing spread. The big problem for hospitals now is a sudden tsunami of critically ill people that the usual ICU capacity cant cope with. Think of it like taking a train - go rush hour on a week day and its packed and you cant get a seat, much quieter in the middle of the day. Go on a weekend and theres no early morning peak so the passengers are divided amongst more trains thus everyone sits down, even though a similar number of people travel over the course of the day. If we can slow the rate if infection ultimately therell be the same number of cases but they wont all come at once so the hospitals will be able to manage them. Make sense?Every country is different so you should follow your local guidelines. Doctors on this forum come from all over the world, what is right where they live may not be right for you.What can I do to minimise my risk?Wash your hands. Regularly. Avoid large gatherings. Follow local rules and guidance. If you have symptoms then stay away from other people. Take this seriously, because it is.Do not ask if we can tell you whether you have COVID based on your symptoms alone - we cant.Should I stop taking my medication?There have been media reports that people taking certain types of mediation, specifically ACE inhibitors/A2RBs (eg ramipril/losartan) or NSAIDs (eg ibuprofen) are at higher risk of catching or complications of COVID. To our knowledge there is no good data to support this. You should continue to take your medication as normal unless instructed otherwise by your doctor.What is my risk?We can't answer that. The data available aren't thorough and granular enough, and we don't have full information, and that can't be calculated accurately even for the best-characterized diseases. All that we can say is repetition of the guidelines from the CDC and WHO websites, or other major organizations. Some comorbidities increase your risk. We can't say anything more individualized than that.What should I do [especially with individual risk factors]?There are no secret super-precautions to take. The recommendations are the same for everyone: wash your hands, don't touch your face, practice social distancing. It's more important for you, personally, if you have higher risk, but it's good advice for everyone. It reduces your risk of getting COVID-19, and it reduces your risk of spreading COVID-19 to someone who is higher risk than you.So a lot of people have reported reduced lung capacity after having recovered from COVID-19, as with pneumonia. Would it be beneficial to practice breathing exercises like the ones listed here, both prior to infection and also after recovery? ###Output :Certainly won't be harmful."}
{"text": "###Input :Is it okay to go outside to a park? There's a park near my home that is never busy even when the world is normal. Can I go there and have a walk on my own or is it better to just stay inside? ###Output :Yes, that should be fine. Please avoid playground structures, public water fountains, etc."}
{"text": "###Input :the reason the goverment and every expert is saying dont use mask is to avoid having shortage for the professionals. Can you imagine if they actually recommended using masks? we already have a shortage. thats what I believe anyways.. ###Output :Please remember we can't answer every question, especially those about whether you might or not have a case yourself.For general questions that we might be able to answer and that aren't explained in government and international websites, ask here. If you're asking a lot about your or loved ones' individual risk, look at the resources from reputable sources, like the sites linked in the original post here. We don't know better than the information provided, and we can't provide individual consultation to everyone."}
{"text": "###Input :Please help. Question about THERAPY for person tested POSITIVE. How to treat?A person I know (with whom I had no contact) has just tested positive. He's not being recovered at the hospital but he's had a very high fever for more than ten days.He's been treated with antibiotics so far: Fidato and Trissyl for about ten days after first negative tampon no improvement. Now after a second test - POSITIVE, they switched to Klacid and Augmentin antibiotics. He doesn't have respiratory issues so far so won't be taken to the hospital.What do you think of these meds? Please can you name any anti virals/ therapies that can be used as a cure?I heard some improved after Tocilizumab (anti arthritis)It would just be useful to understand what options might be taken and I'd like to have opinions from Docs abroad. Thank you so much. I'd appreciate ###Output :If they're treated at home, there is no approved treatment. It's all highly experimental. Chloroquine is used first, tocilizumab is more of a hail Mary treatment because it's very expensive."}
{"text": "###Input :I tested negative for covid but I do have a virus and all the symptoms that go along with that. The doctor that swabbed me didnt swab my nose but my throat. Last weekI took an ambulance trip because I had chest pain and I could barely breathe. They sent me home with alot tests done and looking good. White blood cell count good etc. So should I treat this as any other virus? Obviously I have been physically isolating myself for almost 2 weeks because thats when my symotoms started. Now Ive been feeling much better and only have shortness of breath.I really want to visit my sister and neice. How long before Im not infectious? ###Output :Yes, you can treat it as any other virus.Honestly, please don't visit your sister and niece right now. Only leave your house for essentials. This is not a time for socializing."}
{"text": "###Input :Some Asthmatics apparently are being told to increase their Asthma medicine dose to \"prepare\" if you get corona... But my doctor (who I trust) said not to do this. Increase in Asthma medicine dose won't help and increasing your dose when your Asthma is controlled well in never a good idea.Anyone wanna weigh in? I can't imagine increasing Asthma steroids will help prevent or lessen symptoms if you get corona... Or any lung infection ###Output :I'm with your doctor."}
{"text": "###Input :I'm aware that people are recommended to stay away from taking ibuprofen, cortisone, and other anti-inflammatory drugs. But does this also apply to supplements? For example, St. John's Wort, green tea, and turmeric are all supposed to have anti-inflammatory properties. Would it be better to avoid or limit their consumption at this time? ###Output :Most health care groups have not made any recommendations regarding ibuprofen or other NSAIDs. We simply don't have the information to be able to recommend one way or another. If you have been taking these supplements, it should be fine to continue taking them."}
{"text": "###Input :SoCal surgeon here.. I would. I do take off my shoes before coming into my home. I'm also leaving amazon packages in the garage for at least a day. New England Journal of Medicine just published data on virus survival on surfaces and air.NEJM says SARS-COV2 coronavirus survives:3 hours in air4 hours on copper24 hours on cardboard3 days on plastic or stainless steel.Here's the source:https://www.nejm.org/doi/10.1056/NEJMc2004973?fbclid=IwAR0J1UVMFKkWUq3s4lYPJ2guckp8lGel-0b2ApPysnlr_qR7Xa9vMvD5rjQ ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."}
{"text": "###Input :I'm already on 400mg Plaquenil for inflammatory poly arthritis. Assuming it's helpful for COVID19, is this offering me extra protection? Note: I am not looking for way around any guidelines, we are being very strict with social distancing, disinfecting high touch surfaces daily, and following our stay at home orders. I'm more curious, really! And wondering if it's safer for me to be the one who goes to the grocery store when needed. Thanks! ###Output :Impossible to answer. We simply don't have data to show whether this would be effective as prophylaxis even if we knew it worked against COVID-19."}
{"text": "###Input :I am a male in my 20s and use Fluticasone nasal spray for post nasal drip. I heard that this has immunosuppressant qualities. I am otherwise healthy. Should I worry about this and consider stopping the medication until the virus is under control? ###Output :No worries about nasal steroids"}
{"text": "###Input :If our whole household has Coronavirus, do we still need to isolate from each other? ###Output :No that's pointless"}
{"text": "###Input :How bad do we let things get before going to hospital? I have a sore throat, headache, and a dry cough and my husband has the same + congestion and a little SOB. Both of us feel okay enough right now but I want to be prepared. Hes also traveling for work (non shut down state and he works alone so no exposing others), and Im trying to keep close tabs on him. ###Output :Same point when you'd go to the hospital for any other illness - when you feel that your symptoms are dangerous and/or life-threatening."}
{"text": "###Input :Can my doctor share results/status of my COVID-19 test with my employer without my permission?I was directly exposed to COVID-19 and my employer has me off work for 14 days. I got tested at my local health center (surprisingly)My employer wanted proof I was tested, I guess I took too long to provide and they called my doctor. My doctor let them know that I was tested.When my results come in, can they share they info with my employer? How do I request my doctor not share my info with my employer? Of course I will tell my employer, but I want to tell them.This is already a weird time as Im getting texts from HR everyday asking how Im doing and it all feels so invasive ###Output :No patient confidentiality prohibits this, unless your employer pays the bills (but even then you'd have to give permission)"}
{"text": "###Input :The gist of this is that I want to know whether or not I should be worried assuming I were to get COVID-19. I'm not worried about spreading it, that shouldn't be a problem, but just in case I did find myself sick, I do want to know how bad it might hit me.When I was younger I had a bad throat infection that took weeks to get rid of and came back I think twice, and since then a good amount of illnesses I've gotten have come with a lot of pain and swelling in my throat, but not infection. I've heard that this can hit people with respiratory issues quite hard, but because this isn't a respiratory issue, I don't know if this might also be a problem.I should note that I have had what I believe was an asthma attack, almost a decade a go at school. I don't know for sure because it only lasted a few seconds, during which time I couldn't convey to anyone that I wasn't able to breath due to the fact that I wasn't able to breath, and being an idiotic kid I just was like \"well that happened, I don't want to have to be one of those dorks carrying around a puffer throughout school so I'm just going to pretend it didn't.\" I haven't had anything like that happen since, and that was the first time it happened, but I don't know if I need to actually talk to a doctor about that. I'm really more worried about the throat problems, because I get them a lot, but if this is something I should also be concerned about I would like to know. ###Output :You are not a risk group"}
{"text": "###Input :If loss of smell and taste are symptoms that seem to persist for a long time in asymptomatic patients, how are they supposed to know when they can end quarantine? ###Output :That symptom doesn't count, that's a nerve problem but doesn't indicate that they're still contagious"}
{"text": "###Input :Inexplicable, itchy rash all over my body with no other symptoms (pics in the comment)20M, non-smoker, occasional drinker (3~4 times per month), no prescription medication. Hives started appearing all over my body two days ago, starting from my torso. (this was several hours after having a drink, just in case that matters) They respond well to cetirizine but return around 20 hours later. They seem to start spreading from different spots everyday: one day from my torso and then from my limbs. They itch quite a lot and some spots are tender to touch, but other than that there have been no other symptoms like any respiratory problem, sore throat or fever.While I am mildly allergic to dust mites, I've never had this kind of flareup that manifests itself on skin. I haven't eaten anything new or changed any laundry or skincare products either. ###Output :Finding a \"cause\" for many with acute urticaria in most patients is not a reasonable expectation. It can be caused my infections, medications, other causes... but is generally idiopathic. If you have airway symptoms seek immediate care.Otherwise, see https://dermnetnz.org/topics/acute-urticaria"}
{"text": "###Input :That looks very uncomfortable. Im NAD, but have experienced a similar looking rash everywhere as well. Your doctor may be able to help you, but I do know that putting ice packs on the particularly itchy or painful areas really help to relieve the discomfort. Just wanted to give you ideas. Hoping you feel better very soon. ###Output :Finding a \"cause\" for many with acute urticaria in most patients is not a reasonable expectation. It can be caused my infections, medications, other causes... but is generally idiopathic. If you have airway symptoms seek immediate care.Otherwise, see https://dermnetnz.org/topics/acute-urticaria"}
{"text": "###Input :COVID and Upper Respiratory Infection23 F. 230 lbs and smoker. I went to the urgent care 3 weeks ago and was told I had an upper respiratory infection. I took a 5 day prescription of Azithromycin. Today I tested positive for COVID. Is this concerning that I got these back to back? I never even officially recovered from the upper respiratory infection. Thank you (I am vaccinated, not boosted yet) ###Output :Not really. COVID can be an upper respiratory infection so may still be positive from the first infection."}
{"text": "###Input :Is 5 days of amoxicillin twice daily a normal treatment time for a mild upper respiratory infection?Age- 25 sex- male height- 5'9 location - green phlegm, sneezing, sore throat, etc.I was given amoxicillin but only for 5 days. Twice a day. I'm assuming the standard dosage. I read online typical treatment is 10 days.Is this long enough usually? The symptoms described here are exactly what the doc was told. Do i need more? It was originally scheduled as a covid visit and the doctor was very short with me, so i don't think they were very thorough in anything. Yes, i know i can get a second opinion, that still doesn't answer me. ###Output :I usually prescribe 500mg three times daily for 5 days for a mild bacterial RTI"}
{"text": "###Input :What does it mean when my inflammation markers are off the charts, but I FEEL fineAge: 44 Weight: 185 Location of issue: Blood, I guess? Duration? Approx 24 years at this point.So...about 4 years ago, I was diagnosed with RA. The kind that doesn't show up as RA on blood tests, but I have all the symptoms and my inflammation markers are off the charts, so it HAS to be RA based on ruling everything else out, right? That was my doctor's determination.I'm seeing a new doctor next month...one who is in the same practice as my current doctor (who I'm dumping) and the same specialty (rheumatology) as my current doctor. I had a zoom call with New Doctor recently and she was like, \"Why the fuck are your inflammation levels TOO DAMN HIGH when you've been on two different medications for a long ass time now (4 years on sulfasalazine and approx 2 1/2 years on hydroxychloriquine in combination with the sulfasalazine)? You DO take them as prescribed, right?\" which I totally do.So what does that MEAN? Does it mean my RA is still causing problems even though I feel physically fine most of the time? Does it mean I need to change drugs?I don't have any joint swelling, just occasional pain when I have a flare up. I had no idea (at least not until New Doctor looked at my old blood work results) that my inflammation markers were still off the damn charts even after several years of being on medication to fix that shit. ###Output :What are your labs?"}
{"text": "###Input :Looking for expertise-rheumatology, immunology..?Hi, I'm a 39yo female, a healthy eater and active with daily cardio exercise. I've been on BP meds since 22yo after I went in for a flu visit and it was recommended I start them. My current is propranolol 60mg ER and that's been about 8 years. Otherwise my health and blood work is good however, over the last 6 months I've noticed in increase in flushing, primarily in the face and upper arms, along with small, closed skin, slightly raised lesion marks here and there. Additionally, I get fairly significant swelling and redness in my hands and feet, along with joint pain in my feet sometimes to the point I feel like my feet bones are going to crumble. I do have a genetically bad back with disc collapse in my lower spine and injections have been recommended for that. But Im not sure that could be related to everything else. My original thought was a food or alcohol allergy as the swelling starts minutes after I eat or drink, which is few and far between. The problem is the swelling then stays all day, to the point I have to take my jewelry off. With that and the redness it is super embarrassing and I feel like my face is 110 degrees so it's also uncomfortable. I drink water, I take vitamins and I feel good in the mornings. Come the afternoon though it's like my body starts to fall apart and feel 80 years old. I feel I'm having inflammatory responses to something but I just can't identify it. I use excema lotions and hydrocortisone as needed on my arms. I'm just at a loss and wondering if it could be medication related, or if there's something I'm missing? Thank you. ###Output :It's difficult to diagnose this without an exam and evaluation. I would take pictures of this flushing (what makes it worse/better, worse in sun? Etc) for your doctors, as well as any swelling. Try to see if there's a temporal relation to the joint pain/swelling (morning, night, what makes it better etc). If there's no contraindications, I would recommend trying some NSAIDs to see if it helps the swelling - note that if it does. Always take NSAIDs with food.Also any new supplements you're taking. Some weird stuff in those sometimes."}
{"text": "###Input :Thank you so much, I will definitely do those things and appreciate your time and response. ###Output :A quick aside, if you're looking this up, I'm sure you'll come across lupus. Lupus requires a constellation of clinical symptoms with the appropriate serologic markers - based on your story so far, I would not say you have lupus yet. Just to ease your mind a bit in case you come across this."}
{"text": "###Input :I did see that come across...thank you for easing my mind! I keep coming across rheumatoid arthritis and psoriatic arthritis as well. It's just very difficult to identify whether I have a few different things possibly that just happen to be displaying all together (ie. a genuine food/medication allergy combined with lower body pain from lower back nerve issues, etc). Although i do notice that I have periods of clear skin and minimal discomfort all around, and then it'll transition to a week or two or increased skin redness and sensitivity. The swelling is unfortunately something I'm seeing everyday though. ###Output :Both of those fall under different groups of inflammatory arthritis - this type of arthritis does present with swelling. The pain is typically described as a stiffness that improves with activity - hence it tends to be the worst in the AM or after a long car ride for example. The swelling you have is interesting to me but the character of your pain is a little atypical and the overall picture does not seem to clearly fit inflammatory arthritis.The causes for facial flushing are many - ranging from menopause to thyroid issues. Typically we shoot for a unifying diagnosis but certainly could be more than one - time for a doctors visit!"}
{"text": "###Input :Fingers, Toes turning black and rotting off. Desperate for answers! Also hematology and rheumatology blood results and symptoms that no doctors can explain.I can't embed images here, so I made a pdf with all text, pictures, and labs. https://www.scribd.com/document/511582218/askdocs-pdf?secret_password=VqmaLuJA0tGw5bGE5xYp It will be much easier to read the whole thing there, with the images embedded, but I will copy the text here.36F, 55, 115 lb, white.  Primary complaint = fingers and toes turning black and rotten (pictures included).  Existing issues = random red cell destruction without cause, random platelet destruction without cause, swellings and rashes (labs and pictures included).  Medications = iron supplement.  Occasional Claritin, Advil, Prednisone.  No medication right now.  No recreational drugs or smoking.  Rare/light alcohol (an occasional drink on holidays or weddings)  Rotten Fingers.My left thumb got a blood blister so I put Neosporin and gauze on it.  The pain became so intense that I went 72 hours without sleep.  I went to urgent care, who removed the bandage.  The thumb was very swollen and the top third was black and crusty.  (picture)They sent me to the Emergency Room, where they removed the upper half of the thumb.  The pain completely went away, it was just a little sore and itchy.But a few days later, all the other fingers and 8 of the toes started turning black.(pictures)Thats the hand with the original bad thumb.  The pinkie has a blood blister, the index and ring fingers are turning black and crusting at the very top under the nail, and the middle finger is just inky blue/black without any crustiness or blisters.  The left picture was taken a day after the right one.  Right Hand:  no crustiness or blisters.  The fingers are just dark.  The index finger is getting kind of gooey (last picture).(pictures)Toes look blacker than fingers but not crusty.  All but the two smallest toes on right foot are turning black.The ER doctors were very kind but nobody knew why my thumb turned black and rotten.  Now here are all the other weird symptoms and bloodtests that doctors cant explain.  None of it seemed like a big deal untl fingers started rotting.  2. Rotting BloodFor years my annual bloodwork showed I was anemic.  For example(picture)But I had no symptoms of anemia other than feeling cold, so my NP said being anemic was just my normal and prescribed an iron supplement.Two or three times a year, I would get symptoms of extreme exhaustion that would last a few weeks.  Most of the time, I felt healthy. But for those weeks, I would sleep the entire weekend, wake up Monday, stumble brain dead through the workday, then get home and fall right back asleep.  After a few weeks, Id start to get better.  For years, my NP said it was nothing, just a virus.  But I never felt sick, just exhausted.  Then a doctor saw me while it was happening.  As soon as she saw me, she took my vitals, looked at my eyes, and said, this isnt all in your head.  We need to take your blood.  Here were those blood results(picture)It turns out that the exhaustion is because my blood starts rotting a few times a year.  I went to hematology.  They tested me for every possible cause of blood destruction.  But everything was normal.Tests included DAT/Coombs negative, PNH w/ FLAER no flow cytometric evidence of paroxysmal nocturnal hemoglobinuria No evidence of aberrant loss of GPI-linked markers tested in erythroid or leukocyte populations. Anti-CD45, glycophorin A, CD59, CD24, CD15, CD64, and FLAER tested. Complement: C3C, C4C normal, CH50 high (>60). Cold hemagluttinins: none detected, G6PD - high (>21.00). No hereditary spherocytosis or elliptocytosis. Infections negative.  Blood cultures normal.I can post the tests if anyone needs to see them.3. Bruises and Rotting PlateletsNormally I dont bruise any more than most people.   But once in a while, I get bruises everywhere.  My bra, underwear, and socks all leave big bruises.  Theyre painless and go away in a couple weeks so I never worried about it.  But when a doctor saw and tested, it turned out there were almost no platelets.  The picture shows the bruising left by a loose sock.  My whole shins were just big bruises that followed the pattern of the sock elastic.(picture)In a few weeks they were back up to 40 and the bruises were gone.  Hematologist found no reason for platelets to suddenly drop like this.  They checked for cancers and even took bone marrow but no answers.(picture)All the bone marrow tests like fish and genetics were normal.  4. Symptoms that Seem Autoimmune but Have No Rheumatologic Cause.  Sometimes I get rashes and swellings that doctors think is autoimmune(pictures)Rheumatology has tested EVERYTHING again and again.  Sedimentation rate, ferritin, and CRP are always high.  But nothing else is usually abnormal.(pictures)They biopsied some of the rashes and purpuras (which I dont have pictures of, theyre just little painless red spots that sometimes break out on my legs).  They all showed the same thing, leukocyto elastic vasculitis.  Heres one.(picture)But every other type of test for vasculitis has been negative.   Nobody has explained why someone healthy and pretty young like me should have chronic venous insufficiency either.I have only had one round of tests where there were any abnormal autoimmune results:(picture)But these things were only abnormal that ONE TIME.  Rheumatology has re-tested them so many more times and they are always normal.  They have tested for every other autoimmune disease and they are all normal.  The only rheumatology tests that are often abnormal are sediment rate, creactive, and ferritin being high.   Ddimer and visc is sometimes high but not usually.  PT, INR, and ptt are sometimes high too.  (picture)They dont think its cryoglobinemia because it was only positive once and negative a lot more times.  Also, my C4 was always high or normal and my C3 was always normal, even in the test where there was cryoglobulin.  (picture)The only other thing off on the bloodwork is subclinical hypothyroid.   TSH is high, but T3 and 4 are low normal.  I have no symptoms of  hypothyroid other than being cold.  And the cold could be from anemia.Please, does anybody know what this all means?I had accepted the lack of answers when it was just random blood rotting, swelling, and rashes.  I know the doctors tried hard.  I could live with all that stuff.  But these black fingers, I cant live with it.  It hurts too much.It feels like someone as healthy as me shouldnt have all these symptoms unless its connected somehow.  But nobody knows how.  Rheumatology thinks the rotten blood is not autoimmune because Coombs and other autoimmune tests are always normal.  But hematology says if its not autoimmune, then theres no other answers.  So far, I have no autoimmune diagnoses but doctors still act like I have something autoimmune.Monday I will see my NP and can ask for any tests anybody recommends.IS THERE ANYTHING I CAN DO FOR THE FINGERS AND TOES?  TO MAKE THE BLACK GO AWAY OR MAKE THEM STOP HURTING?I already tried asking a pain forum for tips, but I got a nasty message (Your complaining about 2 weeks of hurt fingers!  Do you understand that we have pain that is severe, intractable and forever*?*  I have ddd and a herniated L5-S1 disc.  I am in 10/10 agony beyond your imagination.  Your hurty finger is a joke.  Suck it up buttercup) so I deleted it and wont ask for help from patients again.I hope doctors will be more understanding. I get it, that there are other people who have it much, much worse.   But I dont have chronic pain so I never developed a high pain tolerance.  Typing this is killing me. Ive had a broken bones, a vaginal delivery, wisdom tooth surgery, and swollen joints, but none of those hurt that bad.  When Ive broken a bone, its only been blindingly painful for ten or fifteen minutes, then it settles down.  Then a few days of throbbing and aching thats relieved with rest and Advil.  This is the first time Ive had pain that Advil cant relieve and that doesnt settle down with time or rest.  I know other people with bad backs or arthritis have it worse.  I dont need to be told that.  But for me, this is too much.  What can cause this?The doctors seem confident that its not just psychological.But I cant shake the fact that I get more symptoms when Im sad or stressed.  I dont have any chronic mental illnesses, but I go through short periods of feeling down or anxious.  At the hospital, I held it together when they took off the black thumb.  I told myself that it was ok, that the pain was finally gone, that half a thumb isnt that important, that its my non-dominant hand, that I dont need a full left thumb to type or do most activities.  When I got home, I was so happy to be pain free and I had so much to catch up on, I just didnt think about it.  But then I looked at the discharge paperwork and saw that under Reason For Visit, they wrote GANGRENE, WET.  I knew that the thumb wasnt good, but seeing it called GANGRENE made me feel so repulsive and sad.  I spent 10 or 15 minutes just crying.  It was right after that little breakdown that all the other fingers started hurting and turning black.  Could all that crying have caused it?Theres also an odd discrepancy.  My black fingers hurt so much but my black toes dont hurt at all.  How is that possible unless the pain is all in my head?I am desperate for answers or relief if anyone can help.  Thank you to anyone who has read this far.TL-DR:  What causes rotting fingers, rotting blood, rotting platelets, leukocyto elastic vasculitis, swelling, rashes, purpuras, and maybe subclinical hypothyroidism but without showing up on normal blood tests for autoimmune or other diseases? ###Output :This is beyond the scope of all but the most seasoned hematologists and rheumatologists. It MUST be rheumatologic or a bone marrow disorder, nothing else fits all the symptoms. You should be referred out to Mayo Clinic or Johns Hopkins or something. I would say the rapid progressions warrants an inpatient workup until a cause or treatment can be found. If those fingers/toes get infected you could get septic pretty quick.Some type of small vessel vasculitis fits best, but theyve tested for all the obvious culprits so its hard to say why nothing has been found yet. Its definitely not in your head, but its no surprise that stress makes the symptoms worse. Stress makes a lot of things worse.I wish I could offer you more, but this definitely isnt my field of practice. Hopefully someone else has some ideas.Agreed agreed. This needs an inpatient work-up in a big academic center. We had a similar case on my MICU rotation in residency and he was getting continuous plasmapheresis while we tried to figure out what the cause was."}
{"text": "###Input :Are there any hematologist/rheumatologist crossover doctors? Like a single doctor who specializes in autoimmune hematology? It feels like rheumatology and hematology pass me back and forth and like both of them think I'm the other specialist's problem. ###Output :Not that Im aware of unfortunately. The problem is they are both at dead ends and think the other specialty will be able to help. Which is why you need your case elevated to the next level"}
{"text": "###Input :If one of your fingers is squishy, you need to go have it looked at immediately. If you have gangrene again it can kill you if left untreated. Im just so sorry you are going through this.So when is a black finger just Raynaud's and when is it gangrene? The right index finger isn't squishy, but the skin is breaking down and it's oozing something smelly. ###Output :OP, this is an indication that the tissue has died and has become necrotic. This tissue needs to be removed urgently. I am very concerned that an infection of this tissue could become systemic and fatal, potentially in hours.This is a definite indication to immediately head to an emergency room.I am so sorry you are going through this, but you need to be admitted and likely get surgery so that this does not become immediately life threatening.PLEASE DO NOT WAIT UNTIL YOUR APPOINTMENT IN AM"}
{"text": "###Input :What to Expect from a Lyme Disease Rheumatology Appointment?I am a 27 year old male, about 5'10\", no remarkable pre existing conditions or allergies, medical history, etc.Some (optional) backstory- I live in and work outside in East TN and various places around the country relatively frequently. I was bit by a tick around April 26 and I estimate it was attached for a few hours (less than 10). Over the next week or two I started having very general symptoms... occassional dizziness, general fatigue, a feeling of weakness, fierce night sweats (probably my biggest complaint.. sweating buckets beginning as soon as I went to sleep), some minor and intermittent joint aches especially in the knees. I measured a fever of 100.4 F on May 8 and tested myself at home for COVID and it returned negative. I also received my 2nd dose of Moderna on 4/21/2021.I eventually decided to just have a Teladoc appointment the night of May 8. The phone doc basically said it would be impossible to treat me over the phone and surmised it was Rocky Mountain Spotted Fever and he was not allowed by policy to treat tickborne illness. I went to an urgent care the following day and we decided to begin doxycycline and tested for Lyme/RMSF. Long story short the test was positive for both and they started a second 10 day course of doxycycline. The nurse practitioner at the urgent care told me I would need to see a rheumatologist, especially for the Lyme diagnosis. They referred me and my appointment is June 22.So here's the question- what should I expect from the rheumatology appointment? I feel fine, the symptoms are gone and I've completed 20 days of an antibiotic. I have a feeling the rheumatologist will kind of just shrug and say if I took 2 courses of doxycycline and I have no symptoms then he's not worried about it. What am I signing up for? Will we at least do a confirmatory test for Lyme/RMSF? ###Output :The physician can check titers of antibodies to look for previous infection but honestly given that your symptoms have resolved and you were treated for tick borne illness further follow-up really should not be necessary.Suprised they sent you to a rheumatologist for this, arguably could have been managed by general internal medicine vrs infectious diseases"}
{"text": "###Input :Why would my doctor test my kidney infection if my finger is mysteriously injured?27F, 165cm, 70 kg, white, smoker, drinker, in Netherlands. No drugs, prescription or otherwise.Primary complaint: The middle joint on my left pointer finger is mysteriously painful. I woke up after a normal night (i.e. no drinking, couldn't have forgotten an injury) and the middle joint of my finger hurt, as if it had been slammed in a door. The pain is localized and only experienced when I attempt to bend my finger. It began on the 11th of March.Existing issues: Ehlers Danlos Syndrome, Hashimoto Thyroidism, Anemia, Asthma, AllergiesMy primary doctor saw me today and did not think there was anything biomechanically wrong, i.e. no break, no dislocation. She tested my blood for infections as I've just returned from the tropics (Thailand) but that was negative. She then ordered a lot more blood tests, liver function, kidney function, arthritis, etc.I understand testing for arthritis, but why kidney and liver function? I am an immigrant in the Netherlands, so sometimes there is a bit of a language barrier and I don't completely understand how my finger pain could be related to kidney or liver failure. ###Output :Could be many reasons. Kidney and liver function is good to have if you will be prescribing medication that is filtered by the kidney or liver. Your doctor may be worried about a rheumatologic or infectious disease which can also sometimes affect the liver or kidney. Also some STDs like gonorrhea can cause arthritis and can be tested for in the urine.Those are just basic labs."}
{"text": "###Input :Hey yall My kiddo (3M, approx 42 pounds, 3.5 feet tall) (daily meds are nexium, senna, zyrtec, tenex, atarax, melatonin) got referred to hematology and I'm drawing a blank on what questions to ask. He had a blood smear that had \"abnormal lymphocytes\" and a high level of lymphocytes. He started seeing Immunology a few months ago because he's always had frequent infections and fevers just about daily for most of his life. Immunology doesn't have any diagnosis, but are thinking of referring him to rheumatology. Im just not really sure what questions to ask or what to say really. If there's a better sub for this, please point me in the right direction. Thanks y'all! ###Output :Where does it say \"abnormal lymphocytes\"? That's unusual language. \"Atypical\" lymphocytes are seen with viral infections, classically mono. If the blood smear was the reason for referral, I would ask what the results mean. If the answer isn't clear, keep asking until you understand. They will tell you the differential diagnosis for the findings and what additional tests they recommend. There might be none.Frequent infections are the rule in childhood, not some weird immune deficiency. Is he really having fevers every single day for 3 years? Also, one of the most common findings with immune deficiencies is poor growth and your son is a tank :) Rheumatologic conditions in preschoolers often come with poor growth, rash, joint swelling, and very abnormal blood tests. But they can be more subtle and I can't say on the internet if that's a possibility in your case."}
{"text": "###Input :i meant atypical, im sorry! it was in the notes for the test result.He has fever just about every day, if its not fever, its right under fever (99.9-100.3) but most days its 100.4 or higher. He usually gets sick 1-3 times a month, and he stays sick and his pediatrician says thats too much especially for a kiddo not in day care or anything like that. Hes been hospitalized a few times and they havent been able to figure out what causes it. This is something weve been dealing with pretty much since he was born. ###Output :Has he ever had a CRP or ferritin? What was the total WBC and neutrophils on the blood count?I think hematology is unlikely to solve this for you. Between immuno and rheum they may have some recommended tests for uncommon causes of recurrent fevers."}
{"text": "###Input :Bad, vivid dreams please help (19F)I am 19F with a ton of medical issues. Meds are vilazodone, duloxetine, montelukast, levocetirizine, propranolol, norethindrone/ethinyl estradiol, and dexmethylphenidate. Conditions are kind of a mess right now because we are still trying to figure out a lot of them but I have allergic rhinitis, either major depressive disorder or potentially bipolar 2 disorder, excessive daytime sleepiness diagnosed as idiopathic hypersomnia but potentially narcolepsy, POTS, ADHD, and most likely Sjgrens (awaiting rheumatology appointment).I have had what I describe as vivid, disturbing dreams for as long as I can remember. I say dreams because I never wake up during them. They are very unsettling and I feel awful when I do wake up in the morning.Last night I fell asleep without taking my medications (I take the majority of my medications at night aside from the stimulant of course). The dreams I had were awful to say the least. Im not even comfortable sharing the details but there was a lot of killing, fear, sexual aspects which I absolutely hated (these aspects were not in any way a good or wanted thing), and the feeling of being trapped. As I mentioned, my dreams are always very vivid and they feel 100% real but I am not in control as one might be with a lucid dream. And for clarification, I hate violence and, if anything, I am sex repulsed. I made a throwaway for this post specifically because I feel so disturbed and ashamed about these dreams.I woke up this morning disoriented, confused, distressed, and with thoughts of wanting to self harm (which I have not done in a long time). I have these dreams often, but not always to this extent.I know medications, especially some of the ones that I take, can cause nightmares. But why would the dreams be worse if I missed my medications? And what in the world can I do to prevent these? Because I felt so terrible when I woke up (and still feel bad now), I want to rinse out my brain so I can remove the dreams from my memory. I would avoid sleep if it were possible but the fatigue and excessive daytime sleepiness make that impossible.Please help because I cant keep dealing with this when I sleep and I dont know what I can do. ###Output :Vilazodone and duloxetine are SNRIs that increase serotonin and norepinephrine levels in the brain. Abruptly stopping or missing your doses can cause low serotonin levels during REM sleep. That'll cause more intense nightmares.Might be helpful to talk to your doctor about adjusting the timing or dosages of your meds to minimize their impact on your sleep/dreams.Have you thought about therapy to address any underlying psychological issues? Someone can work with you to develop coping strategies and explore any unresolved emotional issues."}
