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If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi. I m 13 & have been having migraines since I was 9. I didn t get them very often, but when I did, my right side would tingle and then go numb. Like, the whole side from the shoulder to my feet. After 2, I had a urine test, whicChatDoctore back normal. I had only 2 up until 1 month and a half ago. I was getting migraines everyday, always numb, and would frequently vomit. 3 weeks ago, my mom took me to the doctor who immediately got me to get a blood test, which almost made me pass out. I was recommended to a neurologist who said my symptoms were typical for a migraine patient, but that my numbness was abnormal. She got me an MRI/MRA. The radiologist sent a man to the waiting room with a phone, and gave it to my mom. There was a nurse on the other end who told her they were starting an IV on me. She took more pictures, and then sent me out. My mom sent me away, and later told me that they found something on my brain, but by policy, she couldn t say what it was. She took the second set of pictures because she and someone she consulted wanted to be sure they saw something. That was Friday, and tomorrow (Monday) the neurologist will call and we will make a plan. What could it be? I get nauseous as well.. And I don t know if this is related, but lately, I cannot breath right. Like, I ll be breathing fine, but out of nowhere will feel like I m not getting enough Oxygen. It s become more frequent that I feel like I don t have enough air. I m athletic, and eat healthy (for the most part). Should I be worried about what it could be? Oh, and she put me on anti-depressants (a fraction of the actual dose) because it should help my headaches go away and help me sleep. It does help me feel a bit refreshed when I wake up. She said I was too young for the actual migraine medicine, and that sometimes medicine for other things help for other conditions. ### output:

Hello. I am Chat Doctor. I have read your message. I think I can help you. Your symptoms are highly suggestive of what is known as "hemiplegic migraine". In this, your symptoms of headache are associated with other neurological features. I am assuming your sensory symptoms are located on one side of the body. In this condition, the MRI does show changes which are similar to that of stroke. So yes, changes are there, and you need not worry-they are basically signs of what has been happening. As for the medicine, if you have too many headaches, neurologists start a medicine that reduces the frequency of headaches. In your case that is also needed because every time you develop the sensory features or other neurological symptoms, the MRI gets affected. This in log term can affect you wrong. So the attempts are to reduce the frequency of headaches. And sometimes, if taken sincerely, it can work wonders. I hope this informs you about everything you need to know. Once you know what exactly is happening, I am sure you will be able to understand what is going on. That should help you relax. And it should help you manage your migraines more easily. I have tried my best to make it simple for you to understand. Do understand that there is a lot more to the subject than just this. In case you ant to know more about it or if you want to clear any doubts about what I have mentioned, feel free to ask a follow-up query. Best wishes,

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I ended up tearing a right shoulder muscle and ripped some cartilage around my elbow. The pain was intense and my regular physician gave me a toradol injection for the inflammation and 6 days of Prednisone. My BP was to almost 190/100. Usually I am in the 100-115/55-70 range despite smoking. The pain got worse the next day and since I felt my BP elevate as well, I went to the ER. My BP was 249/110 and they took me to an ER room. The doctor was ordering MRI s and when I told him I was on workers compensation, he suddenly decided that all I needed was xrays and only for the right shoulder at that, as if soft tissue damage will even show clearly on xrays. He kept saying I worked for WC, you can have them do all those haha. I am going on year 9, and it took 3 years to get one body part accepted while after 9 years, I still litigating over other injuries. Anyway, he left me there for 25 minutes after I had 2 techs get xrays; he speny maybe 90 seconds with me, saying this is an ER, I don t have time to listen to all your problems when I was trying to tell him what had happened. He put down calcific tendonitis (misspelt it as well), torn muscle, and elevated BP on the report. Then a nurse came all grumpy, telling me to take a clear grl yhst eas roughly the shape of a 1,000mg fish oil but had a yellow/orange color. I asked him what he was but all he told me was we give this to everyone with high BP . And they read my vitals again which showed 182/5minutes later. He adked the doctor if they should release me, and when the doc said yes, that was it. The ER was at maybe 20% capacity while the doctor eas sotting at the nurses station and chatting away with a nurse. It has been 5 days and my BP never shot above 140. However I have this dull, almost bruised feeling on my left back, right around the 5th rib which feels like a bruise. It almost feels as if it is under yhe bone and cartilage, and straight on the heart but I can t really tell and nothing makes it go away. I wasn t checked or even asked if I displayed any heart attack symptoms or anythong else other than you can get WC to take care of that . Is it possible that the high BP may have caused something or even bruised my heart somehow, or is it possible that I may have had a minor heart attack? My BP was over 180 for 2 days straight, especially considering it rarely goes above 130. And now that I checked thr online patient portal, my 240+ intake BP has also been removed from the transcripts. I am one step from filing a complaint for alst letting me die. ### output:

Hi, You had elevated blood pressure because you were taking Prednisone. Medications like prednisone, steroids, have a side effect of causing high blood pressure. But you should check your blood pressure also after stopping prednisone, as it is possible that you had slightly elevated blood pressure from time to time and you didn't know about it, and prednisone just made it worse. Your pain is related to your muscle and cartilage problems, don't worry, it is not a heart issue. Take fearsome back if you have any further questions

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Spinal History: 37 years ago someone crashed into the rear of my vehicle. At that time my doctor told me that my neck was completely bent in the wrong direction (due to the accident), and that if he did surgery there was a 50/50 % chance that I would be paralyzed from the neck down. Obviously I chose to live with the pain and on/off numbness of arms/legs (as my husband and I had five children to raise). 22 years ago, I woke with neck spasms that occurred about every 3 minutes 24/7; the pain being so bad that it brought me to the ground (you could actually see the muscles in my back/neck moving). My hands were going numb, and it felt as if someone were ironing my left arm with a hot iron. (My doctor told me at that time that my entire spine was degenerating, due to the prior accident, and although I was still quite young, that I had the spine of a very, very old person. 3 weeks later, I was FINALLY referred to a neurosurgeon. He saw me at 3PM one afternoon, and immediately scheduled surgery for the next morning. He performed a nine-hour surgery, fusing sections C5/C6/C7 together with part of my hip (no titanium plates back then). Although I have not had the excruciating pain that I had before my neck fusion, I have continued to have back pain (neck, mid back, lower back - due to the degeneration of my spine). (I haven t been pain free for over 37 years.) Although MRIs clearly show narrowing, I ve been told it s not enough for surgery. In the past 10 years I have endured having electric needles stuck into several of my nerves (on two separate occasions), physical therapy, injections into my spine (injected from the base of my spine to my neck, where the injection was released), pain meds (which I refuse to take because they are addictive), and nothing is helping. Even the injections into my spine only give me a day of relief. FYI I cannot take ibuprofen (it ulcerates my stomach), or aspirin, which causes me to have hematomas. Now the fingers of my left hand are going numb, as is the inside of my left forearm. My neurosurgeon is now retired. Is it possible that the numbness is being caused by my neck (my understanding was that the nerves to my fingers were in C7). On top of that, if I bend over, sometimes I can t get straightened up right away, and then have really, really bad pain in my low back/hip area (sigh). I am a short, petite person (size 2/4), and have tried to keep myself physically fit; however, I cannot exercise without increasing the pain. Someone told me that Botox was being used to treat neck pain. Does it have lasting results? Please advise. ### output:

Hi there, it seems you have provided a detailed history of illness which is fair enough to help you with some options. Botox is not a permanent solution. As per my practice I will recommend you to try doing breathing exercises, little strengthening of your neck muscles, trapezius, triceps and deltoid muscles. Regarding your lower back and hip. Kindly strengthen the core muscles and gluteus muscles to have proper support. Focus on taking advice with a physical therapist and then onto an orthopedic specialist what are the DOS and don'ts for your condition. You will surely be helped by the grace of God.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: i have had hives attacking my body along with a massive headache off and on since December. I started out seeing a dermatologist which put me on Zyrtec. It worked at first then the hives started breaking through and I had headaches. I went back and she put me on Claritin and Tagamet. Two days later I got up feeling like I was going to pass out and was broke out with a little bit of hives. I went to my regular doc thinking that my hypoglycemia was acting up or something. I ended up passing out at the doctors. He sent me straight to the hospital. By the time I was seen in the er, I was getting covered with hives. I was admitted and they said I was dehydrated and my blood pressure was low so they admitted me. I was in the hospital for a week and they took different blood test throughout the week and most came back normal. They had to give me Solu medrol because the hives got really bad. They finally got the hives under control and I was doing better. Still had a dull headache. They discharged me and told me to see an allergist . They put me on Prednisone and antihistamine along with Zantac . The hives were under control until I weaned off the Prednisone. Once again, two days later, I had to go back to the emergency room because the hives came back with vengence and was in my mouth and throat. Along with a fever and massive headache. They ended up giving me Solu Medrol ,Benadryl and Tagamet. Then sent me home with another round of Prednisone. I went back to the allergist and she put me on Allegra twice a day, Zantac twice a day, Hydroxyzine at night, Singulair, along with the Prednisone. I finished the Prednisone again. It worked for another week then the hives came back and they even got in my ears. My regular doc put me on Prednisone again and the allergist added Doxipin along with everything else. Now my stomach started bothering me and I had a loose bowel movement and it was green. I am congested and coughing also. Don t know what is going on and thought you might be able to help. ### output:

Hello, Welcome to Chat Doctor, and thank you for writing to us. Your condition is chronic idiopathic urticaria but can be said idiopathic only after the following tests are negative or normal:1. Hologram and iron levels (or ferritin levels)2. Liver function tests3. TSH fT4 and thyroid autoantibodies (TPO, TG)4. Antinuclear antibody5. C3 C4 Abnormalities in the above tests will need to be dealt with as per results. You are on right treatment and usual triggers for acute attacks of urticaria may be infections; stress; physical or pressure (carrying heavy things or wearing tight clothes); diabetes or thyroid abnormality. Regular prednisolone can cause infections to be common, so please get a Chest X-ray done if the coughing continues. Zantac or omeprazole should be taken BEFORE the prednisolone every day. Treatment with fexofenadine 180 mg, Exocet with montelukast one at night plus HY Chat Doctor. The prednisolone may be required for up to 6 weeks with slow tapering before the urticaria settles. Please get the bloods done to exclude underlying triggers. Best Wishes.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hello, my 15 year old daughter has been sick on & off for the last 4 years. She has lost a lot of weight over this time. She suffers with anxiety & asthma. She vomits on a daily basis, has terrible headaches, small bruises everywhere & crys that she wants to be a normal teenager. I m worried beyond belief now. ### output:

Hello, Thank you for asking at Chat Doctor. I went through your daughters history and would like to know more about her as follows:a. What is the amount of weight loss?b. What are her anxiety symptoms?c. What is the cause of her anxiety? Any particular stressful event? d. What is frequency of her asthma symptoms? What are the symptoms of her asthma? Wheezing, difficulty in breathing, fast breathing? Does she have hyperventilation (related to anxiety)?e. What are her nose symptoms - running nose, congestion, sneezing, etc.?f. What is frequency of vomiting? Does she have any other digestive symptoms - constipation, stomach pain, etc.?g. Has she been investigated previously? What were the previous investigations? Above details would help me to know about her and to make suggestions for her more specifically. At present, from your provided details, I would suggest you as follows:1. I would suggest her spirometry with post-bronchodilator reversibility testing. It will help to confirm diagnosis of asthma as well as to know her lung capacity. Sometimes, an adolescent can have asthma-like symptoms due to anxiety, which will be diagnosed with spirometry testing.2. Based on spirometry report, her doctor would also decide severity of her asthma. It will also help the doctor to decide whether she needs regular medications/inhalers or medications/inhalers for as-and-when-needed basis.3. I would also suggest her allergy testing for common inhaled allergens (house dust mites, molds, pollen, animal dander, insect proteins, etc.) and common food allergens (milk, egg, peanut, tree nuts, wheat, soy, fish, shellfish, etc.). This will help to know if she has allergies as well as to identify the substances causing allergies to her. 4. Weight loss is not a common feature of asthma-allergies. It could be due to poor appetite related to anxiety or other causes. Please get her weight regularly monitored by her doctor, so if weight loss is significant, other disorders could be thought about.5. I would suggest her regular use of antacids like sanitizing or omeprazole to reduce vomiting and gastritis symptoms.6. For intermittent bruises (At present, I assume they are hives, can be confirmed only by doctor after direct examination), I would suggest her to take antihistamines like cetirizine or levocetirizine and application of calamine lotion.7. I would also suggest her a good multivitamin-multimineral supplement containing vitamin D, vitamin B complex (especially folic acid & vitamin B12), etc.8. Please try to identify her stressor and try to remove it, if possible. A psychologist consultation will help her to combat stress. Regular stress reduction strategies such relaxation and meditation may also help. Hope above suggestions will be helpful to her. Should you have any further query, please feel free to ask at Chat Doctor. Wish her the best of the health ahead. Thank you & Regards.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, for a 2 year old boy that had colics and reflux till he was 1 1/2 year old; after going to the beach-the next day- vomits his breakfast(simple white toasted bread, a boiled egg, a small glass of bongurt(a yogurt-like product)(this is more or less a normal breakfast for him, but usually eats with the above,give or take one, plus a fruit(like a banana) and another protein or carbohydrate or cereal).He went to #2 as soon as he woke up (a bit soft but not really abnormal feces); yesterday he drank seawater(he was enjoying the beach too much) but he also ate some snacks for the first time(the restaurant where we had planed to eat was closed): 1cm of a chicken vienna sausage, and 7 doritos(pieces). After going home(1:30 hours after) he ate a normal dinner. Grandma gave him a bit of chocolate(hersheys milk bar). He asked for his milk bottle (usually milk with nestum cereal)before sleeping-1hour later- but I thought he d eaten too much-his stomach was big) and gave him only 3 ounces of milk without cereal. He went to sleep normally, woke only once at night(this normal 2 to 3 times a week, he likes to come to our bed at 4-5 am). He has no fever, no other symptom, and has only vomited today s food. Gave him 1onz of Pedylite, and some water, he has not vomited them. He seems to be vomiting mostly the egg, but it was not a bad egg and looked allright, I had one too from the same batch and it semt fine. My mother says it might be the seawater, specially since the last time we went to the beach he also vomited (but only one vomit) the next day. He sometimes has gagged a bit when eating boiled eggs(and red meat-but not with chicken or fish-) but this time he had already swallowed the egg, stood up to play(he is very active) during his breakfast, but suddenly looked bad and vomited. Could it be the seawater? If so, why didn t he vomit yesterday? I m alert for any symptoms but so far he s playing normally, being a normal crazy toddler like always.He looks a bit tired but I think it is because he had a busy day yesterday plus the vomit. The last month he weighted almost 30 pounds.He is tall for his age, around 90.(He looks like a 4 year old). ### output:

First I would like to appreciate your detailed and beautiful history ! From what you've posted, the possibility I would think of is a mild stomach bug that he got from the sausage. As you rightly said, seawater would have caused him to puke yesterday itself, and if it was a bad egg he would not have vomited immediately. As he is active and playful, you can be reassured that it is nothing serious. Warning signs to look out for:1. Persistent vomiting > 10 times2. Blood in stools3. High grade fever (Temp >102 F)4. Decreased activity5. Not peeing enough (less than once in 6 hours)6. Not eating or Chat Doctor. There is no need to avoid egg in the future :)Hope this helps, and he gets better soon! Feel free to clarify any other doubts you may have.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: My left knee was replaced nov 11, 2014- had intensive rehab -however i stop going to rehab 2 months later, my knee stayed hot -like i had an infection ? But now not hot after over 7 months? About 7 / 8 weeks ago we drove 7 hrs to a social event - & drove back next day- my back -began hurting so severe plus my right foot was swollen - with operated left leg foot swollen now but not as swollen -took 3 dsys to go down with ice & raised over my heart , & 3 weeks ago both ankles r swollen & non operated leg - that ankle is larger or more swollen - i am esting alot of sugar - the medication i am taking is for blood pressure, thyroid contion, vitamin d deficiency. & severe R. Artherisis -non back from another trip flying. 2 hrs Non stop-put ice on ankld in hotel & at home 4 th day -ankles both swollen- sleeping with ice bag& feet elevated -went to rehab & if u push in on side of swollen right foot - it hurts & the dent stays -doesnt bounce bk? I was born with born with heart murmur-plus every 8 yrs im to take a test to see if ? Has moved around my heart -had heart test in 2013 all was ok & i stay tired all the time -WHAT HAS CAUSED MY ANKLES TO SWELL ON BOTH LEGS? Do have bunyon on right big toe - this ankle is largest. & sore Help please-phone is 302-218-0334-dorothy snow-w- i am 69 years old & own my own business 20 years & im depressed Meds -duloxetine 60 mg- armour thyroid 60 mg-losartan 50 mg for blood presure-oxicodond 20 mg twice a day Vitamin d 50 k -volteran gel for pain Restisin for dry eyes - had eye caterate surgery may 10-2014 ### output:

Hi, Thank you for providing the brief history of you. A thorough clinical examination is advised. As your age is 69 years and also the TKR was done, now facing with back pain and also swelling of the leg, it is totally related to the overall body non-conditioning. As body is a single unit the conditioning of the body is of importance to balance the systemic requirements. Now coming to TKR - you should have continued your TKR rehabilitation program as by which you must have been helped more than even thought. The exercises post TKR are helpful to make the muscle stronger not only of the knee but also of the over body when we talk about rehab. If you were only performing TKR operated leg than the rest of the body needs an attention. Since you have a backache, again, physical therapy is of the choice to help you out. Core stability is what needed. Also, for swollen ankle, you need to have a check for your heart and your vascular system. As due to weakness of both the swelling can occur frequently. In my clinical practice, patients post TKR undergo 16 weeks to 24 weeks of rehabilitation program for not only the TKR procedure but also for the overall body conditioning. And the majority of them recover to the maximum. RegardsJay In Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: My husband has a putrid taste in his mouth and can t swallow most all food and drink. He has lost over 50 lbs in the past year. He has had numerous tests and nothing serious shows up. He is 90 years old and looks very good except for becoming so thin. His mind is sharp but energy down. He has heart trouble and now breathing problems. Also has prostate cancer for which he takes Lupron every 3 to 6 months.....depends on PSA count. Eight Drs. have no definitive answer and we are frantic. Uses oxygen nightly only. Food looks good to him, but as soon as it hits the mouth he must force it down then that s it. ### output:

Hi welcome to ChatDoctorI have gone through your query regarding putrid taste in mouth and difficulty in swallowing, and I can understand your concern. It is an appreciable fact that even at age of ninety he is enjoying sound mental and physical health. What ever problems he is suffering are outcome of fault lifestyle and food habits. Iwould like to suggest locating the cause and remove, it will give relief to some extent. Difficulty swallowing (dysphagia) may occur at any age but is more common in the elderly. There can be many factors causing putrid taste. Individuals suffering from digestive system diseases like Acid Reflux, & In take of too much of medication may also result in bitter sensation. Suffering from digestive system diseases like Acid Reflux, Ulcers arising in the stomach upwards through the esophagus, connects, the mouth with the stomach. As a result, toxins accumulated in our system due to faulty intake of food , cause you putrid taste and difficult breathing . . Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. . Difficulty chewing food because of poor teeth or ill-fitting dentures may cause dysphagia. An infection is another cause. Narrowing of the esophagus caused by a stricture or a tumor of the head, neck or chest, may also create swallowing problems. Detoxing of system -by Ayurvedic Punjab - Chat Doctor. Vomit all the water. Clean all the cavities -eyes, nose, mouth by sniffing, coughing, gargling. Repeat this twice a day for 3 days every fortnight, help wipe out all the toxins and lead towards total health. Eat plain healthy balanced diet as fruit, veges, juice, soups, milk, curd, Omega-3, antioxidants -ginger , garlic, almond, cheese, oats, Dalian, coconut water and take a lot of water. Eating small meals more frequently and chewing carefully will help your digestive system too. - Regular physical activity to increase proper blood circulation - walk, exercise, yoga, Panama deep breathing, further detox your system, help boost your immune system and give resistance from diseases. Fast foods, refined sugars and fine floor products, tea, coffee, alcohol, smoking, sleeplessness, dehydration, constipation, worry, stress all induce toxins in your body and cause you sufferings. So avoiding is always a better option. Regular check up from your doctor is highly appreciable Hope this helps solves your query. Take care, All the best.Don't hesitate to get back if you have any further query

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi Doctor, I am a male of 32 years old. I have elevated liver enzymes for already some time (seen in the blood tests for more than 2 years ago and still present). The doctor at the hospital wants to do a liver biopsy if these elevations remain (By now ALT was around 200). He wanted me to lose weight, and then take a blood test again. I lost some weight and started to do more exercise, and the liver enzymes dropped. (ALT : around 100 u/L) Also I felt better and some symptoms disappeared. However I should take a new blood test after some time again which I did not do because I am rather afraid of this biopsy and wanted to see if I could improve my situation by living healthy and do some exercise. I also had an ultrasound, were all seemed normal. No signs of cholostasis (I think this is blockage of gallbladder ducts) However, lately I again get symptoms that indicate that something is wrong. Those symptoms are sometimes mild pressure at the right side of the abdomen, just under the lower ribs, as if something is blocked or inflamed. Sometimes I feel also a bit dizzy, and not clear in the head. Another thing is a bit darkened skin under the eyes. And a general feeling of not feeling very well. Another symptom is that I have often (dark) green stools, which are fluffy, or thin. I can give you also the results of the latest blood test. I was also tested for hepatitis at my normal physician, where it showed negative, but I don t know if this could be still the case. I would like to get some opinion or advice concerning what disease I might have, what to do about it and what the risks are of liver biopsy. I don t have an alcohol problem, I drink very little since already 2 years. I weigh around 86 kg and measure 1m81. Thanks in advance Jonathan Smets Results latest blood test: Bilirubine total : 0,60 mg/dl Bilirubine direct: 0,21 mg/dl Bilirubine indirect : 0,39 mg/dl AST : 39,0 IU/l ALT: 110 IU/l Gamma-GT: 138 IU/l LDH : 384 IU/l Lipase: 44 IU/l Kidneys: Ureum: 38 mg/dl Creatinine: 1,21 mg/dl GFR: 60 ml/min Total Protein: 7,6 g/dl CRP (inflamm. / auto-immune ) : 0,11 mg/dl Lipides: Triglycerides 81 mg/dl Total cholesterol 194 mg/dl HDL-cholesterol 78 mg/dl LDL-cholesterol 99 mg/dl Ratio Tot. HDL chol. 2.48 mg/dl Results for hematology were normal ### output:

HIT hank for asking to ChatDoctorI really appreciate your concern, in my opinion if you do not have any symptoms which are directly related with your elevated enzymes then why to worry about this, whatever symptoms that you have described here are just because of your worry about your nonspecific elevated enzyme and nothing else and not the disease, just forget it state living happily no need to worry about elevated enzyme until it does not give you any trouble, hope this information helps you have good day.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi Sirs Need a suggestion for possible best treatment for the below Biopsy Report and Head n Neck CT Scan Report of My Father. ========================Biopsy Conclusion ======================================== Nature of material Received : Right lower bucco alveolar sulcus(BAS) mucosa biopsy. Gross Description : Received multiple grey white tissue bits aggregating to 1.0 X 0.5 X 0.2 cms. Submitted entirely. Impression : Poorly differentiated squamous cell carcinoma, right lowerbucco alveolar sulcus(BAS) mucosa biopsy. ========================================CT SCAN of Head n Neck ======================= Clinical Profile : CA Right lower GB Sulcus. Technique: MDCT imaging was performed using thin axial plain and post contrast scan of from skull base to lung bases. Findings: There us e/o 32 X 27 X 12 mm (AP-CC-Thickness) enhancing lesion is seen in the right posterior buccal mucosa involving the lower GB sulcus and extending from 1st molar to 3rd molar region. The lesion focally involves the skin. No erosion of underlying mandible is seen. height of mandible below the soft tissue is 20 mm. Upper BG sulcus. RMT and infratemporal fossa appear normal. no evidance of lymphadenopathy on either of neck. oral cavity is normal. oral tongue, base of tongue and floor of mouth is normal. Nasopharynx, oropharynx and hypopharynx are normal. larynx is normal. Both side submandibular and parotid glands are normal. Bilateral maxillary sinus polyps are seen. Rest paranasal sinuses and both orbits are normal. Major neck vessels are normal. No significant abnormality is seen thyroid gland. Screening for thorax revealed no focal lesion or significant mediastinal lymphadenopathy. Diffuse emphysematous changes are seen in lungs. Comments : Finding suggest malignant lesion in the right posterior buccal mucosa involving the lower GB sulcus and extending from 1st molar to third molar region and focally involving the skin. No significant cervical lymphadenopathy. Bilateral maxillary sinus polyps. Screening for thorax revealed no focal lesion or significant mediastinal lymphadenopathy. Diffuse emphysematous changes are seen in lungs. Highly appreciate for any suggestion or treatment. Thank you so much in advance. Best Regards Laxman Odedra. ### output:

Hi, Thanks for writing in. The CT scan report above shows that there is a possibly malignant lesion in the right cheek in the area between gums and cheek from the first to third molar teeth. It measures 32 x 27 x 12 mm and is seen to be localized. No lymph node spread is seen. This shows that the cancer is still locally present and not causing any spread. The polyps in sinus and lung changes are not significant. With the above findings you should consult a head and neck oncologist and discuss is surgery is possible as the tumor is slightly larger. Treatment of this cancer involves surgery if possible and then followed by chemotherapy and radiation therapy. There is a good chance of treatment and survival for more than 5 years. He must stop tobacco and any other habits. Regular follow up with your doctor is required. Please do not worry.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi I just started taking dicyclomine for severe stomach pain in my upper abdomen just below my rib cage. They can t seem to diagnose what s wrong. I ve taken a number of medications Prilosec Prevacid protonix. They help for a day or two but nothings really worked long term. I started taking dicyclomine the last few days and that really helps with the pain. 10 ml 3-4 times a day. But I m having some really weird side effects. I feel slow minded. I sometimes can t form words feel really dizzy and disoriented. My heart rate was really low then gets really high. I feel anxious. My hands and feet have been feeling kind of tingly and numb and I feel uncoordinated. I don t know if all this is due to the dicyclomine and I do take other medications including Klonopin and Ativan and I wonder if the mixtureis causing some of this. I wake up really anxious with my heart racing and shaking all over. I just feel really weird and disoriented and it s very worrisome.should I stop taking this medication? My doctor is not very available to talk to. Wonder if these are normal side effects of dicycomine and if they will lessen over time. Pit really helps with the pain. But the cognitive side effects are scary. ### output:

Hi, thanks for a brief history of you.first you have pain in the left or right side. Well let's take it in general as the upper abdomen. Below the rib cage. Few questions to figure out? What is the nature of the pain? Are you having any gastric issue? Are you facing any trouble with passing urine? Have you undergone the diagnostic ultrasound scan for the abdomen region? If not please go for one as it will reveal any issues faced by the systems beneath the abdominal muscles. Now since you take medicine and feel relief it shoes the medicines are symptomatically giving you a little relief. If you have gastric issues, then your metabolism is slow for which you need to boost up your metabolism. Now question comes how? The answer is to perform some simple core Strengthening exercises. Now if you are facing with any urine related issues like low flow or if you consume less fluid in your daily routine? If that is the case kindly Chat Doctor. Now let's come to the pain, since you said it is below the ribs then I will advise you to do some regular deep breathing exercises while placing the hand over the painful area which will also help strengthen the muscles. What your physician prescribed you was for symptomatic relief from pain. But you need to focus on improving your overall metabolism which can be possible by doing regular exercises.to come to a closer diagnosis you need to undergo a diagnostic ultrasound scan. Which will help rule out something over there. Based on that the next step of medical action can be done. So kindly visit an internal medicine specialist and get this done.in the meantime try doing some core strengthening exercises and some deep breathing exercises. Your muscles will become stronger, and you will find ease of your pain. Physician of your must-have surely tried to figure out the issue. Kindly provide the full cooperation and undergo a scan of abdomen. Taking too much medicine without medical guidance is not advisable. As self-medication on long term always have side effects, and it will lead to gastric issues which will also aggravate the pain in the same region. With the grace of God I wish you a speedy recovery.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: My daughter 7, who is 48lbs has been having constant abdominal pain for the last 21 days started at her belly button moved to her right side and is now back at her belly button. She feels better after laying down for awhile and napping, or with eating crackers. She normally runs between 97.6 and 98.4 but she has been running in the 99s. She doesnt nap but has been sleeping for hours every day after I pick her up from the school and still going to bed at 8p. It doesnt make it better or worse when she eats, or eats certain types of foods. She has had allergy tests done and only showed an allergy to dust not even pollens or pet dander, I can not find a trigger to when it gets worse and when it gets better, however the laying down and crackers do work. The 3 ER visits, and 3 trips to the Drs has given us know answers. A CT, Ultrasound, urine and blood panels done, all with normal results. She is going to school but they then call to pick her up because she is not doing well. She has made a total of 5 whole days in the last 3 weeks and only because she says she tries to ignore the pain as much as she can. No emotional issues, no bullying, she loves school and wants to be there. Her last ER visit the Dr prescribed her 1/2 tsp every 8hrs of Donnatal Elixer to take to see if it helped. Sometimes it helps sometimes it doesnt. However I am concerned with giving it to her as I read the info that says in children use extreme caution. WWW.WWWW.WW Not saying it is Appendicitis that she has but 3 years ago I had the same exact symptoms as her, pain that was constant but would get better and worse, in and out of ERs, Drs, and Specialists with all test showing normal for a month. I was run through the ringer, even after being admitted to the hospital after a month of this, they still ran a weeks worth of tests before deciding to go in and do exploratory surgery. They said I had appendicitis, in fact, they said it had ruptured and resealed itself, and pathology of it said the appendix was completely obliterated. Is there anyway the same thing can being going on with my daughter? Would the Donnatal mask the symptoms of Appendicitis? Is that even safe for her to take? Is there other ways besides surgery I could try to eliminate it being appendicitis or even treating it, preferably naturally with out use of pharmaceutical medicines. What other things could it be, I know abdominal pain is associated with so many different health problems. Any feedback or suggestions that I could take to her Drs would be great, she has a referral to go se a Pediatric GI, just waiting for that to go through. Thank you for your time! ### output:

Thank you for the question. I would suggest visit to pediatric gases. She requires colonoscopy to detect any inflammatory disease of bowels or polyps or diverticulitis etc. Appendix may be normal or would have showed in ultrasound, you may repeat it for it and abdomen as a whole for kidney, ureter also. Chat Doctor. Can be given twice or thrice a day for 5 days 60 mg in three divided doses. Also stool examination should be done for Guardians and other microbes, worms. There is no harm if since dose of zen tel is given

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi Dr. a very good evening.I am residing in bangalore,and I am writing this for my son.He is 19 years of age and doing his B-Tech 5th semester. Dr., for the past six months he is suffering from urinary infection. And I have consulted him with many urologists, still he didnt get a complete recovery. His ultrasound report,blood sugar, uroflam test everithing is normal. During this period he gets high fever & severe head ache, so bad that he cannot move his head in any direction.Im very worried about his head ache and other symptoms. He has taken many antibiotics .It didnt work it is recurrent now. Now, his Dr. has prescribed an antibiotic called urifast, daily two times for 14 days & then he has to take this tablet for 2 months, once daily and, his Dr. told him to take IVU X-RAY also.Dr is there any problem for taking this antibiotic such a long period.HIS IMMUNITY IS VERY POOR.Any weather change he falls sick.Pls help my son. Dr. his body wt is about 94 kg. ### output:

Hi dear, Thanks for choosing Chat Doctor. I have read your question well and understand your concern and I will do my best to assist you. There are few questions I would like to ask to better understand your case such as has your son lost weight recently? You said his weight was 94KG? Has he lost or gained weight in the last 6 months? Does he have any history of Diabetes, Rheumatoid Arthritis, does he take any medications that reduce his immunity? Now if I answer based on the information you provided. First, one thing you should know is that male Urinary tract infection are mostly difficult trace or manage compared to females, its more likely to see a recurrent female infection than male. I don't know what made your doctor to treat your son with only antibiotic medications, if I was your Doctor I would consider admitting him to hospital so that I can take all necessary tests required, I would also consider treating him by giving him IV solution to help him rely Chat Doctor. The ICU test the doctor ordered is a good choice to look for any abnormalities in the whole urinary tract including kidneys. Here are few things I would do if you came to my Hospital, you can consider discussing the following with your Doctor.1. Admit to hospital immediately, so that I can give IV fluids and IV antibiotics and run tests such as CBC, Urinalysis, Urine culture, ICU. 2. Since your son had recurrent UTI, I might consider doing some other tests to see if he has other co-morbidities such as diabetes, Tuberculosis etc.3. Some patient that had recurrent UTI might actually have something called Fistulas caused by a disease known as Crohn's disease. Therefore, if ICU shows normal results, I will refer him to Gastroenterology specialist to do Colonoscopy. Specially if your son suffers from diarrhea Crohn's disease is an Inflammatory Bowel disease that causes severe abdominal pain and could lead to forming fistula (holes between intestines and urinary tract) that might cause some bacteria from the Intestines to reach to the urinary tracts thus cause a Urinary tract infection. I hope you can discuss the points i mentioned with your current Doctor, so they can consider it. Wish you all the best and I hope your son gets better soon.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, I am 22 yrs old male. I have very sensitive skin . It have soft and dry skin . I also have dust and cold allergy . about 4-5 months ago I was in a trip and exposed to sun burn . After that I am facing continuous skin problems. My skin was intensively burned and some of the areas were infected. I used moisturizer on those spots. After that it went away but that infections left black or light brownish spots. I have gained weight about 6 kg in last 2 months . Currently i weight 77kg with a height of 5 8 . 3 months ago I had some rashes in legs. First I thought they are mosquito bites. But the red spots spread, feel like bumps and they were intensively itchy. Sometime it bleed while itching. I consulted a doctor and he gave me Neobet cream (10 mg) and Ebatin 10mg for 10+ days. After that bumps were smoothed but black spots left behind. But, after 15 days of medication red spots with bumps began to appear all over my body. Some of them grow having liquids under the skin. Number is now limited and will be about 15 rashes except legs area. One goes another comes. I masturbate regularly twice or thrice a week. One month age, after my masturbation I felt like my penis is not getting normal. I thought blood in the penis might not be releasing properly. I drank 2-3 litter of water and peed. Though the penis was backed into normal shaped but I felt my penis head was still a little hard. And I also notice 2 tiny white spots on my penis head. When I wet my penis skin looks normal. But when ever it is dry those white spots are visible. There are not pain and itchiness. But I feel slight contractions in the penis vein specially in the penis head. I am currently using moisturizer and olive oil on that spot and haven t consulted any doctor for that. I didn t have sex in my whole life and while masturbating I like to use some lubricants like oil or shampoos. I am really worried about this whole skin diseases. Any suggestion would be helpful. Thank you. ### output:

YOUR DUST AND COLD ALLERGY CAN INVOLVE SKIN AFTER SOME TIME I DON'T KNOW WHAT TREATMENT YOU HAVE TAKEN FOR COLD AND DUST ALLERGY SKIN IS ALSO GETTING INVOLVED WITH ALLERGYADVISE GET ALLERGY TESTS YOU CAN FIND CAUSE WHICH WILL CURE YOUR GALLERIES OF SKIN AND COLDPRECRIPTION FOR TIME INTAKE FEXOFENADINE 120 MGM NIGHTCAP RHINITIDINE 150 MGM MORNINGDONT USE MUSTARD COCONUT WALNUT ALOES SODA OIL SUSE AMLA FOR APPLICATION USE OLIVE FOR COOKINGDONT USE NUTS CONTAINING OINTMENTS CREAMS SHAMPOOSAFTER BATH YOU CAN APPLY CALAMINE LOTION USE PETROLEUM JELLY AS LUBRICANT AT NIGHT YOU CAN APPLY CALAMINE MIXED WITH FLUTICASONE OINTMENT

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: My mother whom is 75 and very very health consicous had a extreme onset of confusion Tuesday. She started having an eye pain, then confusion, speech was highly impaired and it was very difficult for her to get accross anything, severe headache. Again this was sudden. She would type on facebook and text and everything was a mess. She thought she needed to go to the eye doctor because she d been having eye heatlh problems which she has to receive shots for. She hasn t had a eye injection in three weeks now. When she arrived there she did not have an appointment they called an ambulance because she wasn t making any sense! She knew something was wrong and drove to the eye doctor with her hazards lights on. She arrived at the hospital ER and they immediately performed a cat scan and MRI which showed no signs of stroke . She arrived at hospital at 2:00 in afternoon. While in ER with her she did not know her name or any of childrens name! She didn t understand anything! She was so confused and complained of headache. She never slurred speach, she just was making sense. At 11:30 Tuesday night they put her in ICU and performed an EKG which confirmed AFIB heart rate. They gave her medicine to slow heart rate down. At 1:00 A.M. she still didn t know her name or her children s name. At 6:00 A.m. Wednesday she regained the ability to express her name and she knew who her children were. She remember s alot of what happend. Which I find amazing!! My mother reversed her diabeties high blood pressure and high cholesterol at age 73 two years and lost 100 pounds by eating everything right and excercising all the time. She has never swayed from her goal of being fit for the rest of her life since two years ago. Like I said she excersises and eats right all the time!! So the doctor s have been all over the place on what happened! Neorolgist first suspected minnie stroke but now they all say different things. One said she had a urinary tract infection , one doctor said she did not, one doctor put her on blood thinner and one doctor took her off. Now they are saying that her potasium, magnesium and sodium were too low and this is what has caused all of this. She is still in the hospital and it s now Thursday afternoon. I am confused because they seem to be!! My mother even pulled down her paints in the ER and used the bathroom on the floor. She would never do that!! So she was confused for 18 hours total not knowing who she was or who we were and severe headache, heart afib. It all started with the eye pain.... Can you help? ### output:

first thanks for giving a nice history of events what all happened. Your mother is a 73 yr old diabetic, hypertensive, n had high cholesterol;but she was healthy n keeping fit. With these risk factors for stroke, sudden onset of headache with eye pain, confusion n impairment of speech with EKG confirming atrial fibrillation any neurologist will first think of embolic stroke to brain vessels from heart or a form of transient ischemic attack TIA) n that's why she was put on blood thinners. But in old age electrolyte disturbances like low sodium, potassium,magnesium can also lead to acute confusion n sometimes severe Chat Doctor. TIA would have resolved or the electrolyte disturbances would have been corrected.hence she regained consciousness.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: For a long time I have had symptoms of anxiety & panic attacks, they were diagnosed after a few ER visits random with paranoia of stroke or heart attack symptoms which were dismissed as my being told I was low on magnesium had PTSD, paranoia, & my nervous system was stressed from internalizing. However coinciding thru time...-What I always thought was completely unrelated was many other simultaneous symptoms such as an ongoing ear infection that has been there for years even with prescription never went away. -Spacey empty headed feeling & kinda a jump in brain or eyes sometimes-Poor circulation or fuzzy-Feeling of knots in veins or tighteness-Chest pain-Seizure like feeling with many fast flashes like in a movie or chest pain-Recent I lactated without having been pregnant-I often wake not being able to open like a jar or something till later in the day & my hands are tightly wound balls curled-The biggest is my difficulty swallowing which has increased from moderate the last few years to complete discomfort in the last week (coinsiding with being head butted by my ex)-And my tongue is inflammed (which I showed the gyno to ask if it was std related & she said she didnt think so)-I have chronic back pain but I attribute that to my job which is a caregiver & strains back-I can be moody & extremely tempermental pre-menstrual more then the average person (which I have stressed to my doctor but he just says it has to do with my anxiety)-I have extremely extremely bloody periods that are very heavy (which my doctor just says is normal in some women)I have considered the throat & bumps could be related to the fact that I have the HPV virus & spread thru oral but nothing seems to have spread in patches their just bumps in the back of my tongue that have coinciding gotten bigger with my swallowing problem. I dont usually get headaches but after the head butt I have felt head pain coinciding with my ears which tho usually infected have been mild but are felt now in correlation with each swallow. I have had melanoma skin cancer stage 2.5 when I was 23 & 27 I am now 29. It was surgically removed in the effected spots & some lymph nodes. And a mild less then 1 case of cervical cancer at 26. I just feel my whole body is telling me something but as I said other then my cancer diagnosis anytime I have had brief checks ups I get told I am having panic attacks, not heart problems or & it stresses my nervous system. They simply just tell me to take prozac & relax. I have avoided medical care consistent because with all my previous health problems I dont have insurance based on affordability.Insight & thoughts.Please tell me speculations I have been told by random family I am simply a hypochodriac & I dont think I have fibromyalgia I think its more, Maybe one thing maybe 5 but please insight? ### output:

To me, it seems an endocrinological (hormonal) problem considering: lactating without being pregnant, menstrual symptoms, empty-headed feeling etc. In addition, you may have anxiety which may be primary (i.e. psychological i.e. because of your psychological reactions to multiple medications, or functional anxiety disorder) or may be secondary to hormonal problem would suggest first to consult an endocrinologist and a counselor who can try to understand unlike your "random family"

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I am writing because I would like to have a confirmation and I want an alternative method to the hinder the progression of MS. My investigations were motivated because I want to stop taking interferon beta and find an alternative method that is based on a natural basis. The long-term study results from last summer that were on interferon-beta, have not had a positive outcome: (MS Society - WWW.WWWW.WW / NY Times: WWW.WWWW.WW . After 4 years of taking Avonex, I still experience serious side effects that have been fought with Celebrex and Ritalin. There are also positive side effects, because I do not get ill as often as I did. After weeks of research, I reached the following conclusions: I understand that a vitamin D deficiency is a component for some diseases and one is MS. Vitamin D increases the interleukin (IL) 10, and simultaneously reduces the IL-6 and IL-17. It retains these two cytokines in balance. An increased IL-6 creates plaques in the brain and IL-17 is responsible for the autoimmune system. Should the IL-17 be too high, it upsets the immune system and it begins to attack its own cells. Interferon-beta is mainly focused on the IL-17 and neglects the IL-6. I also struggle with the herpes virus which is designated as vIL-10, and this fits into the same receptors that are intended for IL-10. Vitamin D is as you know, created by sunshine and after a 30 minute long sunbath in the summer time, you can have up to 20,000 IU in the body. So I think that a 10,000 IU per day cannot cause toxicity . Vitamin D is dependent on vitamin K , zinc, magnesium and boron, to activate it. I would like to take the following orally: - Vitamin D3 - 10,000 IU - Multivitamins per day which includes, among other things: o Vitamin K - 20 - 60 micrograms (mcg) o Zinc - 11 - 15 milligrams (mg) o magnesium - 100 - 120 mg o Boron - 150 mcg - Omega 3 to 1272 mg - Omega 6-928 mg - Omega 9-475 mg o A balance of Omega 3 and 6 is wanted If the above values are too high, or if there is something missing, please let me know? I will continue taking interferon, but I would like to stop it as soon as possible. I am 39, 150lbs, 5 8 and suffer from RemittingRelapsing MS ### output:

Hi there ~ I empathize with your situation and that you have been having a tough time with relapsing remitting multiple sclerosis. One thing that you may have noticed yourself is that you are focusing too much on labs. One way to reduce your anxiety is to distract yourself from thinking about your condition too much. If you start acting like you have no symptoms you probably will end up not having any problems. I know this is easier said than done but one thing that surely is treated is the anxiety which can make MS symptoms worse. Consulting a psychiatrist may help with getting you on antianxiety medications and appropriate therapy referral. I hope this helps. Take care.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hello. My name is XXXX and I have ehlers-danlos hypermobility. I suspect I have neck instability and my family doctor told me that a referral to my local neurologist would do no good because he was not Eds knowledgeable....what type of doctor should I see for CCI/AAI? ### output:

Unfortunately, there is some definite truth to what your doctor says about the lack of specialized knowledge from a neurologist having to do with EDS or the hypermobility factor which is consequent to having the problem. I'm a neurologist and do have a couple of patients in my HEADACHE CLINIC since these patients will suffer from headaches (both primary types such as migraine or tension as well as mechanical types due to hypermobility issues of the neck because of cervical spine instability from the ED). EDS is confirmed by genetic testing. Actually, Kudos to whoever suspected the diagnosis enough from your presentation to send you for confirmation. The problem with now going to a SPECIALIST for this problem is that there isn't anybody aside from GENETICISTS who may be medical clinicians who would see that many cases during their training in any other field EXCEPT as it relates to the CONSEQUENCES OF the malady. So, I got to meet these 2 patients whom I've been following (and learning a lot from) because of headaches that were not easily treatable but their primary doctors or other specialists. Arthropods might have EDS patients due to musculoskeletal issues that may be best handled by them because of ED...but they do not have truly specialized knowledge in the infirmity since it is really considered a RARE GENETIC problem. Here's a link you can look up if you're not familiar with it to get more information. I suggest you look up doctors who are on their list of treating physicians since these folks have expressed an interest in treating this problem and therefore, through sheer experience and having an idea of what works and what doesn't work in their patients can guide you or help you get some relief using creative use of prosthetics or knowing who else they might be able to call in case they're not sure what to do next. Make sense? First, you may be interested in signing up with a REGISTRY which is GLOBAL and tracks all those who fit the criteria for EDS....check it out...maybe you don't wish to make your information available, but it is a Legit site and has a bona fide mission directed at being able to track and have on hand all folks who fit the registry for future things such as research programs, etc. https://www.ehlers-danlos.com/eds-global-registry/Second, here is the official website for the Ehlers-Danlos Society where you can find a lot more information related to HELPLINES, SUPPORT GROUPS, ORGANIZED ACTIVITIES, CONFERENCES, MEETINGS where both patients and doctors get together and have POW WOW sessions to get on the same page with where the research is, what steps a person can take if they are game to get into a protocol, etc. Send me more questions to www.bit.ly/ Chat Doctor. I think there is a ton of good information that would literally take me hours to go over with you....but you have the time to learn about this and finally there is a DOCTORS DIRECTORY that lists medical professionals by State who you may contact.https://www.ehlers-danlos.com/