{"text": "###Input :Sudden unilateral ptosis + sudden frozen back (needed wheelchair briefly)If you fancy yourself a diagnostician, have I got a case for you. 39 yo female; US; 5'3\" 179lbs; Grave's, Hashimoto's, Celiac (Celiac just diagnosed in fall, others well managed with meds for ~6 years).9 days ago - sudden moderate unilateral ptosisMonday was sitting at my desk (no exertion, no recent falls/trauma etc) and back locked in place, confined to wheelchair upon arrival at hospital. Went to ER and got an acid reducer injection which did enable ambulation again, albeit with altered, ginger gait2 steroid injections Tuesday helped a little bit, still walking very gingerly. Can't bend down. Hurts to sit for long, can't get comfortable, prefer fetal position on my side laying down or in recliner - agony yesterday to lie flat for MRI and x-raysRecent appointments:Emergency eye doctor appointment 8 days ago, nothing identified --> refer to opthalmologist, apt. in 1 monthUrgent care Sunday - no tests performed, referred back to primaryMonday primary referred me to ER where x-rays performed (after identifying it as a muscular issue)Orthopedic doctor Tuesday - ordered lower back MRI. Came back showing moderate disc bulge but nothing that should be causing my 10/10 pain level, nothing surgery worthyRheumatology Wednesday (yesterday). Ordered blood work (partial results below) referral to neurologistBlood work results:High Rheumatoid factor (15.6 - ref rate up to 14)High alkaline phosphatase (134 - normal up to 121) (this has been chronically high over last 9 months, up in the 150s)High Neutrophils to Lymphocytes Ratio (NLR) - (3.89 - normal should be under 2 or 3 I'm reading a few different things here so any insight is helpful)I had a 23 and Me done recently so I have a ton of information there (positive for DQ and homozygous for HLA-DQB1:02, etc)Persistent symptoms since ~July 2022 -Extreme fatigue and malaiseExtreme brain fogWinded easily (i.e. climbing stairs)Have not taken stairs in 2023 because of weakness and how out of breath it makes meExtreme difficulty getting up from seated positionNeck/shoulder/back weakness and pain (diagnosed spinal osteoarthritis and degenerative discs in January 2023 but pain and weakness in neck and shoulders too)Vitamin D deficiencyAnemia (was barely not anemic in the blood work yesterday but was anemic in 3 other blood workups in this period)\"Polyarthritis\" diagnosis in February (additional subsequent Rheumatoid Arthritis diagnosis by Orthopedic doctor but Rheumatologist this week said no)Some headaches, blurry vision, confusion (not necessarily trouble speaking but trouble remembering words occasionally. I typically can't remember the $.50 word so I use the $2 one instead - using bigger vocabulary words more often - I used to be able to \"mask\" this better)Some dysautonomia in that I've had some Raynaud's attacks (been happening ~15 years) just sitting in my living room and sometimes if I get hot I can't regulate my body temp very easily. I will get randomly sweaty (especially on my upper lip it seems?)My most educated guesses: Either myasthenia gravis or Lambert-Eaton, considering the eyelid drooping, muscle weakness especially in trunk and legs, weird sweating, etc. Plus I seem to have every gene on the planet that predisposes you to these conditions.My biggest concern is that those two conditions pop up when your body is trying to fight off an as yet undiagnosed cancer (often SCLC and lymphomas). I am a never smoker but my husband smokes. Originally smoked cigarettes indoors for ~5 years and now has vaped indoors for ~5 years. I also have the double dose of DQB1:02 giving me Celiac. But it also predisposes me to Enteropathy Associated T-cell Lymphoma. I have an eating disorder (ARFID) that is getting in the way of proper management of my Celiac.Please ask me any follow up questions you may have and give me your best guesses. Doctor after doctor is sending me down the line to someone else and I'm afraid of running out of time. I have a 4 year old I would like to spend a little more time with. Thank you so much for even reading this far. I look forward to any replies. ###Output :I dont think you are dying!!The back complaint sounds like a classic musculoskeletal injury. Unfortunately as we get older this is more likely, it can be incredibly painful and can linger. None of these other entities happen quickly like this and you had an MRI.Myasthenia and lambert eaton are not typically painful conditions. I wouldnt diagnose one of these from ptosis, which is more often a local issue with the facial nerve. So i wouldnt go on and say you have cancer, though Dr. Google tends to give this diagnosis with any search.I highly doubt all of these things are tied together by one underlying diagnosis. You are very in tune with your body and human nature is to try to assign a unifying cause."}
{"text": "###Input :Gaining weight despite incredibly strict diet, rapidly losing function. Seeing second specialist (rheumatology this time) next week.I apologize for the length of this. I want to be thorough, and I need some reassurance while I wait for my referral to the second specialist from the first specialist:32f Utah 5 4 (current weight 186, up from 130) Non smoker/non drinker/no recreational drugs.Medical conditions/history: GERD, migraines, Graves, hashimotos (yes, both. REALLY.) seizures of unknown origin (not epilepsy.) gallbladder removed, sinus surgery for chronic infections, hysterectomy (one ovary left) for severe endometriosis and bleeding. Seeing a rheumatologist next week on a referral for ankylosing spondylitis based on current test results between November and now.Medications: Naproxen, Benadryl, promethazine, lamotrigine, topiramate, tizanidine, pantoprazole, Zantac, rizatriptan, gabapentin. Recently discontinued magnesium, potassium, and hydrochlorothiazide. Botox injections for migraine every 3 months.With all of that said: I finally went to the doctor for the first time in November when my symptoms first peaked. My labs were mostly normal at that point. I had gone from 130-160 very rapidly despite barely eating and it was causing extreme pain, particularly in hands/feet/abdomen. Thyroid/heart/liver/kidneys all looked fine. I didnt respond to the diuretic other than to end up in the ER with low potassium.I have changed my diet from what it was then (literally had been eat a small bowl of rice or noodles, if I ate anything, once a day, and then a few bites of dinner for months because of stomach/intestinal discomfort. Lots of water, but also drank 2/3 cans of soda a day.) I started eating fruits, vegetables, lean protein, extremely limited processed foods (essentially: yogurt, cheese, unsalted nuts, unsalted almond butters, unsweetened almond milk, low sodium/low sugar hot sauce or mustard, occasional olives, sparking unsweetened water, low salt seaweed, organic unsweetened or low sugar low salt anything if its in a bag or jar and I am not prepping it raw) I do dry beans, chicken breast, bone broth, plain Greek yogurt, plain coconut water, plain eggs w/ pepper. Kale, spinach, cauliflower, broccoli, beets, peppers, tomatoes, berries, cucumbers, etc. maybe 1/2 can of soda every 2 weeks. About 1 serving of complex whole grain/seed grains a day MAX.Despite this, and still limiting my calories (mostly due to abdominal pain and diarrhea/constipation) and also pushing through the increasing joint pain and muscle pain/spasms to be as physically active as possible (I even swam in a lake and hauled kayaks, went on a couple hikes.. although most days, I can hardly open my own medication, and have fallen in the bathroom and while dressing myself) I have gone on to gain an additional 26 lbs, up from 160-186.Most recently, the doctor my PCP referred me to repeated the blood work and my platelets have remained slightly elevated, as were my eosinophils.. but not clinically significant. My potassium has continued to be a little low. ANA was negative, ESR normal, CRP was normal, thyroid, heart, kidneys, liver still normal. 24 hr free cortisol was normal. HLA-B27 (I think thats what its called?) was positive and MRI positive for ankylosing spondylitis.In addition to the progressive weakness and pain, I have also lost control of my bladder 3x since December, have had several episodes of either very high or very low blood pressure, nights like last night where if I breathe too deeply it feels like someone is sitting on my ribs... sort of right along the level where the sternum ends. I struggle to walk on stairs and get electric shocks through my arms, hands, and legs when I walk down them or bend my neck to the side.Since the rheumatologist had my doctor tell me to take Naproxen while I wait to be seen, Ive had a bit less swelling in my ankles, I can actually see the bone. I get a couple hours where I am at least slightly less uncomfortable. I still feel like my skin is on fire. It gets itchy when I get too hot and often turns bright red. My stomach and hands balloon up when I move around, and the soles of my feet get hot and painful and sometimes turn blue. (The soles.. not raynauds... cold and heat dont change it, and its not something that affects the digits.)Does that really explain the rapid weight gain and abdominal pain despite restrictive diet? I am genuinely scared about the loss of function Im experiencing. ###Output :Just a quick clarification. You mention your complex history of thyroid disease (Grave's and Hashimotos), and I think we need more info, especially as hypothyroidism is a common cause of weight gain. You say that your lab results for your thyroid were 'normal', but with either one of these diseases the lab results would almost certainly not be normal. For reference, thyroid labs usually come in various flavors: TSH, Free T4, and depending on the occasion T3/antibodies. Do you know the specific results of those tests? Also, none of your medications is for the thyroid, and with either of these treatment is usually necessary. Did you have radioablation or surgery in the past?While both autoimmune diseases, Graves and Hashimoto's have opposing outcomes. This would make for an interesting and complex clinical picture, and with more information we might be able to help.And of course, maybe it has nothing to do with the thyroid, but common things being common I still think its worth looking into."}
{"text": "###Input :Of course. I will share the labs and info I have. My thyroid was the first thing I requested to have looked at when I saw my PCP. Initially, I was diagnosed after I had my first child in 2008 and my thyroid was overactive and I had thyroid antibodies that were really high. (I was put on medication.) After seeing an endocrinologist, he essentially said that I had both issues and it was rare but not unheard of. During my second pregnancy, my levels stabilized and remained stable until a couple years back when they were slightly low, but after an adjustment to some medications I was on (seroquel for sleep) they went back to stable so I wasnt medicated. The one thing that has remained high is the antibody levels. For now, my PCP has monitored them.Here is a link to the labsI added the historical and current thyroid labs, as well as the most recent labs that have been run, and a few imaging reports. If you want to see anything else, or if I didnt quite fit something on a page as well as I think I did, just let me know.Sorry it took me a while to get that up, I appreciate you taking the time to look over it. ###Output :Well, I doubt it's related to the thyroid. Your free T4 is normal, and it's free T4 that causes the symptoms of hyper or hypothyroidism."}
{"text": "###Input :34F, 54, 125 lbs, nonsmoker, being treated for lymphoma and lupus, seeking oncology and rheumatology guidance for cohesive treatmentHello, I had to add all that info since the auto mod deleted me for not having all of it. Im about halfway through AAVD chemo for stage 4 Hodgkins and see a rheumatologist for lupus. I feel theres a disconnect between oncology and rheumatology in my treatment and Im not finding much online about rheumatology/oncology, if that is indeed a field that exists. Im willing to travel a few hrs from NJ for treatment, just hoping theres a specialist who is knowledgeable in the treatment of both conditions since lupus, its treatment, and chemo put me at risk for more cancers. Looking forward to any suggestions anyone has. Thank you. ###Output :That field does not exist. The closest medicine gets is with multi disciplinary centers like Mayo or Cleveland Clinic where a bunch of different types of doctors collaborate on your case. I'm sorry you are going through this. Is there some reason why you think it would be best if they were the same person? Is something wrong with your current team? You said there is a disconnect but what does that mean? Perhaps if you talk with both providers, or their office staff, you can have your records synchronized between the offices so you don't feel that way?"}
{"text": "###Input :Could I have Rheumatoid Arthritis? 24FI'm 24 F. I take Adhd medication- methylphenidate. I also take a vitamin d and b12 supplement. Trying to be referred to rheumatology.I didn't know where else to post this but I desperately need advice. Back in December 2022 I noticed a small lump appear on my right hand on my ring finger. I initially put it down to an injury or chilblains as the weather was so cold. But on New Years eve I developed swelling in my hand that didn't quite go away but would fluctuate.Fast forward to Mid-january 2023 the swelling has gotten worse on my right hand with stiffness setting in and it becoming harder to bend certain joints. I called my doctor he told me to go to A&E to make sure I hadn't injured my hand and sent me for a rheumatoid blood test as my mum has rheumatoid arthritis.Went to A&E no hand injury so then I was waiting for the blood test. I had my test and everything came back normal. But my hands were getting worse, stiffness was worse and my left had was also suffering with stiffness, no swelling though. I had a hand examination at my doctors and they confirmed the stiffness in both hands on all my joints. Also the stiffness doesn't go away, its worse in the morning but only gets a little better. I started to notice other things though: weight loss, sweating, odd fevers, appetite going weird, the fatigue has been horrendous. I'm losing hand strength and can't carry shopping bags for long anymore.Present day: I've lost at least a stone/ stone and a half in weight since December. I was 87kg last January (2022) now currently 76kg. I want to make it clear that I've done nothing to change my activity level or diet. I've been working in a bookshop the last 2 years. The tiredness is awful, the stiffness seems to be spreading to my knees and shoulders. Even when I'm walking all day they just feel tight. There was a day my shoulder hurt so much and felt so heavy I couldn't actually pick it up. My overall mood is on the floor, I feel so sad all the time. Its hard to hold my toothbrush, hairbrush etc. I can't pull up a blind some mornings. I have a deformity beginning on my finger.At recent doctors appointment my doctor dismissed my concerns and said I just have chilblains. So now I'm worried I've got everything wrong and I'm just being stupid. I know no one can diagnosed me but I just need advice about my hands as I'm at my wits end. Thank you! ###Output :With a family history of rheumatoid arthritis and the symptoms you describe (worse in the morning, systemic involvement, progressive worsening) a rheumatological process is definitely on the table. What specific blood tests have been done already?I take it that youre in the UK given your terminology, and from what I understand generalists act as cost-saving gatekeepers which is appropriate from a systemic standpoint but can be challenging as a patient who feels like theyre not being heard. I would seek out a second opinion if you feel like your current physician isnt listening."}
{"text": "###Input :The blood tests I have had already are: Rheumatoid factor- my result was < 20.0 iu/ml Serum urea level- result was 2.9 mmol/L Total Vitamin D- results 29.5 nmol/L Serum ferritin- results 30 ng/mL B12- results 155 ng/L Folate- results 3.7 ug/LI've had on and off deficiencies in Vitamin D and B12 since I was 13. Especially Vitamin D, I had a serve deficiency at one point. ###Output :I would push to get an anti-CCP antibody and to see a rheumatologist. Might even have utility in checking an ESR / CRP to check your current bodily state of inflammation. Theoretically even if the RF and anti-CCP are negative you can have seronegative RA. Recognize that were anchoring pretty heavily on this given how youve presented the story, so be open to the idea that it could still be something else if the specialist has other thoughts. Worth exploring though, because the benefit of starting on biologic medications in the case of RA is to slow down the progression of joint deterioration."}
{"text": "###Input :Autoimmune CVID Question - Immunoglobulin Panel27F | 5'8 | Caucasian | USA | Autoimmune concern | No current med except otc Tylenol/Ibuprofen | No smoking/drug use | Very rare drink, only celebratory (weddings, birthday, etc) |To keep this as short as possible, I am experiencing general widespread aches and pains (I say my bones hurt a lot/heavy feeling legs), muscle weakness, joint pain, rashes, petechiae, easy bruising, itchy skin, swollen left axillary lymph node, gastro problems (diarrhea to constipation), chronic sinusitis and extreme fatigue. I have had these symptoms for the past two years or so, but my rash has spread onto my hands and the swollen lymph node will not go down - it doesn't hurt but I do notice it in my arm pit and it is visual when I raise my arm. I went to the doctor, since all my complaints were kind of general and vague she ran an ANA - positive 1:160, speckled. I was sent to Rheumatology, the Rheumatologist checked for Lupus, said I do not look like a typical Lupus pt and all my other Rheum bloodwork was normal (ESR CRP etc). He explained healthy people have positive ANAs. He did want me to go to Dermatology for the rash. He didn't think it looked like Lupus but did say it looked suspicious. He agreed that something was wrong with me as he believes skin is a big indicator in overall health. I went to my original doctor to get a referral to Dermatology - she decided to run an allergy panel and refer me at the same time so the Dermatologist would have everything in my chart they may need. Everything was completely normal, no allergies at all except my igE was at 3 which she flagged as low on my chart, even though the reference said 2.5 was low.After looking low igE up, I am not a doctor so I obviously do not understand a lot of the terminology, but from what I can gather it seems that people with autoimmune conditions usually have a low igE. Not that it is not necessarily a diagnosing factor for anything, but that the two usually go hand in hand *from what I can understand.*My question is: should I request a full immunoglobulin panel? Does having a low igE warrant that? I wanted to touch base with my doctor about the igE but did not want to ask her for an unnecessary bloodwork if igE doesn't correlate with an immunoglobulin panel - if that makes any sense? lol.I have read about CVID and would like to rule this out in my medical journey.Hopefully this all makes sense! Thank you for your time!! ###Output :A low IgE might not warrant a full immunoglobulin panel on its own, but considering your symptoms and positive ANA, I would request one."}
{"text": "###Input :Rheumatology: a positive ANA then a negative one days later?Male/ 38 years old/ USAI had some tests done with my primary care doctor because I had generalized muscle aches, felt run, headaches and cracking joints for a few weeks on and off. I had blood work done and my CRP was 26, my ESR was normal, my rheumatoid factor was normal, my anti-CCP was normal, my ANA IFA was 1:80 positive. Speckled. , and my Lyme panel was normal.I saw a rheumatologist 4 days later who did a repeat of the blood work and those results just came back a little differently. The CRP went down to 15 and the ANA Multiplex Reflex 11 was negative. What do I make of this? ###Output :ANA 1:80 is considered low positive. Some might say negative. Labs like this fluctuate frequently especially if not super positive like 1:320 and higher. And ANAs notoriously fluctuate based on blood storage, travel and lab technician. Its clear based on your CRP that you have inflammation going on. It takes time to garner a rheum diagnosis for most people because the picture isnt crystal clear at the first visit. See what your rheum has to say as the whole gamut of labs is needed for context."}
{"text": "###Input :Thank you doctor! My rheum called and said he thinks it could be a post viral syndrome, especially since I had Covid 3 months ago. Although I recovered fully, it knocked me out for 16 days. He said viruses or post viral syndrome would explain my High CRP, normal ESR and borderline ANA and cause Inflammation, and even low positive ANA titers. Does that sound right? ###Output :Could be. COVID has been known to cause transient positive ANA. In addition, something like 20% of the general population has a false positive ANA up to 1:80 so we dont read much into it unless the titer is higher."}
{"text": "###Input :Could I please ask if the results would be higher or lower if there's was a lot of travel and storage involved. I got the test but the lab they sent it to was quite far away (a few hundred miles) ###Output :Lower. When a sample travels it degrades in quality and some dont use the same ANA tests. Labs also run tests on different days. Usually ANA is M-F in most labs but some with lower volume may do M/W/F which means your sample may sit for a day or a weekend if you have labs drawn on Friday."}
{"text": "###Input :Doctors please help my little sister, she can't walk, I'm afraid she's going to die8F, 78lbs, no medication. She was in the hospital for a long time but they discharged her. She is still in pain, please help. I attached the notes of her discharge.The patient is an 8-year-old white female with five weeks of fever, rash, arthralgias. Last month, the patient noted foot pain involving both left and right feet, as well as a blotchy pink rash on the leg that proceeded to spread to the trunk and then arms and then face during that week. The patient had low-grade fevers with temps to a max of 101. This has progressed to the week prior to admission higher fevers with T-max of 103.5. The patient has endorsed muscle pain, particularly in the right leg and arm, and PMD had seen the patient this week noted right knee and right index finger swelling. There is no noted weight change over this time period. No noted diarrhea or swollen nodes. The rash the patient described the week prior had an acute abrupt onset and 5-10 minutes later would dissipate.Rheumatology was consulted on the patient from admission. Lab studies were sent to rule-out an infectious etiology for rash. Strep culture was negative. EKG was also performed to rule-out a prolonged PR interval. EKG was within normal limits. A DNase B antibody was 547 and an ASO titer was 300. While results were elevated, the patient did no meet clinical criteria for rheumatic fever and diagnosis that was most likely entertained was systemic JIA. Further lab work included an ANA which was negative, rheumatoid factor which was negative, a CRP on admission was 8.6 mg/dL with an ESR about 80. CK and aldolase were within normal limits. Ferritin was elevated at 663. LDH was within normal limits. CBC was reassuring with normal white counts, hemoglobin and platelets; findings nonsuggestive of leukemia. Hepatic panel within normal limits. A chest x-ray was done to rule-out mediastinal mass, and that was negative. From an infectious standpoint, Parvo, CMV, EBV were all negative. Clinically the patient was noted to have a salmon-colored transient rash that would come and go throughout the hospitalization lasting a matter of minutes. No definite arthritis on examination. Oncology was consulted given the history of arthritis and fevers. It was felt in the setting of normal cell lines in evaluating a smear, which revealed no blasts, no indication of hepatomegaly or splenomegaly and uric acid and LDH within normal limits and x-ray that was normal, they felt that further oncologic evaluation was not indicated and a bone marrow was not indicated at that time. Cardiology was also officially consulted because the patient had a 2/6 ejection murmur on the exam. Cardiology felt the murmur was a flow murmur and evaluated the EKG, which they read as within normal limits, and decided an echo was not indicated to rule-out valvular disease in the setting of the rash and arthritis in an attempt to workup acute rheumatic fever. ###Output :Internal medicine doc here but in my differential is Adult Onset Stills Disease which can still present in children and Rocky Mountain Spotted Fever. The salmon colored rash lasting a few minutes is textbook for Adult Onset Stills Disease.I'm assuming she had blood cultures done at one or multiple points during her admission. Did she have a procalcitonin tested? Did she receive any antibiotics? Any steroids like solumedrol, prednisone etc? Does she still have joint pain? Does this rash show up only during febrile episodes? Any auto immune conditions in the family like lupus, rheumatoid arthritis, hashimotos?"}
{"text": "###Input :NAD. My son has Adult onset stills disease, also considered SJIA when in a child under 16. His symptoms were rash (with fever) that could disappear when the fever went down. Muscle aches, joint pain. Enlarged spleen, liver. Elevated CRP, ESR, ASO, and Ferritin. Liver enzymes elevated from the swelling. He is on high dose prednisone and biologic injections. Hospitalized for 3 weeks.Its rare op, but your sisters case seems so similar. It needs aggressive treatment early on for the best chance of success/possible remission ###Output :Yes, the evanescent nature of the rash in this context twigged me to Still's as well. There is a known juvenile onset form that falls under \"SoJIA\" (Systemic-onset Juvenile Idiopathic Arthritis), considered a version of Still's.OP, this sounds exactly like a form of arthritis to a clinician who takes care of children. I agree that what comes to mind for your mother as \"arthritis\" is likely too limited, and that definition might need to be expanded in her mind. Could you look at this, and maybe share it with her? https://www.arthritis.org/diseases/systemic-juvenile-idiopathic-arthritisAbout a third of the way down that page is the SYMPTOMS section, with subsections on Fever, Rash, and Joint Pain. Please read it and see if it rings a bell. Best wishes."}
{"text": "###Input :As soon as they mentioned the salmon-colored intermittent rash I was like STILLS! Very rare but once you've seen it, you never forget it. Anakinra injections worked great for the patient I worked with, along with a major organ transplant due to damage done by the disease. ###Output :I think we need more information. The workup is well described here, and I agree with their consideration of JIA vs. rheumatic fever vs. oncologic. But Im hoping theres more information than this. What did they ultimately diagnose her with when she was sent home? Did they do anything to treat her (i.e. IV or oral steroids)? If they did treat her, did anything help or improve her symptoms at all? Is she following up with any outpatient specialists? Again, their workup sounds thorough, just seems like some info was left out about what they actually did to treat her."}
{"text": "###Input :Hi Dr, they diagnosed her with rheumatoid arthritis on discharge and prescribed her something, my mom doesn't think it's arthritis. ###Output :Arthritis in this case is not exactly the same as what most people think of as arthritis. Older people get osteoarthritis where the cushioning between joints breaks down and you get pain from bone grinding against bone. Rheumatoid arthritis (and JIA, or Juvenile Idiopathic Arthritis, which is much more common in kids) are autoimmune disorders where the bodys immune system attacks itself in various places. One place is the joints but it can also cause a whole host of other weird symptoms including fever and rashes.In this case, what youve described sounds highly rheumatologic in nature. RA and JIA both fit in that category, though Id put my money on JIA based on her age and symptoms. A pediatric rheumatologist is your absolute best bet to get this figured out and get her on medications to treat and prevent flare ups like this."}
{"text": "###Input :NAD.OP, Is the rash painful and burning? Do they resemble hives?I ask because two of my neighbors and three other friends, ages ranging from 16-65 have something very similar. Doctors can't explain it. The 16 year old has been at Stanford Children's for almost a year, and the 65 year old had success being treated with steroids after only a month. Same affliction.They look like hives yes but they come and go on multiple parts of her body within minutes. She says it hurts where the spots are as well ###Output :Juvenile Rheumatoid Arthritis, also known as Juvenile Idiopathic Arthritis, is different from old peoples arthritis. This is an autoimmune problem that needs to be followed with a rheumatologist. The questions and confusion you and your mother are having are both very common and understandable.This is a complicated condition - you and your mother should both go to the next appointment to ask all these questions and more. If you have doubts about her diagnosis or want the test results or discharge summary explained better, talk to her rheumatologist ASAP.Keep taking the NSAID she was prescribed as directed - this is a safe long-term treatment to reduce inflammation (you said Indomethacin in another post). Dont stop her treatment on your own without talking with her doctor.Read more here:https://www.hopkinsmedicine.org/health/conditions-and-diseases/arthritis/juvenile-idiopathic-arthritis"}
{"text": "###Input :I don't doubt the diagnosis but what worries me is that OP stated they live in Upstate NY. Most people around here (I'm by Fort Drum) have to travel to Rochester, Buffalo, or Syracuse if they aren't close enough to NYC. Even worse, if you can't private pay or don't have commercial insurance (translation if you have any form of Medicaid) it can be MONTHS waiting for an appointment, and should an 8 year old go without treatment for several months?Just to give you an idea on time frames: my children's my pediatrician started the process to refer my disabled 12yo son to pediatric endocrinology the 3rd week of August.I got the call LAST WEEK to make an appointment for March 2023 in Syracuse. So that's nearly 7 months from start to finish. FWIW our pediatrician doesn't think my son's issue is endocrine related but due diligence, you know?And this isn't new. Had to bring same boy child to Buffalo when he was 6 for ENT and neurologist appointments (well, Rochester was a possibility but I have family in the Buffalo area I can stay with). Same boy also went to Westchester outside of NYC for medical genetics because the waiting list for Syracuse was 2 YEARS LONG the last I asked and the downstate appointment was \"only\" a five month wait. But, family in the area, so worth the trip to see family too.Sorry for the novel. Thank you for being a pediatrician. <3 ###Output :This is true for an outpatient making a new patient appointment that is not deemed medically urgent by either the referring physician or the office receiving the referral.However, when a patient is seen as a consult in the hospital, they are typically seen in relatively short fashion as a follow up patient by that consulting sub-specialist. (EDIT: for diagnoses that need it. Not for every general admission.)A patient with a new diagnosis of JIA would typically be sent home with a 2 week course of an anti-inflammatory and be seen by the consulting rheumatologist or a colleague within that time period to plan the next phase of treatment. This type of case is not discharged without solidifying the plan for follow up."}
{"text": "###Input :Thank you for your response, I cant recall having that experience. I think it may have happened once with my son when he was an infant (pediatric GI after his second hospital stay) but admittedly my memory is foggy. ###Output :This sounds most like JIA to me. Once a patient is 16 this can be termed Stills disease, which has a characteristic evervescent rash like your sister has. Has she seen a PEDIATRIC rheumatologist? How far are yall from Rochester, NY? Dm me if you prefer."}
{"text": "###Input :We are a little south of Albany. Are JIA and Stills technically the same thing? We Have an appointment with pediatric rheumatologist next week. Could the reaction have been caused by a vaccine? She got it two weeks before the symptoms started ###Output :I may have said it wrong- Stills is a name given to systemic onset juvenile inflammatory arthritis, its a type of JIA. Peds rheum is exactly who yall should be seeing and they should be able to Advise if her symptoms could be vaccine related or completely different. Keep us updatedSounds like JIA. Episodic rashes and fevers fit. Ferritin supports the diagnosis.Youre mom is wrong and this absolutely sounds like rheumatoid arthritis Im sorry to say. She probably doesnt understand that rheumatoid arthritis is not just joint pain but can be fever feeling generally sick last week the interesting rash that youre describing and other auto immune future so its not like osteoarthritis that you would see in an older person for example"}
{"text": "###Input :Do doctors take offense to their patients going to a different practice/not believing the diagnosis?Demographic Info: 24F, 54, 120lbs, white, ~1 year duration, location of pain is basically the joints in my hands, feet, ankle, wrists, knees, and elbows. Non-smoker.Hi all. Sorry if this isnt allowed, Im new here. Ive been to quite a few doctors in the past 10 months (1 Orthopedic, 2 Rheumatologist, 2 Primary Physicians) for the same issues (joint pain primarily, with some secondary concerns). I believe I have an autoimmune disease and suspect its rheumatoid arthritis, but now Im suspecting lupus after my most recent rheumatologist visit. They all have told me (besides the one primary care physician) that it is not rheumatology related, but they have also all either given me either no answer on what it could be or an answer without any real evaluation. The disease/disorder that they say it could be also doesnt match my symptoms at all.Im really at a loss right now, because I want to believe that they have my best interest at heart, but for me to believe a diagnosis, either the symptoms have to match or there needs to be some kind of test result that indicates something.If I go to a new practice that is two hours away, would that look bad? I want answers, but the practices near me cant provide answers using quantifiable/visual data. ###Output :I think most doctors don't care. What can get a little bit annoying is when there's clearly nothing relevant to said specialty going on and they keep seeking multiple opinions. It'd be hard for TWO rheumatologists to miss both RA & Lupus, considering these are probably the most bread and butter diseases they see (other than fibromyalgia). But feel free to try a third (technically 6th opinion). You should go to an academic center if you have not."}
{"text": "###Input :The reason I dont really trust the answers of the rheumatologist is because of the lack of testing/evaluation/time really spent trying to understand whats going on. If a doctor ordered a bunch of lab work and based on the lab work decided it was/wasnt something, I would believe it but they barely looked at my joints, and one flat out said that they dont believe my pain ###Output :Not saying this is your case but an example would be a kid hitting his head then acting normal and coming into the ED. How could you tell he didnt have a head bleed. Well, it is kind of what I do and I know which kids should get a head CT and which shouldnt. So maybe they are seeing something that says no.Another problem is when I see that people have gone to many doctors, I instantly think they are doctor shopping for the diagnosis they want. It definitely biases me and if you go to a rheumatologist, I am going to assume they did their workup, so I am not going to be looking for anything rheumatological. So I am even less likely to draw labs.Not saying either of these things are your case and maybe stuff is getting missed which is a bummer. But all in all, no I dont mind if people get second opinions."}
{"text": "###Input :I get this vibe a lot too, and I try to bring up questions, but then I get talked down to for asking in the first place ###Output :A big part of medicine is learning to read research and interpret the results. You can find a study showing practically anything (one that springs to mind shows no benefit to wearing a parachute vs not wearing one when jumping from a plane). That doesn't mean the information is valid, or valid in the slightly different context to which it often tries to get applied.Doctors generally appreciate an interested and engaged patient very much. We don't appreciate someone who thinks they know better, especially if there are some obvious, fundamental gaps or flaws in their knowledge. These knowledge gaps may not be addressable in a reasonable time frame, so many of us won't bother to try.We (usually) aren't just gatekeeping treatment, there are sometimes significant potential harms from engaging in whatever revolutionary therapy has been suggested online.Actual expertise can sometimes be indistinguishable from ego, depending on what you go into the consult looking for."}
{"text": "###Input :You will have to wait a bit as a new patient but that is normal. I referred someone with MS to Mayo's clinic and they did an amazing workup--that person goes there annually now for follow up. I would start by going online to their website for JH and reach out, see what conditions they specialize in. https://www.hopkinsrheumatology.org/make-an-appointment/ I don't have experience with which centers in the country are considered the best for your condition but you can definitely research that too. Any place where you make an appointment will let you know where to have your past records sent, however be prepared to have labs and tests repeated for thoroughness. ###Output :Nobody cares. They'll go about their day and think about other things. I'm sure if you see enough rheumatologists, somebody will diagnose you with an autoimmune disease. You can always find that 1/10 dissenting opinion if you see enough of them. Same with any other common disease/complaint in another subspecialty (IBD in GI, heart palpitations in cardiology, etc). See enough of them, you'll get a diagnosis attached to your medical record.It's up to you decide if all the other doctors were just lazy/stupid and if that final rheumatologist you found that agrees with your self diagnosis is actually correct."}
{"text": "###Input :F33 - fingers go pale and numbMy best friend, f33, has been having this on and off for years now. She asked me to post on Reddit.Shes always suspected Raynauds Disease. Her fingers go pale white, tingly like pins and needles, and numb. It happens at least once a month.Ill add a photo in the comments.Is there anything she can do? Would there be any long-term issues? ###Output :It's Raynaud phenomenon. Even though it's sometimes linked to some rheumatological conditions, usually it isn't pathological. Consider going to a specialist in family medicine or family medicine if it causes discomfort or if there are other symptoms in association."}
{"text": "###Input :[F26] Fingers swollen, stiff, w small 'lumps'/bumps around joints?For the past two weeks + my fingers on one hand have all been pretty swollen and stiff, to the point where I haven't been able to bend them all the way down. There has also been some redness on some of the joints. However, in the past week as the bigger swelling has gone down a bit/the problem has persisted, I've noticed small bumps around the joints  most of these are kind of hard to capture in pics, but you can feel them lightly running your finger along the skin (i.e. you don't have to press down to feel them). See pics: https://imgur.com/a/TQRDVQSI've been finding this really painful, especially as I work typing all day so it's not been ideal. I've had a p busy 2 weeks so haven't made it to the dr yet, but also keep thinking its about to resolve itself and it just keeps on going  Not itchy at all, just painful.They're worst in the morning in terms of swelling  by the end of the some days I've nearly been able to get them all the way down, or get some of them fully down, & I think its on the way out but then they're just as swollen and stiff the next morning. EDIT: Just realised I should probably say I haven't injured or burnt the hand/fingers recently, or at least if I did it was so unmemorable I really doubt it is the cause!For the past ~year I've had a fair amount of joint pain and some stiffness which is worst in the mornings, mainly in my hands & knees. However, never had it where it lasts throughout the day for so long & the little bumps are also rly weirding me out. Does anyone know what this is??? Or how I fix it?? Should I get it checked by my GP or is it likely to self resolve?I've also been experiencing a lot of other health complaints (you can prob see in my reddit history lol), like recurrent episodes of mouth and genital ulcers, rashes, etc. All my blood tests ordered by GP have been clear & generally normal  tho have all been done when im generally asymptomatic had one while at A&E for the first flare up of the genital ulcers & had high CRP and monocytes (CRP was 14.9, monocytes 12%  tho monocytes have been between 0.85 and 1.09 in other blood tests which I know is above the 'normal range' in some labs but not the ones used here). So far my GP and some of the community referrals I've had (dermatologist, ophthalmologist) are a bit stumped  waiting on two hospital referrals atm, one for patch testing and one to see a specialist vulval dermatologist. All of the community referrals I've had have suggested my GP refer me to rheumatology but he can't with normal bloods (& wants to wait on hospital referral first to see what they say). ###Output :Rheumatologist here: I agree you should see a rheum. It sounds like it might be some sort of artritis, but it has to be seen in person before a diagnosis could be made. You don't have psoriasis, uveitis or an inflammatory bowel disease? Swelling in other joints? What is your ethnicity? In case of genital ulcers, we should also think of diseases like Behets, but like I said, it should be seen by a rheum.A bit odd that he can't send you with normal lab tests. Clinical presentation is way more important than a blood test."}
{"text": "###Input :My hands keep turning yellow. Can anyone tell me why?Im a 36F and I have Sjgrens syndrome and endometriosis. I take Plaquinil, hydroxyzine, and a DIM supplement. My CBC, rheumatology bloodwork, and liver bloodwork were all fine. When it happens, my hands sometimes feel a bit numb. ###Output :If you have a question about something visual, like a skin condition, please include one of preferably more of the pictures in your post as an imgur.com link. It makes it easier to help with something when it can be examined visually."}
{"text": "###Input :F19 ANA development (possibly rapidly?)So context: I'm not allergic to anything and never have been. In November of 2019 I had what I thought was a bug bite on my elbow that exploded into full hives and three days later I was in the ER getting an epinephrine drip (I think. I was super out of it and my mom was too beside herself with worry to focus on what they did) because it developed to the point where my ears and lips were swollen and my throat tightened up significantly. Following that, I've been on heavy antihistamines (A and B) and can't get off them without the hives come back. I've also been having joint pain randomly since then (wrists and ankles primarily)In January of 2022 my allergist ran a lupus diagnostic panel on my blood but there wasn't anything other than general inflammation flagging the systemProblems continue to occur and my former pediatrician got me in with a local rheumatology clinic. I finally get in December 2022 (I'm in college and it had to be while I was on break) and I get the results and I have speckled+homogenous ANAs at a 1:160 ratioTL;DR ANAs went from not showing up to 1:160 in the span of 11 months. Any clue what's up? ###Output :An ANA is a nonspecific test, not a diagnosis. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Antinuclear-Antibodies-ANA"}
{"text": "###Input :transient ekg changes?I am a 24F, 5'3, 160 pounds. Location on body: heart duration of complaint: since December 8th, 2022. Symptoms, nearly fainting randomly, sharp chest pains that come and go, lightheadedness that gets worse at times, also knuckles, knees, and hands go pale or purple randomly. Concerned about poor circulation. Meds: none, medical problems: sjogrens syndrome, mild anemia, rheumatology suspects dysautonomia, asthma, sleep apnea (use CPAP), The ER did an EKG last night and in the notes it said the t wave depression was consistent with incomplete right bundle branch block. Yet I went to urgent care today for the same chest discomfort, lightheadedness and near fainting episodes (with seeing colors) (didn't want to go to the ER again) and they showed a normal EKG. Can these changes be trainsient and induced by stress, or lack of sleep? I am also concerned my body is shutting down because my body temperature is lower then it usually is. It's usually 98.5 but it's been between 95-97F these past few days let it can't regulate itsself. ###Output :They can be transient. They can also be due to improper lead placement"}
{"text": "###Input :Please, please help...no one can figure out whats wrong and at my wits endI've posted here before and no one ever seems to answer but I'm getting so sick that I'm basically bed bound from pain.I'm a 32 yo woman, overweight at 280 lbs, diagnosed with Sjogren's, PCOS, and on these medicines:Metoprolol for tachycardia I've had since childhood Metformin for PCOS Spironolactone for low potassium I've had since childhood (used to have constant racing heart and passed out a lot as a kid because of low potassium) as well as PCOS Nuvigil for chronic fatigue Pilocarpine for Sjogren's dryness Doxepin for ribcage pain Rosuvastatin for high cholesterol Low dose naltrexone 3mg for chronic pain Trintellix for depressionA few years ago, like 5 years now, I was healthy and 125 lbs. Then I had my 2nd child, was about 180 after she was born, and developed PCOS. I could not lose weight and gained a little more and got to about 225.In Dec 2019, my psychiatrist put me on Trileptal for mood stability. About a month later, I started to develop pitting edema and severe low ribcage pain and then had absolutely zero appetite whatsoever. I went to the ER with grade 4 edema, severe low rib pain, and blood in my urine and bloody vaginal discharge. No sign of infection, no excess protein, nothing really out of the ordinary aside from GFR that would dip into the 50s before sometimes coming up again and blood. I did get low iron and potassium, needed iv potassium several times, but they could find nothing to easily explain symptoms. This goes on for nearly a year...I got up to 325 lbs even though I could barely eat or get out of bed. I truly thought I would die.I stopped taking my medicine when I couldn't eat, and noticed I felt worse after taking it again. I also felt worse if I exercised. So I stopped Trileptal and rested for about a month and slowly seemed to recover. Then my OBGYN found uterine polyps and I had surgery to remove them. The next month, my gallbladder was removed. The next month, I had surgery to \"fix\" my urethra since they thought maybe I was having urinary problems stemming from that.But I got better and tried to be okay mentally with the constant dismissals I got from so damn many docs before I finally got some help. It was extremely difficult and I suffered with health anxiety because of it but have done great with therapy. I even managed to get my weight down to 235 after starting exercise after being sure my kidneys were fine again at a consistent GFR over 110.Then a month ago, I got a very bad case of flu. The lower rib pain came back bad. I dismissed it as flu. Recovered from it, then had several days where every muscle in my body felt like it had been lifting heavy weights for days. Everything hurt, and doc said maybe mild myositis from flu. Then I noticed urinary changes. I normally have frequent urination, going a few times a night and usually at least every hour or more. No one can find a cause though. But suddenly not going at night at all and only going like 3 times in the day. Started having white flecks in urine sometimes and strong odor. Then urinalysis started showing blood in urine consistently. Then sharp pains in urethra all the way to anus at times, which I'd had before as well. I have brown vaginal discharge too. A few days ago, I couldn't pee at all and was sent to the er. They can find no reason for my symptoms...nothing on ct, no bacteria in culture, no stones, no nothing. No one knows, but I had to have a foley catheter inserted (was very painful like stabbing) because I had retention and could not pee. Was sent home with it and had it removed next day and I was able to pee again but then developed pitting edema. It's currently grade 1. No cause can be found.I will add in case it is relevant, just before the flu, my pcm referred me to neurology for mris of head and spine and nerve conduction test. I've been having nerve pain for several months. Buzzing, tingling, numbness, shocks, in various places for sustained periods and sometimes just sudden and then goes away. She was thinking the lower rib cage pain may actually be nerve pain since it feels burning at times like the burning headaches in the base of my skull and my neck. My thyroid is sometimes hypo but usually fine, my b12 and magnesium are normal, and I do not have any markers of diabetes other than just being fat currently. My grandma has MS, which she believes was healed by Jesus, but I know enough about it to know that's what she's trying to rule out I'm pretty sure.Can anyone, please , give me some insight about what might be wrong with me? I'm in so much pain with the gnawing, burning pain in the bottom of my ribcage and the electric shock pains in my urethra and anus, and I am so scared of the fact I've got urinary bleeding, vaginal bleeding, and putting edema but no one knows what's up. I've seen rheumatology, nephrology, urology, obgyn, even was sent to a hematology oncologist as a hail-mary.I stay away from Googleing anything because for one, I have too many symptoms to easily fit in a search bar, and I know there's no good coming out of looking at it anyway. I have gotten better care since changing hospital systems after last time this happened, the urologist I saw kept insisting the blood in my urine was from my vagina even though I still had blood in my urine after a catheter was used to sample, and I e just had a really hard time getting docs to push to figure out what's wrong. It feels like since I don't appear to be imminently dying, and they dismiss my pain and exhaustion, no one sees a point in helping.So sorry for the long post but I'm just trying to give as much context as I can. Please let me know if you have any questions as I'm happy to answer. ###Output :In the absence of objective findings on imaging and testing, it is possible that weight in itself can cause the multi-system problems that you have. Obesity unfortunately affects numerous organ systems in subtle ways initially."}
{"text": "###Input :Help interpreting liver testAge42Sex fHeight 54Weight190Race CaucasianDuration of complaint dates referenced on theLocationAny existing relevant medical issues? so many lol RA,hEDS,Endometriosis,Asthma,Current medications, Zoloft,Simbicort ,prednisone, alburtol,muscle relaxers ciplopram ? ,NambutoneALT 0 - 41 U/L 4/4/21 19 10/8/21 20 8/29/22 346 8/30/22 342 8/31/22 352 9/10/22 316 9/17/22 296AST 10 - 40 U/L 4/4/21 14 10/8/21 21 8/29/22 215 8/30/22 194 8/31/22 195 9/10/22 193 9/17/22 186 ###Output :You have active inflammation of your liver. Not sure what the cause is. Could be some autoimmune process, fatty liver, meds, supplements, etc. Favor the first two"}
{"text": "###Input :ostive ANA test, titer of 1:320 and speckled pattern, but negative Connective tissue testI'm a 35 yo Caucasian female, 5'5 and 170 lbs (back to back pregnancies), I vape, I take Omeprazole and lyrica 200 mg daily. The lyrica is for seizures, not pain.Ok, so I just had a bunch of labs drawn, because I've been having numerous symptoms of an autoimmune disease. Chronic fatigue, mouth sores that will randomly show up, lots of head aches, severe random bouts of pain that show up in joint areas that debilitates me when they \"flare up\". Crippling anxiety, and depression is worsening. And lastly, a random rash that will spread across my cheeks and nose, and sometimes radiate into the tips of my ears.I had a positive ANA test, but the more specific tests showed that I was negative for connective tissue disorders like lupus, RA and sjogrens to name a few. Everything looked fine, and my doctor told me that I probably just have inflammation somewhere in my body.My questions are:. Could I still have something like lupus, even tho the CTD labs were negative, but ANA had all 3 parts show abnormal results? And, this isn't my first positive ANA test. It happened 6 years ago, but nothing further was looked into. Where do I go from here to get better answers? All these symptoms are debilitating my life. ###Output :techincally you could still have something on the spectrum of connective tissue diseases with current antibodies negative, but +ANA are pretty common in the health population. best bet is probably continuous follow up with a single primary care doctor, and referral to whatever specialists they think best."}
{"text": "###Input :They ended up referring me to an RA. This is the second time I've had a positive ANA test within 5 years. The speckled pattern is what's making me wonder. I have more of the symptoms of an autoimmune disease, than I don't have. I hit almost all symptoms of moderate lupus, without kidney problems, but I HAVE within the last year, had protein in my urine, but I was pregnant at that time. There's a lot going on I feel kinda dismissed by the doctor. It's almost their discretion to diagnose, because of symptoms and positive ANA alone. I've read on many medical documents that a negative anti ds is not absolute to not having an autoimmune disease. I've heard it's hard to get diagnosed, so hopefully the RA can give me some more definite answers, once I actually get in to see them :/ ###Output :lupus had a discrete diagnostic criteria, it might not be as discretionary as you think. unfortunately the symptoms of many rheumatological diseases overlap heavily with many non rheumatological conditions. best of luck."}
{"text": "###Input :6 year old dying from ARDS all labs are negativeHello, on March 15th my 6yr old son had a fever and cough. This continued through March 17th. He seemed fine the entirety of March 18th. On March 19th he started presenting with a full body light petechial rash and fevers. Appetite, fluid in take and behavior were all very normal. Would occasionally become sleepy with the fevers. Fevers would come down with Tylenol. Over the next two weeks the fevers became more frequent but were still easily treated with Tylenol. On March 31st he began to lose energy and didnt really want to get out of bed. On April 1st he started refused food and drink. The early hours of April 2nd he began vomiting. We had several appointments with his PCM, urgent care, and nurse telehealth during these two weeks. All advising its just something viral and should resolve on its own. After refusing food and drink and then vomiting we decided we couldnt wait the 24 hours to his next appointment and took him to the emergency room. He began requiring blow by O2 while sleeping from night one at the hospital. The petechial rash started to become severe in places where he had any medium to heavy pressure (blood pressure cuff, being held for accessing his port a cath). On April 4th he began needing supplemental o2, between 1.5-5L. After a week in the hospital he was diagnosed with a severe CMV vierma infection. He was started on gancylovir to treat on April 10th. After a few weeks of treatment his CMV levels have finally come down to the 100s (as of early this week). On 4/13 he was out on high flow o2 due to hypoxia. He continued to range in requirements of 15L-30L and 60%FIO2 -100% FIO2. We were advised his lungs would begin to heal as his cmv number declined which has clearly not been the case. On 5/1 he was rapid-ed to the ICU due to expected impending respiratory failure with hypoxia. In the icu he had episodes or high hr, blood pressure, and low O2. However, these episodes were short lived at the beginning and after they were over he would go back to his normal goofy self. Over the next 36 hours his episodes became longer and more frequent. He has a planned intubation set for May 3rd at 6am and a planned brohncoscopy set for May 3rd at 9am. Original plans were to begin attempting ex-intubation post procedure. However at approximately 3am on May 3rd he had an episode that did not resolve. He was placed on a ventilator which failed due to CO2 build up, oscillator was attempted and failed due to CO2 build up. He was then placed on bivalve ecmo on max pediatric settings. He remains on max ecmo settings to present day. He has since been diagnosed with ARDS. He has had an extensive infectious disease work up and rheumatology work up. Every test result has come back negative. Tests show high levels of inflammation. Doctors at our current hospital refuse to do a lung biopsy due to expected death during or as a direct result of the procedure. Please help. We are being told were reaching the end of our options here. We have a second opinion request put in with Boston Childrens Hospital but are willing to travel anywhere that may be able to help him. I can provide any and all test results you need to help and the team here is typically willing to run more with plausible explanation. He has a complex medical history as well be no full encompassing genetic diagnosis.He is currently on anti fungals, antivirals, and antibacterials. He also has a BMX drip for a diuretic. He is on several medications for sedation and pain management for ecmo. ###Output :I am so sorry to hear about your son. I have a child about that age, and can't imagine.CMV is not a typical infection in someone with a healthy immune system, usually we see it with transplant or lymphoma but there can be congenital immune system problems that predispose to severe CMV. It can certainly cause all of the symptoms your son is showing including the petechial rash and severe pneumonitis leading to ARDS. It can affect nearly any organ.However CMV can also reactivate due to stress from other issues so it is difficult to say if this is the cause of his symptoms, or just a sign of how sick he is. While it is risky to do a lung biopsy in a person on venous ECMO, if there is no diagnosis within a week it is reasonable to proceed with doing this, with fairly good safety outcomes.https://pubmed.ncbi.nlm.nih.gov/27894766/The most important thing though is if the treating physicians think not only is it safe (there are other issues such as clotting/platelet disorders beyond ECMO anticoagulation) but if it will change management. Unfortunately a large percent of biopsies will be indeterminate - just showing nonspecific findings of diffuse lung damage from ARDS - and the ones that do change management are generally because they find something that is not treatable. I would entirely defer to your physician team here. They also want very much what is best for your child - doctors and nurses care much more than you may see about thing turning out well - and have the data and expertise to properly advise you.If it is CMV, then the inflammation from the infection will lag well behind the time the virus is cleared with antiviral therapy. He may just need time for the inflammation to improve and then to heal to allow decannulation."}
{"text": "###Input :Thank you. I fully believe the team here is doing everything thing they can think of. Theyve had entire departments sit down to review his case in multiple departments. The reason we began looking for second opinions is that two of the doctors here on his primary team recommended it. It is very comforting to me that they care more about finding answers for him than being the ones to find the answers. I cant speak enough to how much that says about them as doctors and people.In regards to the cmv inflammation lingering in his lungs. Would there be a high level of infection in that area if a pcr was run from a sample from there if thats what was causing his severe inflammation? If so, would a more aggressive dose of his current antiviral help with it? ###Output :That is reassuring to hear. Sounds like they are doing everything they can.If the CMV is the cause, there's unlikely a high level in the lung if any. The antivirals work reasonably well if there's no resistance, the dosage is generally more than necessary for maximum effect, the levels of CMV in the blood can be tracked, and my guess is they are now at worst quite low.Most of sepsis is instead the body's response to an infection. As the immune response ramps up it starts being less and less precise and the rampaging army of white cells causes widespread injury. This continues after the infection is completely cleared despite a counter-inflammatory response that is trying to resolve all of this overactivity. In fact, the counter-response can be just as harmful if overactive, and there can actually be a state of too much and too little immune response at the same time. This is particularly dangerous since it opens things up to other infections.We actually still don't have very good tools to helpfully manipulate this immune response despite decades of research. There are dozens of therapies that are helpful in mice but later failed clinical trials. Sepsis is very dynamic and complex, nowhere near as simple as \"on\" or \"off\", and until we are able to adequately characterize it in individual patients treatments will continue to mostly be limited to the infection itself and \"supportive care\". Fortunately this is still often sufficient, and we've had good outcomes even in patients who were on ECMO for over a month."}
{"text": "###Input :NAD but a fellow ICU mom. Been in twice for my 2yr old and multiple hospitalizations in between. Its a very scary place. Just wanted to say I feel you and hope for a good outcome for your little fighter. ###Output :What led to your son having a port?I am sorry this is happening. Has your boy been evaluated for HLH (hemophagocytic lymphohistiocytosis)? ARDS is not a common manifestation of this, but considering the situation of runaway inflammation and that it is occurring in the context of CMV infection, this has to be considered. You can see inappropriate immune stimulation co-occurring with frequent infections and immune deficiency due to there being a milieu of overarching immune dysregulation. Texas Children's Hospital and Cincinnati Children's Hospital are particular specialists in treating these syndromes. I doubt that transfer of a patient on ECMO is possible, but those facilities may at least be able to provide some guidance."}
{"text": "###Input :Thank you I will ask him team if this has been tested for!Agree with HLH assessment, very tricky disease and its not clear if he was evaluated for it, but sounds like a reasonable suspicion. ###Output :Hey OP! I am sorry that you are facing this trying situation. My heart goes out to you and your child!From what you have described, it seems that not only you, but also the doctors are doing their best!The damage to the lung needs time to heal, something that has become a luxury for your child.As you have stated, all other infectious and rheumatological workup is negative. So, they might have tried steroids or intravenous immunoglobulin to tide through this crisis.We just wait, for your child to fight this through!"}
{"text": "###Input :Thank you. Theyre nervous to attempt any immune suppression treatments without a diagnosis due to how severe his CMV infection was. ###Output :Well ivig can help. Your child's kidney function test is fine? Is he requiring any inotropes to maintain blood pressure?If kidney is fine and not requiring inotropes ivig might be tried if not used before."}
{"text": "###Input :Kidneys took a hit due to the aggressive BMX drip to try and alleviate the pulmonary edema. He was on a drip to help with hypertension but has since been able to come off of it in the last 36 hours. Docs were concerned about heart complications as to why he suddenly doesnt need it anymore (blood pressure has been a big problem since being on ecmo) however his echocardiogram came back normal. ###Output :Ok, ivig is contraindicated in renal failure. So, they might bide for time till kidney function improves. It is reassuring to hear that echo is normal."}
{"text": "###Input :rheum!  Would an underlying autoinflammatory disease be appropriate to suspect? Would it contribute to the severity? Aren't there some that are associated with congenital birth defects too (as OP stated below)? ###Output :Yes and no!On parsing the thread, it is becoming ckear to think on lines of CVID. But, as OP stated, they gave done other rheuunatological workup."}
{"text": "###Input :What about the ones outside of IDs  like MEVF, MKD, Still's, etc. Would genetic testing be worth it for OP to ask about ? ###Output :I like your thinking. You are covering a huge base. But until and unless we are privvy to all histories, blood work up and labs, we are just conjuncturing possibilities.Regarding genetic test, I do agree that it can be done. The PCP in this case has to make a decision!"}
{"text": "###Input :I dont know what constitutes a full immune work up. I know his immunology team says he has B cells but they dont do anything. They suspect something similar for his T cells but I was told they cant diagnose him while hes sick. His thyroid panel came back entirely normal. Is there something else I should ask about? ###Output :Yeah. I understand that it may be impolite to ask:Could you provide the cytoflowmetry reports of CD 19+/ CD4+/ CD3+/ CD8+ cells?Since he was given ivig, I might not be able to interpret the current immunoglobulin levels (if atleast 3 weeks have not gone by since he was last given IVIg)."}
{"text": "###Input :No, he doesnt. He started taking IVIG to help combat the CMV infection. Theyre thinking he has an undiagnosed immune disorder due to how severe the CMV infection was. Hes also had vaccines several times but when tested his body acts like its never seen it before. ###Output :Ok. This is like common variable immune deficiency. The antibody producing b calls just aren't functioning well. That us why his viral illness knocked him bad.But with regular ivig, every 3 weekly (once he recovers) should help him have a normal-ish life."}
{"text": "###Input :This makes sense to me, as the one case I have personally been involved with with a severe CMV viremia was a child with IgA deficiency, CVID, and bronchiectasis. I also sounds like he has had some chronic health issues in the past so it fits that some/all of this is connected. No specific clinical advice from me, but Ill be praying for your boy! ###Output :While it wont give answers right now, Im surprised a full genetic work up hasnt been done. They could start with a targeted gene panel for immunodeficiency and or lung problems. In genetics having multiple seemingly unrelated issues is a GREAT reason TO GET testing not a reason to avoid it.I have seen kids recover from ARDS but its long and slow. Getting a second opinion is always your right, but jt doesnt sound like they could move him. Youre doing everything right for him. Im so sorry youre going through this.https://www.reddit.com/r/AskDocs/comments/13g4w5i/6_year_old_dying_from_ards_all_labs_are_negative/jjz5icx?utm_source=share&utm_medium=android_app&utm_name=androidcss&utm_term=1&utm_content=share_buttonThey did the work up"}
{"text": "###Input :3 years, No diagnosis, Losing hopeSpecs: 23M, 140lb 61, no drinking, no drugs, no previous health conditions Negative Covid tests and vaxxedHey All,Ill try to keep this short, but here is the deal. Since early highschool my energy levels have always been low, my body has generally felt quite sluggish. I always just attributed this to long school hours and work. My dad would joke, its like you got the hangover without the partyAbout 2 years ago I was done with school and really made an attempt to increase my health and energy to actually enjoy my days. For the next year or so I attempted to improve health through a consistent sleep schedule, diet, regular exercise, vitamins/supplements, you name it, I tried it. But after feeling consistently worse I began to seek medical help for:Symptoms:Extreme fatigueOverall joint pain, but focused on my backConstant tired burning muscles (as if I climbed a mountain)Canker sores on soft tissue 1.5in+ in diameterMorning nauseaChillsHard lumps on lymph nodesNo staminaSince July of 2019 I began experiencing episodes consistently every 3 monthsFever 103+Mouth sores 1 in+ and tonsils covered in lesionsBed riddenMuscles burnInability to eat or drink due to mouth and throat lesionsMy docs were highly unhelpful as this was the height of covid and docs were quite busy. For the most part I was passed around with little to no results. I am self employed and this is the only reason I am still able to work, as my last episode had me bed ridden for nearly 5 weeks. I was prescribed Lidocaine, magic mouthwash, acyclovir, VitD3. None of these helpedFast forward to 2 weeks ago, and 6 doctors later, I now have $8,500 worth of blood work done. Everything is normal, except I am anemic and discovered 5 herniated discs in my lumbar and neck. My iron levels are ok, but red blood cell count is low.I have been tested for mono, flu, covid, recurring strep, rheumatoid factor, ana reflex, vitamin levels, thyroid, sleep disorders, allergies, just to name a few. All came back normal.Docs are at a loss and dont know where to go next.I have been turned down by Rheumatology, ENT, Hematology, due to lack of symptoms (more or less I look too healthy to hold a place in the queue). I have been told I have the exact same symptoms by friends and family with diagnoses like RA, Lupus, MS, Gall cancer, gout, lymphoma. But I am getting turned down by specialists so tests are not happening.My daily physical health has slipped to a point of now affecting my mental health. I need answers and cannot continue much longer like this. Nothing I try improves or alleviates any pain. I dont know what to do next. ###Output :Ethnicity? Any family members with similar? How long do fevers last for? Is it 3 months like clockwork? What else occurs during these flares, just worsening of oral ulcers? Where exactly in the mouth are these ulcers? Any vomiting or abdominal pain?"}
{"text": "###Input :White/CaucasianGrandmother: Lupus, Rheumatoid ArthritisGrandfather: Rheumatoid Arthritis, Lupus, GoutAunt: MSUncle: Anemic, celiac, Rheumatoid Arthritis (I have consulted this uncle, he says it is not celiacs)Yes, 3 months like clockwork, no other symptoms I can think of. I have had stomach pains, but I attribute this to my doc prescribing me antibiotics. I cannot eat for the life of me everything burns when it touches the raw nerves on my throat, so the antibiotics on an empty stomach are likely to blame for the upset stomach. No vomiting.The flare ups ulcers are located on the insides of my lips and cheeks, tonsils, back of throat, and tongue. They are according to my dentist \"the largest non surgical sores I have ever seen\" ###Output :Anyone in the family with recurrent fevers, recurrent mouth sores, recurrent tonsillitis or strep throat, underwent tonsillectomy?Any improvement with steroids?Any labwork during an attack? White count, ESR, CRP in particular.Did your rheumatologist comment on the fevers?"}
{"text": "###Input :Nobody like mine. The grandmother had pretty bad mouth sores apparently, and she said it improved with her Lupus medication.I have not tried steroids, so I cannot speak to that... All of my blood work has been during non-flareup times. And I have not been able to see a Rheumatologist yet. ###Output :Periodic fevers can be autoinflammatory or infectious in nature. Stability of symptoms favors autoinflammatory which falls under the domain of rheumatology. I wonder if the referral was for mouth sores only; I would highlight the periodic fevers as the indication for further evaluation. You can suggest the possibility of adult onset periodic fever, aphthous stomatitis, pharyngitis and adenitis (adult onset PFAPA) to your PCP, although other similar conditions must be considered as well. A negative ANA does not rule these conditions out. Your PCP can rediscuss the case with the rheumatology department. I would also suggest requesting an appointment with a rheumatologist at an academic center as they tend to have more exposure to and interest in unusual conditions. I would also ask your PCP if a referral to an infectious disease specialist would be useful.Agree with /u/m3tac0gniti0n regarding steroids. Patients with PFAPA have significant relief with steroids, so assuming infection is felt to be unlikely a course of steroids started with the next flare may be useful for relief and for diagnosis.Best of luck.https://rarediseases.info.nih.gov/diseases/5657/periodic-fever-aphthous-stomatitis-pharyngitis-and-adenitis"}
{"text": "###Input :This was my first thought as well. My daughter had this syndrome when she was in her teens, it seemed to come about during her monthly cycle. It has subsided as she has entered adulthood. The lesions were restricted to her tonsils but with the high fever It mimicked strep and she always tested negative. She's 26 now and hasn't had enough episodes for at least 7 years. ###Output :Feels like you nailed it! Well done!"}
{"text": "###Input :Other than what is listed in my bloodwork, no. Thank you for your input, simply based on the feedback I have received I may ask my PCP for anymore thoughts regarding the possibility of celiac. Thank you for your input!Of course, I hope it might help you find an answer to your problem. Make sure you continue consuming gluten up til the testing is done. Cutting it out of your diet will cause the inflammatory markers to go down and may make it harder to detect. ###Output :Just briefly looking over it,Sounds autoimmune.See if a rheumatologist will see you.The labs you provided do not help answer this question.This is also about as far from my specialty as you get, so if other docs offer ideas I would go with thatI'd say the same.Maybe some further autoantibodies tests should be done to rule out Lupus or vasculitides. Other tests that come to mind would be ANCA/Anti-Neutrophil Cytoplasmic Antibody and/or myositis immunoblot; ANA blot (and ENA blot if needed); rheumatic factor.Maybe, but it's a stretch, if it would be possible, I'd swab the sores and ask for some cultures (fungal and bacterial)."}
{"text": "###Input :Thank you for your input! I have had an ANA Reflex test done. Is this different from what you describe above? They have suggested swabbing the sores, but ENT turned me down at the time, now I am supposedly waiting for my next flare up and they would swab it then.... we'll see. ###Output :Indeed, that's the right ANA test.Sorry about the ENT. If you have any labs that you could get these done, I'd suggest going in by yourself. Depending on your country, it might not cost much.Before swabbing, don't eat/drink anything, so it's best to get these tests before brushing your teeth, in the morning."}
{"text": "###Input :Anti CCP Antibodies. And would recommend having the bloods done during the flare up with inflammation markers like ESR/CRP. Definitely sounds Autoimmune in nature. ###Output :Yeah, during a flare up is the best choice. I saw that they already had CRP done and it was normal"}
{"text": "###Input :PBC DiagnosisI'm male, 30 years old, 5'11, 190 pounds. I have Hashimoto's disease and collagen vascular disease. I take 75mcg Synthroid and 400mg hydroxychloroquine per day. A couple years ago I tested positive for antimitochondrial antibodies at 1:80 titer. My liver enzymes have been normal. My total cholesterol is in range but my bad cholesterol is slightly high.My rheumatologist told me that the antibodies are usually seen in primary billiary cholangitis, but that they can be present in rheumatological diseases as well. My diagnosis of collagen vascular disease is a vague label as my only symptoms are low white count and low platelets, declining for a decade. Cancer was ruled out and they tried hydroxychloroquine, thinking it was autoimmune as I already had Hashimoto's disease. My blood counts have been higher since I've been taking hydroxychloroquine.I get my liver enzymes checked twice per year. Should I push for any other tests so that if I have PBC, it can be caught early? My rheumatologist said he wouldn't do a biopsy or ultrasound as my liver enzymes are normal. Is there anything else that can be done? ###Output :You dont treat normal liver enzymes even if you had PBC. But you don't have pbc because your liver enzymes are normal"}
{"text": "###Input :I've read that the antimitochondrial antibodies can show up years before the disease progresses. Is that true? Should I just continue to have my liver enzymes monitored each year? ###Output :It can but there's nothing to treat"}
{"text": "###Input :Thanks for the responses. I just want to make sure if I develop the disease it can be caught early. I watched my grandfather die of cirrhosis (not autoimmune) and it is scary, especially as doctors tell me antimitochondrial antibodies are associated with the disease and studies I've read say that most people with the antibodies get the disease. ###Output :People don't check for antimitochondrial antibody in the absence of abnormal liver tests so this is not true at all"}
{"text": "###Input :The studies aren't true? Or my testing positive for the antibodies isn't true? My rheumatologist did a bunch of autoimmune bloodwork due to my low platelets and white blood cell counts. He said he tested for it as it can be positive in diseases like lupus. ###Output :So it was for lupus. It's irrelevant to pbc because there was no indication to test it"}
{"text": "###Input :They did a wide array of tests because of my white blood cell and platelet counts as they could not figure out why they were decreasing from year to year and all tests for cancer done by an oncologist were negative. The counts were getting dangerously low. The antimitochondrial antibodies came back positive along with antinuclear antibodies. Then they said I do not have lupus or any identifiable autoimmune disease, but only a vague collection of symptoms. They put me on hydroxychloroquine in hopes it would raise my blood counts as they could not figure out the cause and I already had one autoimmune disease. The rheumatologist said I do not have lupus and that he doesn't know what caused the positive antimitochondrial antibody test. He said it's possible it's a due to a rheumatic disease or that it just happened to turn up positive in the bloodwork. ###Output :Right. But you don't order AMA for pbc unless your liver tests are abnormal. So this is generally worthless. What exactly are you trying to convince me of.If it turns out you have pbc down the line, then you may get treatment if your liver tests are very abnormal"}
{"text": "###Input :Elevated esr and crp with sudden symptoms (started 2 weeks ago)Hi doctors!27 year old female 6 months postpartum, weaning of breastfeeding currently. (If relevant)A few weeks ago I got a bug (negative for covid) towards the end I started having hand cramps, foot cramps, muscle pain in my legs and arms and joints, tiny spasms all over including my face and then followed by pins and needles all over and sometimes a burning feeling in skin. I will state, I have had this type of thing happen before a couple years back. I also have severe health anxiety and have been under immense stress.I went to the dr. And he did blood work. Cbc, comprehensive panel, vit d, magnesium, b12, esr, and crp. Everything was normal except for the esr and crp. Esr was 40 and I cant remember the crp level, but it was mildly elevated. Fast forward to this week, I went to the er for related symptoms (they have improved some) dr re checked blood work. Esr went up to 55 so obviously I have some inflammation somewhere. They said it wouldnt be from being sick, not caused by being obese, or stressed or anxious. They kind of hinted at MS and let me tell you that sent me into a real panic. Dr suggested my pcp order a mri of spine and brain. My pcp did so and also sent an urgent referral to rheumatology. Urgent as in November 30th being the soonest appt.I looked at my labs from a few years back and had the same elevated markers that went back down. I also had a rheumatology panel done then and everything was normal. Ana negative.My symptoms seem to be improving but Im still not feeling 100%. I have been a ball of anxious nerves since this has started so its hard to tell the difference. Now Im convinced I have ms or some debilitating disease. ###Output :ESR elevation is extremely nonspecific. Any inflammatory condition can raise it. Any sickness can get you to the 40-50s. It's up, but not particularly high.I think your doctor is probably managing things well from what you've described."}
{"text": "###Input :My symptoms sound serious to me, but the doctor said otherwise. Am I crazy?21M. Been experiencing this for 4 months and its gradually getting worse. Ive been suffering from headaches and chronic arthritic type pain in my shoulders. My neck is stiff and is tight when I turn it from side to side. The centre of my neck is strained, im in a lot of pain and its stopping me from doing my job and uni work. Sometimes its dull and sometimes its really bad when it flares up, but its always there.They said they dont think its anything serious i.e. muscle tension, but theyll do my bloods anyway to check for inflammation. Im just concerned that nothing will show up if they do my bloods when the pain is dull and ill go back to being in pain all the time and I dont want to seem like im crazy going back to see them. If its something serious will it always show up as inflamed? Thanks ###Output :I assume theyre trying to rule out anything rheumatological, which would indeed result in raised inflammatory markers if you have symptoms."}
{"text": "###Input :Thank you. If it doesnt show up, surely I cant be suffering chronically from all this for 4 months for it to just be muscle tension. Doesnt make sense. ###Output :Very much could be to be honest."}
{"text": "###Input :Asking on behalf of my sister. Liver lab levels insane, among other strange things.Because the leukemia/lymphoma lab is taking forever to come back yet we have a ton others, her pcp isnt giving her much more info. Wonky highs and lows.36F, overall healthy, non-drinker and never smoked. Had 2 successful pregnancies and birth. Eats and maintains healthy diet and exercise. 57 145. All vaccines.3 weeks ago she started feeling achey. No upper respiratory stuff but general aches, fatigue and headache. Took several covid tests and negative. Ended up going to Hawaii where she thought she actually had covid there and those were also negative. She was complaining of the same thing. At one point, thought it was sun poisoning. Shes seemed to get worse and worse. A week later, which was 2 days after returning home she went to the ER for what she thought was severe dehydration. It wasnt that but they werent sure what it was. Said to see her pcp.ER doc did a handful of labs. Initially told her to see her pcp for follow up labs for mono or leukemia. Her joints ache, a weird floaty face feeling, no fever, no upper respiratory, majority of joint pain is in her legs and toes feel strange. Headaches here and there. Otherwise, she feels okay. No notice of brushing, bloody noses, rapid weight loss.Labs below. If a number is in here more than once its because it was the second lab test when increased. Nothing of concern went down, but only up. Only test we are waiting on, of course, is the leukemia one. Mono all came back negative and no antibodies.Sediment rate 4 - normal, Smudge cells - mild, C reactive - higher at 12, Polychrom, platelet morph and others in category this tests were all few or normal, WBC 8.02, Rbc 5.1, Hemagblobin 14, Hematrocit 41, MCV 83, Mch 29, Mchc 35, Rdw sd. 40, Mpv 9 - low., Nrbc 0 , Neutrophils 23.5% low, Lymphocyte 70% high, Mono 3.9%, Eos 1.0 % bordering, Baso 1.2%, Ig .1, Neutrophil # 1.8, Lymphocyte # 5.64, Mono # .08, Eos .08, Baso # 10,Edited and added below AST -57, ALT 61,Others I missed: Anion gap 2, Globulin 3.5, Albumin/gobulin ratio 1All plasma levels seem in range besides glucose bordering high.Can anyone share if youve seen a blood work up look like this? The overall sickness has been going on for 3 weeks now and is increasingly getting worse.If its not CLL like our minds are nervously going towards, do you recommend she ask for a referral to hematology or rheumatology? Weve heard a virus already thrown in there and Im just wondering what virus out there does this to your body bc even tho Im not a dr her liver numbers arent ideal with some other markers showing some poor function Any comment to give insight would be great! Thanks. ###Output :Where are the liver labs? And how did CLL get brought up?"}
{"text": "###Input :I just went ahead and edited. ALT, AST. Plus a couple others. Whats odd to me - a person that isnt close to a dr; her WBC seems to remain decent. And regardless if its infection or virus I would expect an increase.CLL was brought up bc of the higher absolute lympho count and the moderated smudge cell. The ER doc wrote it on discharge to pcp. ###Output :I'm a ED physician, and this...sounds unusual. In CLL, the white count should be significantly elevated which in this case, it is not. Furthermore, the presence of smudge cells is not necessarily indicative of CLL. I be surprised if this was CLL. This is likely some sort of viral infection if I had to guess."}
{"text": "###Input :Odd skin reaction to my hands and feet occurring 3 times recently with no changes in lifestyleAge - 26Sex - MaleHeight - 6'Weight - 185Race - CaucasianDuration of complaint + Location - Longest was the first time, on both hands lasting around 3-4 weeks before fully healing The second time on the feet was only 2-3 days The most recent time, today, again on both hands only not as severe as the first time. I have pics only of today's episode but I took a few sets over some hours to see the changes.Any existing relevant medical issues - NoneCurrent medications - NoneInclude a photo if relevanthttps://imgur.com/gallery/rrcI6jTEdit: just added some description of each e6Hey everyone, hopefully someone might know what's going on. So these pictures are 3 hours apart from the initial reaction I felt. This is now the third time something like this happened but each time has been different. They feel like an annoying chemical itch/burn and come out of nowhere.The first time about 2 months ago my wife and I had gone to the neighborhood pool. Maybe 3-4 minutes getting into the pool and my hands started burning so I pulled them out and they looked like what happen today but a good bit worse. It took about a month to completely heal. I hadn't done anything about it because I assumed it was some reaction to a pool cleaner or something. That day also was fairly busy and there wasn't anyone else showing the same thing. Also it was strange because I had completely submerged as soon as i got in and I didn't have them show up anywhere else. On top of that they looked raisin shriveled for like 2 hours after only 5-10 in the water.The second time is strange too because it looked the same but happened on my feet and it went from 0 - foot arching pain from the burning. I literally walked in the bathroom and I pulled one boot off and I thought I had ants biting me or something. I took off my sock and the same red blotchy chemically burn look and feel all over my foot. I showered right away they felt better and in 2days they went from fairly tender to no issue.Today is the most recent occurrence happening while I was sitting with a patient in the back of the ambulance. I was typing my report and they started burning again from nothing to pretty sensitive really quick. The pictures I posted are about 3 hours apart from each other if that might help anything at all. But even though it's on my hands like the first time, the severity was not nearly as bad as the first time and looks much better after a few hours than that did for a week or two. ###Output :This is not a typical palmoplantar rash. I would be concerned that this dermal inflammatory reaction patter could be caused by a rheumatologic condition or similar. I suggest you seek dermatologic care. A skin biopsy and laboratory evaluation seems appropriate."}
{"text": "###Input :Sudden loss of mobility - PCP refuses referral/treatmentHello, I'm a 32(F) in the USA. African-American, 5'2\" and 144lbs. On Jan 3, 2022, I woke up around 2am with a terrible migraine. I had light sensitivity, confusion and extreme pressure behind right eye. Took excedrin but was unable to sleep due to pain. I was finally able to sleep about 45mins later as meds kicked in. Woke up the next day with a regular headache and soreness in right eye. On Jan. 5th, I suddenly became dizziness at work. The room began to rock and tilt causing loss of balance. My right ear felt clogged and I had pain in jaw joint on the right side. I was taken to ER and evaluated for heart attack, stroke etc. All tests came back normal. I remained in the hospital due to continued dizziness/imbalance but all tests including MRI of head and neck were clear. Was given motion sickness meds but it didn't help. While in hospital, I started having pain in my right hip joint. The joint also pops/clicks with movement. I've experienced the popping/clicking since I was 14 years old (18 years and counting) but this is the first time there has been pain. The pain has spread across my lower back. The pain started as a stabbing, pinching pain and is now an achy and the best way I can describe it is bone deep.I also have weakness in my right leg and intermittent numbness. Two weeks ago, I began to experience multiple episodes of urinary and fecal incontinence. The hip and back pain has gotten worse and the dizziness is the same as when it started. Almost all blood test and urine test have come back normal except for my vitamin d levels. My vitamin d value is 10ng/ml and I was prescribed over the counter vitamin d3 pills (1000unit)An MRI of my lumber spine was done (full report is linked). My PCP said it looked fine but didnt explain anything further. On the MRI it mentions the following:DISCS: L4-5 and L5-S1 disc desiccation and mild to moderate L5-S1 disc space narrowing.BONES: Slight chronic marrow signal changes. Body heights are generally maintained throughout.L3-L4: Slight posterior element degenerative change. Spinal canal and neural foramina are patent.L4-L5: Mild right eccentric disc bulge is slightly improved. Annular fissure. Slight posterior element degenerative changes. Spinal canal and neural foramina are essentially patent.L5-S1: Mild right eccentric disc bulge. Mild posterior element degenerative change. Spinal canal is patent. Slight predominantly bright neural foraminal encroachment.EXISTING MEDICAL ISSUESexercise induced asthma (I take Albuterol as needed)arnold chiari malformationthalassemia traitintermittent fatigueI've also had reoccurring migraines since I was 15 years old along with random, unexplained swelling of my hands and feet. Most recent flare up was unexplained very visible swelling of my left leg in July 2021. (Went to ER and tested negative for clots and gout)I suffer from random bouts of stomach inflammation that has been misdiagnosed as gallbladder disease (gall bladder was removed when I was 16) and has now been attributed to GERD. ( I take omeprazole for stomach and I have a history of stomach ulcers). Most recent flare was October 2021I've also had debilitating back pain since I was 15 years old and have completed physical therapy, acupuncture, multiple courses of steroid injections in my spine and at least 3 courses of prednisone. Pain has been caused by unexplained muscle spasms and bulging discs. I have these flare up at least twice a year.I sometimes have rashes that appear on my back and arms that are often misdiagnosed as ringworm (photos included). Fungal test always comes back negative. So far, the rashes have been diagnosed as eczema and rosacea. Flare ups occur approx once a year for the past 15 years. Rashes sometimes itch but its very mild. Most recent flare up occurred in November 2021.CURRENT SITUATION I requested a referral to be seen in rheumatology and at the spine clinic. PCP did blood test for rheumatoid arthritis plus urine test which came back normal and has refused my rheumatology referral request. PCP also will not refer to spine clinic and has instead enrolled me in a group physical therapy workshop.Dizziness has not changed in 2 months, pain is getting worse, muscle weakness is getting worse but I haven't been prescribed anything. I've been told to use ice and heat and to stretch.LIFESTYLE PRIOR TO CONDITION Before this began, I was very active. I practiced yoga once a week and took dance lessons twice a week. I'm also an avid hiker. I did not fall, over stretched or injure myself in any way prior to these issues. Due to the random flare ups of swollen legs and fingers, I also meal prep and am conscience of what I eat so I believe my diet is pretty good. I've always been an athletic. I played basketball, ran track and played tennis from first grade through high school. In college, I swam and took dance classes most semesters.I'm not used to being in this much pain and not being unable to move for this long. I feel like my PCP doesn't care. I don't know what's happening to my body and because my blood work looks normal, I'm being ignored. Please help! I just want my life back. ###Output :This is a rather complex history so I think it's difficult to give you any proper in-depth input. My main concern here is why you are being managed for this neurological condition by your PCP. Have you seen a neurologist for this? The reason I ask is that you're having multiple neurological symptoms with this sudden bout of headache and unilateral weakness and numbness that you have described. And MRI might be sufficient but a proper and thorough neurological exam is also needed. Unfortunately our current healthcare system does not allow for an in-depth neurological exam even in the neurologists office but at least it's worth a try.Agreed completely. Depending on the specifics of your history and exam, a total spine MRI, maybe slightly different types (sequences) of brain MRI, EMG, full neuropathy and rheumatologic panels may be warranted, as well as imaging of your hip.I will say, for what it's worth, that the fact that the numbness is intermittent is encouraging, and nothing on this lumbar MR report is dangerous or significantly abnormal (though it certainly could account for your back pain). Weakness in a single limb is typically a concerning thing to hear, however issues with the hip joint like you seem to be describing can cause weakness in the muscles surrounding the hip."}
{"text": "###Input :Thank you. I'm glad the MR report looks good. My doctor didn't talk to me about it so I've been very confused/concerned. She hasn't done a neuropathy panel or ordered any hip imaging. As for rheumatology panels, I had a serum rheumatoid factor test, a cyclic citrullinated peptide test, a uric acid test and a ESR. I was told that they all came back normal which is why she won't refer me to rheumatology. I will push for hip imaging because that's where most of my pain is. Thanks for the suggestion ###Output :The other workup may or may not be necessary but yes, a simple hip XR makes sense based on your symptoms. I had a patient not so long ago who had gotten multiple extremely extensive neurological workups for left leg weakness, including chasing things that ended up being asymptomatic incidental findings. She presented to us for hip pain soon after, and it became very obvious (supported by an X ray confirming our suspicions) that the weakness was entirely due to arthritis. You never know."}
{"text": "###Input :I only saw the neurologist while in admitted in the hospital. The visit lasted about 15 minutes. He did brief an assessment, told me that my x-rays and mri looked fine and that was pretty much it. I've asked my PCP for a referral to neurology as well but she keeps saying that since nothing has shown up in any blood work or x-rays, she can't do it. I asked her if it's possible to have a neurological or auto immune disorder that doesn't show up on x-rays and tests but I haven't gotten an answer. ###Output :I am not sure which country you're in but for us here in the US healthcare system when you are in the health insurance system you get health insurance quality care. I often advise my patients to seek out a private neurologist for a deeper exam and insight into what's going on. A neurologist couldn't even examine the right hand in 15 minutes much less do a full head to toe Neuro exam. I encourage you to Google a full neurological exam on YouTube and see what it takes and how extensive it is. When the insurance company will only reimburse you per visit and you have 500k in student loans and malpractice insurance and each patient is a potential lawsuit you tend to do something cursory, order a test and if the test is negative you're protected. I know this isn't fair to patients but it's the agreement we have reached as a society in managing healthcare so I'm trying to arm you with the knowledge to get the right care."}
{"text": "###Input :Thank you for this. Yes I'm in the US and I have insurance through Kaiser Permanente because my employer has a contract with them. I've had horrible experiences with this hospital and thanks to your response, I now understand why. My next step is going to be working with a private provider. I'm definitely stressed about this because I know the cost will be high but I need to know what's happening to me. ###Output :I haven't heard the best things about Kaiser I must say. I worked there myself before and I wouldn't want to be a sick patient there."}
{"text": "###Input :Bad Burn on Hand is Getting Worse Over Time Despite Being on Antibiotics.[34] [F]Pictures - https://imgur.com/a/D5iF0BI34F,5'10.5,13 Stone,Caucasian,1Bad Burn + 1 Lesser,Possible Neurological Issue or Rheumatological Issue (MS/Epilepsy or Fibromyalgia are possibilities being discussed 7 years in)Meds -Lyrica 75mg 2x p/d + 25mg at night.Solpadol - 3 x p/d, 1-2 tablets ( 30mg/500mg ) per taking.Xanax - 0.25-0.5mg when neededAugmentin - I don't have any left to know the dose but it was for Tooth Abscess that was bad and landed me in ERAmoxicillin 500mg one, three times a day.Flagyl 400mg one, three p/dSolpadine 7/500mg for times of lesser pain. Not taken regularly.Aceclofenac (Vitafen)100mg. One p/dDrink once maybe every two-three months.Smoke heavily, daily.Location: IrelandHi all!I burned my ring finger, and, to a lesser degree, my pinky, on a metal pot about two weeks ago.I had a tooth abscess at the time and aprox 5 days went to Caredoc (Irish out of hours Doctor that isn't Hospital) where i was given Amoxicillin.I didn't get the Burn checked out because at the time it was just red and sore like a usual Burn.Next day tooth was worse so I went to A&E where I was given Augmentin as apparently Amoxicillin + the strength was never going to clear up that type of infection.So, for the last 1.5 (ish) weeks I have been on a variety of antibiotics.However, my hand has been getting worse every day.Today, I woke up and my entire hand is swollen and sore.This hadn't been an issue until today.Yesterday was the first time I noticed some swelling but it was only on Ring Finger and pinky.The other cuts on my hand also were filled with pus though they had no reason to be and, weren't before the weekend.I had the Amoxicillin left over so started taking that again. ###Output :Occasionally burns can cause dep tissue infections. Returning to a doctor seems wise"}
{"text": "###Input :Thank you for the reply.I definitely will be returning, i just was looking for some insight moreso, not medical advice as i dont have any experience with this type of burn.I can't get an appointment for two weeks. That seems like quite a long time to me but I'm not a doctor. ###Output :If it gets much worse, seek emergency care."}
{"text": "###Input :Also, do you have any idea what level burn this is? I'm having a hard time figuring it out. ###Output :It seems like a full thickness burn."}
{"text": "###Input :Clots, cysts, and no diagnosis +7m on ...27yo female, 84kg 5ft9, presents w/ multiple clots in stomach - splenic vein thrombosis, mesenteric vein thrombosis, portal vein thrombosis, for main concern - in addition to other clots present in stomach (8 total). Cysts in spleen and liver, constant upper right flank pain w/ sickness and diarrhea and stomach distension. Right shoulder/neck pain. Constant tonsillitis issue, constant fatigue periods followed by unable to sleep for extended periods of time too.Docs determined clots as idiopathic, now on enoxaparin injections 150ml and codeine for pain management. Been under investigation since Dec-21, w/ no ACTUAL diagnosis. Clots were not caused by a trauma.Had CT, MRI, colonoscopy/endoscopy. No IBS. Cirrhosis. No gallstones or issues with gallbladder. Seen a haematologist full thrombosis panel completed: all genetic, autoimmune, deficiencies, all negative in tests. Jak2/PNH/anticardiolipin/beta2 glycoprotein all negative. Thought hyatid disease for the clots given in spleen/liver, however, negative. Under gastroenterology, rheumatology issues ruled out.Abnormal perfusion areas in liver, calcified splenic cysts appear to be long standing but benign in recent MRI. Fatty deposits for 'cysts' in liver, but appear benign again.Recommended weight loss to aid with symptoms and also reduced fats in diet considerably (got an air fryer), lost 10kg since but upper right quadrant pain seems to be getting worse again and sickness/diarrhea.Getting frustrated with lack of diagnosis as to why clots formed, cysts formed, and what's actually happening to me.No previous medical/family history of clots or cysts. Mom has had 3 miscarriages, Dad has cardiovascular issues. Both grandmother's had cancer - bowel and throat.Awaiting elastography of liver to measure scarring so far.Anything else I should be requesting to aid in a diagnosis? Any thoughts on a diagnosis? ###Output :Sorry to hear about your troubles. My first thought was a missed covid infection. You may have had it without any particular symptoms, but it can still (rarely) lead to systemic thrombosis in otherwise healthy people. If this ends up being the case, the good news is that it will likely get better. Heres an example case report: https://casereports.bmj.com/content/14/1/e241027"}
{"text": "###Input :I'm vaccinated, had 3 injections. ###Output :Good for you! This makes it less likely, though still possible."}
{"text": "###Input :Confused from Rheumatology appointment. Doc seemed concerned but also not?25M, 6'4, 195lbs.Been dealing with some health issues that have been affecting me pretty heavily and it was suggested I see a rheumatologist just to be safe.He ran some panels where there seemed to be some out of range factors that he wasn't concerned about. The three he did bring up, though, was aANA Screen IFA - Positive | Pattern was Nuclear, Speckled.ANA Titer - 1:40WBC - 2.4 x10(3)/mcLHe wasn't worried about these results, either. My WBC is usually right below reference range, but not typically this low. He did say that that WBC count should have an eye kept on it.. but not to worry about a positive ANA screen or a titer of 1:40.Is this anything I should check up on? The bouts of what I deal with are really messing with daily life and aside from an endoscopy (which I struggle to believe would be causing any of my issues) that showed gastritis and duodenitis, as well as some labs that came back \"out of range\" here and there.. these results seem to atleast possibly point towards something?Any feedback is appreciated, thank you.If any other labs are needed, please let me know. I can pull them from online. ###Output :Low WBC and positive ANA are two criteria for lupus. You did not specify what your health issues were though.The presence of a nuclear speckled pattern is often indicative of an autoimmune disorder, as it suggests the presence of antinuclear antibodies."}
{"text": "###Input :27F immunocompromised and sick for two weeks. Getting worse. Rheumatologist is out of town and ER doctor sent me home pending blood test results that are still processing. Insight?Demographics: 27 female. Height 5ft 6in, weight 190lbs. Married.Conditions: rheumatoid arthritis and lupus; SVT.Meds: 2000mg sulfasalazine, 400mg plaquenil, 200mg Cimzia injection every two weeks.Non-smoker, no alcohol, no caffeine.Duration of complaint: 2weeksI have four doses of pfizer covid vaccine.Currently negative for covid.Two weeks ago before my scheduled Cimzia injection I spiked a low-grade fever. It was about 37.8c. Since then, my temperatures have been 37.5c to 38.5c. Acetaminophen will not bring my temperature down. It initially started with fatigue and headache and fever.Last week I began to get a sore throat, sweating, clamminess, chills, mild sinus pressure, confusion, shortness of breath, and a slight cough.I went in for monthly rheumatology bloodwork on 7/28. Ill attach the results. Mildly decreased WBC and Neutrophils.On 7/29 I went to the emergency room as my primary doctor instructed me to because I was not improving. Many cultures were taken. WBC further decreased and neutrophils were more than half of the previous day. There is a WBC Morphology pending pathologist review.Sepsis cultures have not shown any growth over the day.X-ray of chest showed no abnormality.Im confused as to what could be causing this. The ER doctor also said he was confused and it could be a medication or a nasty virus (was not tested for these) and that I have neutropenia and I am quite immune compromised but left it at that.Today, 7/30, I have had more difficulty breathing, particularly with movement or talking. Im coughing green/yellow thick mucus. More fatigue. My lungs feel heavy.Im thinking of heading back to the ER tomorrow if symptoms get worse, but Im not sure it will do any good for me or provide me with more.Is there any insights?Ive reached out to my rheumatologists receptionist as well as my primary doctor. However, Monday here is a holiday so the offices are closed. The earliest I could see my primary is on Tuesday, and Im not sure how much further it will progress by then.here is the link to my imgur albumI understand that some of the blood work with the hematology panel is still pending.Also, what does it mean with the WBC morphology Reviewed by technologist Sent to Pathologist for review?Thank you in advanced ###Output :I wouldn't wait a day more. Go to the ER. In my opinion you should be started on broad spectrum antibiotics asap, while waiting for results."}
{"text": "###Input :How do you feel about patients bringing their own files?How do you feel about patients who bring their own files?Im a 28F and was recently diagnosed with a chronic illness and have at least one more serious medical issue suspected. Im asking for advice navigating the diagnostic and treatment process for multiple complex medical issues.Is there anything a CI patient like me can do to make diagnosing and treating easier? Ive heard other chronically ill patients advise to bring a folder full of all medications, symptoms and symptom changes, lab results, etc. to hand to the doctor each visit. Is that something helpful or would you just think they were extra/a hypochondriac?Are there any other things ci patients can do/not do to help? Pet peeves? Im having to go to my pcp or a specialist ALL the time recently and want to make the process as smooth as possible.(For the auto mod: 28F, 5 ft. 10 in., 140 lbs approx., white, dealing with autonomic dysfunction and suspected autoimmune issues as diagnosed by my pcp, neurology, cardiology, and rheumatology teams, have had symptoms for 10 years, medical history previously listed, not taking any relevant medications, no drinking, smoking, or recreational drugs) ###Output :You can bring it but I'd prefer it being sent over before our visit OR letting us review it after the visit. A summary is preferable unless it's truly relevant to what I'm seeing you for. There's just not enough time in a clinic visit to go through a huge stack of medical records"}
{"text": "###Input :So giving you a copy you could keep would be helpful? Ill keep that in mind! ###Output :Only if it's relevant"}
{"text": "###Input :Unexplained Wounds need help to find answersMy husband served over in Iraq in 2011 and came home due to a machine gun falling on his groin and he had to have nerve blocks. 4 years later he started developing these ulcers that in a matter of hours would turn necrotic. When he was over in Irag he was stationed near burn pits. We've been to countless specialists such as dermatology, infectious disease, rheumatology, wound care. We've been to 10 different hospitals and not one doctor can find the cause of this. For about 2 years we thought it was Pyroderma Gangernosum, but with PG if you cut into it, it will make it worse. With my husband it helps. We have become so hopeless and this is so debilitating. Hes lost countless jobs we are praying to find answers and find someone who has this awful disease that may know what it is. My Husband is 27 years of age 5 ft 5 he weighs 200lbs doesnt smoke or drink. unexplained Wounds ###Output :Buruli UlcersBrucelosisI only suggest those two as Ive had a patient with the first one who served in the Middle East, and initially a differential was the second. We also get the Buruli ulcers here, but we call them Bairnsdale ulcersId suggest an infectious diseases specialist.What is a burn pit?Oddly enough I couldnt link the WHO page for the first one."}
{"text": "###Input :Please do this! I have met someone who has had similar complaints and they were not able to get a definitive diagnosis.Also, Schnooks, are you a physician in Australia? I understand Buruli ulcers had some what became an issue in 2018 there. While it isn't an issue here in the States, I wonder if this contributes to misdiagnosis? Thanks for your input! ###Output :I am, anaesthetic registrar.Its not my area, but I think theyre still a problem and actually getting worse (spreading, increasing frequency). They certainly make the news more frequently. Despite the fact theres a syndrome Bairnsdale ulcer down here, apparently theyre a frequently forgotten diagnosis. So it wouldnt surprise me if the same illness would be far from front of mind elsewhere in the world."}
{"text": "###Input :Buruli (mycobacterium ulcerans) is typically gotten in tropical areas by exposure to contaminated water or bites from infected aquatic type insects iirc. As nasty as these burn pits seem if it were buruli the pits aren't likely the culprit. Burning introduces things into our lungs, which is awful but would not give him this type of infection. If he were stacking the animals etc onto the pit or otherwise handling similar items, well then... bingo. ###Output :Middle East isnt tropical (right?), neither is Bairnsdale (Victoria, Australia), both of these places have Buruli ulcers...I have no idea what is going on in OP, but I know neither of my suggestions are commonly thought of in initial work up stages and Ive seen similar presentations here in Oz. And the historical regions of prevalence of a lot of things is changing.QquestionI said typically, which is accurate. I'm certainly familiar with the Australian outbreak. I recall saying bingo, which feels like agreeing to me, and I do agree. It's a definite possibility the specialists they saw didn't consider it. I suppose I muddied the water for no particularly good reason... That's fair.Can also be contracted by unpasteurized dairyIs there a special test for this?Not really, but Id imagine the requesting physician should mention it in their diagnosis list. (It makes the microbiologists go ah, well look for that by setting up these tests)Basically swabs then culture (mycobacterium grow bloody slowly, so it is an extended culture) and PCR (looks for DNA from the bacteria, quicker, but not always as useful).Thanks for the info re burns pits. I would definitely recommend infectious disease specialist/s, being in close contact with burning, dead, decaying animals  human waste is a recipe for really weird parasites/bacteria."}
{"text": "###Input :Did they inform him of the Burn Pit Registry through the VA? ###Output :These look like theyre due to an exotic infectious agent. He needs biopsies, cultures, and I would think about trying doxycycline for like 6 weeks. Ask your ID doctor about empiric antibiotic treatment and see what they think."}
{"text": "###Input :We have done all that and he has bottles and bottles of that medicine but there is never an infection WBC is always normal everything is normal. He does have a vitamin c deficiency ###Output :WBC doesnt really mean much. It can be helpful but it doesnt mean this isnt infectious. Has he ever done antimycobacterial therapy? Rifampin, isoniazid, etc?"}
{"text": "###Input :No but we will look into that with his dr ###Output :Would you mind updating us if this gets diagnosed or if a future treatment works well? I gave you my best impression but this is not like anything Ive ever seen outside of textbooks, and I want to learn from this in case I ever have the chance to help a patient like your husband.QOut of curiosity, I am NAD, but could this be caused from an insect or spider? The reason I ask is I have friend who was bit by a spider while in Afghanistan and he still suffers complications from the wound site. While not near as extreme as what OPs husband is going through, but is it possible that OP is suffering from some sort of parasite or long term degeneration from venom? Would that turn up on any clinical tests? And do you think it would be prudent for OP to contact medical professionals in the country where OP was originally exposed?Has he had biposies of the lesions?QYes he has had biopsies several in fact alot of them come back as a burn but that's not the proble. This is not a burn.The fact that biopsy reports give the wrong answer and he's seen multiple specialists possibly suggests that you're dealing with a new, hitherto undocumented entity. What treatments has he had for this if any? Response to certain drugs could tell us what sort of disease process this is."}
{"text": "###Input :My husband is fighting for his disability because this is so debilitating he cant work. But without a diagnosis the disability people keep denying himHire a VA disability appeals attorney. It cost me 2 grand twice, the first time got me from 30% to 90% and the second time got me from 90% to 100% total and permanent. I personally have far less severe injuries than what your husband has and was suffering the same issue.There are also attorneys for SSI/SSDI benefits, though I havent personally used them as applying for SSDI as a 51 year old is relatively easy. As a 27 year old though it is damn hard and you likely will need a lawyer or a few years of trying, and a lawyer works out cheaper in the long term. ###Output :Need more history, things like past medical problems, medications, drug use, etc. Differential as I see it includes infectious, autoimmune, vasculitis, drug use, medication, environmental (especially considering the burn pit). It's very odd that it would take years after that exposure that these ulcers would start, but not impossible. Why has he lost countless jobs? What did previous skin biopsies show? What have his labs shown?"}
{"text": "###Input :He has no other medical problems, he isnt one any medications, no drug use in fact he quit smoking 5 months ago. He started having small ulcers as soon as he came home but now they are way worse. Hes lost jobs because he has to be off so long and they let him go ###Output :And the skin biopsies? And the labs?Qsome have came back as a burn which they are not and others show nothingAnsNeed the actual reports, which are always available through either a patient portal website or though a medical records department. Also need the lab reports."}
{"text": "###Input :Does This Really Sound Like Dermatomyositis?BackgroundAge, sex: 31Mheight: 5 11race: whiteprimary complaint: purplish skin along with tachycardia and extreme fatigue/tirednessduration: I have experienced skin discoloration since I was a kid, but this progressively got worse once I was an adult. The tachycardia started when I was about 24 and has progressively gotten worse.Medications: My rheumatologist has me on hydroxychloroquine (200 mg), prednisone (started at 50 mg, but now taking only 5 mg), and pantoprozole (40 mg). An ER doctor started me on meclizine (25 mg) as needed for dizziness that started about a month ago. I have also been on Adderall XR since 2019. I currently take 25 mg, up to two in the morning. I do not drink, smoke, or use any recreational drugs.Other medical conditions: ADHD. Morphea (I developed this when I was 8, and it has never gotten any bigger). Splenomegaly. In July 2021, I had encephalitis due to reactivation of varicella-zoster virus.I apologize in advance for the length of this post. I just want to be sure I include anything that might be relevant.Starting in 2014, my heart rate would randomly jump up to 120-140 bpm, and I would experience tingling in my extremities. The purplish skin started when I was a child, but it has gotten worse over the last few years. Between 2014 and 2021, I had multiple echocardiograms done to check for any abnormalities of the heart, but doctors never found any. I also wore a holster for a month, and that came back mostly normal.A couple of months after I had encephalitis, a rheumatologist diagnosed me with dermatomyositis based on the redness and scaliness on my knuckles and redness around my fingernails. Lab tests showed that my muscle enzymes (CK, aldolase), liver enzymes, and IgM all were elevated, but additional diagnostic testing has not shown anything to confirm dermatomyositis. Ive had an MRI of my legs, hands, abdomen, lungs, and heart. The abdominal ultrasound showed that I have a slightly enlarged spleen. Everything else looked normal. I have never experienced muscle weakness or the characteristic rash that DM patients usually have. I did see a dermatologist after I started treatment. She said it looked like it could be DM, but there wasnt anything on my skin for her to biopsy.Since my rheumatologist started treating me for DM, my heart rate tends to stay around 80-90 bpm, and the palpitations are much less severe when I do experience them. My most recent blood tests came back normal except for my IgM. However, my skin still turns purplish, and it sometimes feels like there is a rubber band around my arms.I dont know if there is any connection between the encephalitis, tachycardia, and DM, but it makes me wonder if there is something more serious than DM going on. My doctor does not think its necessary to explore other possible causes. She says that the treatment she has me on will treat any rheumatological disease. I really like and respect her. Shes the first one Ive seen who acts like she cares about my health. I just want some kind of confirmation that shes right.I appreciate any feedback, insight, suggestions, etc. Also, I can submit my full CBC report if that would help at all. ###Output :Please include one of preferably more of the pictures in your post as an imgur.com link. It makes it easier to help with something when it can be examined visually. Additionally, share the values of your ANA, ENA, CK, aldolase"}
{"text": "###Input :Thank you for your response. My apologies for not getting back to you sooner.I am not sure about the ENA. I did a Google search and think I found what test results to include. Let me know if these results are not what you need.Below are the results of lab tests from September 22. These tests were done before I started treatment for DM.CK - 1,063 units/literAldolase - 26.3 units/literANA - Negative (<1:80)RNP/Sm - < 12 unit(s)Anti-Smith - < 12 unit(s)C3c - 107.0 mg/dLC4c - 20.0 mg/dLKappa FLC - 12.7 mg/LLambda FLC - 17.5 mg/LFLC - 0.73 ratioIgG Card - < 9 GPL-Units/mLIgM Card - 16 MPL-units/millileterI'm not sure if ALT and AST help with diagnosing DM, but they came back abnormal. This isn't unusual for me (they've been as high as 240 on tests I've had done over the last 10 years), but I thought I'd include them, just in case:ALT - 56 units/literAST - 44 units/literBelow are the changes in some of these values when I had the lab tests performed again on November 4. These tests were done after I had already started prednisone and hydroxychloroquine.CK - 83 units/literAldolase - 9.2 units/literIgM Card - 23 MPL-units/millileterALT - 15 units/literAST - 14 units/literHere are the best images I have of the skin discoloration. Because the discoloration on my knees is usually worse while I'm in the shower and right after I get out, I took the photos and video of my knees in the shower. There is nothing graphic in these images, but I wanted to explain why I took them in the shower.Right hand - https://imgur.com/icyYOPQKnuckle, right hand - https://imgur.com/fD48uK0Left arm - https://imgur.com/JVPth2XBoth knees - https://imgur.com/bszpHWgRight knee - https://imgur.com/cjdn4zVBlanching (Video) - https://imgur.com/3KszJT7 ###Output :No mention of the most important test - skin biopsy results. Everything you present is less important."}
{"text": "###Input :She said that there was nothing for her to biopsy. This is the note that she included in her report:Physical exam: dilated nailfold capillary loops of fingernails, L>R. Mild erythema of proximal nail folds of fingernails. Ragged cuticles. No evident Gottron's papules, heliotrope sign, shawl sign, holster sign, or other stigmata of DM. Scalp clear with no erythema or scale-prior labs including myositis panel, CK (elevated), and aldolase (elevated) reviewed. Negative myositis panel noted.-findings on exam today support prior diagnosis of DM (esp in context of markedly elevated CPK and aldolase), although unfortunately there is not a high-yield spot to biopsy to provide additional support of this diagnosis. Suspect that pt's cutaneous findings have improved with plaquenil + prednisone therapy ###Output :Spots change over time. Right hand knuckle that you show could be a Gottron's papule. Lupus can look like this as well, as can many other conditions."}
{"text": "###Input :3.5f with mystery illness 4 childrens hospitals and 14 specialists cant diagnoseThis is going to be so, so, so long and Im so sorry. But we dont know what else to do. Ive tried to compress it the best I could. 3f with medical mystery.First year of life: -couldnt latch until 2 months old -refused all food, in all forms. -up every 20 minutes every single night, wouldnt nap longer than 30. -had newborn shakes that stuck around a year old. -consistently has BM 60-70% mucus, and majority of time was green.February 2017(1 year old): -staring spells began -CT at hospital was clean, sent us to neuro. -EEG performed, no episodes happened, clean. -lost all of the words she had and remained non verbal, despite starting speech therapy at 18 months, until over 2.Eventually they went away after a few months. Doc said absence seizures are harmless and not to be concerned. Released us from his care.June 2017: 16 months old. -woke up and couldnt walk. Screamed when weight put on leg. Took to urgent care. Urgent care ran labs and found a sed rate of 44. Referred us to an orthopedic surgeon. Orthopedic surgeon did treatment for transient synovitis. When it became clear that wasnt the cause, sent us to rheumatology.August 2017: -diagnosed with Oligoarticular JIA (right knee only at this point). -started on naproxen.November 2017: -first steroid injection. Kenalog into right knee. -two days later, woke up screaming and manically itching legs. Hives sprouted. Face swelled, eyes became black, hives all over neck and face. Started wheezing and gagging, rushed her to the ER. ER said it was an anxiety attack from the itching, not anaphylaxis. -steroid injection worked for about two months.Spring 2018 (2 years old): -staring spells started creeping back. -swelling in both knees was coming and going. She was in extreme pain and couldnt walk more than a few feet. Rheumatologist said it wasnt arthritis, it was growing pains. Referred to PT. -we werent super worried about the staring spells, and wanted to wait until the arthritis was sorted out to see neuro. The staring spells were coming more frequently. Her speech therapist asked us if wed ever had her evaluated for epilepsy, as she sees several kids with it, and our daughters episodes were scaring her. -We decided to get her in with neuro. It would be a two month wait.May 2018: -second opinion rheumatologist said there was obvious arthritis and sent her for a second round of steroid injections. Allergy had deemed the first reaction as a coincidence, not from the injections. -had an allergic reaction to the injections again. -she begins collapsing and falling pretty much non stop. To the point where PT and Speech therapists were suggesting a helmet because she wasnt catching herself when she fell.June 2018: -steroid injections failed -our first appointment with PT. PT noticed several left side deficits, severe balance issues (that were worsening), and wrote a letter to neuro suggesting an MRI be done. -woke up soaking wet, dripping in urine, and her urine was brown. Took her to the ER, ER noted it was brown but testing was normal, and she was well hydrated. -had an episode where myself and her speech therapist were present. Eyes glazed over and she started walking around like she was drunk. She became delirious. Then that turned into manic aggression (totally out of character). It lasted 20 minutes start to finish, ended with several staring spells. Speech therapist wanted to call an ambulance. 4-5 minutes later, she was completely back to normal. Took her to the ER where they said it was behavioral. I insisted they call neuro, who said it sounded like worsening seizure activity and scheduled an EEG for the next month. -pediatrician urged us to go to a different childrens hospital and demand an MRI. CT showed a small arachnoid cyst, MRI was clean. Her left side reflexes were slow, and she had a positive babinski reflex on left foot. -lost gross motor skills like squatting or standing up without using hands. Could no longer identify letters, though she had been able to since before 2. -discharged after a negative EEG, but nothing happened while she was hooked up. Told us to get video. -balance continued to deteriorate, along with left side deficits. -got videos of staring spells, neurologist said that it could be seizures or it could be sensory. She passed sensory tests with flying colors, OT said it was highly unlikely to be sensory. Neuro told us to go to a different hospital. -things calmed down for about 3 weeks.July 2018: -PT started noticing balance issues worsening again, she wouldnt catch herself when she fell or even try to. Began falling 2-3 dozen times a day. -she began dropping. Like a robot running and then its power source dying. My husband and I would have to sprint and throw pillows or our hands under her head to keep it from hitting the floor. We couldnt be more than a few feet from her. She would collapse, lay there for 10-20 seconds in a haze, and then sit up. -July 19th she told us her head hurt. A few minutes later, she looked out of it. I pulled out my phone because it mimicked the look when she had the episode of delirium. She began stumbling, so I pulled her onto my lap. She began aggressively rubbing her face and making weird faces. Her body then began to jerk/shake. Lasted 20 seconds. When it stopped, she continued to lay down, still, with her eyes glossed over. Her urine was brown again. -pediatrician sent us to ER. Admitting doctor said it was a tonic clonic seizure based on the video. Was attached to a vEEG for 9 hours, nothing happened. EEG was clear. Doctors said it was behavioral and released her from further neurological care. said there was nothing wrong with her. They called her speech therapist who was livid, as she had been watching her deteriorate right along with us. I needed backup since the doctors were blowing me off. Doctors told speech therapist it was behavioral and from sleep deprivation. But she slept 14 hours a night. -as month goes on, shes dropping and having staring spells non stop. -PT says nothing about daughters exam makes sense. Her balance is awful and deteriorating when walking, standing, crawling, kneeling, but she can jump. Shes developmentally advanced so it doesnt seem lime it could be a developmental issue. Shes also watching my daughter turn into a shell of herself and is begging doctors to do something. -MRI of knees and hips was ordered by new rheumy after worsening gait issues. MRI showed a healing stress fracture in the knee, along with bone marrow edema (with no trauma to explain it) -went limp on a ride at six flags and her eyes rolled to the back of her head for a full 2 minutes. -went to playground and she was climbing one of those coils. Body went limp and she fell 5 feet. I caught her and set her down while her arms twitched and she was unresponsive. Slept for several hours after, and took several minutes of shaking to wake up.August 2018: -basically everything continued with no answers from anyone.October 2018: -a 3 day inpatient EEG was scheduled and nothing happened. I mentioned to the doctors that it looked like a mass was growing on her legs and they didnt look. Sent us home. -pediatrician saw the masses and sent us to orthopedic surgeon. -the muscles in her left knee began to atrophy, despite her being crazy 24/7. She never sits still and is always jumping/climbing/running. Orthopedic surgeon said it was definitely neurological, sent us to a new neuro. The atrophy was so bad we were approaching loss of mobility. She still cant walk for more than 1-2 minutes at this point. -atrophy worsens until November. Other symptoms start to go away.November 2018: -started methotrexate injections for the JIA.January 2019: 3 years old. -urine began to darken again. -symptoms started popping up mildly. -had episodes where shed scream and rub her legs manically saying bees were attacking her. She did it both while we were there, and when we werent. I watched her do it on the baby monitor in the middle of the night. -neuro ordered MRI of spine. Normal. -on jan 16th, I heard noises in her room. I looked on monitor and she was sitting and swaying in her bed. I got to her bed to put her back down and by then, she was jerking. I tried to get her attention but she was unresponsive and eyes were glazed over. -I pulled her onto my lap, where she remained out of it. Her body was jerking, and her right leg started convulsing like it was on a washing machine. Once the jerking slowed, I asked her to point out her nose and mouth. She failed but thought she did it. I put her back to sleep, where she remained restless. Her urine was normal again 2 days later. -urine brown again on Jan 25th. Had a staring spell at a birthday party and was unresponsive for 30 seconds. Fell asleep in the car 10 minutes later, slept for 45 minutes, and then woke up screaming. Continued to scream for almost an hour. Urine was clear again a few days later. -Neuro tested for porphyria. Corproporphyria level was 2.5x adults high normal but said it wasnt high enough to be porphyria. No pediatric reference ranges exist.February 2019: -fingers started severely pruning and turning white in just a few minutes, while her sisters hands (who was 1.5) were completely normal. -throughout all of this, little bite/pimple like bumps showed up on face/neck/joints. They come and go. In February, they got bad. No fleas, no bugs, always accompanied other symptoms.March 2019: -GI said that while shes tall, shes short based on how tall she should be since Im 510 and husband is 64. Wanted to run tests. Thinks theres a larger autoimmune disease at play. -genetics said that something is definitely wrong, doctors needs to coordinate. Said porphyria test could have been deteriorated because it sample taken at home and exposed to light in the car. Said hes concerned by the progression and created a team of doctors to evaluate her case. Was afraid it was possibly life threatening. -testing was planned for summer when she began showing symptoms again. She remained asymptomatic.September 2019: -things remained calm, arthritis was under control. -began flaring in both knees and both ankles. -staring spells, balance issues, and not catching herself came back.October 2019: -things are worsening again. -left ankle is atrophying. Neuro wont call me back. -PT is concerned she wont be able to walk soon because the stuff that atrophied last year has never come back. She still cant walk more than a few minutes without collapsing. Sleeping 13 hours a night. Is complaining of pain and isnt eating. -preschool teachers reporting odd behavior and lots of collapsing. -most recently broke her wrist because she fell down the stairs and didnt try to catch herself. She landed on face and chest, with her arm against her chest. -ETA: her urine was brown again this morning for the first time since spring.Any ideas? Weve been to four childrens hospitals and will be pursuing new ones when we move in February. Im so scared for my daughter and still cant understand the lack of concern by the doctors weve seen. I dont want my daughter to suffer anymore and I dont know what else I can do.Thank you so much. ###Output :If a second opinion is needed on this comment, I 100% agree with this. OP is free to try and ask the reddit community out of pure desperation, but be careful of lay comments, even from physicians who aren't experts in OP's child's care."}
{"text": "###Input :In my opinion Rasmussen would've shown up on an EEG or Scan, as the episodes are lasting a while and the activity of the inflammation would probably have been detected, though it's not impossible. I don't see how this goes in line with the arthritis, the stress fracture indicates that the loss of function and pain should not be purely neurological, maybe there are 2 problems going on simultaneously.I feel that you're a bit lost with doctors who don't do anything. So I'll suggest things to do by yourself:start a detailed diary, try to recall everything, every doctor's visit, result, try and collect the imaging done, lab results. But also start recording symptoms like ataxia, seizures, pain, atrophy. Every day. Also note any environmental changes that might occur shortly before episodes. This should include nutrition, but also stress, long exposure to sun, noise, physical activity. Get videos if you can.buy urine test strips, check her urine when it's normal 2-3 times, then when it gets dark. Check for blood, proteins, sugar. If you can, contact urine when it's brown in a clean jar and have your doctor send it to lab.if you have access to it and feel comfortable, also check blood sugar in normal and episode conditions. Again, note it done carefullyconsider to get psychological evaluation and counselling. Not only are you going through a very difficult situation, you will also avoid people saying that's only behaviour, and you're not willing to accept it. I'm not saying it is, but by acknowledging it a possibility, you rule out one more thing.consider changes in nutrition. Observe if anything changes. Might work, might not. Changes may include protein level, fat level, sugar level, etc.Then, what to do while relying on doctors:I agree with getting a second MRI. One usually isn't enough. It needs 2 to notice changes.did you get a check of the peripheral nerve system? I'd ask the neuro to check that. If they don't call back, they're probably out of ideas. Hey a new one.Get a general ultrasound of the organs.get blood test of porphyrines in normal and episode conditions.get liver and kidney blood test in normal and episode conditionsreach out to get metabolic diseases checked, like fatty acid issues, glycogen issues. Try also getting genetical analysis. I don't know about your financial situation, if you're located in usa and they don't do those, consider a visit in a different country. We have a whole ward here for diagnosis. Try reaching out to mayo or Cleveland.consider reaching out to help groups for genetic or rare diseases. They often have valuable contacts and ideas. https://www.globalrarediseasecommission.com/Report/tracks/track-1.htmlI wish you all the best! ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."}
{"text": "###Input :I would strongly recommend rainbow over ccf for pediatrics. ###Output :So to make sure that I have the situation in a nutshell: 3.5 y/o female with progressive weakness, intermittent episodes of loss of tone that are not accompanied by EEG changes, intermittent episodes of darker urine in the morning, and a diagnosis of oligoarticular JIA. Please correct anything that I got incorrect and I have some clarifying questions.-what is the state of her motor function now? Can she run, climb a ladder on the playground, fatigue quickly like walking around a store?-do the weakness episodes seem intermittent, like lasting for a few hours to days, or are they every single day.-does she have unsteadiness when reaching for objects? Having her hand seem to stumble past a cup or fork for example?-does she have any drooping of her eyelids? It would be to the point where the black of the pupil is obscured by the lid or she has to lean her head back to look at you.-following steroid injections did any of her other symptoms seem to get better? the weakness and seizure like episodes.-any family history of children passing away or having major medical issues. Do you, your spouse, or the child's siblings have any medical issues?-any issues during the pregnancy or delivery? Did she have to go to the NICU for any reason?"}
{"text": "###Input :According to what I found online, Mount Sinai has the only genetic test for porphyria. Trust me, I had a couple hundred dollars ready to spend on the genetic testing but everyone I spoke to who was versed in this stuff said it wouldnt make a difference ###Output :TF is going on in here? What is wrong with all of you people? None of you are physicians, I doubt even medical professionals, and even the \"best\" \"written\" comments in here are absolute drivel. You are NOT being helpful. You are torturing someone while stoking a House, MD type fantasy.Dear OP, I sympathize with you. Dealing with a sick kid is trying and tough and this awful thread is NOT useful to your mind state NOR your health.A problem I have noticed in my short career has been clear communications to patients. I highly doubt after 4 hospitals, 14 specialists, and however many other physicians and staff that no one has come up with a diagnosis. What does this mean? I bet at minimum you had multiple different teams with multiple different personnel working on your daughter's case. It's possible the primary team wasn't doing their damn job of synthesizing all of the specialists information into easy to understand information and presenting that information to you. Even when we don't \"know\" what's going on, I can still call something idiopathic (as in I don't know) or I can throw out a variety of possible causes in what we call a differential diagnosis.To everyone saying \"gEt GEnEtIC tEsTiNG\". That's not even how any of this works. Even if we were to use \"genetic testing\" this would only confirm the diagnosis, NOT LEAD US TO THE DIAGNOSIS. Even then it is absolutely unnecessary for treatment in this case. Genetic testing is useful when we are performing family planning or working on research on illnesses. To my knowledge, and I'm open to any updates, bread and butter medicine does not YET have the tools to use genetic testing in the fashion many of you seem to think exists."}
{"text": "###Input :Thats been our understanding. Genetic testing is like the final puzzle piece once all of the other testing is done, and narrows down the list of possible causes. The geneticist said there was a list about 30 things long that he thinks it could be, but wanted further testing before divulging them, which I get.We have seen 4 childrens hospitals but the specialists span. Weve seen 1 endocrinologist, 1 allergist, 4 neurologists, 3 rheumatologists (our new rheumy actually suggested another opinion since she was out of ideas too), 1 GI, 2 geneticists, 1 orthopedic surgeon, and 1 ophthalmologist. They were supposed to be coordinating on a team that diagnosis rare diseases, but when she remained asymptomatic, we held off. We didnt want to put her through anything more if the tests would be inconclusive, under the direction of the team. But red flags have been popping up over the past few months, and theres been a lack of response or a shrug. The atrophy was so bad in the knee last year that she could barely walk. The muscle/tissues/whatever it was never grew back, and she cant walk more than a few minutes. PT is concerned that with the loss of knee support, the ankle atrophy is going to be detrimental. Which is how I ended up here. Her pediatrician finally got neuro to call us and shell now be getting ultrasounds of both legs.I wanted to take a list to her doctor and say could it be any of these?Shes spent most of her life in constant pain, in doctors offices, and its just killing us. I want her to have a normal life, and if she cant, I just want to make it as pain free as possible. ###Output :The most important thing I can recommend is finding a good PCP to make sure you have a medical home. That doctor should keep track of everything and keep the puzzle pieces together for you. I'm hoping that's already your pediatrician. From what you write, it seems like each specialist is stumped and is each trying to treat symptoms as they see it. Let's say we can't find what is going on, this is what we would be doing anyway. I say if things have been continuing to worsen, you may try another hospital system. I'm partial to Mayo, CHOP, and Children's National. On the other hand, you may have to consider that there isn't much to do but keep her comfortable. Palliative doctor's role are just that, keep people with chronic disease comfortable. That may include working with PTs, pain specialists, and whatever other tricks they have up there sleeves."}
{"text": "###Input :'m not a doctor. Along with a suggestion, I just want to say how sorry I am to hear about your family going through this. I know how terrible I feel when our daughter just has a cold.Because I'm not a doctor, I don't have a diagnosis to suggest, but instead I want to suggest that you start collecting data, lots of data, then find your most analytical friend(s) and get them looking at it. They don't have to be a doctor; they're more likely to work in science, technology, engineering, business or law.What I'm suggesting you collect is literally everything your daughter eats, drinks, does and where she goes, including basic nutritional information what she's eating and drinking - carbohydrates, fats, etc. The same stuff that they put in big letters on most food packages.Along with that, put in what symptoms she had and how bad they were; devise a rating for her day if nothing else, where \"5\" is \"it was a terrible day\" to \"1\" is \"she barely had any symptoms at all.\"This is going to be a complete pain in the ass.If it's a metabolic problem, there's a chance you'll see something like \"when she has a high-carb, low-fat diet, she has a bad day\" or \"when she has a lot of fat, she does great\" or some other permutation.If it's somehow an environmental problem, then maybe you'll see that \"when she stays at grandma's house she's better than when she sleeps at home\" or \"if she doesn't go to school, she's better\" or \"she played in the basement today and she's a wreck.\"The doctors are clearly missing something, and maybe with some analysis you can find some clues to point them in the right direction. You may have the problem that they've already made up their mind about her and there's no changing it; in that case, you also need new doctors.Best wishes. ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification."}
{"text": "###Input :Rash EVERYWHERE? Please helpHello, so a little background. I am a 23yo F. I suffer from an ED and weigh approximately 80lbs and am 51. I was diagnosed with MCTD, scleroderma, dermatomyositis, and a grocery list of other things, but I feel those are most prevalent to the issues I am having. I also use marijuana regularly as well as vape. So. I moved to MI from MO last summer. Ever since about.. November 2021 I have been having skin issues. The skin is incredibly dry, most spots opened and scabbed and now they hurt and itch. No lotion I have tried (10+) seem to help. I have it on my legs, arms, chest, hip, back, face, behind/in my ears. Ive never had my skin look like this while living in MO. I have seen my PC and I have a rheumatology appointment end of April. I dont even want to imagine how much more this will progress. Does anyone know what this is? Or how I can manage it to minimize symptoms? Im at a loss. Please help! Skin rash ###Output :Images do not allow us to see the extent and appearance of the eruption. A diagnosis is not possible. You are medically complex and you need dermatology care. I work closely with many rheumatologists and we have mutual respect. I would not count on a rheumatologist to manage your skin."}
{"text": "###Input :What does high glucose in a CSF mean?28, Female, T1D 14 years, 59 165 lbs. I have upper extremity weakness in my legs and arms, worsening over the last year. Cant walk up stairs, all my tests come back inconclusive including genetic testing and nerve (I mean literally I have had an ENTIRE work up- MRIs, X-rays, blood work, neurology, spine clinic, rheumatology) so Im left with getting a triple muscle biopsy and had a spinal tap today. The only result that came from that was high glucose CSF and I cant find anything about what that signifies versus the low glucose.ETA: additional test results just came back showing high wbc and rbc in the fluid. ###Output :Generally we're looking for low glucose in the CSF, as that's a sign that bacteria may be in there. There's usually a ratio between CSF and serum glucose (CSF is about 60% of serum), so I'd wonder if your serum glucose was just on the higher end when you got the LP done due to your T1DM."}
{"text": "###Input :Good to know. Im sure Ill hear back Monday, but additionally seeing the high WBC + RBC in the fluid made me nervous. ###Output :How high for each?Reply Wbc 13, rbc 16"}
{"text": "###Input :My Arms Are Turning Blue, Please HelpTL;DR: I removed lab values, as they are no longer the most recent. I have normal skin underneath, to my knowledge, my skin just sheds blue - unaware as to why. I have neurologic and gastric issues, like already stated in edit one, so no need to retouch on that, just briefed about a new procedure I didnt know was going to be requested. I will update about the (dead) blue skin, the literal reason for the post in the first place, if ever discovered.No confirmed, or believed hematologic issues. I only shed blue skin? My skin recently came off, and its pink underneath like it used to be, for some reason it just comes off in blue heaps (random dead skin, I assume, but unsure as to why the color is blue). The veins are extremely bright, but thats about it underneath, I believe. I already have eczema/atopic dermatitis, I know that, but this still confuses me because it doesnt appear to be that. I plan on seeing my derm soon just in case.I thought Id add this information, only to discuss how thorough Ive tried to be, but none of which is the cause for it either. I have a whole host of neurological issues, migraines and OC as listed below, among other newly diagnosed issues, like tremors and possible nocturnal seizures (Im epileptic). Im going to be getting a VEEG done, as ordered by the newly epileptologist I just began seeing. My medications are being readjusted, and a hospital is the only safe way to do so.I also have gastric issues, like I said below.Bottom line, thank you all. If I ever figure out why Im shedding blue skin, Ill make sure to share.TL;DR: I took all suggestions as best I could. I was denied by hematology, rheumatology found no issue despite only slightly abnormal values (mainly NOT severe muscular degeneration that Ive now been made aware of, it didnt alarm him like I said), EKG and EEG requested are both normal. There have been newly diagnosed neurologic issues, but easily fixed with botox.Edit: Thank you to everyone who suggested various things that it could possibly be, and please know that I took your advice, both from this post, and the follow-up one I made awhile back, that Ive since deleted. Here is the in-depth follow-up that some had asked me to provide.Hematology: I was denied by two different hospitals, even though I had a thorough PCP referral, as both places said my issues werent possibly blood related. There were no other hematologic options in my area, so I decided I needed to move on from hematology completely, because I wasnt getting anywhere. Ive not been tested for any hemoglobinopathy as suggested on this post, or any other blood-related issue due to this.Rheumatology: This was the major one recommended on my other post, and I actually just went there a couple days ago after a successful (and surprisingly quick) referral. Despite my leg pain, color-changes and other various issues discussed below, the doctor doesnt believe its anything rheumatology related, either. A physician on the other post I had made, suggested getting a work-up and asking about APS (antiphospholipid syndrome), but I was only tested for possible muscle diseases to my knowledge. I havent received those results yet, but Im sure theyll be normal. Well see.Ive also recently had a redo of my heart echocardiogram done (which came out normal) because the last one was poorly imaged. My most recent (required) EEG was completely normal, but Ive been put on yet another epilepsy medication, unfortunately.The only thing Ive been diagnosed with, since when this was originally posted, has been migraines and occipital neuralgia, which I now receive injections for.Original Post:25F, 185lbs, white, non-smoker, non-drinker.TL;DR: major breathing difficulty, chest discomfort/pressure, (mainly) left leg heaviness/throbbing, odd blood consistency and possibly abnormal values.Hello, Im in quite a predicament. Ive now been labeled a zebra by a vein specialist, because no one can figure out the reasoning behind my current issues.For context, this is now seems to be a somewhat progressive issue, as different symptoms have arisen as time has gone on. I began not being able to breathe well sometime last year, but every time medical professionals take my O2 stats, it never goes below 98. However, its becoming increasingly harder within these last few months, especially taking deep breaths. After having some bad reflux episodes, I was told I had GERD, and then given some medication. However, Ive now been hospitalized twice for my severe breathing issues, both occasions in September, after my GERD diagnosis (and its well controlled/no reflux episodes), so I have a feeling its definitely a separate issue. My chest also feels as if theres a crushing force on it very frequently.I started getting severe leg pain, that made my (especially my left) calves feel heavy one minute, almost like carrying around tree trunks, and then pulsing/throbbing the next. I was scanned for blood clots in my left leg while at the ER, and everything came back normal. The same day I was scanned, a nurse noticed my left arm being a vibrant blue. The ER doctor then pointed out the fact hed noticed that it was also on my right arm at that point, as well. Ultrasounds have recently been done on both my arms, but those results also came back normal.My blood is now starting to be impacted as well I believe, as its appearing to have trouble stopping or clotting quickly. Im not sure if this issue is related to the color-changing or not. My blood will borderline gush out after blood draws/IV site wounds. My RBC has also been consistently high for awhile now, and my MCH and MCV are now dropping again. The values being abnormal arent by much or extremely significant, but Im not sure the reason for the abnormality either (again, reiterating the fact that Im not sure if its connected to the color-changing or not). ###Output :Except for the bleeding, you're pretty much describing a sickle cell disease crisis. Did you ever have a hemoglobin electrophoresis test?EDIT: I saw the conversation further below. Some common traits for hemoglobinopathies are indeed low hemoglobin, high RBC and low MCV. I'd say you could catch about 80% based on these values (but then, electrophoresis is still required for final diagnosis, or DNA testing for alpha thalassemias). Anemias can be compensated for with high RBC counts. MCV, as in sickle cell anemia, may be normal since the sickeling occurs in the microcirculation at low PO2s.EDIT2:I'll give a short summary of things written below (including personal interpretation of what was written) for any physicians currently tuning in;Summary28F, non smoker, non drinker, not on birth controlFatigueSevere leg pain (excruciating), pulsing, throbbingSevere pain 'everywhere', especially shoulder bladesBlue discoloration in armsOxygenation is fineBoth arms and legs were scanned but no clots were foundNo history for excessive bleeding during surgery or tooth extractionsPeriods were heavy in the past, but no longerPictures could be interpreted as deep-tissue bleeding/bruising, but no discoloration has been described (cave too recent)No weight loss, fevers, infectionsLiver and spleen are normalLabNo full lab results on hemostasis (e.g. PT, APTT, Fibrinogen)Initially high RGB, normal MCV, hemoglobin. Now all three are decliningNormal d-dimer, normal plateletsNo hemoglobin electrophoresis was donePossibilities (in no particular order)(Acquired) Bleeding disorderThrombosisSickle-Hb C diseaseAnxiety...?"}
{"text": "###Input :I have not, I dont even know what that is. ###Output :No problem. Would you mind posting your history of values? Mainly hemoglobin, RBC, MCV"}
{"text": "###Input :Sure! Im going to hit the hay first since its 6 AM here and I havent slept yet, but when I get up, Ill get my bloodwork out.How do you want me to write it out on here? Like the reference ranges, and then my results? ###Output :Screenshots are fine too btw.Otherwise, maybe like so? Dates aren't crucial, just give an indication of how far apart (e.g. months between or hours). If there's a missing value in one of the labs, just put a '-' so the values stay aligned vertically.RBC [ref], x, x, x, x MCV [ref], x, x, -, xI'd update your original post, and we'll go from there."}
{"text": "###Input :I updated it! I just separated it by the blood test, and it looks kind of chaotic I know, but I tried my best.Ill have to grab ahold of more of my bloodwork at my primarys office soon, so that theres not just three ###Output :Hmm, these results neither confirm nor refute my first thought. But on seeing the photos they remind me more of deep-tissue bruises.Do they ever go away or change color at all? Was a tourniquet placed on your upper-right arm?Could you perhaps elaborate a bit on your bleeding history? Ever had any surgery or tooth extractions? Nose bleeds? How are your periods?Personally really looking forward to the comments of the hematologist."}
{"text": "###Input :Can alpha thalassemias present with normal hemoglobin, but chronically low ferritin? My hematologist suggested my hemoglobin was normal because I burn through ferritin so quickly. Like OP, my specialists have all but thrown in the towel after four years of treatments (for a diagnosis that has now been thrown out - Von Willebrands 2M).I have had high RBC and low MCV, normal HCT and HGB, low B12 and D (take weekly injection of the former, high dose oral supplement of the latter). Ive had two iron transfusions ~4 years ago. I can provide complete blood work for the last four years if that would help. ###Output :Hemoglobinopathies (like thalassemias) produce red-cells that have a shorter life-span than regular 'normal' red cells. So yes, there is a high turnover and therefore higher demand of nutrients. However, there are other explanations as well. If you like further exploration I would suggest you make a new thread? Results from the last 4 years would give a tremendous head start."}
{"text": "###Input :I updated D-dimer and platelet results now that Im home to see my bloodwork. I apologize I keep replying, but since you made the list, I thought Id let you know, in case you end up not seeing it. ###Output :Do you have a picture of your blue arms? Is it al over? Are the blue areas painful or itchy?"}
{"text": "###Input :Theres a small sliver, same area on both sides, that is my pale skin. The rest of my arms are completely blue. Im currently trying to link photos, but I still am in the process of deleting photos, so that my already filled up iCloud storage will allow me to actually create a link lol. ###Output :Would be really useful to see a picture! (Once youve had some sleep)"}
{"text": "###Input :Dont link through your iCloud to avoid being doxxed or anyone with nefarious intentions causing you more trouble.Edit: create an Imgur account (takes 2 seconds) and link ###Output :Are you on any medications, otc stuff, supplements? Lots of exogenous substances can cause blue pigmentation (colloidal silver, amiodarone, minocycline to name a few)."}
{"text": "###Input :I put the data in that I was asked for, but I can totally do the whole thing, if you think itd be helpful! Quite a bit of my results are online, though, so Ill probably take some screenshots. Ill add it in the post too, once I do. ###Output :Screenshots would be fine (and probably easier) as long as its readable."}
{"text": "###Input :I put it in my post! Theres a lot of screenshots lol, so beware, but its every test result Ive received most recently (September 11th). ###Output :Is it just your arms that are blue? And the right started before the left?QYes, just my arms. The left one started turning blue before the right one, its the blood oddity that started in the right. My lips used to also occasionally turn blue months and months ago, but now its strictly my arms.Sorry it took so long to get back to you things have been crazy on my end with covid. Ive been thinking a lot about your case over the last few days. I think its really strange that its only your upper extremities that are changing color. Please keep an eye out for color changes on your legs or other body parts. Typically when there is some form of differential cyanosis (one part is blue and others arent) we think of cardiac defects and if its one specific limb poor perfusion. But given your age and normal echo a cardiac defect causing your symptoms is unlikely. My next best guess would be something like pernicious anemia/B12 deficiency. This could explain your developing anemia and some of your pain symptoms. The blue coloring could be due to easy bruising related to it. However given that you have microcytic anemia (small red blood cells) and we typically see a macrocytic anemia (big red blood cells) with pernicious anemia/B12 deficiency. But that doesnt necessarily rule out that as a cause for you symptoms. To evaluate this you would start by checking b12, folate levels. Like other have mentioned you could have a hemoglobinopathy causing the cyanosis and anemia which would be more consistent with your microcytosis. However I would have expected this to show up before now, have some known family history of anemia or bleeding disorders, and/or have cyanosis or bruising on more of your body than just your arms. My best guess would be some kind of vasculitis causing vasospasm in your arms giving them a cyanotic appearance. The vasculitis could also be causing the pain you experience in your legs. Your developing microcytic anemia could be early anemia of chronic disease with maybe a pinch of iron deficiency thrown in. Id recommend asking for a ferritin and iron level to evaluate the anemia more. In terms of vasculitis workup, its a bit out of my wheelhouse so Id recommend considering seeing a rheumatologist for further evaluation. Those docs typically (or at least the ones I have worked with) are more of the safari guides than other docs and specialize in zebras.Tl;dr: Possibly a vasculitis, consider rheumatology. Also could be B12 deficiency/pernicious anemia or hemoglobinopathy but less likely due to nerd stuff as above.*edit: Like to add that you should probably also consider seeing a hematologist as well if you havent."}
{"text": "###Input :Thank you! I appreciate all this information greatly, and I will definitely take the advice. Im sorry things are bad with COVID right now, honestly I couldnt imagine what its like to be a doctor during this pandemic. Ive already had it myself, and my mother almost died from it. Its nasty stuff. Im praying for all of you.I went to the doctor today (my primary), and Ive been given a referral to hematology and cardiology, as most of my previous heart echo was suboptimally imaged and apparently the cardiologist remarked several times that he couldnt see hardly anything. Were making 100% sure its not my heart first, and then were going to hematology because Im having extreme bleeding issues again. I had blood drawn today for a new PT and PTT also and the tubes were filled up within seconds. The phlebotomist even remarked on the situation, and my blood appears to be almost the consistency of water. I was born at the hospital Im going to for hematology, so maybe there can be some connection if possible. Also, apparently on my last echo, it was remarked as me having trivial to mild mitral valve regurgitation but Im not quite positive what that is anyways, or if it is even something to question.Ill definitely be hitting up rheumatology next, especially if these dont pan out. ###Output :Mitral valve is valve on the left side of your heart. The regurgitation means it leaks a little allowing some blood to flow backwards. I wouldnt think much about trivial to mild mitral regurgitation especially if it was a bad echo. I hope you find your answer. Please feel free to DM me at anytime if you have questions or concerns. Always happy to help"}
{"text": "###Input :Rheumatology- [49][female] Methotrexate and ColdMy mom is a patient of La county hospitals but does/t have a PCP only a specialty clinic doctor that she sees every 3 months so Im hoping to get some advice. She recently got a cold this past weekend, she tested for covid and had a negative result. She has a cough and is taking Acetaminophen from OTC. She is due to take Methotrexate today due to her Lupus treatment for her flare. Her doctor recently increased her dose to 10 pills weekly which I understand to be an immunosuppressant. How does this affect her if she has a cold? Should she skip until she gets better? ###Output :That's a spectacular question,I wouldn't panic, I don't think it's radically dangerous but this does merit a phone call to the doctor's office. It's important and should be answered by someone who understands her particular history with lupus quite well.I say don't panic because it is not radically uncommon for people to take immunosuppressive drugs when they are in fact sick with an infection, that is the whole basis of taking steroids(the most iconic immunosuppressive drugs) when you have covid, it's looked at like a double-edged sword. So that's good with bad. In theory it could make her cold much more intense and last much longer than it would in a normal person .I don't know how bad her lupus flare is and if that's going to hurt her more withholding the drugs; or how bad her cold is, and if she's really going to fall apart, so I will refrain for making an explicit recommendation.I recommend you get this specialist to give the recommendation, but either way giving it or holding it, she will probably be okay for the meanwhile."}
{"text": "###Input :Thank you! I feel much less panicked now. Ive tried getting a hold of her doctor but have not able to. Ill continue trying. On the lupus thread, Ive also seen that others have been told by their doctors to skip methotrexate when they had a cold. Ill let her know to skip and take it next week, when shes hopefully back to her normal self. ###Output :I think that's probably an OK decision. Not my decision. I don't know her."}
{"text": "###Input :Chest/Neck CT/PET in preparation for lymph node biopsy for neurological/rheumatologic(?) symptoms, also showed lung nodule?Hello everyone! I just had a chest CT and neck CT with contrast to evaluate lymphadenopathy of the neck as well as potential lymph node activity of the chest, and to move towards a lymph node biopsy.This is what was found so far (also had an ER ultrasound showing multiple mildly enlarged lymph nodes in parotid, submandibular, levels 1 and 2 no fatty hilum)-Multiple nonenlarged reactive appearing cervical chain lymph nodes bilaterally. Asymmetric 0.9 cm left level 5 and 4/5 nodes, with preservation of the fatty hilum, likely reactive. Subcentimeter right retropharyngeal node similar to the recent cervical spine MR, with an elongated reactive appearance.My ENT, advised by the rheumatologist I am seeing, was somewhat hesitant on doing the biopsy before having a PET scan done because she stated a biopsy would interfere with a PET/CT for 12 weeks afterwards. The PET scan was recommended by the rheumatologist, as we do not have solid leads for the issues I am having and per his words can collect more sensitive data. I have symptoms progressing by the day, and would like to go ahead with the biopsy and forgo the PET scan also because of the high radiation dose. My questions are, does a biopsy really impact PET results for so long, and would it make sense to perform? Can I request the biopsy first instead? Also, would an excisional biopsy really be needed over a core needle biopsy?The CT also found a 4 mm right lower lobe nodule adjacent to pleura image versus subpleural atelectasis. Should i be concerned about this nodule or its location, and could it represent a rheumatologic disease process?I appreciate any advice! I am a mystery case to all the doctors I have seen and feel completely utterly hopeless.28F, 57, 172 lbs, Asian, No drug use or smoking of any kind, Current Medications include Levothyroxine, estrogen, and progesteronePrimary Issue- Multi system wide involvement including neurological, dermatologic, possible rheumatologist, endocrinologic- Severe neurological presentation of symptoms beginning as constant left-sided facial pain, progressing to tingling and cold, then constant numbness and deadness of sensation in peri orbital area, decreased corneal reflex, whole cheek, down to jaw, and through lips, combined with massive headaches in occipital temple and behind the eye, feels like face is falling off face and sagging. Loss of muscle in face and body as well as muscle twitching/pulsing in top and bottom eyelids (right and left) constant muscle twitching/aches/pain in random muscles throughout body. Recently spread of pain in parotid, submandibular, occipital, ear canal, left neck, supraclavicular areas with associated mildly enlarged and reactive lymph nodes, mostly on left but also bilaterally. Very recently tightness, compression, and loss of sensation in left front of foot and back of left calf which is still present.Many other non-neurological symptoms, have seen 60+ doctors.Duration: 2 years of worsening symptoms. ###Output :Reactive lymph nodes are usually from some infection or inflammation and biopsy will likely not be helpful. Id say go for the PET first. The lung nodule does not seem worrisome. PET once again may be helpful to see if it is metabolically active"}
{"text": "###Input :Positive ANA test 1:1280, whats next?Hello im F 24 i weigh 110lbs and am 51 Ive been on a four month journey of trying to figure out whats wrong with me, had an oncology appointment recently as my physicians were suspicious for a lymphoma or leukemia. Had an ANA test along with a myriad of others and it came back positive 1:1280 speckled pattern. im being sent to a rheumatologistIm wondering what are the different things that can come from this positive test? and are petechiae something that happens with autoimmune diseases?ive had widespread lymph node swelling, with some hard immovable ones in my neck and underarmsdaily feversnight sweatsweight loss 10lbs in four monthspetechiae and bruisingred bumps in areas of lymph swellingfacial flushingburning sensation on skin face, neck, shoulders, armswidespread intense itchinessextreme fatigue, weaknessdizzinessupper abdominal pain & hip/lowback painand migrating pain that feels like growing pains in my bones throughout my body ###Output :Could be lupus, maybe Sjogrens. Both can look like lymphoma and cause most of the symptoms youve listed. Rheum will test a battery of inflammatory markers, immunoglobulins and antibodies for a specific connective tissue disease (CTD). Many CTDs can cause petechiae and purpura due to vascular fragility and small vessel vasculitis. It can take some time to make these diagnoses."}
{"text": "###Input :Blood work off after MTX. Should I hold the next dose until Rheum consult?30F non-smoker 147 lb 5ft 2in tall, years long history of rheumatoid symptoms and indicative blood work. My degree is in clinical nutrition which means unfortunately I understand the basics of my blood work but am not sure what to do with it. My rheumatologist is out for a week.After 7 weeks of 10 mg oral methotrexate weekly with absolutely no contraindicated medications (sulfa, alcohol, etc) my blood work has come back. I'm just hoping for clarification on if these results are expected with methotrexate, or if I may want to hold a dose until Rheumatology is back in office next week.Creatinine has dropped to 0.51 and was 0.70 prior to treatment. BUN has risen to 24 and was 17 prior to treatment. CRP at 1.4, was 1.3 prior to treatment.If I can ask for any input just to ease my mind, I'd really appreciate it! ###Output :I would not worry about these labs. They are inconsequentially different from prior.For your information - Creatinine is a measure of how well the kidneys are working. We worry more about kidney injury when it is high. BUN is not as specific and should be interpreted in the context of your creatinine. Your CRP is basically unchanged.Your rheumatologist would likely go more based off your symptoms in adjusting your meds, they are probably monitoring side effects of methotrexate so looking at blood counts for signs of low counts and liver function tests. Methotrexate is cleared through the kidneys so if there was a major change in your creatinine it may prompt a dose change. CRP and ESR are inflammatory markers that will be trended.Hope this helps!"}
{"text": "###Input :Should I see a Rheumatologist?Hi I am 26F, 150lbs, currently only taking hormonal birth control (sprintec). I have been dealing with recurring hand and arm pain for the past four months or so. I'd estimate since the end of January 2023. It started as a sort of tingly feeling in my fingers with some pain around the proximal interphalangeal joint in all 10 of them. I wouldn't describe the tingling as numbness exactly, as it's not the pins and needles that others use to describe it, but it is constant. The pain is in both hands, but my right hand is worse as that is my dominant hand. As there is no specific moment I can remember when this started, I thought this might have been carpal tunnel or some other overuse injury from spending time knitting & crocheting as well as being on the computer 8-10 hours a day for my job/fun. I stopped knitting as much and when it didn't get better around a month in I stopped knitting completely. The pain does get worse when I use the computer and my phone so I am trying to limit the use of both and I have already switched to using a vertical mouse which didn't seem to make a difference. Specifically when I click the mouse with my right pointer finger I feel a pinch between my ring and pinky fingersI went to an orthopedic hand surgeon who said that he didn't think it was carpal tunnel as those are unusual symptoms for it and even more unusual to be experiencing the pain in both hands. He took X-rays that he said looked normal, and he ordered a bunch of blood tests for me including one for Rheumatoid factor. He also prescribed me physical therapy after I complained about still being in pain. The physical therapist did a bunch of intake tests that showed my grip strength and other strengths were on the low end, but normal and he seemed stumped on how to help me. After 3 sessions of in office physical therapy I did not seem to get better and if anything it's worse. As I now feel regular pain up my arms around my forearm and triceps (feels kind of like a tight stretching) in addition to the pain I described earlier. Also in the last couple of weeks I've experienced actual numbness in both of my pinkys, on seperate occasions. For the record I wasn't as diligent with the PT as I could have been, ie sometimes I would do exercises only once or twice a day instead of the recommended 2-3 times. I was diligent about the heat he recommended though.My blood tests came back all negative so the doctor said that he's at a loss, suggested I maybe make an appointment with a rheumatologist and prescribed me a 4mg medrol dose pack as a last ditch effort. During and after the prednisone I didn't really notice a change in pain levels. That coupled with the negative Rheumatoid Factor suggests to me that maybe there is no inflammation causing this? But I know that seronegative rheumatoid factor exists, hence why I'm now asking on reddit. Does it seem like this could be RA? Would it be worth it to go to the Rheumatologist for this? Was my doctor just wrong and it is some kind of overuse injury and I should just try a new orthopedic doctor? Maybe someone less specialized in the hands because the physical therapist suggested it might be a spinal issue since the pain is traveling up my arms. Should I just give up on doctors and try to be more diligent about the physical therapy on my own?For the record here are all the blood tests I got:CBC W/PLAT AUTOMATED DIFF - Only showed I have a slightly low red blood cell countANA PANELSEDIMENTATION RATEC-REACTIVE PROTEINRHEUMATOID FACTORURIC ACIDHLA-B27 ANTIGENCYCLIC CITRUL PEPTIDE ABSANACHOICE(R) SPECIFIC ANTIBODIES W/RFLX TO DSDNA ###Output :Picture does not sound rheumatologic to me. In addition to the negative labs and imaging, most patients have relief with steroids on initial diagnosis of a rheumatologic condition. This tells me what is going on is unlikely autoimmune or inflammatory.Some ideas and thoughts on things that can cause pain/tingling/weakness in the arms and hands that I do have are have you ever had any neck trauma or whiplash? Has your B12 and thyroid been checked? Do you have any history of migraines?"}
{"text": "###Input :No neck trauma or whiplash and I'm not sure my B12 has ever been checked. I went to an endocrinologist last year because I found out I had a high level of thyroid peroxidase antibodies (166 iu/ml) after testing for a seperate concern, but my T3, T4, TSH were all normal so she said to come back in a year. I hadn't thought about it because the endo seemed very unconcerned, but do you think that could cause this?Also no real history of migraines, I remember I had 2 around when I started puberty and haven't had one since. My (older) siblings do occasionally have them though, not sure if that would matter. ###Output :Hypothyroid can certainly cause some real muscle pain, joint pains and parasthesias (tingling in hands/feet). As a matter of fact, carpal tunnel syndrome is a common neuro symptom of hypothyroidism and is often reversible with thyroid hormone therapy.Get your thyroid checked. Id still also check B12."}
{"text": "###Input :69M - prostate cancer? - what to expect?Hello, this is concerning my father (69M). He's 6'3\" and about 15st. Anatomically this concerns this prostate, and geographically we're in the United Kingdom.He is a moderate regular drinker (2-3 small glasses wine most nights) but has never taken recreational drugs. He used to smoke but quit about 35 years ago.He has mild asthma and chronic sinus issues caused by nasal polyps that cause total nasal obstruction. He is awaiting followups for a cauterising surgery, but this seems unrelated.As part of routine bloods, my dad got a psa test about a month ago, which came back at 13.3, which is obviously elevated.His GP hasn't seen him in person and hasn't carried out a rectal exam, but instead referred him to urology. His urology referral was a telephone consult to tell him that he was being booked in for an MRI.He had the MRI (with contrast) last week and today was told that there was something suspicious on the left side of his prostate, and that he would need a biopsy. He hasn't had the biopsy yet.I understand that this is all geared towards a prostate cancer diagnosis, and I understand that at this stage, prostatitis is unlikely. All the clinicians with whom my dad has spoken have been very reticent when he has asked about cancer, but simultaneously tell him he might need a bone scan based on the outcome of the biopsy.I'm under no illusions that prostate cancer is high on the differential, but could benign prostatic hyperplasia still be on the cards? I understand that both conditions are diagnoses histologically, but it would be helpful to know whether PC and BPH look distinct on images?For background info - he has no urinary symptoms but has been losing weight steadily for about 3 years (maybe 4st in 3 years?). Assumption has been that he hasn't been eating much because his nasal polyps have robbed him of his sense of last largely. He also lost his wife (my mum) to breast cancer six months ago. He can't cook and eats rubbish, and also likely has depression.Any insight here would be useful in terms of differentials, outlook (based on the vagaries I've provided) and generally what to expect. I definitely feel that no clinical has been forthright with my father thus far. That's no criticism of the docs, but it hasn't helped him and has compounded his stress as he's gone straight to Google and catastrophised. ###Output :Urologist. Impossible to provide much advice since he hasn't actually been diagnosed with prostate cancer and there are many nuances depending on what type / grade / stage of prostate cancer we are talking about. Certainly a chance you can have an elevated PSA and no prostate cancer even with an MRI. Only way to find out is biopsy. Results of that would determine what needs to be done.If he does have prostate cancer it is almost certainly localized to the prostate. Options would then be surgical prostate removal, radiation, or surveillance and waiting. Obviously I don't want to go into these with out a proper diagnosis. Biopsy happens in the office, takes about 15 min. Results take a week or two to come back."}
{"text": "###Input :[Urology] 27M, Pee drops \"leaks\" after peeing. Embarrassed to visit a doctor.As the post says, I am 27M. After peeing few drops of pee leak out after peeing.As a \"solution\", i \"rub\" my penis to move any pee in the canal outside. I do it even from behind the testicles. However recently, it seems even that doesn't work out. As i still get few drops of pee afterward, especially when i sit down.I wanted to go to a doctor, however i am extremely embarrassed. And I am not even sure if there is anything that can be done at this point.The thing is: the reason i believe this is happening, is because when i was a kid, i inserted a thermometer in my urethra, it was deep enough that i felt it penetrating something and pee came out.However if i recall correctly nothing really changed after that incident and this leaking issue started happening about 5 to 8 years ago. ###Output :To put your mind at ease, there is a VERY low likelihood that these issues are secondary to your \"self-exploration\" event that you journeyed on when you were younger. Additionally, there's absolutely no reason to be embarrassed about this. This is what us physicians do on a daily basis, and we do what we do because we love to help people (most of us, that is). And I promise, for every \"embarrassing\" event you think you might be bringing to the table, I guarantee all of us have seen much, much worse. But again, there's absolutely zero shame in what you're going through whatsoever. Get a referral to a urologist from your PCP; all they focus on is genitourinary tract issues, and they should hopefully be able to help you find an answer to what's going on."}
{"text": "###Input :Piggybacking... had this start happing to an extent sometime in my 30s or 40s, and figured this was just attributable to aging... Would a urologist visit typically be warranted if there's no other symptoms or related trauma that could have caused it? ###Output :It's true that many men will develop these types of symptoms later in life due to something called BPH (benign prostatic hyperplasia), which is essentially when the prostate grows too large and starts \"pinching\" the urethra closed, which subsequently may lead to symptoms such as difficulty starting a stream or completely emptying when they go. However, your 30's is way too early for this to begin occurring. I would start with going to your PCP first so they can do a physical exam and ask more questions, and then they can help decide whether or not a urology consult is appropriate for you."}
{"text": "###Input :Cystocele76 old woman. Her nurse practitioner diagnosed her with cystocele. What kind of doctor would be the right doctor for cystocele? Would gynecologist be better option than an urologist since the patient is a woman? ###Output :Luckily you don't have to choose: there are urogynaecologists out there, which are gynaecologists who specialize on urological and proctological issues in women. I'd go to one of those."}
{"text": "###Input :Does OB/gynecologist fit that category? Medicare physician finder doesn't even have the doctors category of urogynecologist on their web portal. ###Output :Ah, I see. Sorry, I'm not in the united states. It's the right type of doctor, yes, but it doesn't tell you their sub-specialisation. Maybe look the ones you find via the portal up on the internet or call their office?"}
{"text": "###Input :27m - Urology/Andrology Question - successful Penile vein ligation and shockwave treatment contra indication? What happens to ligated veins ?Hello to all,I have been diagnosed with severe organic erectile dysfunction and am using PDE5I, injectable PGE1 (Alprostadil) and sometimes alpha-1-antagonists (doxazosin).I am suffering from organic erectile dysfunction and had a successful dorsal vein ligation (3 years ago - superfical and deep dorsal vein as well as two ectopic veins (which helped me to get erections with medication).Even though shock wave treatment might not be very promising I still want to try it and as I happen to live in a country where it is comparatively cheap I am about to do 10 sessions in 5 weeks.But I fear that it might \"unblock\" the vein ligation ?Hypothethically speaking - if the ligated veins where freed from their suture would they pop open again ? Or is there scar tissue built up which will continue to block the vein ?I fear the shockwaves might damage the \"suture\". Since I cannot happen to find information about that online maybe someone can help me out.Thank you and best, ###Output :The suture themselves dissolve after a while. So 3 years later the veins are closed by scar tissue. Also, when a blood vessel is surgically closed, a longer segment of the vein eventually becomes \"clogged\". Sounds very unlikely that anything could break them open again, even if they should deliberately try.So I don't think you should worry about this specific complication. There's probably a lot of other possible complications though, I don't know much about this specific shock wave procedure. Sounds very experimental though. Do you know how it's supposed to help for ED?"}
{"text": "###Input :Constant 9/10 flank pain Female 31Hello fellow people of reddit. I hope you are all doing better than I am currently.Overview: I had my first set of kidney stones in may of 2022. I had another set in July of 2022. In December of 2022 I started having constant pain in my flanks. Ive been to the emergency room several times since then. Ive seen urology, Ive seen my pcp, Ive seen the pain clinic, Ive seen a nephrologist. I have bloods done frequently as well as UAs. Ive been ignored and sent home every time when I seek help. Otc meds dont work and the narcotics just make me sick. I feel like Im going insane. Im Im so much pain on a constant basis. My mental health is starting to tank because of this. Any advice would be appreciated.I do have hypercalcemia, and hyperparathyroidism, and my nephrologist believes I could also have necrosis in my kidneys.I am 31, obese, 5 foot 3 inches tall. I have never smoked, dont drink, dont do drugs other than weed in gummy form every now and then.Current Meds are:Concerta, Propranolol, Losartian, Amlodipine, Nebulizer, Quvar, Alb inhalerHere are my most recent labs.UA:https://gyazo.com/d5f6f1fc96058f29dd17ea6d2e3126f9https://gyazo.com/fca06118e1b739c171942f1b3050492fCBC with Auto Differential:https://gyazo.com/940243c0ec3bb61963388832f51c2bd0CMP:https://gyazo.com/2586ac67b7574917dcb76db00ddf78ae ###Output :The fact there is calcium oxalate in your urine, plus blood +++ indicates there may be a stone in the process of breaking up, and this is what is causing the pain for you (especially if you have a history of kidney stones). Looks like a slight UTI too, which isn't going to help."}
{"text": "###Input :Thats what I said, but the only stone they can see is, according to them, no bigger than a grain of sand. The doctor I saw last night also said that I didn't have a UTI. I've had the crystals and blood in my urine every single UA since December. ###Output :You don't have a raging UTI and your culture is negative from what I can see. But there are white blood cells in your urine, and bacteria (though no leucocytes/nitrates, which tend to be the classic uti markers). Plus, a high number of epithelial (skin) cells, which indicates sample contamination. So, not anything that warrants treating.And yes, kidney stones can literally be a grain of sand size and cause utter havoc."}
{"text": "###Input :Man, I wish the doctors here would understand that. Because every time Ive gone to the ER (which is a lot unfortunately because I cant deal with the pain and otc meds don't work on it) they just tell me Im being dramatic and to go home. ###Output :I'm sorry to hear that. When I come across patients with pyelonephritis/renal colic etc, they tend to benefit somewhat from hot water bottles."}
{"text": "###Input :My heating pad does help to a degree. Sometimes, it helps enough that I can sleep or do whatever it is I need to. And sometimes it does nothing. ###Output :Do you have any imaging? Does the pain come and go? Where is it located? Is it the same as when you had kidney stones? What therapies have you tried, what did urologist say about the pain?"}
{"text": "###Input :Nephrology says it's probable stones and/or renal papillary necrosis.s.ne. There's a constant dull ache and then like a colicky pain that gets really bad really fast. It feels very similar to past kidney stones. The pain is on both flanks and spreads to my side right above my hip.I've had a couple of CTs. The last one showed at least one itty bitty stone. There's a constant dull ache and then a colicky pain that gets really bad really fast. It feels very similar to past kidney stones.I've done heat, cold, narcotics, NSAIDS (which the nephrologist said to stop) Ive done physical therapy, exercise, and stretching.The urologist says he didn't see anything and that I'm being dramatic.My PCP says there is something wrong and to see urology.Nephrology says its probable stones and/or renal papillary necrosis.The pain clinic says Im being dramatic ###Output :I agree that NSAIDS and opiates are not the way to manage this, and I believe your pain you are not \"dramatic\".How high is your calcium? Your hyperparathyroidism is possibly the most crucial thing to get under control. Chronic hypercalcemia obviously predisposes to stones, but also to a disease called nephrocalcinosis which can be painless but sometimes causes marked pain as small rocks of calcium get lodged in the draining portion of the kidney.The other not mutually exclusive possibility is you are having ureteral spasms, which are associated with hyperparathyroidism and hypercalcemia but no stones.So it is crucial to get your hyperparathyroidism under control. Even with \"normal\" calcium this can cause kidney problems and with hypercalcemia can cause kidney failure. If this is already under control then possibly it will get better once the ongoing calcium deposition improves. Dietary changes can also decrease calcium deposition, your nephrologist can advise on these.There are several medications available that are somewhat helpful for ureteral spasms including oxybutynin and tamsulosin but would focus on the underlying cause."}
{"text": "###Input :My calcium bounces between 11.5 and 13.5. I have surgery to remove the overactive parathyroid glands at the end of next month. It was supposed to be this month but the hospital broke a needed machine the day before it.I will have to looked into the nephrocalcinosis, I haven't heard of it before. ###Output :Holy smoking gun batman.Yes I suspect this surgery will help tremendously with your pain. If it was delayed long you should have been on a calcium lowering agent, though likely a little late to start now."}
{"text": "###Input :Fun fact my endocrinologist told me to take calcium and vit d.Im really hoping the surgery helps because I might just loose my mind if it doesnt. My calcium has been like this for about three years but I was always told it was fine until recently. ###Output :I don't know the details so I can't really assess what is going on here, but in general we wouldn't let someone be that high for that long. Surgery is usually done fairly early and if not medical therapy offered, targeted at lowering not raising the calcium."}
{"text": "###Input :Unfortunately, I had a pcp that seemed to believe that everything was either due to menstruation, things I was doing, or that it was due to my low mental health or that I was lying. But he was the only one my insurance would cover. As soon as I switched doctors I got referrals and scans and procedures but that only happened in November of last year.The Ed always said it wasnt that high and it wasnt something to worry about. ###Output :The ED is never going to treat hypercalcemia or really any chronic problems. It isn't acutely life threatening unless very high so not on their radar.They aren't mini-PCPS.Unfortunately people have poor access and get stuck in the ED visit spin cycle with care never moving forward. I think you are on a goodish path now though."}
{"text": "###Input :The case of the constant invisible urine flood: neuro? Psych? Other?This is a bizarre one, so Im hoping for any ideas here.Pt (family member) is an 80 year old female residing in an assisted living facility with hx of benign essential tremor and recent dx of possible Parkinsonism (tremor, left side more than right. A&Ox4; No signs of dementia; MOCA 7.1 score 28/30. More hx and meds below) About three months ago, pt c/o urine constantly running down my legs. She reports that her clothing, shoes and socks get soaked with urine, to the extent that she leaves wet footprints when walking, and smells urine strongly in her room and on her clothing. She has been wearing adult incontinence briefs, but reports that the urine bypasses these briefs.Heres the problem. Family, caregivers, physicians, nurses, and therapists cannot see, smell, nor feel the urine. When pt says her pants are soaked, they appear and feel dry to the touch. Incontinence briefs also feel dry, and there is no sign of urine on pts bedclothes or clothing. She recently spent two weeks in an acute care hospital and another two weeks in a rehab hospital, and in that time, only one instance of urinary incontinence was noted and that was on admittance when it had been some time before she could be seen.She has seen a neurologist who prescribed Sinemet (carbidopa/levodopa) for her tremors. The neurologist mentioned that Sinemet can exacerbate incontinence, but didnt really address pts insistence that she is constantly having urine flow that soaks her legs and shoes but somehow bypasses the incontinence briefs leaving them dry.She has seen a urologist, who prescribed a bladder training regimen and voiding journal, but a bladder scan showed she is emptying her bladder just fine. Labs show no sign of UTI or other infectious or inflammatory process. Urology suggested this was more likely a sensory issue than a urology issue and referred back to the neurologist.Pt insists that her fellow assisted-living residents can also see and smell the urine, and has reported that she believes the caregivers are lying about not seeing it in order to be polite.Complicating this is that pt has a history of anxiety disorder, depression, sometimes exaggerating physical symptoms and deciding she has a grave condition of some sort until tests are done to rule it out. A psychologist has suggested she may have a personality disorder with emotional dysregulation and attention-seeking features as well.The fact is, though, this pt is miserable and 100% insistent that she is experiencing a constant flow of urine and sitting in wet clothes all the time. We cant get her in to the psychiatrist until late April.Are there ANY ideas of what we may be missing to explain this from a neurological/sensory standpoint or another place to look? I have been really trying to advocate for this pt but its very difficult when the problem seems to be invisible for everyone but her. On the chance this is not psychosomatic, Id really like to make sure weve considered all options and are not just blowing her off because of her mental health issues.No alcohol, no drugs other than prescribed, no marijuana, no tobacco/nicotine use.Meds: Sinemet 25/100 2 tabs tid (Parkinsonism) Bupropion 75mg qam (depression) Liothyronine 5mcg tid (hypothyroid) Levothyroxine 50mcg qam (hypothyroid) Trazodone 50mg qpm (sleep) Buspirone 5mg bid (anxiety) Alprazolam 0.5mg qpm (anxiety/sleep) Ibandronate 150mg q30day (osteoporosis)Surgical/other hx: Hysterectomy/bilateral oophorectomy ~40 years ago Pregnancy: G2P2 ~50 years ago Melanoma removal, L knee, ~5 years agoLabs:CBC shows minor anemia beginning the day after starting Sinemet but seems to be resolving.BMP normal except for elevated AST (last values from Jan 2023 to Mar 2023 were 88, 71, 144, 156, 162, 91, 101 in chronological order.)Imaging:MRI Lumbar spine w and w/o contrast 2/1/2023: they didnt think it had anything that would explain constant urine flow but I can post the report if needed.CT head 1/30/2023: impression was: 1. No acute intracranial abnormality.2. Atherosclerosis. ###Output :I would guess these are vivid hallucinaties, resultibg in a delusion. These can be caused by her combination of meds ( levodopa, bupropion and trazodone can cause agitatie and confusion in eldery patients). Did it start after starting levodopa? Parkiinson itself can cause vivid hallucinations too,but often parkinsons is more advanced then. And it could also be caused by depression. Older people often have these kind of delusions when they have psychotic depression.I would go back to the neurologist or psychiatrist for an evaluation. Probably stopping some meds should be tried, or antipsychotics compatible with parkinsons like clozapine added. But ask her doctors first what and how."}
{"text": "###Input :Oh, I forgot to answer your question: No, this started quite awhile before she started levodopa and buspar.She had been taking bupropion, trazodone, and alprazolam for years, but spent a few weeks in an inpatient psychiatric facility specifically focusing on elderly patients (edit: for depression/SI) about 9 months ago, and the psychiatrist there doubled her bupropion from 75mg qd to 150mg qd.The urinary problem started about three or four months after that. Two months ago, she was hospitalized for increasing tremor and weakness, at which time a consulting psychiatrist said to titrate her off the bupropion as he felt it was contributing to her anxiety levels. At that time, her bupropion dosage was cut in half to the 75mg she is currently on.The increasing tremor and weakness were determined to have been simple deconditioning due to self-isolating, turning away physical therapists, and not moving around much at all. She went from acute care to an intensive inpatient rehab facility and very quickly (about 2 weeks) regained much of her strength and a decrease in tremors.Thank you so much! We are trying to wean her off bupropion for that exact reason (not hallucinations specifically, but because it can exacerbate anxiety), so thats good to know. We just saw the neurologist yesterday but he sort of waved it away and suggested we discuss med interactions with the pharmacist.Further complicating matters is that shes tried pretty much every SSRI and SSNRI for depression and has had bad reactions to all of them, so bupropion at the time was thought to be a sort of last-ditch effort and seemed to be working for her. Since it also works on dopamine, the neurologist was completely unconcerned about it, but admitted that comprehensive med review was not in his wheelhouse.We did specifically ask the neurologist if this could be related to the Parkinsonism and he said he didnt think so because of the rest of how her condition appears.So, it sounds like I should continue trying to get her into the psychiatrist sooner? So far her other doctors dont seem to think theres a problem that they can speak to. ###Output :For depression with psychotic symptoms, like these hallucinations/delusion, often tricyclic antidepressants are used, so probably meds she has not tried yet or maybe a few decades ago when they were more common.Personally i would try to get an appointment as soon as possible, because something is clearly not right and she is suffering probably.That could be a psychiatrist specialised in the eldery or (another?) neurologist. Consulting a pharmacist with an interest in psychopharmacology however also a good idea in the meantime.Armchair diagnosis is easy, but i could be very wrong and there is something else going on. This is just some thoughts that came to mind"}
{"text": "###Input :Child urology: Double kidney, megaurether, uretheroceleFemale, 10 months old, 70 cm, 7.5 kgHi all,I am searching for second opinions and experiences for my 10 months old daughter.She was born with a double kidney whose upper part is polycystic and thus not working properly. The urether of this part became a megaureter, probably because it ends in an ureterocele in the bladder.Her first surgery was when she was 1 month old. They cut into the ureterocele so the urine can flow into the bladder. However, at this point they thought she had only one urether for both systems and thus there had been enough urine to guarantee sufficient flow. When she had a persistent infection with Klebsiella pneumonia, we were referred to specialists who saw the second urether and, 2 weeks later, her second surgery was done to make a urostoma, so the basically standing urine from the megaureter could flow directly outside. The ureter is smaller now and except that she receives prophylactic treatment with antibiotics, everything is normal. But the stoma has to be closed of course. Now there are 2 options:connect the ureter from the dysplastic part of the double system with the healthy ureter from the healthy partcut out the dysplastic part of the double system and part of its ureter, leaving the other part and the ureterocele where they are, as there is no refluxOur doctors recommend option 1), as the surgery is shorter (90 minutes vs 3 hrs) and less invasive (opening up the existing hole from the stoma a bit more vs making an additional cut close to the lungs) and the healthy kidney part is not damaged (vs certain loss of at least 7% function). The only risk is that the connection of the two ureters leaks, which is rare and easily fixed they say.These are all compelling arguments, but we were also told that option 2) is the more common one. Does anyone have experience with similar cases? What's her best option in your opinion?Thank you very much for any feedback! ###Output :!redditsilver"}
{"text": "###Input :Is it normal for a Urology PA to try to prescribe antidepressants/SSRIs?(Posting this again to fix some things that I needed to fix in this) Age: 24Sex: FemaleHeight: 5'1\"Weight: 100Race: CaucasianDuration of complaint: urinary issues for about a year, suspected interstitial cystitis. Appointment was todayLocation on body: urethra/bladderCurrent medications: N/ANo recreational drugs, non-smoker, non-drinkerI had a very uncomfortable urology appointment today and while one of my doctors confirmed this was really weird I kind of would like to hear from other doctors unrelated to the situation.I went in because my gyno suspects that I have interstitial cystitis.I'd like to mention he's very very specific with me about what will happen. He knows that I rely on a really precise description of what the plan is (I have really bad anxiety and sensory issues). So it was weird to me when I went in and the PA immediately scoffed and said \"it's never interstitial cystitis. They just claim that and send you off our way\". Then she insisted on pelvic floor massage which I am unable to do and I said no to because my gyno and I went over all the options and he didn't think that was even on the board of necessary ideas. She pushed and said that \"I injured my shoulder and got pelvic massage therapy and it fixed my shoulder\".She claimed she had read all of my charts and medical background and asked if I was taking anything for the pain. I thought she meant Tylenol and said no because it doesn't work. She then started listing off amitriptyline and two other antidepressants/SSRIs. Then cymbalta. I got confused and told her I'm already taking savella and she asked me \"what for? What does that do?\"Shouldn't she know what that does? It just sent off a really red flag for me because those are usually meds that you need to involve a psychiatrist for. And if she had read my file and is messing with those kinds of meds why would she mess with my antidepressant that is package insert for pain and depression? She also would've seen that I'm prescribed tramadol.She also got really snotty when she asked if I had been surgically diagnosed when I said I had endometriosis which also would have been in my file/medical history. It also seems like any message from my gyno she just threw in the trash pile and came in with her mind made up that he was full of it.I guess I just need to know what to do. If this is normal and she just was kind of awful then okay but it really didn't feel normal. Do I tell someone about this? Who do I tell? She told me \"then just go back to your gyno and see what he says\" and (as I expected he would) he's sending me to another urologist, I imagine he's wondering why there was a problem.Edit: she also asked me about a bunch of food and drinks, I answered honestly that I just drink water with an occasional soda and about my food habits. Then she sent me home with a list of food to stop eating and all of it is stuff I point blank told her I don't eat. I'm just really upset because I had to drive a long way to get there, do things that will set me back anxiety-wise for days and she didn't even listen to that.Edit 2: There's also the unfortunate fact that the more stressed I got by her ignoring me and getting really pushy the more I started to stim. And she decided the best thing to do was start IGNORING me (I was still speaking to her, just no eye contact and moving my fingers) and only speak to my mother. I was then completely invisible. ###Output :That sounds like a mix of multiple bad things. Theres a strong whiff of functional medicine (read: quackery) in massage for everything and weird food restrictions. Theres stigma against psychiatric treatment and mental illness. And theres ignorance.Theres nothing wrong with a urology PA managing antidepressants if he or she actually has expertise in those medications, but that isnt what happened here. This PA might be right about it not being interstitial cystitis, but even if so behaved so badly that youd want a second opinion anyway."}
{"text": "###Input :Definitely getting a second opinion, hopefully with someone that actually is interested in sitting down and talking things out instead of whatever this whole mess was.Thank you for letting me know that it's not unusual for urology PAs to work with those meds in general ###Output :I think it actually is unusual. Its not unprofessional or absolutely a bad thing, but its unusual.Its not only psychiatrists who manage psychiatric medications, but most of the other doctors (and PAs and NPs) who do it are generalists, so probably family our internal medicine primary care doctors and the occasional gynecologist who does primary care."}
{"text": "###Input :Yeah the savella is for my fibromyalgia and depression, I've cycled through stuff like elavil (ultimately dismissed as an option when I was 14ish) and cymbalta (horrible reaction) so I don't find that so weird. I guess maybe it put me on edge because I've had bad experiences with a lot of those? I'm very touchy about messing with those when I'm settled in one because it's hard physically and mentally and I really don't feel safe unless my psychiatrist is involvedI've gotten the \"what's it for\" question a lot it was more the \"what is that\" that got me because I thought it was a pretty well known med ###Output :Sorry this is short. No signal. Speed read the issue. Only have to say.... Cymbalta is a powerful antidepressant which has use in resistant stress incontinence , that is leaking on exercise usually later in life.Amitriptyline has a big role in bladder control mostly for nocturia, peeing at night. It is used at doses much less than when used 50 years ago as an antidepressant but I like to correct people who complain theyve been put on an antidepressant when the dose is 50mg instead of the 300mg it was then. It was a poor antidepressant but people said that their bladders were better"}
{"text": "###Input :That's interesting. But also odd because I told her I'm not having incontinence ###Output :Precisely. It doesnt really make sense so maybe another opinion"}
{"text": "###Input :My (72M) father was sent off for a number of urology tests, are these standard procedure?72M, 160 lb. He has had frequent urinary urgency for years now, untreated. Recently has gotten much worse, and the need to urinate has been waking him up 5+ times each night. When he does urinate, he has trouble emptying his bladder.I scheduled an appointment for him with a urologist and the urologist prescribed Flomax to him. This was today. The urologist sent off for a number of tests:PSACreatinineUrinalysisAlso, these procedures:Transurethral cystoscopyRenal ultrasound and ultrasound of the urinary tractI'm wondering about the cystoscopy - as this is what my father is most fearful of. I spoke with the urologist and he said this is to see if there are issues that need to be addressed by surgery that the Flomax can't help cure. I'm still not sure what this is done for and if this is standard procedure? Would it be better to just see how he responds to the Flomax and perform the procedure if he doesn't? Or is there value in doing this anyways? ###Output :Flomax was given as due to the likelihood of benign prostatic hyperplasia, and pretty much every guy has an already enlarging prostate when they're above 60 anyway.The cystoscopy is to look into the urinary bladder for any issues that may not be due to the prostate (prostate would still be the number one source of problems in this age group regardless). All these tests should cover all the bases for the probable urinary tract issues for his age."}
{"text": "###Input :Seeking information regarding dads renal cell carcinoma. Any urologists here?My dad has been having serious issues with vomiting, nausea, and weight loss. They ended up doing abdominal CT because colonoscopy and upper GI scope were normal. There was an incidental finding of a 2 cm heterogenous(I think???) lesion on one kidney. Per radiology report, it says renal cell carcinoma until proven otherwise.Today we saw the urological surgeon who said due to size of tumor and my dads age, hes a candidate for ablation and theyll give him a referral.The appointment was very rushed and I (29 F) went in with my dad because he has a history of TBI and has a hard time remembering/relaying medical info. We basically were just told that its cancer (which I figured from reading rad report) and that it can be ablated very quickly and the doctor then basically told my dad to drop his pants for a prostate exam so I made a swift exit.My questions lie in whether more imaging needs to be done on my dad to make sure theres not other cancer somewhere? The doc said most likely stage one but theyve only done the abd CT and nothing else?? I understand its a small tumor but does that automatically mean theres no metastasis?? I dont understand how they know that its only stage I without additional testing or imaging? Can anyone give me insight here about this process?We will be following up with that physician where I will be asking for clarification. It was such a whirlwind of an appt and I just didnt feel prepared to ask necessary questions. ###Output :From the information provided, this is not standard of care - but giving us the image files (upload to e.g. dicomlibrary and CT report would be very helpful.Here is NCCN's very helpful patient guideline for kidney cancer.A suspicious 2 cm lesion on a kidney often, but not always is renal cell carcinoma. A 2 cm renal cell carcinoma that's confined to the kidney is usually pretty harmless and very unlikely to relapse or metastasize.The problem is that 1) staging is incomplete and 2) you won't have histology going along with this to confirm that it is indeed renal cell carcinoma and 3) your father has concerning symptoms that are as of yet unexplained.Initial evaluation and staging vitally includes comprehensive labs (CBC, metabolic panel, LDH), abdominal CT with and without contrast, chest CT (or at least, but that's discouraged in the guidelines, chest X-ray) and a thorough physical examination and history.If there are any alarming signs on history or examination, additional imaging must be done. I'd consider vomiting, nausea and weight loss to be alarming. At least brain imaging (preferably MRI) should be done to exclude brain metastases imho.Also, when not performing a partial nephrectomy, which would be preferable to ablation if possible, an initial core needle biopsy to secure histologic diagnosis is recommended. Otherwise you won't ever know what kind of 2 cm mass they burned. The NCCN guidelines stateBiopsy of small lesions confirms a diagnosis of malignancy for surveillance, cryosurgery, and radiofrequency ablation strategies. Ablative techniques may require multiple treatments to achieve the same local oncologic outcomes as conventional surgery."}
{"text": "###Input :I did an in home vinegar test yesterday and the area he was referring to did NOT react. I did have a single spot react, but not the one he was referring too. The vinegar test has a high false positive rate so I'll talk to him about that, but still, the visible areas he could have been talking about DID NOT react.I want this guy to be sure i have HPV before he charges me to cut shit that's been there forever. I can take care of a skin tag for under $5 at home. And while I know it's incredibly common to have hpv I want him to be sure if I'm going to have to disclose that with future partners. Maybe I should see a dermatologist?What are some questions I can ask to make sure he's right? ###Output :Easiest and cheapest way is to post a picture here and Ill check it for you. Its a clinical diagnosis and honestly not that difficult to determine.Edit. Also, if you have had unprotected sex with > 1 partner, chances are you have been exposed to the virus."}
{"text": "###Input :http://imgur.com/a/lhCk8a4Again, its been there my entire life, including the skin bridge. I always assumed they were caused by the same shitty circumcision.To your edit: I've never had unprotected sex. That includes oral (not fun). ###Output :Doesnt look like a wart and your history doesnt really support that diagnosis either."}
{"text": "###Input :Bleeding vs. clotting risk - When is heparin bridging appropriate?Hi all, I am just a simple-minded EMT, trying to understand this concept for a family member who recently underwent surgery.The family member has chronic a-fib, which has been well managed with warfarin. He needed a trans-urethral resection of a bladder tumor (TURBT). His cardiologist said he should not be off warfarin for more than 72 hours, and his urology surgeon said to stop the warfarin 48 hours in advance of the surgery (meaning the plan was to resume the warfarin 24 hours after surgery). After the surgery, the surgeon said he was not able to cauterize all of the 'wound' (I am not sure the correct term here), so my family member had a good amount of hematuria, though the surgeon said it was not a life-threatening amount.He was supposed to take aspirin after being discharged, but they ended up admitting him due to a good amount of clotting in the bladder, which required daily irrigation. I am not sure if the nurses ever ended up giving him aspirin or heparin while he was off the warfarin. The surgeon seemed very concerned about the bleeding, and said that my family member could not go back on his blood thinners for another 48 hours after the initially planned resumption (which would result in a total of 5 days off the blood thinners).Now my question is, isn't it easier to fix a bit of bleeding than a blood clot (which could cause CVA, AMI, or PE)? Wouldn't it be better to keep him on blood thinners and handle the bleeding, than to risk a deadly clot?We would ask his surgeon, but it's sort of a foregone conclusion at this point as my family member has already been discharged. So, this is just for my personal education. Thanks for your insight. ###Output :isn't it easier to fix a bit of bleedingGeneral surgeon here. No, it's not always easier. Sometimes the tissues are just oozy, and you can't just throw a simple suture in or cauterize it and make it stop. Sometimes, the more you cauterize something thats oozy and inflamed, the more it oozes and bleeds on you. Sometimes, you just need to let the body do its thing and form a clot. So either you stop blood thinners for as small a window as possible, and accept the risk of developing a clot elsewhere, or you keep them on blood thinners and just let them ooze and ooze and ooze, potentially requiring blood transfusions, which then opens them up to other risks. Others may have other viewpoints, but this is from a surgical view."}
{"text": "###Input :Thank you.Do you always do a heparin bridge or is this contraindicated under certain situations?Does a patient history of a-fib affect the outcome of the risk calculus? ###Output :When considering the decisions here, you need to weigh the benefits and risks of anticoagulation.His stroke risk from afib can be estimated with the CHADS2-VASC score. Look this calculator up online. Most people stand an annualized risk of 2-11% of experiencing stroke. On a day to day basis, that risk is super small. Like 0.001% chance of having a stroke every day he's off anticoagulation, and even that is probably an overestimate of his stroke risk.The risks of bleeding are obvious. He's bleeding into his GU tract. This could occlude his bladder. He could bleed into the wound bed in ways that make his recovery worse. The chance of bleeding while anticoagulated is 100%.The last nail in the coffin is that we have multiple large and well-designed trials (BRIDGE and PERIOP2) that show no benefit to bridging pre or postoperatively in any population we've looked at this far, including mechanical valves in the post-op setting.At this point the only cases where bridging might be worth it is acute DVT/PE within 3 months of surgery, and maybe mechanical mitral valve."}
{"text": "###Input :What monitoring is usually needed when taking a patient off anti-coagulation therapy for surgery? e.g. CT scan, d-dimer?For reference, this family member's CHADS2-VASC score is 4.Thank you for your help. The CHADS2-VASC calculator definitely improved my understanding. ###Output :No monitoring is needed. The idea now is to resume anticoagulation once appropriate from a surgical standpoint. Not uncommon to wait anywhere from 5-14 days post-op to resume anticoagulation depending on how bloody the procedure was."}
{"text": "###Input :I (f25) recently was referred to the one stop urology specialist clinic for tests, but the specialist I saw refused to do any of the tests I was booked in for based on my age.Hi there! I am F25, around 8st (I don't weigh myself due to history of anorexia nervosa), don't drink, smoke cigarettes (have cut down, do not smoke heavily), don't use recreational drugs, and live in England. Previous diagnosis fibromyalgia ~5 years ago, ASD, c-PTSD, juvenile arthritis (age 14). I am prescribed quetiapine XL 200mg once p/day, naproxen as and when needed, promethazine hydrochloride as and when needed, cocodamol as and when needed. I also take a probiotic, vitamin D, iron, vitamin c, and a multivitamin all as supplements once p/day.I have recently been having a lot of medical issues, which my GP is trying to have investigated. I have petechiae all over both arms after sun exposure, internal pain in the chest, and incontinence with internal pain in the kidney area. Also, a year or so ago I had blood tests done which indicated my kidney function was lower than normal. I also have a lot of other symptoms, but these are presumably to do with fibromyalgia, so I won't list them. The incontinence gets worse in the evening and at night, where I am needing to urinate every 10-15 minutes. Pretty much every time I drink anything, I need to urinate straight after. GP sent a urine sample away for lab analysis, which showed microscopic blood in the sample, and protein. I was referred for an emergency CT scan due to the intense pain, which flares up and is not constant, but the hospital declined to do one (due to not having space, I think). I was then referred to the urology clinic for a four hour appointment.When I arrived at my appointment, I was told I would have an ultrasound, a flexible cystoscopy, blood tests, urine test, and flow rate test. After going back into the waiting room, I was shortly called back into the doctor's office. He told me that he would no longer be performing any of the tests I had been booked in for, except for an ultrasound. He did a stick test of my urine sample and told me I had no blood in it, but the blood from my previous sample was microscopic and was only found in the lab analysis, NOT in the initial stick test. I was told that, because of my age, I could not possibly have any health issues, and that he had people with possible bladder cancer who he could be seeing but wasn't able to as I was \"taking up [his] time, when others need it more,\" despite my time being booked in. He explained that the only issue I could have was kidney stones, and also dismissed my pain further when he found out I have fibromyalgia.I then went in for my ultrasound, which came back as no kidney stones. I was then called in and, to the doctor's surprise, told that I don't have stones (which I already knew and had tried to explain - I have had kidney stones in the past, and my recent issues have not been consistent with my previous experience). He said \"I'm a surgeon, I look for problems to treat. You don't have stones, so I can't treat you.\" I asked why I am having incontinence issues, and he said \"probably because you are a woman. It's common in women,\" and when I asked what I'm supposed to do about the awful pain for which painkillers barely touch the side, his best advice was \"get pregnant. Pregnancy often cures all sorts of illnesses.\" I was almost in tears at this point. My response was \"I just had a miscarriage in December. I've had two miscarriages,\" and he said \"try again.\" I said \"I don't want to,\" but he insisted this was the best idea. I also explained that my GP had said there could possibly be an inflammatory issue, and he said it wasn't possible to have inflammation without kidney stones or an infection. He also implied that my fibromyalgia is not real because he \"prefers not to label patients if [he has] no real evidence.\" He also stated that the only reason he was going to do any other tests in the first place was because if he didn't it would be \"sod's law\" and I'd actually have something wrong.I feel at such a loss. I was so devastated after my appointment, and still ended up being in there for 3.5 hours even though he refused to do any of the tests. Fortunately I had my partner with me, who was able to support me whilst I was sobbing in the waiting room. It's been such a long journey to find a GP who takes my complaints seriously, and have had years of doctors being dismissive. I genuinely thought I might begin to have some answers after the appointment, but I now feel like I'm just five steps back.Is it normal to be refused tests based on age and gender? Is anything he said to me actually true, as I feel like it was all completely dismissive? Should I request to see someone else, or will the same thing happen again? I'm honestly devastated, and concerned for my health. Any advice is welcome, I just want to know what the best way to proceed is, and if there is anything specific that I should be emphasising with doctors in the future to be taken more seriously. I tend to mask and come across as very polite, but maybe it would benefit me better if I acted less positive and worked harder on getting across the severity of the pain? Also, am I able to request any specific blood tests? If so, what would be recommended?Thank you so much for reading, apologies for the long post. ###Output :Medically he may or may not have been justified in not doing all the initial tests - one-stop clinics usually book you in assuming youll need everything even if thats unlikely to be the case. And your urologist is probably a better judge of that than the GP.However, the way you were spoken to is bizarre and clearly inappropriate. Id suggest you contact the PALS service for the hospital you were at and ask your GP to re-refer you to urology - perhaps another urologists outpatient clinic. PALS may also be able to help with that."}
{"text": "###Input :[8 F] Higher WBC than RBC?My 8 year old daughter had labs and her WBC was 8.8 thousand and RBC 4.76. These are both in normal range, but is it actually ok if there are more WBC than red?We do have two doc appts this week for follow up, but my pediatrician did not notate anything about this in the system notes, only made a note for her to increase zinc intake based on her slightly low zinc.She has a variety of other health symptoms that we havent figure out also, but Im just curious if this is specifically alarming.Im sure Im over thinking it. I definitely have some medical anxiety since my mother passed last year, which I completely acknowledge. Thanks for any input!EDIT TO ADD: Conditions- bladder area pain (working with urology), abdominal pain, sometimes has protein in urine, burning feet/neuropathy (new symptom- one month), urine leakage during daytime, pale/flushed face, general malaise ###Output :The units on them are different - the red cells are in millions per cubic millimeter, the white cells are in thousands. Everyone has way more red cells than white. When it comes to the specific numbers on labs, we don't compare them like that."}
{"text": "###Input :What about having 57% lymphocytes? Is that ok too? ###Output :Yes, totally fine."}
{"text": "###Input :Urology or dermatologyAge: 28Sex: maleHeight: 170cm (5'7)Weight: 66kg (145 lb)Race: AsianDuration: several monthLocation: Singapore. Condition is on penisNo other health issueNo medicationMy husband has a little bump on his penis for several month. It's several mm wide, there's a hole in the middle, and can see some black stuff inside. The black stuff is shaped like a thin disk. It does not hurt or itch or anything.We are planning to see a doctor in Singapore to check it out, but I don't know if we should book a urology doctor or dermatology doctor. Any advice? We don't have a general doctor.Thanks in advance! ###Output :Both specialties would be a good choice."}
{"text": "###Input :Concerned over 'Spironolactone' Rx for acne as a maleHello, (30y/o male).I was recently seen by an NP at a Urology center and during my visit my acne was brought up. She just got done some time working in dermatology. I had stated I was not comfortable with something like Acutane since I am trying to have kids and honestly that medication seems very scary to me from a health standpoint. She Rx me something called 'spironolactone'. Coincidentally I was seeing a male health specialist (an NP) the next day and he also brought up my acne and suggested 'spironolactone' out of the blue..Before I picked this up from the Pharmacy I googled it, because I like to know about medications and nowhere does it say this medication is safe or FDA approved for men. It's apparently outstanding for female acne, but as an androgen blocker, is not intended for use in men, and in fact a clinical study showed 100mg of daily use for 3 months in a group of 18 men, 8 of them developed significant gynecomastia..I called and canceled my Rx for spironolactone. I wanted to get an MDs opinion on this. I am a lay person so maybe I was just dramatic here. I am quite confused why two entirely different NPs, practicing in different states, would both suggest spironolactone (100mg a day) for acne in men..Patient History:Pituitary tumor which impacts my testosterone levels (sub 100) so am on 100mg of T a week. I have cut this down and am weaning completely off of it because I am currently 0.00 10x6 for sperm. NP just started me on 5mg of 'finasteride' (for acne due to DHT conversion maybe?) and HCG (0.75mg a week) to try and get that up. Another NP started me on Clomid and suggested I finished off the HCG (*I know, its not ideal to have two providers dictating care for the same thing - but NP #1 didnt know I was at a 0 and wanted to determine if I needed something like Clomid after the analysis came back but I dont see her again for 2 months).*I will say the IM testosterone has changed my life. I cannot explain how much better I feel. Its so profound I almost want to cry. Its like seeing in color for the first time in 20 years. I am sad / nervous to get off of it, but its for a purpose so I can handle that. ###Output :I have never heard of spironolactone being used for men's acne. Without good evidence, I use it frequently in women."}
{"text": "###Input :Reoccurring UTIHi just looking for some advice and what to know looking forward. Before Christmas I had a UTI for approximately 2 weeks, during this time I tried one course of nitrofurantoin (100mg twice daily) which didnt help at all, then two courses of pivmecillinam (200mg three times a day, with a loading dose of 400mg both times) which also didnt help. Eventually I was referred to urology who did bloods (normal), urine dip (positive for protein and blood) and ultrasound of kidneys bladder and ovaries. Scans came back completely normal and the urologist then prescribed ciprofloxacin 500mg twice daily for a week. The cipro seemed to have worked and I was fine over Christmas, but potentially still had some dysuria/frequency though a lot less than before. In the past few days symptoms have come back to the extent that they were before the cipro.Im going to pick up a new prescription for ciprofloxacin in an hour or so and its a 5 day course. Should I be concerned and see a urologist? Or is this just a UTI that wasnt fully treated so has come back?21F, Mixed African-American/White, 60mg fluoxetine daily, 75mg desogesterel daily, 40mg propranolol up to three times daily ###Output :you should probably see your urologist again who may want to do a full urinalysis and culture/sensitivity test."}
{"text": "###Input :Coughing up blood after surgery29M, 150lbs, 57. No medication, no drug use, a drink 1-2x a week.Hello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight. ###Output :Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED."}
{"text": "###Input :Thank you so much! Also, please let me know if you need more details/clarity on his medical history. ###Output :I'm not a urologist, but I imagine the recommendation was for a transurethral resection of prostate (TURP). Relatively routine from my perspective."}
{"text": "###Input :Hello, 23f, 56, 48kg, venlafaxine 37.5mg. For the past few years Ive been having microscopic blood in my urine samples with a few clear ones here and there but nothing has ever been done. Another symptom Ive been having for a few years is on and off stinging when burning and multiple urinations during the night despite not drinking anything. I remember even as a little kid though I would pee throughout the night.I have now finally been referred to urology and have a cystoscopy next week and a CT scan at some point. My other symptoms arewaking up with a full bladder in the morning which is painful almost like a period pain which stays for a little while after I pee.Microscopic blood in urine.Cloudy urine sometimesSometimes burning when I peeBelly feels tight most of the time idk if this is what feeling bloated isHaving to stop and start peeing towards the end to empty bladderPain deep in pelvis during sex sometimes, like that tight period pain (dont know if relevant)On top of all this I have agoraphobia and havent left the house on 3 weeks and now I have to go half an hour away for horrible tests so no idea how Im going to get through this. I suffer from severe health anxiety and Ive convinced myself I have cancer and Im spiralling out of control with worry. I dont know if this is relevant but I also had chlamydia 3 times when I was 17 (6 years ago). Im just hoping for some reassurance that not might not be cancer  ###Output :Could be stone issues, urethritis etc. Def not cancer. Go to your urologist appointments!"}
{"text": "###Input :Thank you, could I ask why def not cancer? I will try my very hardest to go ###Output :Too long history, none of your symptoms are signs of cancer and cancer is virtually nonexistent in your age."}
{"text": "###Input :So signs of bladder cancer are: Pain in lower abdomen Pain when urinating Frequent urination during the night Blood in urineAll of these I have? But I do see what youre saying about it being too long history ###Output :But they are not specific to bladder cancer. In fact, they are some of the most common symptoms there is. Microhematuria for instance, is almost to the point where im more surprised when a random f23 surgical ER patient doesn't have it than when she does. (Macrohematuria is another matter altogether).Health anxiety is difficult, and all I can offer is my perspective that your presentation does not in any way signify cancer."}
{"text": "###Input :[32M] Lung Nodule Time!Age 32Sex MaleHeight 6'0Weight 190lbsRace WhiteDuration of complaint: Just startedLocation: Lower Right LungAny existing relevant medical issues: DepressionCurrent medications: WellbutrinHello, everyone. I know lung nodules are typically nothing, but I can't seem to find a whole lot. And I know wait on my pulmonologist appointment to go over the findings. So naturally I'm freaking out anyway.So last year I had gallbladder surgery so I had a CT scan done. I had another one today for something related to urology and a swollen lymph node (everything fine there) and that's when it was discovered.From my understanding, they compared it to the CT scan from January 2021 to the CT scan today, and it was 1cm then and now it's 2.7cm. I was diagnosed preliminary with a lung nodule that has grown into a cavitary lesion by the primary doctor and he's referring me to a pulmonologist. I currently don't have any symptoms.I know it could be dreaded cancer but is there anything else it could be at that size? Most of what I've found online is people talking about 10mm or less.Thanks for any input. I am just looking for possible alternatives so I can focus on that and can sleep until my appointment.I am 32M. 190 lbs and 6 feet tall. I currently take Wellbutrin for depression. I don't drink, I don't smoke, I don't do any recreational drugs. I had asthma from around age 5 until 21/22 when it went into remission. I had pneumonia once when I was 5. ###Output :A growing cavitary lesion is most likely to be inflammatory, infectious, or malignant (probably in that order of likelihood for you). There is a long list of possible causes. Something that big likely warrants further investigation, potentially with a biopsy. The pulmonologist will be able to further narrow what the possibilities may be (heavily dependent on where you live and in-depth past medical history)."}
{"text": "###Input :Thank you. I'm in Alabama and the pulmonologist will have access to all my past records because I've stuck with the same facility pretty much my entire life. Tomorrow I will continue my good vibes going into this. Your answer helps alleviate a lot of the anxiety - I know how serious this is. I'll update once I know (pulmonary appointment hasn't been established yet) ###Output :Yea. I wouldnt be too stressed about it. Certainly something to get worked up further, but not something to lose sleep over or run to the ER about as long as youre feeling well."}
{"text": "###Input :Pregnant with kidney mass38 yo female 24 weeks pregnant (IVF) History of hydronephrosis (2017) 3.5 cm simple kidney cyst found while hospitalized for it as well as ovarian cystsI am currently 24 weeks pregnant, I had some pretty bad pain in the same kidney that I had hydronephrosis in years before. The pain only lasted for about an hour but I then had what felt like a UTI so I went to the doctor. My urine tests came back fine but my doc requested ultrasound of my kidneys given my history. I went and got it done and received a call the following morning to go straight to ER that I had an abscess so I did (4.7cm). My urine and cbc both came back ok and didnt indicate any infection so they sent me home with order for another kidney ultrasound in two days. I got that done and it came back complex mass 5.7cm with recommendation for MRI that I cannot get done while pregnant. I have been told that its ok to wait these 4 months but I cant help but be terrified in the meantime. I have an appointment with urologist in 2 weeks. What am I really looking at here? On a scale of 1-10 how concerned should I be that this is cancer? Google is really scaring me. I plan to have MRI while in the hospital after I deliver. What can I anticipate at the urology appt? Any insight is greatly appreciated. Thank you for reading. ###Output :Youll have to wait for the imaging study, but the wait shouldnt be a big deal. I prefer CT renal protocol over MRI, but maybe your urologist may feel differently. Based on the report its hard to say exactly whats going on. Theres no mention whether it is solid or not, which is critically important. Maybe just be a benign complex renal cyst. CT or MRI will clarify.Pelviectasis is minimal dilation of the renal pelvis. Based on your symptoms it sounds like you probably have a mild UPJ obstruction causing intermittent pain (Deidls crisis).Edit: spelling"}
{"text": "###Input :Hello everyone;This is my first ever Reddit post and I am finally turning to the deep dark web for some feedback.I am a 40yr old woman who has some medical issues and I have been my own advocate since July 2019. I am still waiting for a family physician for my son and I here in Canada - it's been too long without support.A little back story...I had my son in 2009 and in 2013, I had the lovely pleasure of having a partial hysterectomy - As a lot of you know these two things can cause the uncomfortable issue of incontinence. Well in 2018, after two and a half years of very uncomfortable sexual activity and very embarrassing incontinence mishaps I finally decided to see a specialist.After all the testing, my only option really was: TVT - which is the procedure where you have your bladder lifted in a mesh/sling. Surgery was unable to be booked as at the time my family had some changes and we had to move away. Finally after a year. I received a phone call from a specialist in the new area, and yet again due to some unforeseen family issues - I had moved away yet again to another area. So in July 2019, I started hitting the ground on my own. From that day I was going to walk in clinics for UTI symptoms (blood in urine each time usually every other month until September) - got antibiotics monthly and went on my way. Finally in September 2021. I had to change my tactics. My life was completely upside down, the pain and the symptoms were increasing and I wasn't getting anywhere. So I started going to the Emergency room. And started asking for referrals. I was there twice a month until March 17. I was confirmed to finally see a specialist for my case in June. However; I was still in the emergency room three more times after.Finally I have a specialist!!! How exciting is that? Finally I can get fixed! After a cystoscopy, I remember three things he said to me;-- \"You took that like a champ\" (loved this made me laugh, I thought he was funny) -- \"Unusual growths\" -- \"We'll fix you\"Had a biopsy surgery on June 20th. And then... I had to wait 4 weeks for my next appointment. Let me tell you ya'll I didn't think I had cancer, I am ill tho I know that. I have no appetite, I don't sleep because of the pain. I am wearing adult diapers because I have no control, and the blood is only sporadic, I am tired, I am anxious, I am nauseated, and sick sometimes. I hold a low grade fever of 99.5-101 daily it will not break.Heading to my results appointment. I was ready for a few things...Not CancerDo the surgery to lift my bladder and while in there they will check others to make sure I am ok everywhere else.Meds to clear up whatever is causing these fake uti's - cause every culture would come back negative. The ONLY thing I didn't want to hear was; \"I don't know what's going on, let's try these pills, and not do the surgery...\"This is what I remember about the appointment...I told him since he likes to make jokes and laugh I had one for him before we started... He said ok shoot.\"After my biopsy surgery you tried to poison me\". His reaction was inquisitive. I explained that I was prescribed Codeine pain meds and I am allergic and it's in file. He blamed it on one of his staff and then never replaced the medication either. (One reason I already lost trust)2. His exact words \"Yay you don't have cancer\".Kind of like the first meeting here is what I remember him saying...-- \"I made a mistake, there weren't actually growth in your bladder. You have a beautiful bladder. It was just murky from this infection.\" (Lost trust for the second time - you mean I didn't even need a biopsy surgery?!?) -- \"I did measurements of your bladder while you were in surgery because when you are under, your bladder is relaxed. And you don't need it lifted.\" -- I don't know what's wrong, but we are going to treat you with Overratve Bladder (OAB) with pills and a low grade antibiotic forever.  If in 3 weeks there is no change we will increase your dosage. NEXT ONE'S THE KICKER!!!! -- \"If that doesn't work I will refer you to someone SMARTER than me\". (Lost all faith - he had a diagnosis from a specialist he was choosing to ignore to what put me on medication he didn't even know as going to help me?!?)So ya'll I am not going to lie. I was angry, frustrated, confused and couldn't speak. I took the script and left. After I left, I was beside myself and totally confused. How one specialist 5yrs ago said my only option when I had NO infections or other symptoms, said I had to have surgery... Now I am 9yrs after a hestorectomy, and this doctor hasn't done half the testing to see about a prolapse bladder (which again was diagnosed in 2018).I called my original specialist, he told me I would need to be referred back to him but he was concerned with the fact that he is over 2 hrs away from me now. He advised me to request a 3rd opinion with someone locally.I can say that has been requested... Now how long do I wait for this 3rd opinion?I am seriously in so much pain. I suffer from fibromyalgia and that is the only medication I am taking, so I am unable to manage. I haven't slept in 4 days. I feel like my right hip/leg are going to snap off me. I want to BIRTH something. I feel like I am in that last push pain of birthing... Everyday ... All day... I have been on medications for 5 days. The only thing that has changed, is that I no longer have blood in my urine. That's it.I am tired... Am I wrong for wanting to have a doctor to just please do an internal ultrasound to see if it's prolapsed? I mean seriously I feel like it's coming out. But they won't do that testing at the ER, and this specialist won't do it. How long do I need to wait?!?Thank you for listening... ###Output :Incontinence is s vast vast subject, i can't give you definitive answers online.For a tvt one of the most deciding factors if it will help or not is the Marshall Bonney test (you know the one with the urologist inserting 2 fingers in vagina and lifting motion to full bladder and telling you to cough)Has it been done and what was the result?A tvt or tob isn't always the answer, it doesn't work for any woman, there is a host of urodynamics tests and pelvic floor, abdominal pressure etc etc....that need to be done beforehand.The cystoscopy is also a must before the tvt for multiple reasons i cant describe them all (limited English and time) one of the reasons for the cystoscopy to be done and under anesthesia is to relax completely the abdominal muscles so the urologist can apply pressure to lower abdomen and with other hand to look at the roof and forward wall of bladder so not to miss anything. Without anesthesia he will not be able to see clearly and make a good assessment of the forward wall and roof.The biopsie isn't necessarily done only by suspected bladder cancer but also to outrule something called interstitial cystitis which is somehow similar symptoms to uti with clean uricults.Also not all urologists are the same, some like working exclusively in a practice, work fixed hours, ultrasound, diagnostics, cystoscopy, small stuff. And they know urodynamics and incontinence stuff (diagnostics) much better than me.Others like me work almost exclusively in the hospital performing multiple surgical procedures daily and also doing oncall shifts for EREven in hospitals, some do like 5-6 renoscopie procedures daily, others do kids daily, others the lucky ones do mostly DaVinci robot assisted surgeries, others kidney cancers, others tur-p tur-b holep etc... etc......That's why you can always get a second opinion. A urologist who is good with kidneys and works that daily and is concentrated on the malignancies in urology will not be a good fit compared to a urologist who knows his pelvic floor good and all types of incontinence and meds and bands. Also OAB represents similisr symptoms and can be treated with meds, if tjey don't work and marshall bonney test is negative, then botox injection in bladder is an option that works wonders for someIf you can provide me result of marshall bonney test i can give you a \"guess\" if tvt is right for you or not. A trustworthy diagnosis i cant provide online.Tvt done unnecessarly not only it will not help but can lead to complete shut close urethra and acute urin retention, so we don't want to do unnecessary procedures that will make matters worse. Also there is conservative approaches like pelvic floor exercises which in some patients do work well.Also TVT/TOB procedures aren't emergency and don't get priority so right now the waiting list at my workplace is about 3 months minimum and if another covid wave hits, it will be delayed further.Another Tip: gynecologists are more than capable of placing a tvt or tob. Its not a complicated procedure. Fairly straightforward but carries risks but rare when done by an expert. So if you can get a faster appointment with a gynecologist then do it."}
{"text": "###Input :[ Please Help ] CT Scan Abdomen and PelvisHi , i am male . the doctor at the Urology hospital asked me to do a CT scan of the Abdomen and Pelvis. will be done next week. My question is, will this CT scan show a testicle report if there is a problem with the testicles. or it is a different scan. because the Scan is for Abdomen and Pelvis ###Output :Nope. Testicles can't really be seen on this kind of CT."}
{"text": "###Input :Were my father's doctors negligent?My father was in hospital being treated for a suspicious catheter bleed and a UTI. As part of this the urologists had stopped all his anticoagulation/antiplatelet medication and presumably because of this he suffered a large ischaemic stroke. He was admitted on a Tuesday and I first noticed the stroke symptoms on the Thursday evening when I attempted to call my father on his mobile phone and when I finally managed to talk to him he had severe aphasia and cognitive decline. I immediately called the ward he was on and told the nurse that this was a very sudden and severe change in my father's condition (my sister had been to visit him that afternoon and he'd been absolutely fine - I had spoken to him earlier too and he was fine then) and the nurse said she would call for a doctor to review him overnight and he'd also be seen by his regular urology doctors in the morning and they would better understand the changes in him. I called the hospital a further two times that evening expressing my concerns about him and that I was concerned he might have had a stroke.On the Friday morning I call him and obviously he was still struggling to speak and still sounding very confused but he was however able to follow along with a conversation. I call the ward and the doctor has bumped my father up to IV antibiotics and fluids. I'm told later in the day that he was sleeping for most of the afternoon and didn't eat much through the day.Then Saturday morning my older sister spoke to the nurse looking after my father again expressing how concerned we are about this major change in him and we're told she will get the on call registrar to come and review him again. Later I am told he's being given stronger antibiotics. Saturday evening my father seems to be improving and is once again eating normally, also able to speak a little better.Sunday morning when I call the ward I am told by the nurse that my father isn't very good and he has been sent for a CT scan because he was really messed up that morning, exceptionally confused, unable to swallow and his aphasia has gotten worse. I called back a while later and spoke to a registrar who confirmed that the scan shows that my father has likely had a stroke. That afternoon he was moved to a specialist stroke ward.Over the last few weeks I've spoken regularly with the doctors on the stroke ward and they seem pretty mortified that it took 3 days for anyone to think to order a CT to check for a stroke. It seems obvious to my sister and I that when we have kicked up a fuss and he's been seen by a doctor they have just assumed that it was delirium brought on by the UTI but according to his notes no one had considered any alternatives. So I'd like to ask, would you consider this negligence?Relevant info81MUKWhite British79Kg5'11\"Non smoker, no drugs or alcoholHistory - Alzheimer's, type 2 diabetes, metallic valve replacement and double bypass in 2011, diagnosed with kidney stone in late 2021, left side PCNL at beginning of February and recatheterised after a failed TWOC a few days after surgeryMeds - enoxaparin sodium 80mg twice a day, aspirin 75mg once a day, metformin 500mg two twice a day, gliclazide 80mg two twice a day, oxybutynin 2.5mg twice a day, linagliptin 5mg once a day, tamsulosin 400 micrograms once a day, donepezil hydrochloride 5mg once a day, colcalciferol 1,000 units once a day, bisoprolol 1.25mg once a day, atorvastatin 40mg once a day ###Output :Wait they took a guy with a prosthetic valve replacement off anticoagulation? How bad was the bleeding? Which valve was replaced? This is kind of concerning since mechanical valves need anticoagulation or else they clot and cause  you guessed it, stroke.Were they giving the enoxaparin and aspirin in the hospital??Obviously hindsight is 20/20 and perhaps it wouldnt have changed anything, but it seems like an oversight that no one ordered even a CT."}
{"text": "###Input :I'm unsure on which valve was replaced, I've honestly never thought to enquire. The bleeding wasn't really all that significant, at least that I saw, my father wasn't complaining of being in any pain either and originally I was told that bleeding without pain shouldn't be a concern - it was only when I noticed he was passing clots into his catheter bag that I was told to get him to hospital.They 100% stopped the enoxaparin but I'm not totally sure about the aspirin.Edit: after checking with family we believe it was an aortic valve replacement ###Output :From a US standpoint I agree with everything here. Is it worth having a malpractice lawyer look at this? Yes. Is there a clear delay between stroke identification and likely onset? Yes, it sounds like it. Is there clear harm done? Not necessarily. Im so sorry all this happened, OP. Its hard even if there is no mistreatment."}
{"text": "###Input :This is very helpful, thank you. Regarding the improvement and them seeing anything on the CT - the report on the CT only identified a single stroke and described it as sub-acute so I was told it was likely to have happened a couple of days prior. I thought much the same as you originally, minor stroke on the Thursday and larger stroke sometime Saturday night into Sunday but I was told no.I have been intending on getting in touch with PALS for a while now and this should give me the push I need, at this point I'm not even sure what the situation with the bleed was by the time the stroke happened. It's not been an issue since he was moved to the stroke ward and they resumed anticoagulation (high dose aspirin originally and then unfractioned heparin infusion). ###Output :One thing worth noting is that inflammation after a stroke is worst ~72 hours afterward. The worsening symptoms a few days later may have been related to swelling and inflammation."}
{"text": "###Input :Leukocytes but no BacteriaAge: 34Sex : FemaleHeight: 511Weight: 170lbsDuration of complaint: 3 weeksLocation: USAny existing relevant medical issues: NoCurrent medications: None currently, just finished a round of macrobid.Hey guys, I posted something similar to this in a micro group but things have changed since then so Im just looking for further advice.Almost 3 weeks ago, during a routine exam i showed moderate leukocytes in urine with trace blood. Id had no regular uti symptoms at all other than some pressure after peeing like once. No burning, urgency etc. According to my blood work I was also dehydrated. My NP, who is also my boss & friend, gave me a prescription for Macrobid and sent off a culture. I took the antibiotics for 3 days then I got the call that my culture was negative and to stop the antibiotics. So I did. From there it was back and forth because although I was still asymptomatic I still had leukocytes in my urine. So another culture was sent off - same results 25 - 50k cfu mixed urogenital flora okay cool. So what do I do? NP tells me to just finish the antibiotics so I did. I did get a micro UA done as well and it showed 5-10 wbc with few bacteria, mucus and epithelial cells but none of my urine samples were clean catch.On Saturday after finishing my antibiotics completely I took one of those AZO uti strips after a shower and it had a small purple speck in the middle of the leukocyte pad after 2 minutes. I text my NP to let her know and she sent me in yet another prescription for antibiotics.My concern is that Im not one to take a lot of antibiotics. Actually, I havent taken antibiotics in several years so I feel uncomfortable just taking them with no identifiable bacteria present. I do have a referral to urology but its going to take some time and Im worried about getting a kidney infection. I also feel as though my concerns arent being addressed properly because of my NP being my friend, so she doesnt run the tests she would on a regular patient (IE I had to bug her for the culture and micro ua because she just immediately wanted to give me antibiotics and call it a day).Thanks in advance for any advice, I know its a long read. ###Output :Asymptomatic leukocytes in urine, with no growth on a culture, from a sample that isn't a clean catch, is not a UTI and does not need antibiotics.Stop getting medical \"care\" from this person. Sounds incompetent. Get an actual PCP, preferably a physician.Urology is gonna be scratching their head on why they have this referral."}
{"text": "###Input :Why are small kidney stones worse than my larger one?Female, 38yrs old, bilateral nephrocalcinosis, no other health concerns and only medications are acute pain relief (30mg codeine & 500mg paracetamol combined tablets at 2 per dose, Tramadol 100mg, Diclofenac suppository 100mg, Buscopan 10mg). Currently in absolute agony.8 weeks ago I passed a 4mm stone that was exceptionally painful. Worse than my unmedicated child birth. That pain started around 7am but by 5pm I had passed the stone. It was horrific, more intense pain than I currently have but at least over in less than 12hrs.I had a CT scan and a follow up call from a urology nurse informed me I only had very small stones, described as like gravel left. No treatment or management plan - just a follow CT in a year.Which would be fine but for the past 2 days I have been in agony in my right kidney. Im on maximum doses of all my home pain relief and Im getting breakthrough pain every 2.5-3hrs.I would love to understand why this is more drawn out than my bigger stone? Im drinking large amounts of water to flush it/them out but Im not passing much urine at a time and theres a lot of blood in there too. I think I could cope better if I knew why this was taking longer or if I could work out just how long this was going to go on for. Urology nurse was very terse and basically just said Theyll pass without intervention. Just take your pain relief.Grateful for any insight/ideas x ###Output :Not a urologist, but we deal with similar issues in the bile duct. When it's a single stone, it is very easy to pop out because there's nothing else obstructing or limiting its dislodgement. However, when the bile duct is full of sludge and copious amounts of smaller stones, it's like trying to pull out a tube full of thick gravel or sand and extraction becomes a lot more tedious and prolonged. My guess is that it's just difficult for the gunk to move through your ureters because it's somewhat clogged up."}
{"text": "###Input :Cant stop peeing blood! Help!Hi everyone! Please let me know if theres any other/better places to ask this but I didnt know where else to go. I am going through hell and feel so embarrassed talking about my bloody pee online but I have gotten blown off more times than I can count. I am 22F 59 with no prior history of UTIs and I have been peeing blood for TWO WEEKS with extreme pain! It started out full and just generally lower abdominal pain, but now Im starting to feel occasional sharp stabbing pain in my side/back which is making me think its my kidneys. Heres a timeline of how all of this has gone:1/2/22- notice blood on the tissue when I wipe for the first time, freak out, schedule an appointment with my GP1/3/22- I go to my doctors appointment, she tests my urine and finds high white blood cell count (infection) prescribes me 5 days of macrobid1/6/22- bleeding gets heavier and abdominal pain gets worse1/8/22- finished my antibiotics, still extremely ill, more pain more blood, I start running a low grade fever and throw up1/10/22- I go to an urgent care, blood found in urine but no signs of infection, gave me a shot of ciprofloxacin and sent pill form home with me, told me if it gets worse to go the emergency room1/12/22- after never noticing a difference in pain or blood I go to the emergency room. They test my blood multiple times, take urine sample, and do a CT scan. My blood work shows elevated white blood cells and elevated high lactic acid levels. They send me in for a CT scan (no contrast) and dont see anything. I get sent home because nothing is in my CT scan and get told if the pain gets worse come backI am in a lot of pain and I dont know what to do. I am STILL peeing blood and having awful pain. I have a urology appointment tomorrow but I dont know if I should wait or go back to the emergency room. My back keeps having these painful twitches and I cant stop shaking. The nurse who discharged me said she thinks its interstitial cystitis and it is an infection that is curable that you treat with antibiotics. I looked it up and thats flat out not true. Other nurses had said all night it seemed like I had a kidney infection, and thats honestly what it feels like. What should I do? ###Output :If they did basic blood work, urine tests, and you haven't had true fever, then you probably don't have a kidney infection.Did you original urine sample ever grow anything in the culture?Do you urine results show blood +? Do they say if they specifically see RBCs or not?Edit: include the actual lab info if you have it availableIt kind of upsets me that the CT A/P was done non con. I guess maybe they were looking for stones... But still. You cannot reliably comment on pyelonephritis on a non con CT.I'm sure they were hunting for stones. Shouldn't really need CT imaging to make pyelonephritis diagnosis.Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. This includes medical students."}
{"text": "###Input :How urgent is urinary problem?40F, 5'7, 205 lbs, Caucasian.Primary complaint: blood in urine, lower abdominal painHx: Neurogenic bladder from fall in 2009, Intermittent catheterization. Hx of kidney stones, UTIs. Partial loss of feeling due to nerve damage in abdomen. OA/DDD with SCS implant.Painful cath 4 days ago with strange pinkish red tissue string in toilet.3 days ago Pain in right flank/lower back attributed to too much dancing the night before.Yesterday, orangish tinted urine, blood suspected.Today, bright red blood in urine and a strange feeling in my lower abdomen, which I would describe as pain-like.I moved states and have yet to fully establish care locally. I have not seen my primary or urology. I did see a resident yesterday for medication refills, who ordered blood work and a UA for my primary care appointment next month. The blood work is to be done in a week or two to get me back to full strength on my lithium.My question is: should I do the UA today and wait a few days for results or should I go to urgent care?Medical issues: Osteoarthritis, SI joint dysfunction, neurogenic bladder, Bipolar 1 Disorder, anxiety, PTSD, migraines, recurrent Varicella zoster, IBS-DMeds: Lithium 900mg daily Levothyroxine 50mcg ac am Metformin 500 mg bid (for weight loss) Prazosin 6mg nightly Trazodone 200mg nightly Tizanidine 4mg 1 tab am, 2 tabs qhs Alosetron 1mg bid Voltaren gel CannabisSmoke 1 pack/week, drink 1-2 drinks couple times a month (including the 2 heavy drinks night this began), No street drugs.Any light shed on the urgency of this issue would be awesome! Thank you all! ###Output :Sooner rather than later. Urgent care may not be that helpful unless you're pouring out blood or you're obstructed from a blood clot. You should do the UA soon. The only specific reason I'd go to urgent care is if you think it's a UTI which of course is possible given you intermittent cath.The bleeding could be trauma or a stone but the worst case scenario would be bladder cancer, especially since you have a smoking history. A work-up is definitely needed if the hematuria is persistent."}
{"text": "###Input :How to talk to my daughter's pediatrician about a concernUPDATE: The appointment went as expected. The pediatrician wasn't too concerned because she was still able to eat and \"looked fine\". So I took matters into my own hands and gave her a total of 6 doses of Miralax starting on Thursday. She had MAJOR success yesterday afternoon and finally ate a whole meal.Hi docs, I need advice on how to talk to my daughter's pediatrician about an ongoing kidney & bladder infection without sounding like a crazy mom. She's 12, 52 inches, and now weighs 87 lbs (from 98 lbs).She first became sick on Aug 25th, with fever and vomiting. The first dr visit was diagnosed with a stomach bug and period cramps. Ended up at the ER a few hours later with a temp of 103.7. ER ran tests for hours. Urine came back good, bloodwork showed an infection. After several tests, the conclusion was a kidney infection. Sent home because there were no available beds. This went on for 4 more days, in and out of the ER. After 8 days of yucky, she returned to school.On Sep 20th, I got a call from the nurse to come and get her. Temp was 102.7, BP 90/49, HR 125 and she was vomiting brown. Took her immediately to the ER. ER put her in PICU to treat the kidney and bladder infection. She was in the PICU for 6 days and step down for 3.Went to her pediatrician for the follow-up. She did bloodwork and ordered ultrasounds. Bloodwork wasn't so great. I picked up the ultrasound report and the report stated there was a fecal impaction. I asked the pediatrician, she told me to give her Metamucil and sent me off to a urologist.We had the 2nd urology appointment on Tuesday. The fecal impaction was brought up again when she was going over her (the urologists') ultrasounds and cystography. I asked more questions about this impaction and was told to give her FiberCon or Metamucil. She still has kidney and bladder infections. Urologists put her back on antibiotics.I have an appointment with the pediatrician this week. I really need to seriously discuss this fecal impaction. I have been giving her both Metamucil & FiberCon for about 22 days now. And have given her Milk of Magnesia a few times. She has not had a bowel movement (a small amount) since Wednesday.I have picked up all lab and radiology reports from 2 hospitals and 3 different doctors. The CTs on Sept 1 and Sept 20th note the impaction. Ultrasounds on Sep 22 and Oct 7 also mention the impaction. And now, the urologist mentioned it on Oct 26.She is still not feeling well and not eating much anymore. This morning her temp was 96.9, BP 103/53, HR was 65, and she said she was extremely tired. I logged in to the portal this morning and received Friday's blood and urine labs, neither are great news, but there is some improvement.How do I approach the pediatrician with all this information without sounding like a crazy paranoid mom? Or maybe I am and this is not a major concern or issue? I have asked about this and feel like I was brushed off. I feel kind of crazy as it is because I went to all these places and got the records and put it all together. Thank you. ###Output :First of all, don't ever worry about how you come across to a doctor when you're talking about literally the most important thing in your life - the health of your child. I have parents tell me all the time \"OK, don't think I'm crazy.\" I never do. I go out of my way to tell them I don't think it's crazy and that the reason we're talking is to make sure we're all on the same page and we're both comfortable with the plan.Just express your concerns honestly and in a straightforward way. It is literally their job to help you navigate something that evokes a strong emotional response. If they can't do that, they aren't a good pediatrician. (But thankfully, most pediatrician, in my experience, are excellent at this).As far as the fecal impaction, Metamucil won't cut it. Rectal fecal impaction is a common cause of UTIs, especially in girls (who have shorter urethras than boys). I usually use the big guns - like a Miralax cleanout or a Mg citrate cleanout. Basically the same thing we would do before a scope. This usually helps you start over from ground zero and then you can work on keeping her poop soft with Metamucil or whatever else you think works for her on a daily basis (Miralax is still my favorite for this too)."}
{"text": "###Input :Granma here, just wondering...no enemas, these days? ###Output :Enemas work great, but dont go too far up. Cleanouts from above take care of the whole problem at once."}
{"text": "###Input :Alcohol Flush Response. If not allergy, what could it be?44M WhiteAbout 3-4 years ago I developed an alcohol reaction. I can have a single drop of alcohol on my tongue and end up with a bright red, itchy and hot face, and I would sweat. I do not get chest pain. Often, if I ignored then the issue would disappear quickly (10 mins). Often, I could continue drinking and be fine.Sometimes the same alcohol would not do this another time (e.g. same drink one week vs next).I have been tested (23&me) GG for alcohol flush syndrome and am fine.I saw a GP after seeing a post on reddit where someone said something similar and everyone told him it was lymphoma. The GP checked me and said I was fine. I have no weight loss, no night sweats, no obvious lymph node issues.I spoke with an allergist and they said:\"These reactions are unlikely to be an allergy as it does not occur every time alcohol is taken and also disappears after the first initial reaction.It might be due to the histamine in the alcohol, or even the presence of sulphites, but if this were the case then the reaction would be maintained throughout the period that alcohol is consumed.We do see people who have had reactions to alcohol, to rule an allergy out, but rarely is an allergy the cause.\"I am currently on betahistines for something else, and have no reaction, so I don't think it can be histamine allergy, and I have tried some drinks which say \"includes sulphites\" and have no effect.Last year I have had some urology issues (difficulty peeing). They did not get to the end of it and told me I had 'shy bladder' - I disagree, but I was told I had an enlarged spleen after ultra sound, but later told I did not.So, what could this be if not lymphoma or allergy? My GP is not being very helpful, but it is really affecting my mental health and I am worried a sign of something else.I do not drink any longer. I am currently dealing with a new thing, vestibular migraine, and this is all swirling around in my head. ###Output :A transient effect like this seems more likely to be an autonomic response, which would be very difficult to diagnose and there aren't any tests for it. This sort of thing usually goes away after a few minutes.You might still have an alcohol flush response, despite \"normal\" genetics from 23&me. There are more genes that have been described recently. The only way to know for sure is to do an acetaldehyde breath test, but this isn't very widely available."}
{"text": "###Input :Total loss of bladder controlWhat would cause a complete loss of bladder control in 17 year old with cerebral palsy. Yes he has cp and thats what his primary wants to relate it to, but hes been in control since age 8 and now suddenly, theres about a 2 second warning before he goes. Sometime he doesnt even know he went. Cp is non progressive. Last 2 months there has been 5 separate episodes of blood (not from urine) in his brief in the morning. After standing for sometime and then sits, he feels a slight pain in the groin area. Urine was cultured, no bacteria was found, only microscopic blood. Referred to nephrology and his kidneys are good but his compliment levels were low. Doc thinks from having COVID in November. Testing again in 2 months. Next step is urology. Thanks in advance for any insight....Edit: he is now being followed for increased hemoglobin and hematocrit in RBC ###Output :How severe is his cerebral palsy? Is he ambulatory? Is he bed bound? in children with significant skeletal deformities or minimal ambulation, kidney stones are very common. These can cause blood in the urine and the urinary incontinence that you are describing. You need to go see a pediatric urologist for evaluation. First step should be checking for a urine infection, but after that imaging with an ultrasound or CT scan is likely the next step.Moderate spastic cp, wheelchair yes, but can walk with a walker short distances. He did have kidney and bladder ultrasound that was unremarkable. He also had a urine culture that was clear of bacteria. Thank you for your repl"}
{"text": "###Input :Can CT Scan without Contrast IV detect Pelvic/Abdominal Cancer22m, 220lbs, 5'6. No smoking or alcohol use.Got a CT scan from ER to look for kidney stones and they found none.Quote the patients case was ultimately discussed with urology who agreed with further evaluation with CT abdomen and pelvis to rule out renal and urethral calcinotic/renal pathology. The patient demonstrated no signs of acute intra-abdominal renal pathology. Urology advised to follow up with non-urgent cytoscopy\"Im currently experiencing a lot of dull abdominal pain and worried about potentially having cancer in the pelvic region.For 3 months Ive had lower abdominal pain, frequency urinating, pain when urinating, urethral pain.I have no signs of kidney stones, leukocytes or blood in urine. Ive tested negative for bacterial STDs as well and even Hep B and C, Syphilis, HIV at 3 months. ###Output :To answer your question, a non-contrast CT scan does not rule out cancer in the abdomen/pelvis, barring a huge mass or obvious metastases. In fact, even a contrast enhanced CT scan is not very sensitive for several types of cancer.You should discuss with your physician whether or not additional imaging would be warranted. I don't know much about your history but in general, it is exceedingly rare for a 22 year old to suddenly develop some sort of intra-abdominal malignancy."}
{"text": "###Input :What would be used to rule out cancer then? ###Output :Again, I would recommend discussing this with your physician (either primary care or the urologist). We generally do not recommend blanket scanning everyone with CTs and MRIs for non-specific abdominal pain especially in young patients, unless the clinical history warrants further investigation (it's not because we mind the extra work; it would be comically easy to read a bunch of negative studies all day and charge for it).Laypeople and even people in the medical field tend to assume that imaging is a magic answer box, but it oftentimes is not and the potential benefits of imaging may not outweigh the risks/costs."}
{"text": "###Input :Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th. ###Output :How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder/ureter/renal pelvis, rarely but possible with RCC or a urethral caruncle"}
{"text": "###Input :Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued. ###Output :n a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues."}
{"text": "###Input :Complex Cystic Mass 8.5 cm x 5.9 cm x 5.0 cm - Left KidneyYesterday I had an ultrasound of my abdomen as I have had intermittent pain on my right hand side by my gallbladder and liver. I did not expect this result, but now it makes a bit of sense as it is probably pushing things over to the right which is causing my pain.I am a 38 year old female.Symptoms: Tired a lot, Full easily, Nauseous oftenLEFT KIDNEY: Normal size. Normal echogenicity with no hydronephrosis. In the left mid kidney there is a complex cystic mass with several septations and which have internal vascularity and areas of mural nodularity. This cyst measures approximately 8.5 x 5.9 x 5.0 cm.I am having difficulty getting a Urology appointment soon as everywhere is booked up until March or April. I have reached out to my primary doctors as well, but I am curios about what my next steps should be.What should I be eating? What should I be doing while I wait for my appointment? What should I not be doing?What tests should I have?I am assuming due to the size it may need to be surgically removed. Is that generally the outcome?Thank you. ###Output :Nothing really to do or not do in the meantime. You can expect that they'll want to do an MRI or multiphase CT to see if there are actually any nodular areas that enhance with intravenous contrast, because that would be suspicious for a cystic renal malignancy. If so, these things tend to be really slow-growing and amenable to just being surgically removed with curative intent.Regardless, I don't think the cyst is causing your abdominal pain and was probably just found incidentally."}
{"text": "###Input :Low right side front abdomen and right lower back pain (kidney?)Age 43 Hawaii Male UsaSo 3 or 4 months ago after a scan someone out in a Urology referral with no other notes other than hidden away positive for nephrolithiasis.Ive had this pain right where my kidney is. It becomes moderately painful after doing moderate work and takes a couple days to settle down.Is this still potentially a stone or would it have passed because of the time frame? ###Output :Stones that remain in the cavities of the kidney will grow and recede based on things like pH and ion concentration over time. They are relatively normal to find, particularly as we get up there in age. They almost never symptomatic, unless they break off and get lodged in the ureterat which point its very symptomatic. Its hard to say what the sensation that youre having is; sounds like its causing a pretty significant obstruction for you that would be worth seeing your PCP about to get it worked up."}
{"text": "###Input :Coughing up blood after surgeryHello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight. ###Output :Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED."}
{"text": "###Input :27Female unable to walk, urinary retention, gastroparesis27 year old female, weight:57kg, height164cm. Previously diagnosed with autism, pernicious anaemia, iron deficiency, epilepsy, POTS.Taking Wellbutrin, lamotrigine, clobozam, vitamin d, iron, vitamin b12 injection, pantoprozole, and now because of gastroparesis I am taking domperidone also gravol IVI have leg weakness and my legs feel heavy and like they will give out on me. I have diminished feeling in them but the EMG came back as completely normal.I had an MRI and an MRI with contrast and it showed a disk bulge effacing the anterior disk space and moderate to severe narrowing of both neural foremen on disk L5/S1Disk protrusion which is mildly protruding into the thecsl sac and causing mild stenosis and mild neural foramen narrowing on L4-5I have gastroparesis which was just diagnosed during this hospital stay. I was vomiting almost everything I ate (which wasnt much because I got full so quickly) and they did a gastric emptying study.I have urinary retention meaning that I am unable to start urinating and it caused me to retain over 2L of fluid. I am currently catheterized. A urologist wouldnt see me because they believed it was a neurological problem but neuro suggested I see urology.I have a lot of the symptoms of Ehlers danlos syndrome as well (hyper mobility type) such as hypermobile joints, hyper elastic skin, soft, easily bruised skin, dislocations and TMJ disorder (which have caused jaw to dislocate many times).I have not been diagnosed with this yet but could the leg weakness and other symptoms be caused by ehlers danlos or is there something else we (the doctors and I) should be looking at.I am doing Physio and am getting a bit better at walking but my weight is mostly in my arms and so my legs dont give out I have been using a chair for the majority of the time here and walking with Physio using a walker. Im really unsteady on my feet and have a hard time controlling where my feet go which is making it hard to walk so I can only do pivot transfers.I had an ultrasound done of my abdomen/pelvis and am not sure the results yetDoctor is referring me to an EDS clinic because no one here knows enough to diagnose me ###Output :Really depends on what the neurological exam shows."}
{"text": "###Input :Made an appointment with a urology office to discuss getting a vasectomy, was told that the initial consults are with a nurse practitioner and not the actual doctor performing the procedure. Is this common practice?I'm assuming I won't even be meeting the doctor until the day of the procedure, which I think is kind of strange and makes me even more nervous than I already am. I know doctors are spread thin and minor procedures like vasectomies are probably low on their list, but I would at least like a few minutes of facetime with the guy that's going to be working on my junk... ###Output :That's typical for many offices. If the doctor is meeting with everyone individually, then that's a lot fewer procedures they can do. Just the way healthcare works in the US."}
{"text": "###Input :21M URGENT UROLOGY HELPI was masturbating excessively yesterday and during / right before ejaculation I lost all hardness and my penis became flaccid, stretchy, and curved to the left. My left testicle is also much more lower now and the right one doesnt doesnt move as smoothly. I basically cant really feel my penis anymore and its hanging very loosely downwards, as are my testicles. I saw a urologist right after it happened and he dismissed any fracture since there was no pain upon inspection and said everything was normal. My penis doesnt look, feel, move the same and i can no longer get a hard erection, the most i can get is a semi erection very loose penis with a 60 degree bend to the left side. What should i do? Had to add that my penis has become much more fatter maybe swollen?, and much more veiny, and has its flaccid size has increased, also scrotum shape is very weird and wrinkly. ###Output :The only thing that sounds abnormal to me is the bend in the shaft of the penis. I'm not a urologist, but if you were unhappy with the urologist that you saw, I would recommend you seek a second opinion from another urologist."}
{"text": "###Input :Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th. ###Output :How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder/ureter/renal pelvis, rarely but possible with RCC or a urethral caruncle"}
{"text": "###Input :Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued. ###Output :In a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues."}
{"text": "###Input :Urology vs. Nephrology28M, White, No drugs, Social drinker, no tobacco, 2 days kidney painIve had kidney pain for a couple of days. I went to urgent care this morning, but they unfortunately have no lab or imaging capability. They were able to dip my urine and detect blood. I have had no urinary symptoms. Theyre sending my urine for cultures (3 day turnaround) and also referring me to an outside facility for CT (unknown turnaround time).I am in need of a provider that is able to find the problem (and hopefully solution) sooner than later.My only question is, do I need to try and get an appointment with urology or nephrology? ###Output :Urology"}
{"text": "###Input :Just got a worrying looking letter in the post following an ultrasound for varicocoele. Is there a urologist here that can help me translate this? (UK) Urology Cancer???Age 33Sex MHeight 6\"1Weight 74kgHi All,Im based in UK. Just got this letter but I dunno what it means. Its from the Urologist to my GP that I've been CC'd on so it doesn't make a lot of sense to me. I could wait until I actually hear back from the Doctors but obviously I'm a bit worried now having read this so I hoped someone here could explain it to me. Here are the headlines:'His PSA is at 0.65''Ultrasound scrotum showed left scrotal varicocoele, bilateral mild hydrocoele and of note he had an ultrasound of the urinary tract which showed normal kidneys, a residual urine of 400ml and a soft tissue mobile non-shadowing focus within the bladder which is avascular on Doppler. This is unusual and I am going to review this in our MDT.''We will review him in our MDT urgently.'I have done an ETCI for a flexible cystoscopy'.Can someone please translate this for a layman? Many thanksI've just googled that the MDT is the 'Multi-Disciplinary Team (MDT) consists of a team with specialist training and experience of the diagnosis and management of Urology cancer'. ###Output :You may have a funky mass in your bladder and theyre going to stick a camera up your penis to get a better look at it."}
{"text": "###Input :Mobile means its moving around, which is a good sign in general (means its probably not growing from your bladder). The most likely culprit in these scenarios is a bladder stone. The fact that its nonshadowing makes it unusual because most bladder stones have calcifications that shadow. In any case one has to go in with a camera to take a look at it and do something with it. ###Output :By \"mobile\" I'm not sure whether they mean like rolling all around the bladder (which in this case sounds like it would be a blood clot, not a stone), or an actual soft tissue mass that is swinging in the breeze but attached to the wall by a stalk.MDTs are used for anything complicated or unusual, not just for cancer."}