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Two month back my father got a brain stroke due to high bp...while medication and tests performed it was found dat hehas cronic kidney disease too and from last month his cretenine vary in between 3 to 4. Doctr has given aplazaar 2tab trice a day and two days back suggested for espogen 4000 once a week. Hemoglobin is 10.2. Is the medicine ok to avoid dialysis. ### output:

Hi, Chronic Kidney Disease (CKD) is due to persistent underlying disease like diabetes, uncontrolled high blood pressure, untreated kidney stones, rarely it may develop as a consequence to AKA (Acute Kidney Injury). In your fathers' case I want to know-1) Presence of Diabetes, Blood pressure, Cholesterol problems if any and treatment taken for it.2) Any habits like smoking, alcohol. Stage of CKD depends on EFR (Glomerular Filtration Rate) it depends upon Age, gender, serum creatinine, weight. Treatment of CKD is to prevent or to slow the process of deterioration of kidney function. It requires-1) Diet with adequate vegetarian proteins.2) Control of Diabetes, blood pressure, cholesterol.3) Avoidance of nephrotoxic food and medicines like pain killers4) Water intake needs to be restricted if there is tendency to retain water.5) Low Potassium intake (avoid intake of fruit and fruit juices, coconut water) in case there is potassium retention in body.6) Maintain calcium, phosphorus, uric acid levels under control.7) Avoid smoking, alcohol. 8) Screening for complication on heart. As you have mentioned your father has got stroke it means he is at increased risk for other vascular events like heart attack (coronary artery disease)Regarding medicines you have mentioned-APLAZAAR: it is a nutritional supplement containing amino acids and other nutrients for kidney that help in containing kidney function but not necessarily it will avoid dialysis. SPOKEN: It contains erythropoietin a hormone needed for hemoglobin formation and is produced by kidney. It is used in CKD because deterioration of kidney function is associated with decreased production of erythropoietin and low hemoglobin. Treatment of CKD is to prevent or to slow the process of deterioration of kidney function. It requires-1) Diet with adequate vegetarian proteins.2) Control of Diabetes, blood pressure, cholesterol.3) Avoidance of nephrotoxic food and medicines like pain killers4) Water intake needs to be restricted if there is tendency to retain water.5) Low Potassium intake (avoid intake of fruit and fruit juices, coconut water) in case there is potassium retention in body.6) Maintain calcium, phosphorus, uric acid levels under control.7) Avoid smoking, alcohol. Need for Hemodialysis depends on on-1) Amount of Urine production daily.2) Serum electrolyte mainly Potassium.3) Serum Creatinine level.4) Arterial Blood Gas (ABG) analysis which denote degree of acid accumulation in blood.5) Signs of water retention like breathing difficulty, swelling over body, puffiness of face.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I recently began having shortness of breathe upon any type of even the slightest cardiac output from working in the yard to running the vacuum over the last 2 weeks; I had a chest X-ray performed and upon the radiology report the only notation was Bilateral perihilarmperibronchial peribronchial predominat upper lobe infiltrates, Consider in differential granulomatousmdis disease or chronic less common airway disease; Ive never had a report of such and I feel certain Ive had a chest X-ray in the last year, which if chronic, should have been seen or notated then.Case History in short; Ive been on hemp dialysis 25 years this September, male 44 years of age, non smoker, with no other health issues other than the ESRF. I have always taken incredible care of myself and have earned my PhD in general medicine. I recently have gone thru a divorce from my wife of 12 years which was literally here and happy one day, and completely psychotic and stressed the next and last 18 months of my life, which unfortunately led me into a life which I was not accustom to, in that my diet is weak and poor as is my exercise, and now ability to even think of exercise. The physical rated at which I was exercising prior to all this was private training with the local professional soccer team, and playin level 5 tennis, all on a minimum of 4 days or 16 hours a week, Ive never had any type of incapability to work out or work, although a HD patient the Sat 24+ years; this divorce has really taken it out of me, but I am just now coming thru it, and ready to get back to it. I also have full custody of my 10 year old daughter, which she needs Dad to be close to 100%... This latest issue has really got me sidelined; Id like to add, I just found out Friday my over all Fe/Iron levels are way down. Although I will not know the ferritn until Monday, my current total iron is down to 19, TIBC is 218, TSat is 9. I have a HGB of 13.0 currently which is a little low for me but hanging in there. I guess my query is whats this lung issue and is it something I should be looking into, or could it be simply a fluid issue, my medical training hasnt prepared me for anything such as this. ### output:

Thanks for your question on Chat Doctor. I can understand your situation and problem. In my opinion, you should consult pulmonologist and get done 1. Clinical examination of respiratory system 2. PUT (Pulmonary Function Test) 3. Sputum examination for AFB (acid fast bacilli-bacteria causing tuberculosis). 4. CT thorax with Contrast. Possibility of tuberculosis (granulators infection), bronchitis and other bacterial infection is more in your case. So PFT is needed for the diagnosis of bronchitis. Sputum for AFB is must for detection of tuberculosis. Hemodialysis is a risk factor for tuberculosis. CT thorax will identify the infection if present. So better to first diagnose yourself and then start appropriate treatment. You may need antibiotics, inhaled bronchodilators and inhaled corticosteroid (ICS). Hope I have solved your query. Wish you good health. Thanks.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi there! My mum is very obsessive when it comes to cleaning and being very judgemental. Everyday she is moaning about cleaning whether I have done this or not, even at about 6:30 every morning she is constantly asking me to do something which has cleaning involved she will even finish work earlier just so she can do extra cleaning or preparing food. She was raised in a very strict home with parents who are strict, my mother is a bit like my grandmother who believes the women should do all the cleaning and cooking while men just do nothing. However this cleaning disorder has been having a huge effect on me as she thinks I have not been doing enough every day and therefore she is constantly having arguements with me. I have tried not to be at home so often because of this and when I am she never asks me how have I been or how my day has been the first thing is an arguement about cleaning yet again. At home I try my best to help by washing dishes, moping, hoovering, cleaning the garden, maintaing a clean bedroom, dusting and etc... What more could I do? I am to the point where I can t deal with this anymore and I am only 19, my mother doesn t spend any time with me even though I ask to go to the cinema or come out for dinner with me (my treat)... but chooses to clean. Since starting my new job at a Bank I haven t been able to do as much cleaning as I could before, but I still help and because I am finding it quite difficult I have brought up the subject of getting a cleaner and I would pay, however I got laughed at. My dad who isn t together with my mum said that she went to his house and started inspecting it to see if his cleaner had done a good job. I know my mum so well that if I was to get a cleaner to come home she would just do it herself again as she does the same to me after I cleaned the day after or 2 she will go back to cleaning the same spot again. My step dad has not even bothered saying anything as in my view I think he enjoys that she does all the work... and says we do not need a cleaner, but basically my main question is do you think she has a disorder? I have even offered kindly to pay for therapy and she declined saying she does not need it. Not to mention my mum has been on anti depresants before and now I am having to suffer with her cleaning habit and on going arguements with me. Help please?????!!!! ### output:

Degree understand your concerns went through your details. I understand your emotions. In my opinion naming a disorder for your mothers behavior or obsession is quite easy. It can be called OCD. But is there any requirement to name it? Who is not obsessed? Everyone is with something of others. As long as the obsessions go out of hand and become a behavioral hazard, better not to ad Chat Doctor. Your mother is doing well and finding her own satisfaction level with her current behavior. Let her enjoy. You can pacify her when she gets enraged. Please understand. Starting a psychiatric treatment for OCD may cripple her self-confidence and self-esteem. She does a good job, enjoys it, and never negative about it and is satisfied. What else do you want? Put her in trouble of psychiatric treatment? I shall oppose. Do according to your conscience. God bless you. If you require more of my services, please post a direct query with every Possible details. Hope this answers your query. Available for further clarifications. Good luck.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I have a boy 6 yrs 8 months old ( 25 kgs weight).When he starts to sneeze he continues for 5 to six times with white thick nasal discharge coming out after two or three discharges.This condition is present in him for about three years.Of course, this does not mean that he sneezes frequently.But when he starts to sneeze it does not stop quickly.Three years back once when he had fever with cough and cold he started wheezing particulary after repeated coughing.So far I have seen four episodes in him with rougly eight months to one year gap between each episode.During the second and third such episodes he also complained about slight pain in the chest muscles and shortness of breath.During the first episode I took him to a pediatrician who told to my shock that he may have Asthma.He asked whether anyone in my family has it or not.My mother developed Bronchial Asthma at the age of 45+ due to over load of work and climbing of stairs and also because we used to have pet dogs and later cats in our family.She is still having the same problem.However, now netiher we have any pets in our house , nor there is any chance of vehicular pollution or cigarette smoke.I don t know how my child could get asthma.The doctor gave salbutamol to him and some antiboitics also.But I did not give the salbutamol tablets to him fearing that once it is given it may permanently damage his lungs.During the second such episode after about one year.I took him to my company hospital where the doctor suggested to give nebulizer with asthaline for 5 minutes.This time I obeyed and my son told that he felt releived .During the third time also as per the advice of our Company s doctor I gave him nebulizer for 5 minutes .Recently, he had fourth such episode after about one year gap.This time the doctor sggested nebulizer for 5 minutes at Hospital and also 2 salbutamol 2 mg tablets daily for five dyas along with Cefpodoxime 100 mg for 5 days ( 2 daily).When he was a small baby we used to keep him near to our closed wodden window as our bed was situated near the window) during sleeping after covering him with sweater and all other precautions during cold seasons.Is it that due to exposure to cold her lungs got damaged.The place where I used to work then used to get very cold during cold season.Anyway I used to keep a room heater below him also.Please confirm whether my child is asthamatic or not.Earlier to this episodes I used to give him cetrizine cough syrups on some occasions when he had cough and cold. ### output:

Hi, I have gone through the detailed history you have given. A possibility of asthma is more likely in his case. In my opinion, you should definitely get done PFT (Pulmonary Function Test) with reversibility testing. If there is significant reversibility then asthma is confirmed. In my opinion, he will need intranasal spray containing steroid (fluticasone) and antihistamine (elastane). Oral combination of antihistamine (levocetirizine or fexofenadine) and anti-allergic (montelukast) is also beneficial. So consult a pediatrician and discuss all these. Hope I have answered your query. Let me know if I can assist you further.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: on Saturday night I was rough housing on my bed with my cat. I started to slowly fall of my bed and I tried to stop but it didn t work. I ended up on my head on the floor and all my weight (I weigh at least 131 pounds) on my neck and my body went over my head and then my head popped up. So it was kind of like an extremely painful back flip or somersault, off my bed. The pain right now is probably a 15 on a scale of 1-10. I went and saw Ms. Will (the school nurse at my high school) about my neck and she said that in between my vertebrae was probably swollen and to go see a doctor if it gets worse. So anyway the pain was not that bad unless I tried to look up. At the end of the school day the pain got worse and I got a bad headache. ( I don t know if that has anything to do with my neck but in case it does there you go) My symptoms are: pain (really bad severe pain), swelling (in between vertebrae most likely) and reduced flexibility. What can I do for the pain? Ibuprofen doesn t seem to help because I tried and it helped my headache but not my neck. I take strattera for my adhd and I had a concussion in 2008. I am 14 years old and I am 5 feet 1 inch. I weigh about 131 lbs. ### output:

Hi, You have mentioned Severe pain in your neck region along with swelling and stiffness. All this actually points out to the pattern of Neck injury which you sustained which might have lead to all the three symptoms in your case. If you have localized Neck pain with no other symptoms like radiating leg pain, neurological symptoms like numbness, weakness, paresthesia etc., then in my opinion you can start with following recommendations for initial period of 2 weeks: - To maintain proper posture of your Neck while working and sleeping - If pain is more as it is in your case, then you can take a short course of an anti-inflammatory medication like tab Diclofenac etc. along with a muscle relaxant for 5-7 days, you can add antacid if you have issues of acidity after NSAID intake - Physical therapy like use of some modalities etc. can be initiated, but no exercises till the pain subsides completely - Ice packs can apply 3-4 times in a day - Analgesic spray for local application can be used and is easily available - Avoid lifting heavyweight/ acute forward bending in mornings etc. We will observe you for next 2 weeks how you respond to this conservative management protocol, you can also use a soft cervical collar if movements in the neck region increase your pain, but from my side if you have no neurological symptoms, then we can follow this protocol for next 10-14 days. If you do not feel better in terms of pain, swelling and stiffness etc., then we will have to get some investigations like, dynamic x-rays of Neck and few blood tests for evaluation. Just also keep me informed on what medications you are taking because unless you take proper pain management medications, your pain won't become better. Do not hesitate to contact me if you need any further assistance. You can also discuss your case and treatment plans with me in a greater detail in a private consultation. Hope I have answered your query. Let me know if I can assist you further. Take care

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: hi my name is stefany,i recently was injured in an auto accident. i was rear ended by two vehicles while i was at a red light. i dont understand my MRI vary well. 1. mild lower lumbar hyperlordosis 2.a 4mm mostly central disc protrusion at L4-5 with. mild central stenosis 3.a 2mm disc bulg at L5-s1 comments on mri: there is very mild lower lumbar hyperlordosis w.out significant scoliosis. tha sacral base angle is minimally increased. the lower two thoracic and first three lumbar interspaces are normal. at L4-5, ther is mild disc desiccation in conjunction w. a 4mm slightly broad-based but predominantly midline disc protrusion,mild thecal sac impingement and mild central steno sis. no major foraminal narrowing or nerve root impingement.facet joints are grossly normal. L5-s1 no significant degenerative disc disease. small disc bulge 2mm accentuated just in the left of mid line because of hyperlordosis,central canal is capacious and no significant central OR FORAMINAL NARROWING. conus is normal. no fractur or dislocation no intradural or paraspinous masses.. will i recover from this or will i have pain long term ### output:

Hi, Thanks for writing in. Please find your MRI findings explained below in simple language.1. Mild lower lumbar hyperhidrosis. The curvature of spine is increased in the lower back.2. A 4 mm mostly central disc protrusion at L4-5 with. Mild central stenosis. At L4-5, there is mild disc desiccation in conjunction w. A 4 mm slightly broad-based but predominantly midline disc protrusion, mild thecal sac impingement and mild central stenosis. No major foraminal narrowing or nerve root impingement. Facet joints are grossly normal. There is a small disc bulging at the L 4 - L 5 level which is causing slight narrowing of the spinal canal. The disc also shows loss of water content which is a degenerative change. No pinching of nerves is noted.3. A 2 mm disc bulge at L5-S1 comments on MRI: there is very mild lower lumbar hyperhidrosis w.out significant scoliosis. The sacral base angle is minimally increased. L5-S1 No significant degenerative disc disease. Small disc bulge 2 mm accentuated just in the left of mid-line because of hyperhidrosis, central canal is capacious and no significant central OR FORAMINAL NARROWING. Conus is normal. There is a slight disc bulging at L 5 - S 1, and it is more to the left of midline. There is no pinching of nerves.4. The lower two thoracic and first three lumbar interspaces are normal. Rest of the discs in mid back region are normal as visible on the scan.5. No fracture or dislocation no intramural or paraspinous masses. No features of trauma or growth seen on MRI. From the above it is seen that you have mild disc degeneration problems at L 4 - 5 and L 5 - S 1 and this is not a serious concern. Any pain is to be treated with physiotherapy and neurogenic pain relievers.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: i have A bright red rash in the creases of my elbows.. went to the doctor he said it was a yeast infection caused by my pregnancy hormones its now been a yr and it still comes and goes... but ussually when im the most stressed out ive used every thinng and nothing seems to work,,,what could it be and there is also lupis in my family could it possibly that ### output:

Cellophane You for contacting Chat Doctor. Welcome to Chat Doctor. My name is Chat Doctor. I have gone through your query and would try to help you in the best possible way. From Your description it can be a simple allergy, or actually a hormonal effect as your doctor suggested to that these are hormonal effects of pregnancy, and now you told that this appears when you are stressed ...when one is stressed hormonal changes occur same as in lupus, LUPUS: is a systemic disease by systemic I mean it effects the whole body not just skin of less than 1% of your body, plus lupus has rash, but mostly it appears in response to sunlight.and its location is mostly on ones face. For your knowledge as you have lupus in you family I will here tell you other signs and symptoms of LUPUSAlthough I can well understand it's in your family, so you would have studies it well and know about it by seeing the literature on it and your family members. What happens in Lupus is that your body fights against itself and destroys itself gradually: so symptoms fatigue:Lupus causes mild to extreme fatigue-Joint and muscle pain: Joints may be painful, red, war. Lupus arthritis often occurs on, the small joints of the hands, and the elbows, knees, and ankles.-Skin problems: SKIN RASHES are often an important clue to the diagnosis. Many people have a butterfly rash, which goes over the cheeks and bridge of the nose.-skin sores-flaky red spots on the arms, hands, face, neck, or back-mouth or lip sores; and a scaly, red or purple raised rash on the face, neck, scalp, ears, arms, and chest.-Sensitivity to light: Exposure to ultraviolet light (such as sunlight or tanning parlors) typically makes the skin rash worse and can trigger lupus flares. Many people with lupus are sensitive to light, with fair-skinned people tending to be more sensitive.-Fever.-Changes in weight.-Swollen glands.-Headaches.-Reynolds phenomenon: Some people with lupus have Reynolds phenomenon. It affects the small vessels that supply blood to the skin and the soft tissues under the skin of the fingers and toes. It causes them to turn white and/or blue or red. The skin affected will feel numb, tingly, and cold to the touch.-Hair loss:This hair loss usually isn't permanent. Inflammation of blood vessels in the skin (cutaneous vasculitis): Inflammation or bleeding from the blood vessels can lead to small or large blue spots or small reddish spots on the skin or nails. COMPLICATIONS: include 1-Nervous system2-Heart2-Lung problems. Conclusion:-It doesn't seem to be lupus-If you are still suspicious Talk to your doctor and get yourself tested for lupus.-Some topical anti-allergic it may work-keep them area

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I am an extremly active 59 yr old female. I have gained 38 lbs or more over the past 3 years. I eat very little. I clean houses 2 times per week that takes me 8 to 10 hours. I also am a live in care giver for an obese woman & some times ya just have to lift her. But, litterally, over night, my hips, the joints, started hurting very bad.Also my lower back & has now moved into the groin area. I m now walking with an extreme limp. After cleaning a house, that same night, I awoke racked in pain like I never experienced before. From the hips, swollen knees, to the groin area & swollen feet, I could not move- at all. It was that painful. It took me at least an hour to lift one leg to the floor. I could not walk at all. I went to 3 specialists with no answer. No rehitoid artritis, no gout. I have been going to a pain clinic 20 years every 2 months due to lumbar facet disease. Plus on opiat medication which does nothing now. This pain doc is not using steroid but some kind of cocktail injections. He is a very good doctor with an impecible reputation. He s even been on T. V. 2 times!!! Last week, the very same thing happened to me again. After over an hour to crawl out of bed, I wrapped myself in ice packs. This time after the last incindent, It left me feeling unwell for the next 3 days. Please do not tell me that I am getting older. I am sick of hearing this. I have always been extremly active but what ever this is, it s slowing me to a crawl. And it happened like the very next day. no onset of symptons, nothing. I ve also gone to a chiropracter with no relief. Please, have you ever heard of any thing like this? My e-mail is YYYY@YYYY ### output:

Hi there. Lumbar facet disease is a type of degenerative arthritis that can cause narrowing of the canal through which your nerve roots pass and depending on the level of the vertebrae that is getting affected. I can understand that a person with a very active lifestyle like you hates being told again and again that they're growing old, but that is not the only problem you are having. You're a caregiver and have history of lifting heavy weights which kind of add to the loads that your back is facing and probably worsening the facet problem. Now the various treatment options for this are taking rest, lifestyle changes, weight loss, physiotherapy exercises like core muscle and para spinal muscle strengthening exercises. For somebody who is having a persisting problem like you are I would like to recommend a trial of ESI or Epidural steroid injections. These are mainly used for disc related pain, but they might prove to be of some benefit in chronic inflammation of the nerve roots which can occur in facet disease. Also, please avoid lifting heavy weights, I can understand it is an integral part of your profession, but there are certain physiological limits to which you can exert your body. Besides, that these injections, even surgery will take care of your pain in the thighs and around the hips and the groin, but the back pain may reduce or may even persist. The reason being that there are numerous pain generators in the back which might contribute towards your local back pain, not just facets alone.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: My health back ground. Im 33.male nurse. DX at age twenty with crohns, had three bowel resctions six bowel obstructions, three ID rectal abcess acute kidney failure at age 32 for two weeks, still dont know why, went back to normal with no treatment 2 weeks later. , age 28 with lupus anticouglant factor 10 after having lower right l;eg dvt and PE in both lungs. Started on coumadin. Stopped coumadin after seeing hemotoligst 18 months ago. and my factor 10 results were back tp normal. two weeks ago i woke up one morning to having my entire right hand swollen and no feeling to the hand and fingers. I could not move fingers and no sensation anywhere in the hand past the wrist . Went to the Er. They did and Ultrasound and it came back normal. A eurologist came in and told me that i needed to be admitted for further test. On that same day they did two ultrasounds, two mris to both right arm hand and wrist all came back normal. As the day went on, pain become to be intense in my hand, but couldnt move my fingers nor move my wrist. When they moved them It hurt very bad. The next day, a ortho hand doc talked to me about few opyopns. 1. Do a cortisone injection into carpal tendon to see if it would help my symptoms or just go ahead with carpal tunnel surgery. my third option to do an angiogram to see if we are missing a small clot even though all test were neg so far. I decided to do the angio due to my history, then to everyones suprise the dye could not move past my arteries into my arm that go to my hand. My ateries were collapsed. They did inject three rounds of nitrogylverine. The opned but collapsed right back. They stated me on two b/p meds to see if it would help. Nifedpine and isotop. The next morning i had some sensation. :ot of sharp achy pain but everyday it got better, But now they need to see why this all happened. They want to test me now for Lupus, RA, Ryndom syndrome. Now yesterday my entire right leg from my thigh down to my feet went completely numb. I was in a chair no longer then ten minutes. The symptom went away after about six minutes. What are ur thoughts. I see my family doc tomm, thena Ruemotlogist monday. ### output:

Hi, I understand your concern. From the history you have presented, I feel you have been suffering from a chronic autoimmune rheumatic disorder involving musculoskeletal system, joints, vessels and nerves. The Chat Doctor. I would suggest you to immediately see a Rheumatologist and follow whatever treatment he or she suggests. You may even need some physiotherapy and exercises to maintain your limbs movement and sensations.This kind of rheumatic disorders persist for a lifetime, but can be definitely controlled if you remain careful and strict about your health. Hence, my suggestion to you would be to keep a check on your health, continue the medications, maintain proper lifestyle, follow physiotherapy, do exercises and persist on a life-long therapy as suggested by the rheumatologist to prevent recurrences of the symptoms. Wish you a healthy life. Hope you recover soon. And do write to us whenever you feel that you need our help.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Dear Dr.,My name is Prashant Patil. I used to have multi resistance TB. And I need your help regarding this. My TB history:APRIL 2004: first time detected, cough fever etc. first treatment for 3 months and I feel ok. (i was in munich germany) MAY 2005: came back: was in hospital for 8 weeks in isolation, MTB detected, treatment with Anti MTB medicines (i was in munich germany)... Strptomycin, Cirpofloxin, ethanbutol taken for 1 yr. and 3 months around. APRIL 2008: TB came back with very badly.. cough, fever etc... dr. suggested medicine (H/R/E/S/LFX)..I feel good but have lymphnodes in stomach. The x rays were become stable. October 2009: I came back to germany and regular CT scan check up... nodes found not decreasing. I had no fever, no cough nothing, I was okay. German doctor said the infection is increasing better to make operation the left most infected part of small upper lobe in left side is removed. (hospitalization in germany 8 weeks) from sept 2009 I have taken following medicationstill jan 2011: Moxifloxacine 400 mg 1-0-0Pyrazinamide 500 mg 3-0-0strptomycine 1 g 1-0-0 (stopped after 2 months)Para aminosaliclic acid (PSA granuals) 0-0-1Benzbromaron 1-0-0Omeprazol 20 mg 0-0-1Terizidon 1-1-2zyvoxid 1-0-0 (medications have many side effects, missmaneged some drug after 8 months) Problem of today:I did CT scan in jun 2010 and it looks stable... After 6 months in 4 jan 2011, I did again one CT scan and on left side of lung, the is very little growth of bacteria found. Now my german doctors are very confused. Activities from last few months :brochiascopy has been done the sputum has been taken...The result is negative no bacteria found after 8 weeks also and bronchoscopy result also negative.. no bacteira found after 8 weeks no growth... I need right suggestion, there is very little growth in left lung but not detected for TB, is it any other bacteria or TB or what.. anything else! and its treatment.. Physically, I am healthy. Thanks you very much. Best regards, ### output:

Thanks for your question on Chat Doctor. I can understand your concern. I have gone through the detailed history you have given. Your bronchoscopy was normal. Your sputum AFB culture is also negative. So no need to worry about tuberculosis at present. CT scan is most likely showing old healed lesions. Tubercular lesions on lung heal by fibrosis. And these healed areas are seen on chest x-ray and CT scan life long. Since you are asymptomatic, healthy and all your bacteriological tests are negative, no need to worry about active tuberculosis. Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Dear Dr, I am Raja.Age 38.height:158cm,weight:58.from Tamil nadu. I have problem Atrial septal defectASD(OS).I will given my MC report , Kindly suggestion to my report. Iterpretion: 1).M-mode and Two Dimensions Echocardiography IVC- Right side, IVC drains into-Right atrium, Pulmonary Veins drains into- Left atrium, Right atrium/Right ventricle-Dilated, Left Ventricle (LVEd-28mm,LVEs28mm, LVEF-65-Normal, Anatomical RV with Tricuspid valve-Right side, Anatomical LV with Mitral Valve-Left side, Cleft in anterior mitral leaflet-Absent, Positions of atrio - ventricular valve annuli- Normal, Size, shape and thickness of right ventricle-Normal, Size, shape and thickness of left ventricle-Normal, Aorta-Right side and connected LV, Pulmonary artery-Anterior, left side connected to RV, Relationship of aortic and pulmonary valve planes- Perpendicular+ Normal, Intracardiac shunts-Medium size of ASD-OS-Type 15mm, Mitral regurgitation-Nil, Pulmonary hypertension-Nil, Ventricular dysfunction-Nil 2)Doppler study: Mitral regurgitation-Nil, Valvular stenosis-Nil, Left ventricular out flow tract obstruction-Nil, Right ventricular out flow tract obstruction-Nil, Pulmonary Hypertension-Nil, Coarctation of aorta-Nil, Shunt-medium size ASD (os) Lt to Rt shunt 1.5:1 I consulted cardiology Doctor M.D,DNB,DM, He was suggestion to me.Not necessary close this Cole.So whats ur suggestion.pls give clear answer.I am daily going walking(3 km :20mints )and gym.so I am waiting ur Ans. kindly explain me about my Medical report.I must take close this cole?or?our doctor told me,this very small cole so,not necessary close And I would like to know it is necessary for me do this advance level - device closing immediately or can I do this after a year please let me know that too. If you suggest me does this in Chennai itself please let me know how much days I want to stay in hospital & what will be the total cost for this? As I decided to close this device, kindly let me know before going for this Advance Level Device Close do I want to take the TEE test. so kindly refer my MC report.If any possible close this Cole.kindly give all details. if any treatment in Ayurveda medicine.kindly tell meThanks in advance ### output:

Hello, What you have is atrial septal defect osmium second type, So I will enumerate my recommendation. 1) No ayurvedic treatment will help. 2) As the right heart dimensions are normal, and you are asymptomatic, you may consider not closing the hole at present. It can be easily closed with a device, and it is a procedure without any significant risk. Generally a TEE is done before device closure to determine the exact size of defect and select an appropriate device for closure. I would suggest you should get it closed as the procedure is non-invasive safe and can prevent any future complications. The best doctor in Chennai and probably India for the same is

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hola! I had a lumbar spine MRI and was told my L5 transverse process is articulated with the sacrum. This is obviously what has been causing me low back ache (and other aches and pains) since I was a teenager. More recently (since pregnancy over 5 years ago) I also have a more localised pain which turns out to be the exact location of where the L5 TV would touch the sacrum. I am in physiotherapy for this but I really think that the results will be temporary if my pain is relieved. I think this because if I miss a couple of days of exercise, I m back to square one with the pain and ache. I really want to have the resection (transverse process) surgery. The thing is.. I really want to know if the surgery could actually give me the flexibility I never had in my back due to the Bertolottis syndrome that I ve had for so long. Mechanically it makes sense that it would, but in reality is it too much too late? I would like to hear from any surgeon who has experience the this surgery... and what is the recovery like for this op?Many thanks ### output:

Hi, thank you for providing the brief history of you. As by reading your history I can understand that the backache is bothering you too much. As in my clinical experience I see cases with such abnormalities of spine. I personally have recommended people not tonunderfo surgery to the importance of the muscles and the bony factors. Performing regular exercises will surely help you proceed further. The reason to avoid the surgery is also the recurrent post surgical pain. As the spine will be more of the instable. Usually, post laminectomy, discectomy, etc. any spinal surgeries the pain persists in the future. Since it is more of a joint play understanding here that the physics of the spine is designed to bear the sheer stress and load onto it. Also, once the muscles are stronger with the following exercises the levels are under control. Exercise includes - Core stability, Pelvic floor strengthening, Spine muscle strengthening, hip muscles strengthening, and later over all body conditioning. Looking forward to the other matter here is why the pain arises, it is the understanding of the just bony deformity, or it is more of the physics of mechanism involved. To head further I recommend my patients to use the hard wooden surface to sleep in nights, which the body in momentum and the recurrence of pain is much less. Practicing regular exercises post learning from a physical therapist helps in longer run. Surgery is a memory relief of pain, but post the surgery the pain and aches are more due to instability of the spine, which I have personally experienced in my clinical practice. Also, the best job of an orthopedic surgeon is to safeguard the joint and not to allow it to damage more. A good surgeon will never advise for the surgery as the original joint has its own importance which no good surgeon will have a mind to lose. I will recommend undergoing a good number of weeks of physical therapy where you will learn various ways to exercise and safeguard the spine for future and avoid surgeries. In my clinical practice I have this same attitude of teaching more of the physical exercises then looking for the surgery. As exercise is the natural form of safeguarding the spine and surgery is the artificial. So choice is left up to you. In my opinion learning the best way to exercise is better than undergoing the knife.regards. Jay In Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: HI, I STARTED HAVING ABDOMINAL PAIN ABOUT A YEAR OR SO AGO. WENT TO MY PCP ORDERED A COMPLETE ABD ULTRASOUND WHICChatDoctorE BACK COMPLETLY NORMAL. THE PAIN COMES AND GOEST IN SPURTS LIKE AN EPISODE. ABOUT A YEAR OUT I WAS STILL HAVING THE PAIN. I WENT BACK AND MY PCP ORDERED A CAT SCAN. THE CAT SCAN SHOWED MILD JEJUNAL WALL THICKNING, MILDLY PROMINENT MESENTERIC LYMPH NODES (LIKELY INFECTIOUS OR INFLAMATORY) IT STATED. MILD PANCREATITIC DUCT DILATION WITHIN THE PANCREASE HEAD AND SOME FOCAL ADENOMYOMATOSIS. THE GI DR THEN ORDERED AN MRI MRCP. THIS TEST SHOWED SOMWHAT THICK WALLED STOMACH THOUGH NOT DISTENDED. THE THICK WALLED LOOPS OF JEJUNUM NOW WERE NORMAL AND STATED THE MILD PROMINENCE OF MESENTERIC LYMPHY NODES WERE UNCHANGED PROBABLY REACTIVE. IT ALSO SHOWED MILD PROMINENCE OF DUCT WITHIN THE PANCREASE HEAD OTHERWISE THE PANCREATIC PARENCHYMA APPEARD NORMAL. IT ALSO SHOWED INCIDENTAL ADENOMYATOSIS OF THE GALLBLADDER FUNDUS. THE CAT SCAN STATED ALSO THAT THE PANCREASE APPEARED NORMAL DESPITE THE MILD DUCT DILITATION. EVERYTHING ELSE WAS NORMAL. NO ASCITIES OR OSSEOUS LESIONS, PELVIC FLOOR NORMAL. I AM NOW SCHEDULED FOR EUS/EGD FOR FURTHER WORKUP. DO YOU THINK THEY FEEL I HAVE STOMAH CANCER OR PANCREATIC CANCER? WOULD ANY OF THOSE OTHER TEST HAVE SHOW SIGNS OF THAT? PLEASE HELP! ### output:

I. This is a very classical finding of tuberculosis of the jejunum with secondary changes seen in pancreatic duct. This can also be due to dysfunction of the Sphincter of Odd, causing dilatation of the pancreatic duct. MRI and MRCP helps a lot for diagnosis. The Adenomyometasis of the gall bladder is an indication of the removal of the gall bladder- Cholecystectomy by Laparoscopy and at the same time we can have FNAC or biopsy of the mesenteric Lymph nodes and jejunum to confirm the diagnosis. ERCP will be diagnostic for Sphincter of Odd Dysfunction and stenting would help ti alleviate the symptoms. This is the best plan for you. Enteroclysis (barium study) for the jejunum will add to the diagnosis and treatment plan

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I had a MRI of my brain in 2009 because of eyelid surgery I was going to have. This showed a minor stroke that I was not even aware of on the right side. Mt dr. didn t even say anything about this until one year later. The past year or so, i have had trouble thinking of the right words to say...I know what I am thinking but can t find the word. I am retired, 71, don t have any hobbies really. I have been frustrated about this. a neurologist did a CT scan and eeg, whicChatDoctore back normal. He though it was related to depression/anxiety. My new pcp gave me wellbutrin and celexa to help. However, I haven t noticed much improvement. Could this have been caused by that mini stroke? I smoke a bit, don t exercise either. But have some language problems, not forgetfulness. My drs don t think it is dementia, but I worry. Do you have any advice? ### output:

His am Chat Doctor. I have read your message. I think I can help you. First, I do not think that your prior stroke is involved. What you have described is a type of aphasia neurologically speaking. And aphasia is usually caused by a left sided brain problem-not right like you state in your query. Second, if it was truly due to the stroke, the problem would have been since 2009. Brain problems in stroke don't get delayed. So, I don't think that your prior stroke has anything to do with the issue. Second, the main causes of aphasia are stroke and dementia. It is not a stroke as per prior CT scan, and not dementia-dementia is memory loss, and from the query, your memory is pretty good-you remember the year 2009 clearly (suggests long term memory is good), and you remember the medicines (suggests short term memory is good as well). So like your doctors, I don't think its dementia either. However, I disagree with the choice of investigations- the CT has clearly missed your pre-existing stroke as well. So I cannot be sure whether it has missed a newer stroke as well. So, I would have ideally suggested another MRI brain (a more sensitive study than CAT Scan) and a CV Doppler. However, I still don't think it is a stroke. A stroke starts suddenly. And you have definitely not said that there was a sudden onset of symptoms. If however you have forgotten to mention this in the query, you should definitely think about stroke and plan an MRI and CV Doppler as suggested before. Third, a significant history that you have given is the loss of work and lack of hobbies and physical exercises. I won't call it depression or anxiety. And therefore I don't think your medicines will work either. In your case, the age-old adage-all work and no play makes Jack a dull boy-is probably most appropriate. So my suggestion is that you need to stop smoking and get some company and daily activities. It may sound odd to you, but inactivity does take its toll. I don't think medicines are needed in your case. You just need to fill in your time with more activities so that your mind is active again. I have tried to make it as simple as possible for you to understand. Feel free to ask another query with a specific doubt based on the information I have given you. I would be happy to help you further. Best of luck,

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: How can the intake of 5 mg daily intake of Acitrom due to Aortic valve replacement in Jan. 2000 by a 63 years old can be co-related to the problem of sensory nerves weekness, including the problem of ED. Also pl. let me know if there is any more safe alternative to Acitrom or lesser dose of Acitrom, for maintaining INR at +2 level in the increasing age. I also start feeling numbness from knee till ankle and medium level pain in left foot after standing for 15 -20 minutes or walking for about 1.5 - 2.0 Km., which presently disappears after a rest of 5 minutes and i can walk another Km or so only. How can i lead a reasonably comfortable retired life with an hour+ of Yoga and Pranayam daily in the morning, followed by a walk of 1.5 to 2 Kms.? I am otherwise a tea totaller and pure vegetarian, not even eggs or fish and non consumer of alcohol or beer etc. ### output:

Hi! Welcome to ChatDoctorAcitrom is an anticoagulant that helps in prevention of formation of any blood clot so minimizes the risk of stroke or anywhere arterial occlusion by any thrombus. The present problem of numbness feeling of foot is the peripheral neuropathy where your peripheral nerves are affected. You are telling after a long walk of 1.5 to 2 km you get the numbness feeling. So it means when you walk for a long time your legs muscles require more blood circulation and also there is muscular contraction during a constant walking. So the muscular contraction and little feeble circulation due to weakness of arterial wall of aging process combined put some stress on your peripheral nerves, so you feel numbness. If you have diabetic history that also another cause of peripheral neuropathy. Those are the expected cause of your neropathyNow regarding its treatment if you are following the below-mentioned things will be very helpful1) Do the yoga regularly for 30 minutes. It will help to keep active all your hormonal system. It will also help to give some mobility support to all muscles, tendons, cartilages. Furthermore, it will help to maintain a normal blood circulation to all parts which is very much required2) Add more fruits and raw vegetables with your daily diet menu. Take all seasonal fruits. It will help to provide all natural micronutrients to your body. Avoid all sorts of artificial, fast, junk foods. Avoid all types of nicotine or alcohol. Avoid taking raw coffee or strong coffee if taking. You can take green tea. Take your meals in time. Chat Doctor. 3) daily 30 to 45 minutes morning walk. Do the Panama daily which will help to proper oxygenation of all your cells by stretching your lungs alveoli. 4) Take homeopathic treatment for your numbness of foot complain. Homeopathy will help to relieve the symptoms in a short days' duration. Here is homeopathy medicine you can take for the peripheral neuropathy symptoms. Chamomilla-CM - Take one dose just before walking for constant 4 days then give a gap 3 days, again take 4 days. Then stop and can communicate with me further. No more reputation. 5) You can continue citron. Hope it will be helpfulThank you

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I have occasional sores in my mouth, not painful, just shows up raised and red stays around for a little while and then disappears. Teeth break off . Sores in my nose, that come and go. Boils usually 2 to 3, on my butt weekly. I have areas on my scalp that come and go they itch scab over and mostly annoy me. I am achy much and my joints hurt often. my knees sound like they are grounding loudly and make a crunching sound. I can not regulate my body heat. Sometimes I am burning hot and other times I am shivering cold, the conditions around me do not effect this inability to regulate my body temps much. An area under my left rib aches, especially at night I notice it. I have much sleep difficulties. I have had various illnesses and many different problems with various organs. I have had a cervical fusion, a bad kidney infection that I was hospitalized for, pneumonia about 6 times (I have since received the pneumonia shot and not had it since), bleeding tumors in my uterus, endometriosis in bowel and female areas, throat scrapped due to acid reflux scar tissue, infertility struggles, a lump in my breast that the radiologist said was cancer previous to doing an MBI and discovering that there was not cancer there, lump remains but doc was hoping it would go down after my complete hysterectomy. Extreme fatigue. As long as I push myself and am on my feet I m ok. Once I rest I am usually out. I fall asleep very quickly, but I usually don t sleep through the night, I have ICS (bladder), puffy eyes and huge bags under them as well. High total cholesterol I believe it was 278. Diagnoses with fibromyagia. I believe it is lupus? Family members have diabetes (me too), fibromyalgia, rheumatoid arthritis and lupus. I have episodes where I get extremely ill. Stress and cold weather make me feel much worse. Sometimes my cheeks get really red and my heart often races and/or feels as though it has stopped for a few seconds. My memory is awful and I often feel mentally foggy.My memory is awful and I often feel mentally foggy. I have had ocular migraines where I saw rainbow zigzags in my peripheral vision, and headaches where it was sharp pains on only the right side of my head too at times. Prior to the migraines I felt odd, not myself. I have also had dizzy spells and times when I would feel myself fall back, usually catch myself. Once I leaned forward to pick up a toy and hit my head on the doorway hard, it was as though the hit woke me up, like I had rapidly passed out and then came to due to the shock of my head hitting the door frame hard.A year after my cervical spine fusion the doctor did a test and said it showed that I had a growth on the fusion. ### output:

Thanks for an elucidated history and this at least shows that you have a good memory. So many problems: I can really understand the plight you are going through. You must under a proper care of many Doctors/ Specialists. I would suggest such a patient to undergo psychological evaluation and consultation of a psychiatrist as may of your problems have roots in what we call as a psychosomatic disorder. This will help solve half of your problems very soon,

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I am a 29 year old female who is currently terrified thinking I have RA or something like that. About 5 days ago my feet started hurting or rather aching. Its gotten a little worse and now it is switching between a dull aching and sharp pain every now and then. Both feet feel the same way and my heels hurt badly when I stand up. Almost as if I have no padding under them? It does no good to rest and put my feet up or walk. Feels the same regardless. Today was the worst yet and its extremely uncomfortable to stand. I have not done any sort of exercise, had no accidents or anything. I am self employed..work from home so Im not on my feet all day or anything like that. I do not have any swelling, redness or warmtChatDoctoring from my feet. Only discomfort, aching pain. It radiates up into my ankles as well and also hurts in the tops of some of my toes off and on. Mainly the heels though. I have no prior foot problems. I currently have been taking Viibryd for about 8 weeks and I did read it can cause joint pain but feel this is probably not caused by a medication. I should also mention about a year ago or so I did have aching and tenderness in my wrists and thumbs. It lasted a few weeks and then went away and I have had no prior issues (I am a wedding photographer so I shoot weddings on the weekends a other shoots during the week so I figured I was having issues from holding my camera and editing on my computer daily). My Dr. told me to let her know if my hands started up again and that she would test me for RA. So now that this is happening with my feet I am terrified beyond belief. Im hoping there is another explanation. Everything I have read online about RA sounds terrible and basically says that it is crippling and it ruins your ability to lead a normal life. ### output:

Hi, thank you for providing the brief history of you. A thorough neuromuscular assessment is advised. As mentioned by you the brief history I do not feel you have an RA issue. As per me, I feel you need to get assessed your neck and lower back region for any soft tissue Injury. As one of the thing which triggered me to think this is the symptoms of radiation. What I can say is over here it is repetitive stress injury which has got wide based of a combination of symptoms. Also, when there is nerve impingement there symptoms can occur into the distal joints and feels like something else could be there, but the actual cause will be in the root of the nerve. Once traced by a clinical neuromuscular assessment and with the help of an MRI of lumbar spine one should be able to guide you better with it. Also, exercise is a wide subject to mention here but undergoing a proper physical therapy for your problem should solve your pain and aches to the maximum. Physical therapy is a non invade way of getting treated with no side effects. In my clinical practice patient come with similar complaints and have prescription on which it mentioned something else. But the root cause is the spinal nerve root. As human body lands into the degenerative phase depending upon the metabolism of each individual and lifestyle as well. As per my personal Hanson in clinic I feel you should get an MRI of lumbar spine done and see the soft tissue status. Also, a physical therapist will be of help to you. RegardsJay In Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Dear Dr I am a patient of PV for the last 3 years with hypothyroidism for the last 6 years. I am presently on 15mg Predesolone+100 mg Azithroprine+188mcg thyroxine+1 shellcal + Multivitamin+ Vitamin E + VIT D weekly. 3 years before when I was diagnosed PV I was given 32mg Methylpredesolone which was tapered from time to time over about a year and when completly stopped it relapsed after a fortnight. Again I was restarted with 48 mg Methylpredesolone which is now tapered to 12mg + 100mg Azithroprine (50mg morning& evening). At 8mg methylpresolone+ 100mg Azron my I did not get any lesions for about a month but all of sudden there were several lesions on face, body & scalp. Then I consulted other Doctor who administred me 140g IVIG. After IVIG my lesions were reduced, my skin health improved and itching disappeared altogather. After about a month of IVIG again 7-8 lesions appeared and was put on 30mg predesolone {instead of Methyl)+100mg Azron which is now tapered to 15mg Predesolone+100Azron. I am not getting any lesions now for about 2 weeks and my Dr is suggesting to taper it to 10 mg which I am doing from tomorrow. He is also suggesting 2 infusions of Retumbix 0.5g each over a gap 15 days each & thereafter 1 more infusion of IVIG ne month thereafter. Now I request you to please suggest the best course of treatment. I am 60 yrs old male with 5 -2 height & 72 kg body weight, with hypothyroidism. With regards skk ### output:

Dear SKK, it's really a pressure upon you to gulp so much of medicine, which I would not like my patients to continue for such long, lifetime. You can't stop it either. I would rather suggest my own such patients to get support of pure herbals to gain some resistance against disease. To start with Turmeric, Holy basil leaves, Manisha, Need powder, Malawi and Duchy alone would help you a lot. But may be it's slower in action. But what did you gain after getting so many fastest acting medicine. Even if you have to take slow medicine for life, what's the harm when there's no side effect, no interaction with Chat Doctor. But you will find in few weeks what benefits you will gain in few months ahead. If you are in India, you get all the herbs at some Pan sari shop i.e. herbal grocery shop. Get all these - clean, grind and mix in equal ratio. Take with pure honey if not diabetic. Otherwise, with water. We may also help you in getting these if you so desire. Globally you may get capsules of much cos containing extracts or powder of these herbs. I prefer Himalayas pure herbs' series. For any other query, pl write direct question. I want that you must start taking support of these herbs. In few weeks you will start realizing the benefits. These all will not only detoxification, cure but also raise your immunity.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Good Evening, I had a few concerns about some recent symptoms I have been experiencing for the last 4 to 6 weeks. I am 30 years of age, 5 2 and 119 pounds. I have a higher then normal cholesterol level of 193. When researching I have read that anything under 200 is considered normal although the docs do consider it to be a bit high. I have also experienced low blood sugar in the past off and on for about 5 years. I seemed to have low blood sugar issues since I caught the virus mononucleosis in 2007. Honestly, my body has never been the same. I have been waking up at night about an hour after falling asleep with rapid heart rate, higher then normal BP of usually 130 to 145 over 93 and heart rate can get up to 110 to 113 at times. I start shaking all over and become weak all over and lightheaded. I feel cold in my hands and feet. I also have a lot of numbness in my hands and feet while lying down and while sleeping at night. this symptom has been going on over a year. I have been to the ER and was told I had a heart arrhythmia but nothing serious whatsoever. I also had a low Rdw of 12.2 blood test and low phosphorus of 2.1. I also have a drop in blood pressure when lying down. sometimes is goes as low as 87/44 but heart rate is within normal range. These recent blood tests were the only tests that were low. I did have an ekg which was normal and chest x-ray which was normal as well. I was recently thinking maybe I had a thyroid issue or endocrine issue. I have had basic thyroid tests done and they were in normal range but my direct T4 seemed to me to be on the lower end of normal. When I told a Nurse from the ER my recent thyroid test results, He said it was on the low normal side. Do I seem to have some kind of heart issue and why do I have these episodes at night? Sometimes the episodes are so severe I have to get into the shower just to shock my body. It can be very scary. Any suggestions or input you can provided me with would be greatly appreciated. ### output:

Hi, This is Chat Doctor. Increased heart rate & palpitations can have a lot of causes. It can be normal sinus tachycardia due to anxiety or stress, or it could be abnormal supra ventricular tachycardia. For the diagnosis, you need to do ECG at the time of palpitation & tachycardia. If the duration of palpitations are short enough to reach a nearby hospital, we put a 24hr ECG monitoring (Holder Monitor). You also need to do a 2D Echo & thyroid function test to see for any associated abnormality if any. As you have already done a thyroid profile which seem to be normal, I'll recommend you for an echo & holder study to see if there is really some heart abnormality. Your cholesterol is normal & you don't have to worry about that. Normally when we sleep, our body tend to get relaxed & thus our BP falls. This is also a normal phenomenon. But if the BP is falling significantly on changing posture than it sometimes mean fluid deficiency in body & you need to take more of fluids. Rest be stress-free, live a healthy life & you Will be absolutely fine. Thanks

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hello,Im a 19 years old male, 5 feet 11 inches, and 164 pounds. Ive recently noticed a roughly 2cm in diameter red (probably because Ive touched it), solid/firm lump next the bottom of my tailbone. It is not on top of the bone itself, but rather to the left of it, and on top of the skin there. It is painful when I touch it. There is no noticeable blood, pus, holes (as in the case of maybe a pimple or a bug bite). Im quite worried about this. Medical history: When I was a baby I had a condition where my intestines overlapped/squeezed my stomach? and I quickly threw up any bit of food I was given. I had a blood clot in brain a few years ago. Maybe 3 years ago, excluding for the most part this past year, I would feel as if my heart would skip beats randomly, It would be normal, then out of nowhere I would feel a very strong beat, and usually get quite dizzy, this would last anywhere from just one beat to continuing for a few minutes, and would happen on an off almost everyday for those two years, and it still occasionally happens now. Starting maybe last August my bowel movements completely changed, I would frequently (up to 14 times a day) have a sudden and painful urge to defecate. It was often diarrhoea, or at least not completely solid. I did start eating much more and changed a lot of my diet maybe two months prior to that, but had no symptoms prior to August. I went to the doctor for this, got a catscan and they found nothing. The painful frequent bowel movements continued, and I think maybe last January, or February the feces became a bit more solid and it wasnt so painful, but still frequent. Lately, Ive been having some stomach pains in my upper stomach (right below my rib cage), the frequent defecating also seems to once again be very noticeable. Nearly 3 or 4 minutes after I wake up, I get the sudden painful urge to defecate. And the same thing happens almost every 2 hours for the rest of the day.Thanks ### output:

HI, Dear, Thanks for the query from you for your 2 cm, red painful hard-lump at the tailbone? .1-I am happy that you are serious to know why this painful tailbone-lump occurs?2-In my opinion this 2 cm sized red firm solid painful lump is of the -infected colonial cyst and is infected with the cellulitis and induration of the tissue in it and around.3-Though the medical history is elucidative, does not appear to be relevant to the main lump question and is diverting from the main question and hence needs no comments.4-But would explain, why this red lump occurred now-is due to the extensive stress leading to the infective colonial sinus to crop up on the tail bone.5-I would advise General surgeon to Chat Doctor. 6-Hence I would suggest you to go to ER Surgeon or the orthosurgeon for the evaluation and treatment of such cases.8-Hope this would resolve the causative worry of the patient in question. If treated on this line, the fearing patient, should not worry you much.9-Hope this would solve your worry of the red painful lump.10-Wellcome to Chat Doctor for any more query.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi I have had menstrual cycle problems in the past however with diet and exercise advised by a gynacologist my periods became normal with a 24-25 day cycle.. Recently.. I got my periods 10 days earlier.. And it was quite worrying.. I have travelled to a country that s very hot and normally I stay in the uk which is cold so I m assuming maybe it was the heat.. I got my blood tests done hormonal blood tests to check if everything is okay.. My RBC is very low ### output:

Hi welcome to Chat Doctor Dear, Most women will probably suffer Early Menstrual Periods at some point in their lifetime due to psychological and physical reasons. Stress and disease is the main reason. There is nothing to get panicked. Worrying will not help. You must get proper treatment by your gone. Keep in mind that in most cases a combination of psychological and physical treatments is the best option to manage Early Menstrual Periods and related symptoms as low RBC count. Best Remedy for low RBC is to strengthen your immune system by rectifying your fault food habits and derailed lifestyle. In fact, Your body is always fighting something -- an infection, a toxin, an allergen, a food or the stress response -- and somehow it redirects its hostile attack on your joints, your brain, your thyroid, your gut, your skin, your kidneys or sometimes your whole body. It weakens your immune system. You have fewer white blood cells in circulation to fight off germs. This leaves you susceptible to infections. Your immune system is your defense against invaders. But when the immune system becomes weak, by frequent sufferings, disease cells can grow out of control, the disease overpowers. The only remedy is suggested to strengthen your immune system to include essential nutrients in your diet --FIBER RICH, LOW SALT - LOW FAT DIET, fruit, green veges ginger, garlic to balance Air factor-- Vāyu Dosh -- in our body, vitamins and minerals in natural form -, coconut water,, nuts, almonds, and supplements full of antioxidants as Aloe vera juice + AMLA juice 2 spoons, Lemon juice with water and a pinch of salt and black pepper gives immediate relief. Fish oil and flax seeds for Omega-3 and Turmeric powder + Almond oil is very important for our sound mental and physical health and strengthen immune response naturally and will take care of your RBC problem. Avoid fried fast foods, sugar, tea, coffee, alcohol, smoking, stress, worry, anger, Constipation. Proper regular walk, Adopt proper for blood circulation. Exercise, yoga , Kapalbhatti Panama -deep breathing, Anglo Film, Calamari are help full for soothing nerves & relieving your stress inducing sleep and eliminating toxins from our body and help the natural hormones work, Meditation also helps sooth the mind helps in detoxifying and strengthening the immune system to enhance resistance from diseases and pave way for healthy disease free life. It is important to seek medical attention and get thorough check up. Take Homeopathic Cal Pros 30 / Thrice a day / Take 4 hourly / for a week Can repeat if required. Hope this helps solves your query. Take care. All the Westmont hesitate to get back if you have any further query.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hello, my name is Devonne. I have had blackout experiences. Examples: My sister left for Arizona. I remember dialing her but remember nothing after that...nothing. Much later my son set me down to tell me what he thought was some psychological disorder I had. I remember saying Whoa wait a minute, this is way over my head. Then I remember nothing. He called his wife in to ask why I didn t like her, as far as I understand because I cannot remember her exact moment of arrival. Later after saying things I don t remember she began to cry. I left to have a cigarette and my son went with me. He was yelling at me, telling me I was embarrassing him but all I could reply was what did I say? Went back to the table and the rest is blank until my daughter in law told me to get out of her house. So I did...came back to some distant reality and found a hotel I could stay at. I drove right to it with no problem finding it. A few years later I went to live in KC with them. Apparently I called my daughter in law said some things I guess were bad. I remember nothing about it...dialing the phone or anything. Another blackout occurred at my sisters house when I was helping her put up the siding. I was on a six foot ladder, my knees began to tremble. I blackout and fell on the cement. I remember nothing about the fall. My sister said I just fell flat on my back with no attempt to protect my self. I suffered broken ribs and mild head condition that was addressed for dizziness. It worked well. During the head and rib exam (gp) I began to get so dizzy the nurse was having a hard time keeping me on the exam table. I m 59. I ve been diagnosed with epilepsy. I just don t think I have it. ### output:

His am Chat Doctor. I have read your message. I think I can help you. The episodes that you have mentioned are definite episodes of seizures the way you have described them. There is no other possible cause. A seizure comes suddenly-so a person cannot protect self-hence the fall from the ladder. There is no way one can protect oneself. The patient has no consciousness of self and that explains why you don't remember the episodes, despite even speaking in the episodes. Most convincing of all, people think there is a psychological effect. This is because they do not know that seizures are not just the shaking of limbs - a version of seizures which is widely known. So, I am quite convinced that you had seizures-most likely focal seizures with generalization (that is to say that you develop just a part of the seizure first and this becomes more extensive as the episode progresses-hence you could remember your daughter-in-law walk in, but not the rest of the episode). From your last line, I surmise that your neurologist has told you the same thing. From the same line, I feel that you have been initiated on medicines that you are not taking. I should tell you that you need to take the medicines, to avoid further episodes. In case there are episodes despite the medicines, you need to meet your neurologist to get the dose modified and to change the medicine if needed. If it persists, a scan, preferably MRI Brain will be needed. I have tried to make it as simple as possible. Please feel free to contact me for clarification on any particular point if needed. Please do start your medications. Best of luck,

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I had a lumbar/sacral MRI scan(pars view) done 15/06/12 after I eventually got to see a specialist on 11/05/12. He told me I have a slipped vertebra above sacrum and demonstrated on a plastic spine . He also mentioned that nerves were misfiring causing abnormal muscle tension in glute and hamstring and other leg muscles going unused.( I have been doing physio to strengthen thighs. I had arthroscopy , debridement and removal of bone cysts 2008. Cartilage damage in left knee then only stage2, right a little better). I have not got my scan results. The extreme discomfort in lower back stabbing and wrenching pains in hip and odd numbness side of left leg worsening steadily.I cannot find a comfortable position to sleep. Any activities are severely unpleasant. I have an active job in retail and I find I cannot do things at pace anymore as I cannot tolerate sudden movements .I find bending down to access low objects a torture which I have to force myself to do. This makes me urinate too frequently, strangely lifting heavy objects is not any more painful than the bending.( When I first started having back symptoms I thought it was severe cystitis and even had a course of antibiotics.) Walking to and from work is also a torture. I cannot even handle sitting in one position for very long esp on hard chairs. Luckily I do not have the opportunity to sit at work except for on a kickstep (I work 50hrspw ave). I still go to gym about once a week where I was told the leg press is helpful. I choose my activities carefully but still like to push!! My current pain relief daily is up to 400mg tramadol, 240mg cocodamol,2 naproxen(crap) omeprazole and now amytriptiline25mg evening and I still get breakthrough pain( and I am now a cabbage). I need treating as I am getting worse, I dont think resting works particularly either. How do I proceed?? I have only been offered a phone appt with specialist for fri 6/7/12 for 10 mins. I asked diagnostics to send scan to gp but they failed at that too. I cannot concentrate as I can t get comfortable. What should I do???????? How is it acceptable for a working person, who pays ni, to be fobbed off and not given any specific info or advice just some meds. I do feel the slip is not stable and wondering what may happen next...should I obtain my own copy of mri?? ### output:

I think you have significant back pain. From your history it looks like you have unstable spine, and you are a surgical candidate. These problems can be cured completely with surgical management. Daily dependence on pain medications is not advisable, and it has adverse effects. Do you have Lateral flexion and extension X-ray? MRI? Need to see that. You will be back to your work in 2-3 weeks after surgery. Also, this is not only about pain, I think you started developing neurogenic symptoms and signs and in that case timely interventions gives the better prognosis. If you can send you X-ray and MRI images I will be able to tell you more about type of surgery you need. Hope this helps you.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I have a horrible tooth ache, #19. Some history. I recently got my braces off after having them for 2.5 yrs. about a year ago, this same toothe started bothering me when I would bite down. At my regular dental checkup, I told my tent its and he checked the bite and said it was off, so he file the tooth down just a little bit. It was fine after that. Then about 6 months ago, while I still had my braces, the same tooth started hurting again. Only that time much worse than before. It came on very quickly, and felt like the tooth had raised up over night, so that every time I closed my mouth it hit the top teeth. The pain was horrible. I couldnt bite down on anything. I went to the dentist and he checked it, and again my bite was off. He filed it down, and I had immediate release, however, it wasnt 100%. He did X-ray it and and mentioned a brown spot on the root, but sati that it could be because of the orthodontia work, so said hed monitor it. Since then, Ive tended to avoid eating anything on that side for fear of it hurting. Sometimes I would try it just to check and it felt okay, but not perfect. More recently, it has been more sensitive to cold. Ive experienced this off and on through my life, so it didnt concern me until this past month when heat started bothering me. This was a mild irritation until last week. Now, it hurts dreadfully, And not necessarily in response to temperate changes. It can be fine one minute and the next I feel like crying it hurts so bad. At first it was just the tooth and then gum around the tooth. Now when it hurts, its like its throbbing around several teeth and in my cheek. I went to the dentist this morning, and he took an xray and said it looked fairly normal. But because of my symptoms, he could see som areas where it may be a problem, so he referred me to and endodontist. Well, now its been throbbing off and on all day. The whole lower side of my mouth hurts and so does that side of my tongue and neck. And for some reason, a spot in the roof of my mouth is sore. Why is my neck, my tongue and that spot in the roof of my mouth hurting? Is this typical? ### output:

Hello:)Welcome to Chat Doctor. Repeated episodes of heat and cold sensitivity suggests you have a pulpits on the tooth. Also, the dark spot around the root suggests a periapical infection. Dental pain can be radiated to the neck, ear, head, and whole jaw as in your case. Do not worry, take a Novato 500 for 5 days b.i.d. Also take Idol plus (analgesic) t.i.d for 3 days.(Make sure you are not known allergic to these medicines, not asthmatic). I suggest you to get the x-rays done and go for a root canal on this tooth. Also check if there are nearby teeth which are also infected. A root canal for this tooth will ideally remove the infection and eliminate pain. You did not mention if you use a retainer. Check if it's hurting on your palate to get it trimmed. Regards.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I just have a few questions about some fo my bloodwork and symptoms. I am a 24 y/o male. I currently am seeing a hem-onc regarding iron deficiency. My serum iron is 7 microg/dL, TIBC 460, transferrin sat 3%, and MCV 71.4. EGD and colonoscopy showed nothing, and Hemoccult negative for occult blood x2 separate occasions. I have been on p.o. iron for 5 months (serum feritin was 3 in nov 2010 and mar 2011 was 7). Also, celiac sprue panel negative. Hgb 13.8. All other blood tests and serum chemistry are normal. U/A was negative for blood. Retic count 2.5%. I have also had a couple of night sweats, spleen was 12 cm in 11/2010 and 14.5 cm in 2/2011, also I have 2 cervical lymph nodes (about 1cm each) enlarged just above clavicle. They are painless, but non-fixed and have been enlarged for about 8 weeks but have not increased in size. I have had no recent illnesses, except for strep throat in 12/2010 and glomerulonephritis shortly after that. I also have very bad exertional dyspnea since about october, to the point where Im SOB after 2-3 minutes of minimal exercise (and ive been taking tae kwon do for 2 yrs without any trouble unitl recently). I also am extremely tired recently (I used to operate on about 5 hrs sleep/night and am now sleeping 12-15 hrs/day). I have never had any anemia or iron deficiency before. I have no family hx of blood cancers; however, my maternal grandmother had stage 4 breast cancer at 31 y/o and stage 2 breast cancer (which was unrelated to the first cancer) at 40 y/o. No family hx of iron absorption dz. My hematologist recommended IV iron dextran 1x per month x 4 months. Just wanted to know if I need a second opinion or is this just probably an iron absorption problem. Only past med hx is mild GERD. Currently taking nexium (for past 5 years ) and Bifera rx iron supplement (since nov. 2010). ### output:

Hello, I would suggest an FNAC fine needle aspiration cytology of your neck lymph nodes if they are still enlarged. I presume that you have had a peripheral blood smear evaluated by a hematopathologist. If not then peripheral blood smear examination is necessary. If you have not done certain tests such as TSH thyroid stimulating hormone test you may also get that done. Based on your description your condition appears to be iron deficiency anemia. The exertional breathless sensation may be a symptom of anemia. However, as anemia is uncommon in a young male further work up is necessary especially that of your lymph node. A second opinion from a hematologist is prudent to exclude the possibility of a condition called lymphoma of your lymph node. Though it is a rare possibility it is prudent to get a second opinion. Best regards. Should you require further assistance in test interpretation please post your queries here?

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, I am a 68 yr female. Quit smoking in 1988--at 1 pack cigarettes/day. General History: bronchitis and pneumonia 1975. I have walked over a mile every day up until 2005. Chest has been clear with no cough or sputum. I saw my family Dr 2 weeks ago with the problem of chest pain and shortness of breath with moderate exercise/activity. Chest was clear and no cough.I have been experiencing this for 1 year but on a lesser degree...it has been getting worse the last 4 months. EKG in office was normal. Chest x-rary displayed HYPERINFLATION OF LUNGS. I was diagnosed with ADULT ONSET STILL S DISEASE in 2006-- 1st symptoms extreme wrist pain lt wrist started in 2003-- which carpal bones had bone loss about 30% and complete fusion of left wrist by 2006. I was started on KINERET INJECTIONS od s/c---- July 2006. My symptoms at this time were extremely severe. I had been sleeping in a recliner chair for over a year as I could not get my breath laying down.I could only walk 50 feet with dyspnea.I had difficulty swallowing,laryngitis daily,swollen lymph nodes all around my neck----- felt like suffocating . I was hospitalized for 2 months --- May 2006 to July 2006--- hi spiking temperature 104F, salmon raised rash lower trunk and thighs,weight loss over 1 year 55 pounds(dropped to 90 punds),blood tests showed up indicative as a severe infection(but no infection was present),low RBC count(required 2 blood transfusions). I became almost symptom-free after Kineret injections commenced--- blood work was normal within 24 hours. My breathing was normal after starting Kineret. I experience most of the systemic symptoms of AOSD --- almost daily sore throat,extreme fatigue,joint and soft tissue pain,especially wrists and feet. WHENI stop taking my Kineret injections all of the above symptoms become extremely bad within 40 hours of missing 1 dose.--- especially breathing and swallowing. Can this HYPERINFLATION OF LUNGS be related to my ADULT ONSET STILL S DISEASE?? Sheila H ### output:

Thanks for your question on Chat Doctor. I can understand your concern. No, hyperinflation of lungs on chest x-ray is not related to still s disease. Your hyperinflation is due to smoking history. Smoking causes chronic bronchitis. And this is the reason for your symptoms like chest pain and breathlessness on exertion. So better to consult pulmonologist and get done clinical examination of respiratory system and PFT (Pulmonary Function Test). PFT will also tell you about severity of the disease and treatment of bronchitis is based on severity only. You will definitely improve with inhaled bronchodilators and inhaled corticosteroid (ICS). Don't worry, you will be alright. Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi I am a 33 year old with dizziness, ha s and HTN over the last week. A am a RN and took my BP with a automatic cuff 174/106 after expereriencing dizziness and HA and episode of nausea. I immediately called clinic and was seen but BP had gone down to 136/102. They did an EKG, UA a/ChatDoctor and labs-all of which were normal. I am healthy, 33 y/o, work out 4-5 days a week, 5 9, 147 lbs and only take BCP s. My mom has HTN but is also overweight. I am not stressed. They thought I had BBBV or a migraine. But my HA was not that bad (it was no migraine). Why would my BP be elevated with BPPV? I saw a PA who did not seem to think it was a biggie having my BP that high. My BP s since then have gone done to 140 s/upper 90 s. I know in the past my BP is usually high when I get seen because I am really sick or in pain. For all I know I could have been having elevated BP for some time now......any ideas. Dizziness is still there a little (not as bad) was able to work out, slight HA, BP 145/98. Thanks concerned RN ### output:

Hello, As what I understand from the history is that the dizziness and nausea feeling is due to vertigo. As both are interred related and are due HMF. The nausea feeling can be triggered by Chemoreceptor trigger zone due to vertigo. Since you mentioned you Blood pressure was high on a digital monitor at home, was it same way measured digitally at the physician center? If not than did you follow the correct way of measuring the blood pressure? Like taking rest in lying position for 30 minutes before taking the blood pressure? Also was this measurement of blood pressure happened in sitting position as soon as you reached the physician center? Which arm was showing signs of high blood Pressure the right or the left? Many things are unanswered in the history. But as you mentioned your age as in the early 30s, and you are a good physical workout kind of person, ignore this high blood pressure sometimes as it may be fluctuating in the time of the day. If we have to confirm you are having a high blood pressure than we need to follow the basic principle and also have to check you on a sphygmomanometer along with Echocardiogram and Electrocardiogram with some blood routine. Also, there should be some clinical symptoms before confirming you are having hypertension. As what I feel is your blood Pressure is not the concern and the concern is the BPPV. You need to meet up a good euro physiotherapist, so an exercise prescription is provided which should help you. In my clinical practice of 12 years I have been coming across such cases of vertigo and that is dealt with proper assessment and examination. Most have been having on their early 30s lowered the blood Pressure and also the symptoms of vertigo with a precise exercise prescription and vertigo medication. I wish you good luck and request you to stay calm and follow the guidelines of exercise. You should do well. Hope I have answered your query. Let me know if I can assist you further. Jay In Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Age 60 years ,diabetic since 2003 but usually keep it under control with medicines and exercise except some short duration jump in glucose level. HbAIc level remains between 6.5 to 8.2. Since 2009 I have developed B.P and am taking Amdepin 5 for it.For the last 3 years I have developed cracks under the sole of my feet with hardening of skin around the cracks like rashes which are difficult to heal. There is no peeling of the skin.Some Doctors diagnosed it as dry eczema ,others fungus and some other as psoriasis. I took treatment for all these but with no permanent relief. I have used salicylic acid ointments but the cracks do not heal fully and re-appear after very short duration.I have noticed one particular phenomena. When the cracks are about to heal say around 90 % and if suddenly I have tension due to any reason even for a moment I feel as if my blood is boiling and feel strange and acute itching under the sole my feet and within few minutes there are cracks again. within next one or two days skin thickens around the cracks. Suppose I have arguments with any body for a minute, immediately there is itching under my feet and cracks appear thereafter. Cracks also aggravate whenever I have allergic cold . I am taking following tablets now a days for diabetes and H.T:-Morning dosages:1. Amdepin 52. Glimisave M 13. Aspisol 754. Nuromark5. Evion LCAt dinner:6. Piglit MF 15Note: For H.T I have tried Telmistar tab but that does not suit me and causes sudden unsteady gait for a second while taking morning walk. My father suffered from Psoriasis/lichen planus. He took treatment from different Hospitals and doctors like A.I.I.M.S, Irwin Hospital, Dr Ram Manohar Lohia Hospital, Behal Skin Institute and other Private practiotioners but with every treatment his condition deteriorated and ultimately he died of Skin Cancer in the year 1986 at the age of 57. Therefore I do not want to take any oral medicine especially averse to taking any Steroids.At present I am applying Xerina foot cream in the morning and at night. My diabetic physician has now prescribed the following drugs:1.To stop Evion LC and take Bio D3 Fem once daily and Tayo 60 K once in a week for 4 months2. Instead of Amdepin 5 to take Ramihart-53. To take Telekast-L once daily in the night.4. To stop Nuromark for one month and restart after that.Please advise. ### output:

Hi, welcome to Chat Doctor,first you need to be diagnosed properly, as different physician has diagnosed differently, fungal infection, psoriasis and Chat Doctor. Although clinical diagnosis is straight forward, but some times need diagnostic help to diagnose. Skin smear under KOH will show fungal hype in fungal infection. Psoriasis needs dermatopathological examination. If you can send us clinical photograph then it will be helpful. Psoriasis has no cure, it can only be controlled. Thanks

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I am scared because I don t know if this is stress or really a heart problem? Last friday (last week, not this past friday) I had been experiencing difficulty breathing, more pronounced then usual. I went to the doctor and they did an EKG and said I had AF, so I had to go to the ER, where they did another EKG and said it looked normal, and the doctor EKG looked normal (they say) and that there were artifacts that were contributing to it. I am still not convinced. Can an EKG reading be abnormal one instance then an hour later be back to normal? I am scared because no one will try to conform anything, and if I ask to go to the doctor one more time I m afraid my mom is going to slap me X_X She really can t afford all this. I normally don t breathe really deep, it s somewhat shallow, and everyone pointing this out has me worried now. For the past month I ve had alot of chest tightness. A panic attack only lasts a little while, but the chest tightness/pain doesn t go away, and my heart beat still feels very odd every so often (like there are extra beats) They said it sounded fine but these weird beats come and go. I m scared because I don t want to have to sit around until it gets worse or something bad happens. They ve done bloodwork a few weeks ago and last week (never heard about last weeks) and said it was ok. I ve had numerous x-rays done the past month (one at the ER too) and they said it looked ok. I just don t know what to do. I m mostly bothered by the difference in the 2 EKGs, and why it would point to me having AF if I supposedly don t have it. I don t know, CAN it just be stress/anxiety? This weakness and shortness of breath (even though im getting enough oxygen) and the constant discomfort in my chest has made me loose so much sleep, and i ve got so much tension pain from that and so many aches in my legs and arms . I am not sure what is what, and it s scaring me. I m 17, btw. I have been tested for asthma twice in my lifetime, I don t have asthma, and they kept trying to give me asthma medicine that did not do anything :P So I m pretty sure by now I don t have asthma. Nothing directly causes the chest tightness. ### output:

Chest tightness and difficulty breathing are normal symptoms of Anxiety disorder but its also normal symptoms for Asthma. I would get heart palpitations (irregular heart beat), and shooting pains through my chest and arms. The only way to find out if you have asthma is to take the medication for a test run. If you feel better after using it, then its just that. The doctor can also put you on a test run of antianxiety medication for a week or so. It's best to just give it a try to find out what you have, because anxiety and asthma are difficult to diagnose by having tests done. As for the type of anxiety medication you should try, I would recommend Effector XR, or something similar. You can ask your doctor. I wouldn't recommend Zoloft as it can make you depressed. It is possible for one test to come back differently than another. It can all depends on a lot of different factors. I hope this helps a bit.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi,I believe I have pinworms. My internet queries solidly indicate this issue. Ive been taking albenzole and mebendazole for a year now and they have not gone away. Albenzole is not a prescription item here and the mebendazole came from another country where its not a prescription item. Ive been to the doctor overseas here on three occasions, but they say its very rare here, but pinworms is what they suspect. Months before I started treatment they were all over me, I would put transparent tape around my hips and hundreds would get stuck on the tape. They were obviously just pouring out of my anus. I took the tape to the clinic here and it came back negative, but I really think they were clueless. It was so clear there were these little white v-shaped threads, how could they not figure it out? After I started albenzole they dimished a lot, but I still feel them crawling on my anus and walking on my scalp. It appears that they are living in my scalp, it appear they have moved though my bloodstream to different parts of my body. I have not seen this issue in my internet queries. I have a metal lice comb that I use daily to try to get rid of them on my head, but they come back daily. I was taking 1/2 tab albenzole for 5 days, then off for 5 days, but that didnt cure. Then I went to 1 tab per day, 5 days on, 5 days off, then 14days on. Still not cured. Then I used 250mg Mebendazole twice a day for 3 days, off for 5, 3 on, 5 off. Still not cured. Im guessing the eggs floating around may be one issue, but Im starting to think I have something far more serious going on. I have two dogs that stay on one sofa and am thinking they stir up the eggs. I have treated them for heartworms so unless they are reinfecting themself by breathing their own worm eggs (assuming they have worms, which I see no evidence that they do). The meds Im taking have reduced the worms but I am taking way too much and they are still around. I have followed all the different advice regarding sanitation, I am squeeky clean and wash my hands/nails with a nail brush, roller my bed linens with a lint roller after getting up and before sleeping, wash all clothes in hot water, carefully avoid breathing near my dirty laundry when Im changing clothes or putting stuff in the washer. I hope theres some good advice coming. Thank you. ### output:

HI, thanks for using Chat Doctor Pin worms, as you mentioned, do not usually travel to different aspects of the body. They are not present in the bloodstream, so it is not likely that they have traveled to different parts of the body. A stool sample sent to the lab would be able to determine if you have any parasites in the stool. Blood tests for complete blood count and ESR would determine if any infection is present. You are also correct in saying that using these medications persistently is too much, this is the reason you should have the tests done to see if you need to still take them. A gastroenterologist or infection control specialist may the best doctor for assessment. I hope this helps

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I started getting these dizzy spells about two maybe I think it s been longer than that. Today last night I had gotten a little talkative with my son and his friend. I went to my room and started cleaning up and I have some things happen back far in the past that for the last two years I would once a month and sometimes a few days and sometimes a little longer except in the beginning. I have done all the research that would put a organization on blast to the world. I go in to hyper focus most of the episodes and others I get memory after memory that I see a lot clearer today than when it happened. So I want to use the one time of what I thought was so scary kinda because it was everything I would say and something I wanted to do with most of the really intelligent way I was saying these findings or whatever I would at the end of this statement or finding something was a whole different because I never got to finish because I went completely blank and could not remember what I was even talking about. I just looked at something while I was thinking and remembering things I would go blank. I said at least thirty times throughout this going on with me. I think it was around 1:30am and I didn t notice when or why it just stopped but 5:34am is the only thing I remember from that time this morning until I went down and ate something and I came and this was on my iPad when I opened it and I remember what happened to me and how worried I got. I said earlier about the example for maybe you will see the degree of how fast I would forget what I wanted to say or do. I got a number I needed to hurry up and right down so I didn t forget because I all of the sudden had it pop in my mind. I picked up a index card and pen and before I even got it half way off the dresser I said I completely forget the number like it was never even thinking about writing down at all. That happened again a few hours later. I jumped from something I was thinking, to a complete different thought or subject as if the first thing I was thinking never existed. So, I don t know if you hear how much this was a concern because of the complete loss of any thing I just had been saying to myself and then I was completely lost and could not remember what I was even thinking to get to the end of all the thoughts or numbers and whatever I was doing, I could have been almost to the end of a well known story and before I got to the end to finish the story it was a complete mystery to me what I was even thinking about. Hopefully my very long and sorry for that, explanation of what was happening will give you a good idea of what I was going through. I thank you for your time and your opinion on what you think or say about this. ### output:

Hello, First, you should measure your blood pressure, and if it were high you should receive a medical treatment, take Aspirin twice per day after meals and do an ECG and an ECHO on your heart, besides decreasing salt and fat intake every day. If you are a woman, and you take oral contraceptive pills or hormonal replacement therapy, you should ask a gynecologist for help. Second, you should take vitamin B complex once per day after meals and Benfotiamine 40 mg twice per day after meals. Vitamins B complex are essential for memory. The results of the ECG and the ECHO can help us with your diagnosis. I hope I answer all your questions. Hope I have answered your query. Let me know if I can assist you further. Take care Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: this is my problems please solution & treatment. Ultrasound Examination of Abdomino- pelvic organs: Liver: Liver is mildly enlarged in size. However, hepatic parenchymal echotexture and echodensity are uniform. No focal hyper or hypo-echoic lesion is seen in the liver. Intrahepatic portion of IVC is normal. Portal vein is normal. Porta-hepatis is normal. Gall bladder: Normal in size and contour. Wall thickness is within normal limit. No evidence of echogenic structures or biliary sludge is seen within the gall bladder. Intrahepatic biliary radicals and common ducts are not dilated. Internal diameter of CBD (3mm) and that of portal vein (9mm) are within normal limit. Pancreas: Parenchymal echotexture of pancreas is homogeneous. Main pancreatic duct is not dilated. Spleen: is mildly enlarged in size. However, it shows uniform in echopattern. Kidneys: Both kidneys are normal in position and size. Bipolar length of- (a) Right kidney is 09,0cm & (b) Left kidney is 10.2 cm. No mass lesion or calculus is seen on either side. Pelvi-calyceal systems are not dilated. Cortico-medullary differentiation is normal in both kidneys with normal cortical echogenicity. Ureters are not dilated. Adrenal glands : Both adrenal glands appear normal at USG examination. Urinary bladder: Normal in outline. No wall thickening seen. No demonstrable intravesical lesion is seen. Prostate Gland: Prostate is normal in size. It measures about 2.5 cm X 2.7cm X 2.9cm. Its volume equals to 11.142cm3. It shows homogeneous echotexture with smooth and intact capsule. IMPRESSION: Mild hepatosplenomegaly. ### output:

Hi, Common causes of hepatosplenomegaly are mononucleosis, hepatitis, and Lysosomal Storage Disorders (LSD's). Mononucleosis spreads through saliva and mucus, and may cause a high fever, enlarged lymph nodes, and a severe sore throat. Other causes of hepatosplenomegaly may include tuberculosis, malaria, and some forms of cancer. Some autoimmune disorders can also lead to this condition, including Systemic Lupus Erythematous (SHE) and juvenile rheumatoid arthritis. Parasitic infections, chronic alcoholism, and cat scratch fever are also associated with liver and spleen swelling. The treatment for hepatosplenomegaly largely depends on the underlying cause. Most of the time, when that is treated, the swelling goes down naturally. In those with conditions that can't be cured, treatment focuses on managing the symptoms and improving the liver and spleens function. This includes things like enzyme replacement therapy, which can help keep the size of the liver and spleen down, and avoiding things that stress the liver, like Chat Doctor. Hope have answered your query get well soon and take care.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I have had back pain and been diagnosed with degenerative disc disease as well as stenosis of the spine. I am 37 and my pain began when I was 19. That s when i decided to get help the first time. The remedy and news were depressing that it won t get better. I have had a discectomy about 8 years ago and during rehab fractured a pedicule in the spine causing what honestly felt like lava flowing through the veins in my legs. It was extremely painful. After time that pain subsided as I healed but I have always had back pain. I haven t felt my left thigh for over 15 years now. I should also mention that I have also had recurring pilonidal cysts below my tailbone and I had the last surgery roughly 3 years ago and thankfully have not had one of those monsters since. However along with the normal (my normal) back pain and numbness in my left thigh I have been experiencing a sensation as if I were sitting on a cell phone on vibrate. It is fairly consistent for the past couple of weeks and there is no additional pain. I am currently prescribed zubsolv as it helps to keep my mind off the pain I have and does not give me the bad side effects of pain killers like oxymorphone. I am more active than I was from age 25 to 35 but I am still overweight even after losing 85lbs. Is my degeneration or stenosis getting worse now that I am more active? I am a delivery driver for the past year and in addition to carrying 20-30lbs I also am in and out of a car 30-40 times a day. Any advice you can give me would be most appreciated! Thank you for your time and compassion. I hope you are well. ### output:

Hi, thank you for providing the brief history of you. As mentioned you still have pain, tingling and numbness in the thigh which is troubling you, also further you have a spinal stenosis and disc degeneration, it is sad to hear you had it as a very early age.a thorough neuromuscular assessment is advised. Also, in your case what I feel is the weakness of the muscles which are not able to stabilize the spine. You need a thorough and deep assessment of the muscles of the spine as by which how to handle your case will assist us further. Also, may be your hip muscles will be weaker than, the hip muscles act as a base of support to the spinal column the strength in the hip muscles is of due importance. Besides, stabilizing the spine with cores stability is of due importance. Also, to understand that only spinal muscles strengthening is not the concern here, here the concern is to see the body as one unit and rehabilitate as a whole. Besides, the Strengthening of the pelvic floor, hip muscles, core muscles, lower limb muscles and on later stages the spinal muscles will surely make the body as one unit. I have seen cases of lumbar disc degenerative disease when patient was 16 years old. But applying the correct exercise prescription helped him back to action without aches and pain. I will recommend you to undergo a proper assessment and then a physical therapy as working out behind you will be a tough task but not an impossible one. Slow and steady wins the race. I hope to see you recover soon.regards Jay In Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: hi doctor,now-a-dayas im lossing my temper very fast...cant control it...though im short-tempered frm childhood.Cant sleep properly...a bad headech occureddurring this time....i lose my confidence level...i cant make my mom happy...all the problems happened in my moms life, just bcoz of me...she was a divorcee...but my father(step) is not behave properly with us...frm Class-V, i grown up,watching their qurrale everyday...Now im an Animator--was working in mumbai,but as my mother fall ill i cant continue there anymore,so back to kolkata...got a job here also...but for some financial cause that office closed for last few months... so im in home now...but my mom force me to join the course,which help me to get a govt.job....but im not interest in that..she cant undertand that. Whatever goes wrong to her life,she blemed me for that. Recently,one of my pet lost,when going towards my cats yearly checkup to animal hospital....this time i suggest to go their(cat) hospital,instead of calling the doctor home,as we did earlier...Now,as the pet is lost,she make me guilty...all the times she cry n tell everybody that she lost her(the cat) for my fault...and as i cant cry and cant say anything ,she think that i do it intentionaly....i feel very bad. Though my family is a broken family, its very few to look that,we are talking with each other. But now -a-days its become horrible...ive a boyfriend,may be we get married next year...our family know each other...but as these thinks happen, I dont want to marry him...bcoz,in future if something goes wrong,then everyone bleamed me...i loss my confidence...sometime i think suicide is the way go get rid of dis things...sometimes think that escaped frm home will be better....what to do...am i going mad???plz help me... ### output:

Degree understand your concerns went through your details. I suggest you not to worry much. Anger always comes due to frustrations in life. Frustrations are normal with everyone. People learn to ignore frustrations when they get experienced. Do you get angry to circumstances outside your home as you get angry at your house? Your office, bus stand, railway station, neighbors etc. If yes, you might need to get evaluated for anger issues. If NO, just understand and compare the two situations, and you can be better yourself. I sincerely suggest that you are victim of your own negative thinking. You cannot term your current state of mind as clinical depression. Rather, this is just disappointment. Disappointment which arises out of unforeseen life events do bring such symptoms like sadness, irritation, anger, lethargy, lack of interest, lack of appetite etc. Please understand this fact and make sure to introspect. Talking to your friends, outdoor activities and being creative should give you relief. Find the reason for your disappointment and consult a psychologist if need be. Psychotherapy techniques should suit your requirement. If you require more of my help in this aspect, Please post a direct question to me in this URL. http://goo.gl/aYW2pR. Make sure that you include every minute details possible. I shall prescribe the needed psychotherapy techniques. Hope this answers your query. Available for further clarifications. Good luck.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I have received prolotherapy, prp (which did temporary relieve all pain in my knee, but has since returned), and two stem cell procedures using adipose tissue and spaced a year apart. All this was following arthroscopic surgery, physical therapy and cocks comb injections which provided no relief. The arthroscopic surgery made the knee even worse. After the second stem cell procedure, the pain tripled in severity and the physician instructed me to take three Motrin three times daily. After no relief in pain, he told me to increase the dosage to six Motrin three times daily, but again no relief. During the adipose tissue harvesting, he had an observer present who later left with some of my stem cells, but without my then knowledge or permission. In addition, I see that lidocaine from Hospira that was used might be part of a lot that was infiltrated during manufacture with metallic particles that could lodge in injection sites or be carried to other sites and cause severe pain, stroke, or other adverse effects. I have been complaining about increasing pain at all injection sites (knee, tibia, sole of foot), but have not had any success with resolving the issue. I did receive notice that Hospira manufactured the Lidocaine, there was no record of the lot number and that the facility did not receive a notice that they were part of a recall. I was a self pay patient and all is far worse following my August 2014 treatment than I was before treatment. The doctor said that he is sorry he couldn t help me and has me talking to a nurse who I have not heard from in two weeks. I recented made an appointment with an orthopedist at a nearby tertiary hospital who spent 8 minutes with me. He asked me to tell him what the problem was, never looked at my knee, took new xrays to the tune of $1100 and then stated that he would not operate on my knee. He told me that he was going to have me see another doctor who specialized in spinal surgery (I have a 22 degree curve that does not cause pain). The office staff was not alerted to this when I asked immediately after and told me that I would be called back. This was over two months ago and I am still waiting. I have a consultation with another doctor in June for evaluation for a TJR, but am now using a cane, walker and almost ready for a wheelchair. Before the last stem cell treatment and prp I still was walking without much pain so my hypothesis is that something in the lidocaine must have initiated the pain since every spot injected hurt and continued to and even resulted in a ruptured quadracepts tendon where injected when he tried to even up my posture. I will be calling Hospira to find out whether the bad lots of lidocaine were purchased by the facility that I had the procedure done at and take it from there. What is your perspective of my situation? ### output:

Hi It seems that you have been suffering badly from pain at multiple sites, which you have correlated to injection sites. One doctor you saw recently has a different opinion, pointing towards spine pathology. You said that injections were given in the knee joint then why tibia or soles be involved. There is a pathology in your backbone causing curvature of spine, possibly Canal stenosis which can explain all your problem. I would suggest you undergo an MRI of your back and NCV of your legs to assess the nerve pressure.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I had a mild stroke in 2013. I was fine, just playing Scrabble with my husband, when a warm sensation traveled from my lower extremities through the urinary tract and within minutes my left eye became impaired and I lost vision in that eye. I naturally thought it was an ocular migraine since I ve gotten many in the past with auras around the eyes but this seemed concentrated in the left eye only. NO OTHER STROKE SYMPTOMS...I immediately went to the kitchen to chew a 325 aspirin and my husband called my eye doctor because I do have Glaucoma and a history of very debilitating migraines. I also have A-fib. It ended up being a stoke and no one knows whether it came from the eye or the A-fib. although I wasn t presenting with A-fib at this time and believe me, I KNOW WHEN I HAVE A-FIB--very symptomatic. Today I had that warm sensation travel up my body just like before but without loss of vision, no face droopiness, no numbness in arms, speech OK, just scared to death. Grabbed another aspirin...I ve been taking Plavix for 2 months but there are so many side effects I was going to quit it tonight and go back to the 81 mg. aspirin...now I ve had my aspirin for the day. I was lying down when this happened and my back [middle] was hurting me a lot but I do have LUMBAR and Cervical spine issues. I also cannot tolerate blood thinners or anti-arrhythmic drugs. I m a cancer survivor as well [breast cancer]. What was that unusual warm sensation? It scared me because it was just like the one I had last year. I feel OK now but still shaky and was tempted to just go to the ER but I m savvy about medicine having worked in 2 hospitals and NIH for 32 years. I also have Hyponatremia if that helps any. Have trouble holding blood sodium levels in the normal range. Thank you. Sally ### output:

Hi, thank you for providing the details about your health condition. What I am able to understand is the metabolism of your cells needs a booster along with the immune system. Usually performing regular - meditation, Breathing exercises, general body exercises, will help improve the metabolism. As you are a cancer survival and Stroke as well, you need to focus on improving the cellular Metabolism. As body is the medicine of its own, many major issues are taken care by body. Also, for the neck and back pain you need to see a physical therapist who by using the therapeutic ultrasound therapy and TENS therapy will help reduce pain. Besides neck and back spine Strengthening exercises are advised to improve your body. Body if not in momentum will lead to the lack of the cellular functioning and later end up anywhere, where there are weak zones. Also, by doing the regular exercises the Chat Doctor. I hope you understand the importance of exercises. Maybe it is little to do a day but with little only the bigger improvement comes. Also, after stroke, breast cancer, cervical and lumbar spine issues you need to perform physical therapy to improve the Metabolism, immune system and get strength. You can discuss the same with the physician.regards Jay In

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hello Doctor, I have been suffering from lower back pain for last 4 weeks. I was told that i am suffering from muscle spasm and need to take rest. I was asked to do some stretchable exercise, physiotherapy and hot showers on the affected area. But till date I have not got any relief. Now I am not able to walk independently and it hurts a lot while walking few steps. Please advise. PADMA ### output:

DEAR PAD MA, HI, I AM Chat Doctor. I WOULD LIKE TO HELP YOU. ASSUMING THAT YOU HAVEN'T STARTED USING A NEW PAIR OF PARTICULARLY HIGH HEELS AND YOUR OCCUPATION DOESN'T INVOLVE SITTING FOR LONG DURATIONS, YOU WILL HAVE TO GO BACK 4 WEEKS IN TIME AND TRY TO REMEMBER WHAT YOU WERE DOING IN THE EXACT MOMENT THE PAIN STARTED .THIS WILL GIVE YOU A CLUE AS TO WHAT THE CAUSE MIGHT BE SINCE THERE ARE MANY REASONS FOR LOW BACK PAIN WITH MUSCLE SPASM. MUSCLE SPASM IS USUALLY THE BODY SWAY OF PROTECTING THE VERTEBRAL COLUMN FROM FURTHER INJURY BY LIMITING YOUR ACTIVITY.SPASM CAN ALSO BE CAUSED BY SOMETHING THAT IRRITATES THE MUSCLE.FOR EXAMPLE IF YOU WERE INTO SOME HEAVY LIFTING, OR JERKY TRAVEL, OR A FAST MOVING SPORT YOU MAY HAVE SLIPPED A DISC ...IN WHICH CASE YOU MAY HAVE TO GO FOR A X-ray/CT/OR MRI AS YOUR ORTHOPEDIC IAN MAY Advise. IF IT STARTED AFTER A FALL OR AFTER SOMETHING FELL ON YOUR BACK YOU MAY HAVE SOME INJURY TO THE BONE WHICH CAN ALSO CAUSE MUSCLE SPASM I ALSO WANT YOU TO THINK IF YOU HAD ANY OTHER SYMPTOMS BEFORE OR AFTER THE PAIN STARTED LIKE A FEVER, AN ABDOMINAL PAIN, DIARRHOEA, URINARY INFECTION, ANY VAGINAL INFECTIONS OR EVEN A CHRONIC COUGH, ETC BECAUSE THERE IS AN INTRA-ABDOMINAL PATHOLOGY CALLED A PS OAS ABSCESS THAT IS SO PAINFUL THAT IT CAN EVEN STOP YOU FROM PUTTING YOUR FOOT DOWN DUE TO THE PAIN. SO IF YOU HAVE NOT GOT ANY RELIEF FROM YOUR PAIN SINCE 4 WEEKS I THINK IT IS TIME FOR YOU TO GET A SECOND OPINION PREFERABLY FROM A QUALIFIED ORTHOPEDIC IAN.AND PLEASE BE WARY O F DOING EXERCISES AND PHYSIOTHERAPY UNTIL YOU CONFIRM THE CAUSE OF YOUR BACK PAIN.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: two weeks ago I had a lump removed. supra-clavicular, left side. biopsy showed cancer...the theory is that I had an abcess removed from my scalp...feb or march of 2013.....crown of my head that was always getting banged when I d get into the buses and vans here. That removal in a simple Dr. office never had a biopsy. dumb. I know. While working and not wanting to take time off etc. I had this lump grow....assumed it was a giant lipoma. HA! should have done some internet looking back then....but I ve always felt that one way you can convince yourself you have a really weird, morbid disease, is to go looking for trouble. So I finally get this lumped checked out....I first had sonograms of the neck, shoulder areas, thyroid etc. and a chest xray. they take the 3cm mass out. and once I was told it was cancer I went to the local cancer institute here in Cochabamba Bolivia. I have had sonograms of breasts, arm pits. intravaginal....plus regular exams like pap smear etc. The icing on the cake is when I had to get the tomography. of my head, sinuses...and then of the abdomen. no other lumps nor bumps found....(just confirmed that my gall stone hasn t gotten any bigger...that I have some yucky problems with my back bonedegenerating. (I m 62 yr old ) female. Had one pregnancy and normal delivery when I was 33, nursed for two and a half years. Periods were always like clock work but quite heavy. tomorrow I go in to get the decision of the team.....I m pretty sure it will be to have radiation from my clavicula up the side of the neck. That is what the oncologist said Friday when I turned in all my films and lab. oh ya. lab. great lab. no markers out of wack etc. my question....Why would radiation help something that maybe is floating around in all my body at this point....The abcess process was over a year and the lipoma another year nearly. If everything is clear then why go thru the traumatic radiation..... might the diets....vegetarian type, no sugar, chocolate, junk etc be as useful? Will I not have to continue to go in for checkups from time to time with or without the radiation anyway? We do not have insurance here. We have been doing some school teaching....but there are no benifits there either. well, I should have just sent you my diary I guess.....didn t know the novel-itis was lurking in my finger tips. ### output:

Hi, dairy have gone through your question. I can understand your concern. You have mass in supra curricular region. As you say it is cancer. Treatment depends on type of cancer whether it is lymphoma, soft tissue sarcoma or metastatic carcinoma. You should go forbbiopsy of that lump. It will give you exact diagnosis. Then you should take treatment accordingly. If you have already gone through biopsy then send me that report. Your other clinical conditions or diet has no relation with that. Radiation treatment or chemotherapy or surgery can be done depending on type and stage of cancer. Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using Chat Doctor. Wish you a very good health.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: hello doctor. I am a 20 year old male with a strange condition and its a bit descriptive. Your help will be very valuable to me. So let me start. I was a smoker once. I used to smoke Marijuana from about July 2013 and left smoking after February 2014. I also smoked cigaretes from about December 2013 to February 2014. The reason I quit smoking was because I had a very bad hangover after smoking marijuana. When I was high I was thinking if it could kill me and all of a sudden I thought I am going to die and my heartbeat raced and I was full of fear, It might have been a panic attack but I thought it was a heart attack and I became restless and started running and splashing my face with water, I was terrified. after few hours I was normal but my fear remained for about 2 days and after that i became completely normal. Few weeks later(in march 15 approximately) at night I had a slightly sharp pain in my upper left abdomen and I thought it was a heart attack and I had another episode of that panic but this time it lasted only for a minute(may be even less and might have been due to gas) but after this episode I got very depressed thinking that I might have developed a heart condition or lung problem or even stomach cancer. I used to remain depressed all day and was also frightened at the same time for about a week. I used to search the internet about everything that could have caused it. After a week my paranoia reduced but was not completely gone. I had my exams that week and after the exams were over my paranoia reduced but was still there to cause me stress. after few months during my next exams my stress returned with a vengeance and I used to feel headache and inactive all day and I thought that I still might have some disease related to smoking and after the exams were over the symptoms were all gone. It has been almost 5 months now since that panic episode. but whenever I get mild chest pain mainly due to gas or mild heartburn I get anxious. Is there a way out? I know that I have no serious condition cause I didn t get any check-up after that episode and in these few months more symptoms should have appeared. Your help will be highly appreciated. Thank You. ### output:

HELLO AND WELCOME. I READ YOUR HISTORY CAREFULLY. HERE IS UR PLAN. FIRSTLY IT SEEMS YOU ARE VERY WORRIED ABOUT YOUR HEART CONDITION. EVEN THOUGH ITS HIGHLY UNLIKELY THAT U HAVE A HEART CONDITION AT AGE 20 LET US JUST GET IT OUT OF THE WAY FOR U TO FEEL COMFORTABLE, GET AN ECG AND ETT DONE IF THEY ARE NORMAL U HAVE NOTHING CARDIAC TO WORRY ABOUT. 2NDLY ITS GOOD THAT U HAVE RECOVERED FROM THE Chat Doctor. 3RDLY START THE FOLLOWING MEDS TAB MEBEVERINE 200 MG TAB CARBON BOTH ONCE DAILY FOR 2 MONTHS. CAP NEXUS 40 MG ONCE DAILY FOR 2 WEEKS. THAN N TAKE CARE

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I have been suffering from severe upper right back and neck pain. I cant move my neck to the right it is so painful. Other symptoms are a swollen right lymph node in groin and at my recent visit to my obgyn they noticed swelling in one ovary where I have numbness that goes down the front of my upper leg. I am 47 never had children I do have endometriosis. I have swollen and sore breasts. I also have a bit of bloating in my stomach and alot of gurgle sounds or gas in stomach. My appetite is normal no sudden weight loss or gain. No temperature. I have had some difficulty with bms and being constipated but no diarrhea and no vomiting either. I had an ultrasound done and go to doctor tomorrow however I am too frightened about the prognosis being cancer. I also had an MRI done regarding my upper back pain and neck a few months ago and they saw problems in my C4 C5 where the spinal nerves were pushing together I have scoliosis as well. It did not show cancer or life threatening illness however Im not sure if that would be seen in an MRI or not. Could the pain in my neck head area be connected to the symptoms in my pelvic area? I had a recent blood test and donated blood in November and all tested fine, would that show signs of cancer? I cant sleep toss and turn nightly as you can see it is the wee hours in the morning and I am reaching out to you. lease let me know what I may expect to hear from my doctor tomorrow...I feel like cancelling the appt. I am so scared and nervous. I know my body is not right the pain is not a normal pain. Please help........ ### output:

Here the back pain problem could be because of scoliosis, and c4,c5 disc and nerve issues also. Along with this constipation can also be related many times with scoliosis. For this you have to consult orthopedic and physiotherapist for discussing on possible treatment plan. As far I have seen for sever damage in spinal curve with scoliosis orthopedic doctor will give surgical option. As well if there is no much damage as well if surgery can not be performed, then for this kind of case orthopedic will suggest for physio treatment and exercises. This will help to improve strength and stamina along with scoliosis curve too. You can also use hot and cold pack frequently at home for some more pain relief as well to relax soft tissues at back. Next is about your lymph node swelling and tenderness in breast:Here I suggest not to cancel your appointment and visit your doctor. And take treatment as per the diagnosis and report. It can be cancer related lympjnode swelling or normal lymph node swelling too. But early detection will help you a lot for treatment and will be good to recover fast. Next is constipation and stomach problem:Here it can be related with scoliosis as well lymph node problem, or it can be just general gastric issue. I suggest not to worry and change your food habits and lifestyle. Keep healthy eating habit like having food on time, keep your diet fiber rich, Don't Take spicy food, do take fruits regularly, have water daily 3-4 liter, etc. And you will improve gradually. With suggestion of your doctor if your want can take anti acid tablets too. Take care.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi.....my son is 19 yrs old.....two years ago out of nowhere, his wrist swelled up and then his arm, with icing and tylenol , it went away after a couple of days......since then it has come up a few times...knees, wrist , ears and lips..... ..however , since March 2nd.., it has come up repeatedly....as soon as we treat it with the icing and reactine....a few days later, it comes back..... he went to the hospital because the swelling was horrendous....diagnosed and andiogema......it hasn t been a week yet and it s started today again on his wrist.....i personally, have mixed emotions if he really has been diagnosed properly..... however, .all his blood work was great, no sign of any other problems.. ...i am more concern of what is really the cause of it, then the treatment....the episodes are too close to each other and giving me great grief.....today, the hand is very swollen, red and hot.....at the hospital they were concerned that maybe a clot, but that was ruled out. after all the tests... ,,,any ideas.....??????!!!!! as a young boy, he was very involved in sports, never had this problem....now, .he spends a lot of time in the computer at home and University.........poor .circulation.....(can this be a factor,????.....)...his diet is rich . of organic fruits and vegetables..every day, drinks plenty of water, loves red meat, but very lean , doesn t smoke and doesn t drink......,,,, ...even if it s andiogema......can it be treated......????....i don t believe that the reactine is of any use....any ideas.....?????.. the icing works , but it takes a few days....one doctor suggested cortison injections when it gets really bad......no way.....i have a problem with that.....what s your view.....if, the attitute is ...(we think...it s.... andiogema.......) it s not good enough for me...it s either it is or it isn t.......the reactine is useless ....any ideas........pls advise .. ### output:

Hello, As what I understand with the history is that, your son might not have angioedema. Because angioedema is itself a different condition. You need to provide some more details like, what is his physical condition, did he ever have any kind of pain in the chest, did he injure the limbs etc.? As the doctor diagnosed with angioedema than has he checked the heart and the circulation of it? I think your son might need to get a thorough checkup of the cardio and also need to check for the other things like the rheumatic factor. But from history, both these conditions sound negative. You meet up a good physician and get the blood routine done along with the checkup of the heart to check the cardiac output. Along with this a rheumatic factor too can be checked in the blood routine. Until we have a diagnosis we cannot just say its angioedema or RA. So time being I feel the treatment he is undergoing is just symptomatic and not specific. Please feel free to contact me if you have any other questions. Also, provide more details about any other things which are missed out in history. I feel it can surely be not angioedema. Hope I have answered your query. Let me know if I can assist you further. Jay In Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: i am having continued stiffnes and pain in my leg leg/hip. It radiated from my hip down through the knee and lower leg. It feels tight throughout entire leg. i am able to walk on it however to left my leg (i am not able sit with legs cross or to lift leg up to put on a sock or tie a shoe). Along with these symptoms I have had unexplained itchiness in legs (Top of thighs, back of knees and tops of feet) I did see my family dr She ordered Hip x-rays that showed no fractures and slight narrowing in hip joints. Blood test were done: Erythrocyte Sedimentation Rate was 44 mm/mr RA Quant (CPAL) was ANA Screen (CPAL) was negative. The dr s diagnosis was that I have bursitis in my hips. I was given a cortizone injection yesterday afternoon. No follow-up. I ve been takeing Aleve daily and Aleve PM at night for the last 4 months - no relief HELP! ### output:

Hi, I wish you gave us some other important information such as your age, your sex, the duration of the symptoms, whether you have concomitant low back pain or not, whether you feel any weakness in your legs. Erythrocyte Sedimentation Rate of 44 can be normal or abnormal according to your age. Anyway, based on your provided information, it seems there are some other possibilities which are more probable than bursitis of the hip (which is actually not a common finding). I will summarize some of them for you: - A disk protrusion between the lower lumbar vertebra sometimes causes pain which is felt in the hip and the legs but not at the low back itself. One simple test is that you can lie down on the floor with both legs stretched and then raise one of your legs slowly (with extended knee), up to about 70 degrees, if you felt a pain radiating to the back of your thigh or leg, the test is positive and there's a possibility to have a lumbar disk problem (We call this test as SLR): plan: A more detailed exam and possibly a lumbosacral MRI (according to findings) - A trigger point (some sort of muscle tightening) in one or more of your hip muscles. The pain of hip trigger point can refer to the lower limb and sometimes mistaken by disk problem. Plan: A detailed exam by a neurologist, orthopedist or physiatrist then physiotherapy: if positive for trigger points you need repeated stretching of those muscles as well as some physiotherapy sessions. Chat Doctor. - Irritation or local inflammation of the soft tissues at hip region could also become problematic sometimes. This also can be diagnosed easily during your exam.: plan: a few days of rest as well as taking an anti-inflammatory medication such as Ibuprofen, Diclofenac. My Overall suggestions: 1- Provide me with the other information that I mentioned above 2- Do the SLR test that I explained earlier 3- see if there are one or more points in your hip, gluteal area or low back that are sensitive to pressure and become painful: if you have some, report them 4- If you already have taken a lumbosacral MRI or EMG test, give me the results. Hope I have answered your query. Let me know if I can assist you further. Take care

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: My husband is suffering from impotency which he never disclosed before marriage as we never had sex. This is an arranged marriage and his second marriage. When he failed many times after marriage, I tried a lot to understand him but all in vain. Sometimes he told me that he is 30, not 20 years old and sexual urge in men decrease with age. At other times, he told me that he is tired or I shouldn t ask him for anything. He cannot perform when asked, so i shouldnt try to arouse him or touch his private parts. Everything went in vain, i cried and he shouted at me telling me that my sexual urge is very high. He even abused me verbally. I gave it back to him asking him to take medicine or I will have to go out of marriage. Very reluctantly, he tried medicine and was able to perform only in 50% of occasions during his sleep. Through medication and persistance, I managed to concieve and delivered a baby. Our marriage is only 15 months old now and we have a 1 month baby. Since I have concieved, he never approached me for sex. He doesnt even talk about sex and keep on running away from this topic. I am only 30 years old and so is he. His old divorce was mutual but it has come to my knowledge now that in his first 6 years of marriage, he never attempted sex and that was the reason why she committed adultry after 6 years for which he left her. I am asking him the reason for non performance, and he is providing me some false reasons like he never lived with ex for a long time. I had to call her ex and she tells me that for all 6 years, she was staying with him under the same roof but he never approached her for sex. She used to cry every night but he ignored and never attended her even emotionally. Also, i have discovered that he got optical internal urethrotomy done just 5 months before our marriage which i never knew earlier. I have a question on my future sex life with my husband. He is not available physically or emotionally driven by himself and dont make me feel like a woman. I am already feeling burdened because he cheated me but thinking about the baby, I want to understand his mind. He never shares anything with me, his regular routine involves spending 10 hours in office and sleeping off with dinner and TV in the night. When i ask him about his problem, he becomes agitated and fights with me. After the delivery of the baby, he tells me that he is normal and this is very common behaviour in indian men. He refuses to get treated and considers it a public humiliation to visit a doctor. It has made me so frustated that recently, i abused him back once on phone and he recorded that. Now, he is using that to threaten me of divorce on gounds of cruelity. I am feeling extremely depressed and I am worried that he might even hurt the baby if he can threaten me of divorce instead of feeling happy for the birth of the baby. Please suggest what should I do. ### output:

HELLO! You have all rights to be worried but not depressed. Being mother is the most beautiful thing for the women and for this reason you should be more understandable because your husband is passing a big problem. You should treat as a friend that he expresses his problems to you. After this you should go with your husband to a doctor(psychiatrists) to explain his problems.I'm sorry but you should be strong for you because you are very young and for your baby. Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: i hav a 11 yrs old daughter who got disabled at the time of birth due to cord rounded around her neck. her survival was not complete and now she is a special child. she is completely bed ridden and dependent on liquid or mashed diet. she is bed ridden can not hold her neck and also feels fits. she passes stool after 6-7 days. she is on medicines like revotril drops, tab topamax.kindly suggest balanced diet for her particularly to keep her fresh and avoid constipation ### output:

Hello dear! I can understand your concern as I am a mother too. It feels heartbroken to see your child in misery. I would advise you to make a diet chart based on her caloric requirement according to her current weight and considering the ideal weight at this age. Suppose at this age, she should have a weight of at least 35 kg, which I am sure she wont be. So you should start with LEAST 60% of the required calories of this weight that is 1800 calories (60% would be around 1000 calories)I am making a sample of diet chart which you can give to her and gradually increasing calories. Starting from 8 am give her whole egg in the form of a purée made with poring egg in about 5 ounces of boiled milk and gradually stirring with a whisk.it will be like a custard. Add in 2 teaspoons of sugar and a Chat Doctor. At 10 am you can give chicken stock made with about a 100 gm of chicken in water with selected spices like black pepper or paprika and salt, whichever she likes.it will provide around 150 calories save the meat of chicken and blend it with a cup of wheat cereal with a little stock if remaining)it will provide around 250 calories. At 12 noon you can give about a cup of rice pudding made with 4-5 ounces of boiled rice and 8-10 ounces of milk with added sugar if she likes and a cardamom to enhance the flavor. It will provide around 200-250 calories.at 2 pm you can give her mashed veggies like a mashed potato medium-sized.you can also grill with butter and sprinkle some salt and then mesh it with chicken stock or milk or anything you like. It will provide around 150 calories and with added butter and stock around 250-300 calories. At 4 pm repeat the wheat and chicken stock (wheat cereal/oatmeal is high in fiber to avoid constipation). At 6 pm give her banana shake.2 bananas in 5-6 ounces of milk, it will provide around 200 calories. At 8 pm give her lentil soup (about 100 grams) with selected spices. It will provide around 250 calories in almost a cup of 5-6 ounces. At 10 pm repeat rice pudding At 12 midnight give her warm milk about 5-6 ounces with a tablespoon of olive oil. It will enhance the calories and relieve constipation. Hope it will help. You can always make variations in the diet with the choice of ingredients. Wishing your child good health :-)

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Dear Sir,I am from Dhaka, Bangladesh. Age 45years. I am a patient of CKD and my doctor is asking to do kidney Biopsy for further treatment. Would you please advise me as per following info what I need to do exactly and if I need to do biopsy of kidney then who will be the best Doctor at CMC vellore and how would I can get an appointment asap ?Urine examine report shows :Albumin : +++Pus cell : Numerous 24hrs. Creatinine Clerance Rate (CCR) : 35.0 ml/min/1.73m224hrs. Urine Protein : 6.7 gms/24hrs.24hrs total urine volume : 2.5 Liters/24hrsHematological Test shows:ESR : 105mm.1st hr.Biochemical Analysis report shows:Plasma Glucose (Fasting) : 8.4 mmol/LS. Urea : 16.4 mmol/LS.Creatinine : 261umol/LHB A1C : 6.8%S.Triglyceride : 786mg/dlSonographic Findings on KUB :Kidneys : Both kidneys are normal in size, shape and position withh ill-defined cortex, medulla. Cortical echogeniicity of both kidneys are increased. size of right kidney is 10.2 X 4.2 cm and the Left kidney is 10.9 X 4.2 cm. There is no calculus or any sign of ureteric obstruction in the pelvicalyceal system of both kidneys.Ureters : Ureters are not dilated.Urinary Bladder : well filled and uniform and normal in contour. There is no evidence of stone or growth. comment : Increased echogenicity of cortex and medulla. ### output:

My dear friend, your report says that you are having diabetes and dyslipidemia (lipid disorders).Hence, there is possibility that you are having diabetes related kidney disease. In most of the CDs kidney size decreases, diabetes is an exception to this rule.The same is your report. Look, for diabetic kidney disease, renal biopsy is not at all recommended nowadays, unless any other type of renal disease is suspected in a diabetic patient. You are prone to have urinary tract infection because of diabetes. So the first thing you must do is to do a culture sensitivity of your urine and if it comes positive then take antibiotic as per the report(after consultation with a reliable doctor because for your renal problem dose adjustment is necessary). Urinary tract infection is a very common cause to decompensate the stable status of diabetic kidney disease.In the meanwhile have an eye check up-FUNDOSCOPY to rule out diabetic retinopathy. Have your blood sugar, pressure and lipid tightly controlled. There are some Chat Doctor. Consult a nephrologist or good internist for detailed follow up. You can get them in your country or if you wish you can come to India. Good luck. By the way, your problem is very common among plentiful diabetic patients so don't panic.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Is microvascular leukoencephalopathy progressive? My mother had an MRI done in 2007 showing white matter disease, subcortical atrophy and small vessel disease. Over the past 6-7 years she had been falling in the house and I noticed after the falling she had been experiencing some forgetfulness. She has been to a neurologist about 5 years ago and he had given her a mini-mental state test, and sent her for neuropsych testing. She also suffers from renal insufficiency due to hypertension (she is in Stage 3). She was in stage 4 but a nephrologist has her in stage 3 due to the right medications. Her mother had died from uremic poisoning over 50 years ago (no dialysis then). Anyway, the neurologist based on his examinations and testing feels that she is in a mild to moderate stage of alzheimer. Her cardiologist told me that she has microvascular leukoencepahlopaty (she also has hardenining of the arteries). Her primary care physician feels that her dementia is microvascular (AKA vascular due to small vessel disease; she also has diabetes, coronary artery disease, hypertension, hypothyroidism, cholesterol.) She was a smoker, but stopped about 17 years ago. She also has perepheral artery disease. She is on many medications including aricept and namenda. She also experiences parkinson-like tremors. She had a eeg showing a slows of speech language done about 4 years ago. Based on what I have told you is this dementia of a vascular origin, or is it a mixed dementia? She is currently 86 years old and resides in a nursing home. I know I witnessed while she was at home some forgetfulness like leaving a stove on, poor hygiene, moods swings (verbally and hitting). Also, she would have auditory & visual hallucinations (hearing music, talking to imaginary people). I thought at this point she would be better in a facility where she is exposed to people her age and mind stimulation would be more available than staying at home with a home health aide. She had a sister who had passed away last year at 83 years old from alzheimer. Could both sisters have the same thing? I know her sister had hypertension and atrial fib. ### output:

Hello, Microvascular leukoencephalopathy is usually progressive, as one ages changes to blood vessels usually add up. Apart from her age (in itself a risk factor), she has all other risk factors like hypertension, diabetes, cholesterol changes etc., so while it is attempted to slow progression by controlling these factors it can't be stopped. As for whether she has Alzheimer's the forgetfulness and the hallucinations you describe are not common with vascular dementia, would go more in the favor of Alzheimer. However, neurological exam, imaging and neuropsychological testing are necessary for a more complete assessment. In addition to that one doesn't exclude the other, it is common to have mixed dementia due to both Alzheimer changes and small blood vessels ones, they are both the most common causes of dementia. Hope I have answered your query. Let me know if I can assist you further.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: 19 yo Male About 6 months ago, I snorted .3mg of pure methamphetamine in a matter of an hour or two. I ve had a history of amphetamine/coke use prior to this but the symptoms always seemed to be gone after a couple days.. A few days after trying meth for the first time I felt like my blood circulation was off and my legs/feet were Tingly/Sweaty/Numb . Then 2 months later, I had to go see a doctor because my feet were so red, almost purple that It was unbearable for me to manage the pain. Excessive sweating in my feet, hands, depression. I can still feel my feet, had multiple tests done of doctors poking them with a tooth pick. It s just the tingling sensation, the sweating and the urge of not having any desire to wake up in the morning. I feel like all these symptoms are related to REALLY poor blood circulation. I know I don t have diabetes, had a series of blood tests done which all came back negative. I m 100% sure that these symptoms came from meth. My question to you is what should I do to finally get rid of the pain? I know that cayenne, garlic helps with the blood flow. I also started to exercise recently, but that doesn t seem to be helping. My muscles used to twitch a lot all over my body for no apparent reason, and my heart rate was really high for the longest time, but it seemed to gotten a lot better. It s the tingling all over my legs/arms, really sweaty feet and being cold in an 80 degree room that REALLY BOTHERS me..I hope you can provide me with some promising treatments. As for the doctors I saw, they didn t do much. Wouldn t give me any meds for pain or something to improve my circulation or heart rate. They just wanted me to get an MRI then to go see a cardiologist and have some more tests done...I don t have the greatest insurance to cover up all these expenses so I just thought As long as I m not having a heart attack or a stroke, I should be good . But the tingling is really annoying and at times, unbearable . ### output:

Degree understand your concerns went through your details. I suggest you not to worry much. You had visited some doctors, and you say that they did not help much. They did not help because that is the treatment you needed then. Doctors never advice Psychiatry treatment unless they feel confirmed. Otherwise, they just motivate the patient and leave them. They know in a span of around of some days, the patient gets better. That is life and its teachings. You should understand that you are not depressed. You are dissatisfied, disappointed. Furthermore, you are anxious due to that. Furthermore, you felt tingling, and you related it with your health or mental health. Now you are obsessed with that tingling and become anxious. The tingling is not actually real. It is just your creation. You must treat your anxiety or obsession. Consult a psychologist for psychotherapy. If you require more of my help in this aspect, Please post a direct question to me in this website. Make sure that you include every minute details possible. I shall prescribe the needed psychotherapy techniques which should help you cure your condition further. Hope this answers your query. Available for further clarifications. Good luck.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, may I answer your health queries right now ? Please type yAround 3 weeks ago, I had a positive pregnancy test on a Saturday, Sept 11th. Went to the doctor that Monday...they did a Serum ChatDoctor and it came back negative, but took another home test and it still showed positive. Monday night I started cramping and bleeding bright red blood....went to ED on Tuesday Sept 14th to be positive that I was miscarring bc I had positive test and negative ChatDoctor serum, my levels at the ED were at a 7 for ChatDoctor. Bleeding stopped Tuesday...was asked to repeat Beta ChatDoctor on Tuesday. I was curious so over the weekend took another test...still showed positive?? Had my labs done Tuesday Sept 21st and they increased from 7 to 101. Set up gyn appt. and went for my appt Sept 29th, they did a ultrasound and no gestational sac or signs of pregnancy are apparent. I still have the symtoms of tiredness, frequent urination, metal mouth, and increased appetite. They said maybe i miscarried three Tuesdays ago at the ed or maybe im early in pregnancy and couldnt see it being my levels were so low. Repeated ChatDoctor Sept 29 and and levels increased again to 204. What im confused about is why would my Beta ChatDoctor go from 7-101-204 in a 3 week toime span if nothing is there? Im confused...any answers??our query here... ### output:

Interesting case. Not a frequent one too. In short, pregnancy test is positive but since levels of BChatDoctor are below the discriminatory levels nothing is seen at the Transvaginal (endocavitary) scan. You need about 2000 mid/DL BChatDoctor for a pregnancy to be seen in a high resolution scan. You have a condition called PUL (Pregnancy of Unknown Location) and serial measurements of BChatDoctor can lead to the right diagnosis, options are: in this order of frequency1.- Normal intrauterine pregnancy (UP), 75%2.- Miscarriage (spontaneous abortion, SA), 25%3.- Ectopic pregnancy (EP), 1%Since BChatDoctor duplicate its levels every 72 HS and considering 7 as the initial level by Sept 29th your BChatDoctor levels should have been about 400-500, this means that:1.- no normal duplication pattern is seen, pregnancy might not be right and there might a miscarriage or an ectopic pregnacy2.- discriminatory levels are not met and that explains why a gestational sac GS is not seen3.- there is still the possibility of a normal pregnancyWhat would I do? Wait, repeat BChatDoctor in about a week and perform another scan with the new resultsLevels fall, no GS on scan: miscarriageLevels rise, duplicate and GS seen: Sublevels rise but do not duplicate or reach about 2000, no GS is seen: considering EP and new levels are measured and scan performed about a week later if more than 2000 units are measured, and no sac is seen, I would consider / perform a laparoscopy

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hello I am 38 years old and in 2011 I had a positive pregeancy test we had a 3 year old that it took 10 years and 3 miscarriages to conceive my pregeancy in 2011 was horrible I stayed In the hospital from 16 weeks until I had a emergency c-section at 26 weeks due to blood flow they diagnosed me with scleroderma and crest syndrome they said we were not gonna make it i had my tubes clamped 2 days ago I had 2 home pregeancy test that was positive I was misdiagnose I have burgers diease I was sent to duke they did test that is what they found no scaladerma or crest is it possible for me to be pregeant with my tubes clamped ?? And if so if the baby is planted in the womb could i Carrie it I do have to have loveanox shots when I am pregeant I am stressed beyond please help ??? Thanks shelly Conley ### output:

Hi Shelly, How are you doing ? I understand your concern. Let me start by saying that you can definitely conceive with the tubes clamped, but not by natural method, only by IVF or you will have to laparoscopically recanalize the tube & then try(of course there is risk of tubal pregnancy then). The main risk factor I see here is your age. As you cross 35 yrs pregnancy chances reduce, but only after 40yrs it falls Chat Doctor. But the main plus point is that you had pregnancies in the past, no matter how it ended, maybe it was these underlying conditions which were causing abortions & blood flow problems to baby. With Gods grace you can surely have baby through IVF/ CSI. First have a Serum AMH level, this will tell you how many eggs you have in ovaries. They only give the quantity, not quality. I bet the result will be normal. In IVF you will be stimulated with hormone injections, when they are of mature size, diagnosed by scan, they will be aspirated out & at SME time your partners' semen is collected. They are taken into embryology lab, each egg is injected with one sperm. Now this is ready to grow into a baby. This is left in incubator for a stipulated time. Embryos are formed. In your country, they transfer 1 embryo at a time straight into the uterus. Baby is in uterus & it grows. So you see tubes are not needed at all !! You have to take Lovenox Injections till the end of pregnancy. This will improve the blood flow to baby, preventing abortions & also any blood flow problems to baby. Lovenox doesn't cross placenta, so will not affect the baby. After IVF extra embryos will be frozen in your name in the lab. You can use them at later date, say after this baby is old enough. Embryos age will be frozen at 38yrs age(your present age), even when you are 40, 50, 60 or so, embryo will be 38yrs. So you can have babies till those frozen embryos get over. Pregnancy is God given, prey well, you will make it. Never lose hope & never get stressed, trust in God. Hope I have cleared your overall the best

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, I am a 24 year old who has recently been diagnosed with pCOS, the doctors put me on Triquilar for 3 moths but the problem did not resolve now they are asking me to use primolut for 3 months, is it safe since Im trying to conceive. I am 153cm and weight 81.5kg and I dont have any medical history. ### output:

Hi, How are you doing ? POD (Polycystic ovaries), This is a congenital condition, I mean it is a genetically programmed condition, you get it from your parents. When you suddenly put on weight, this cholesterol is converted into estrogen hormone (if I may simulate- haven't you have seen obese men developing breast & in young obese girls, who develop periods at younger age - they all have high levels of Estrogen hormone / female hormone) In your body too when fat, which is a store for tomorrow, is more than normal, this is converted to hormone which tips the balance between FSH (from brain) & the ovarian hormone. FSH(Follicle Stimulating Hormone) as name suggests stimulates follicle from ovary, but once the follicle is big enough to ovulate, the FSH is suppressed by the same estrogen hormone from ovary. But when the same estrogen hormone is coming from fat, brain is confused & follicle growth stops early at a smaller follicle size & will not rupture, next scan you will see all these follicles as POLY CYSTIC OVARIES.!!! This is usually associated with Obesity, irregular cycles, no periods for few months & later heavy periods with clots & fleshy masses, or spotting on & off, Thyroid abnormality & prolactin problem indirectly. You develop that extra-pad of fat around the midsegment of body, especially waist, thighs & breast, no fat beyond elbow & knees. Excessive body hair growth, hair fall, dark shade over lower half of face, acne, oily face skin, black skin over back of neck, inner thighs & under surface of breast. May have a family history of Diabetes, especially father or his family. This will not allow ovulation to occur at time & so you cannot get pregnant, till treated. It also increases your chances of early pregnancy abortions. But this has a solution. Your weight has to be Weight(in Kg)= Height (in CMS)-100Your expected weight is 53-58 kg. Once you reduce weight to normal range, you won't need any medicine to get periods or to get pregnant & pregnancy will be healthy. To reduce weight -NO FASTING, No junk food/ fast foods/ red meat, reduce snacks in between mealsHave low calories' food, high proteinsRegular exercise (especially for the waist & hip area), aerobics, yoga, brisk walking(swing your hands well) ,try to reduce 2-4 kg / month. Don't hurry on weight reduction, it will be difficult to maintain. As soon as you reduce at least 5 kg, you will see changes. When you take Primolut-N only your periods get altered, does not do any good or bad to your pregnancy chances Hope I have clarified your queries. Do write back if anymore queries the best

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi doctor!!, I am 31 year ,male. I am having a pain at under right hand side of rib and also in middle of stomach since Dec-09. The pain resist their with regardless of eating or not eating of anything. I went through series of test but couldn t recovered uptill now. I was very slim before this pain and now i look like bloated n fatty. Honestly speaking i am fade up with this pain, this is killing me every day like a slow poison. I hope if any one can understand my problem and suggest something right cure for me, which i know is very difficult :( Please see below Diagnosis History which might helpful : 1. Blood sample test (Report Status: ALT= Normal, Hepatits B,C cerology = Negative, LTF = normal, full blood count = normal, Ferritine = low [suggested medicine Ferrous sulphate], S.BILI = normal) 2.Urine test (Report Status: normal) 3. Ultra sound (Report status: normal), 4. Barium follow through (Report status: Normal), 5. Gastroscopy (Report status: H-Pilori Bactaria Found, for treatment doctor has given me medication course for 2 weeks, of Lanzoprizol, amoxicillin and clarithromycin. After this course i gone through with another test i.e. faecal antigen test which results shows negative). 6. Colonoscopy test (Report Status = They found small rectal polyp, which they removed entirely ( Polyp patholoy result = Inflammatory polyp) 7 CT Scan = (Report status = mild fatty liver) 8.Capsule Endoscopy to investigate the iron deficiency ( Report Status = Isolated Ileocaecal inflammation and then they suspect for crohn s diseases ? or NSAID related ?. ( Medication suggested for Isolated Ileocaecal inflammation = PENTASA 500 mg course for nearly a month by consuming 8 capsule a day) 9. Small Bowel Enema (Results = No evidence of inflammtion or mucosal ulceration at terminal ileum) So far all the test which i gone through were unable to diagnois my problem which is causing pain. I can t sit properly because i am feeling unbearable pain in middle of stomach and due to this i can t concentrate on anything happening around me. My whole life is distrube and i can t enjoy any moment of my life..Help me please..... ### output:

Thanks for your consultation at Chat Doctor! I have gone thoroughly through your entire history and all the investigation that you have done do far. To me most of the diseases have been ruled out with your investigations... But if you have got stressful life and altered bowel habits then you might be suffering from Irritable bowel syn Chat Doctor. .your attending physician will take appropriate through history and necessary examination in light of your investigations. Second you should have done CT abdomen with pancreatic protocol to rule out recurrent pancreatitis... For time being if you are in stress and have sleep disturbances do take alprazolam .25 mg at night daily it will help relieve your symptoms.... Also meet a consultant of Internal Medicine too. Hope your question has been answered appropriately.... If u still got any query feel free to ask... Regards

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: My doctor ordered a serum protein electrophoresis package test and a ck custom test. I have been having severe bone pain and worsening joint pain (I have lupus sle) ANd I have always had back problems but recently my back pain has gotten SEVERE to the point it hurts to laydown or lean back on it. I am wondering why he ordered these test and what he may be looking for? He ordered my usual test for my Lupus sle for baseline info and he ordered these without telling me why I found out after I got home on my paper work.Now I am concerned. ### output:

His am Chat Doctor. I have read your message. I think I can help you. First, a package test means that multiple tests are included that correlate to the test. CPK and SPE can both be package tests as there are many related tests needed in a diagnosis. The symptoms that you seem to be facing as per the query is basically severe backache that increases on lying down or bending-in other words, anything that causes the spine to be under pressure. Now SHE itself can cause the symptoms. The muscles and bone problems can arise in SHE itself and thus possibly one will feel that there is nothing more to do. However, in many situations, the doctors may get biased my a diagnosis. So, I think it is good that your doctor did not get biased with your pre-existing diagnosis of SHE and continued to look for other causes of backache. A severe backache can happen due to muscle disorders, a condition known as myopathy. The cause of myopathy may be SHE itself. The test commonly done to test myopathy is CPK or creatine phospholipase. This is a test done from blood. The idea is if the CPK is raised, it suggests myopathy. In this situation, your doctor will need to modify the therapy. I am unaware of your medication from the query. So I cannot really comment upon it. But some medicines themselves cause myopathy. And sometimes, the dose of existing medicines need to be stepped up for treatment of myopathy. So I presume your doctor wanted to check that. Second test was SPE or serum protein electrophoresis. This is one of the tests for multiple myeloma. This is a type of malignancy that affects the bones and causes bone pains and should be ruled out in middle-aged to elderly commonly if the backache is worsening and is specially bad when lying down. If the test is negative, there is nothing to worry about. If it does come out to be positive, multiple myeloma can be treated. So again you need not worry since the treatment is available. Why the doctor did not tell you about the tests is something I can only speculate about. I guess it was because these are just doubts, considering you already have SHE- in medicine, the usual dictum is that one disease can explain the symptom, the other condition should not be sought. Having said that, it's a folly to miss another diagnosis due to a pre-existing condition. I think he would have told you if the tests came out positive. So there should be nothing to worry about-the doctor was just making sure that there is no other problem. Possibly since there was nothing else diagnosed, he did not tell you about it. I have tried to make it as simple as possible to understand the situation. In case there are still doubts, feel free to contact me for further details. Best of luck,

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Three weeks ago, I went to the washroom and saw that my stool was pale colored (NOT white but like a pale-ish very light wood color). I became terrified because Ive read via the internet that it can be a variety of the things. The most popular reason is the possibility that my bile in my gall bladder duct is obstructed by a stone(s) or might a serious liver problem. I have been a drinker of alcohol for many years, have had a bad diet that has consisted of a lot of greasy fatty food, and have also been taking Prilosec for my acid reflux (for a very long time) due to this sedentary lifestyle. A year ago my doctor had found that my bilirubin levels had increased by a little, therefore, she was not concerned at all but that I should cut out my drinking, which I did but, only for 5 months. Fast forward to one year later and this happens; I immediately call my doctor to tell her what occured but she told me that she wasnt very concerned or worried because I didnt display any abdominal pain, black tarried stool or brown colored urine and no other accompanying symptoms, and she said that it was possible that my diets the culprit. She also said that if Im really concerned that I should set up an appointment for blood work but to not be worried. It is now the fourth week, and I have changed my entire diet for the better. So, far my stools are back to normal. No pale stools. No nothing. Can someone with experience shed some light as to what might have happened to me that day? I am still a bit nervous. Is this reversible? Why would my doc say she isnt worried about this? Why is it that I should be worried ONLY if I have abdominal pain, dark urine, or jaundice? Please help! ### output:

Hello, balls, Thank you for contacting Chat Doctor with your query. I am glad that you admit abusing alcohol and I hope you are completely staying away from it. If you already have signs of liver damage from alcohol, this is the first step. Alcohol can cause what is called fatty liver where liver cells are loaded with fat and they can't function properly. If a person continues to Chat Doctor. There are also lots of complications such as bleeding from ruptured enlarged veins in the esophagus and stomach, build up of fluid in the abdomen and swelling of the legs and feet etc. You mention pale stool and your internet search showed you what the causes are. Yes, bile duct obstruction or blockage from gallstone or stricture from inflammation can lead to this. Stool is usually chalky due to lack of bile. Sometimes, the blockage can be inside the liver, the smaller channels that bring the bile to the gallbladder. That can happen with liver disease. I would suggest that you get a complete set of blood tests, including blood count, liver panel, and also a sonogram of the liver and gallbladder. Eat a healthy meal with whole grain cereals, nuts, fresh fruits, vegetablesand plenty of fluids. Exercise regularly at least three times a week. I also want you to take a good super B-Complex tablet daily along with Vit-C1000 mg. daily. Hope this helps you. I wish you the best.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I am a 44 yr old female with abdominal pain. The pain began intermittently about 1 and 1/2 yrs ago. I went to the doctor and they completed an ultrasound of my abdomen and also an EGD. No findings of gallbladder stones, etc. Since that time I have had instances of pain in the same area (upper right side) - sometimes after meals but not consistent until about 5 weeks ago. I went to the urgent care and they ordered a HIDA scan. I did not have the test at that time because morphine used in the test makes me sick. Four weeks later the pain was acute and I went to the ER. They did another abdominal ultrasound - no stones. I did follow-up with my doc who ordered the HIDA scan - had it done and no stones. I also had a CT and another EGD and colonoscopy - no stones but the pain now is every day. I have an appt with a surgeon on Monday only because I have become my own advocate for help - the pain is there and they have dismissed it as gastroenteritis - I have had GERDs for the past 10 yrs and it is much worse now with the pain on the right side. The doc who completed the colonoscopy prescribed a drug for cramping after but also prescribed Amitriptyline??? Lets be clear, I am not depressed. Yes, for the past 2 weeks that they have been trying to diagnosis this pain, it has been rough, but why would they prescribe this drug? It is so frustrating to be in pain daily and then because they cannot seem to figure it out, they think that I must be depressed?? I am hopeful that the surgeon will either order an MRI to more precisely diagnosis what is going on, or take out the gallbladder. Your thoughts? ### output:

Thanks for coming to Chat Doctor. I understand your concerns of pain with no apparent cause diagnosed, and repeated testing is making you frustrated. Doctors sometimes prescribe Amitriptyline for pain and for functional causes. Let's leave that aside and focus on your pain issue. You have mentioned that you have HERD, what treatment are you taking for that? Also, you indicated the link of pain with meals, can you please tell us more about this pattern (in how much time after meals does pain start, location of start, does the pain radiate/move/spread anywhere, duration it lasts, what makes it better, any link with particular food items). Besides, did you notice any link of pain with cough/deep breathing? Does the pain increase on pressing the area or increase after taking-off hand pressure? How is your bowel movement pattern? If you got stool analysis done, please share reports with us. In upper gastrostomy, how was the mucosa status ? In colonoscopy, did they find any diverticula? I am asking details of these questions to understand your condition better so that we can help you. If you have not visited your surgeon yet, I would suggest waiting and avoid any further testing while you share the above details about your pain and test reports. But in case of severe pain, please visit emergency. Gall bladder removal might not solve your problems right away and every surgery (open or laparoscopic) comes with its side effects; I would recommend avoiding it till the cause is clear. Hope you get better soon.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: all of my past tragedies are catching up with me finally. I was raped when I was 12, my family was already in the midst of my brother being institutionalized at a State Mental Hospital after slicing a man;s throat and being diagnosed with schizophrenia . I have three siblings he is the oldest almost 10 years older. My parents were always visiting him so nobody was around to talk to. Also I was afraid to tell anyone for fear of how much more turmoil it would cause. When I was 19 my father was killed in a skydiving accident. I became involved in an physically abusive relationship and than became pregnant. I have severe asthma and was hospitalized for two weeks when I was seven and a half months pregnant and had an abruption and went into DIC. We lost Nicole and I couldn t even go to her funeral. I became more entrenched with drugs and drinking and left my husband. Even though emotionally I didn t detach. Finally I helped my sister get out of KC the town we grew up in when her husband had been diagnosed with AIDS from using dirty needles and was caught robbing a store.My mother a friend and I brought her and her 2 children who were 3 and one and a half to michigan were my mom was living . Eventually she went back to her husband and I decided to stay. I met a man and had two children and married him. When my son was five and my daughter Liz was 3 we were in a car accident while I was driving and my mother was killed. I always rationalized in my own mind that there are so many people who have been through so much worse. My father taught me that you have to be strong. Don t show your weaknesses. You can get through anything, but you know what I can t anymore. I don t sleep. I hurt all the time both physically and emotionally. My asthma hasn t been under control for years. I m always angry not just mad like on the edge. I ve tried to commit suicide twice, obviously not successfully, but it is always in the back of my mind. My family thinks that if you need to see a counselor you re crazy. In fact they actually say that when they are trying to hurt me. My husband has a problem with drinking but won t do anything about it. I ve been on SSI for five years and only make $398 a month because I ve never been able to stay a a job for very long because I become ill. So according to them I really don t do anything to help the family, even though I do all of the housework, cooking etc... My asthma has gotten so bad that I have had to have a port put in because my veins are shot from all of the steroids. I don t know how many times I have heard things are so much better when you re not here. Please help. I don t know how much longer I can hold on! ### output:

Hello....... Thanks for your query. I understand the multiple stressors you have faced and the devastating effect it has had on you. I would suggest that you seek professional help from a psychiatrist/ clinical psychologist to assess for depression/anxiety disorders/ adjustment / other stress related disorders as well as assess your range of coping skills. This can be followed by appropriate antidepressant/ anxiolytic medication and psychotherapy as appropriate. Hope you find my suggestions useful. Regards Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: original question I have a pain on the tip of my right elbow. I have gone to three doctors, and they have all diagnosed the problem as elbow tendonitis. however I believe it is a bone spur. I believe this because I recently broke a bone and had to undergo bed rest for two months. instead of getting better, my pain got considerably worst. I believe this is because the spur is rubbing against the bed sheets. when I attempted to discuss this with a doctor, he got noticeably defensive and said that there is no evidence that bone spurs cause pain, and even if they did there is nothing that can be done about it. what is the truth here? Doctor s reply to your question above... Hello, Thanks for posting your query. Bone spur itself is not painful but if it causes compression of the adjoining soft tissues or cause inflammation of the surrounding tendons then it can cause pain. Bone spurs if these are symptomatic can be removed surgically or local steroid injections can be given to decrease the inflammation. You can get an X-ray of your elbow in lateral view to detect any bony spurs in the area. A soft tissue abnormality like tendonitis can be best diagnosed with MRI scan. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal second question thanks. can you please direct me about what to do next, to actively address the pain? of course, i have had a x-ray. the x-ray appears, to me, to show a visible bone spur. however all my doctors have informed me that this is not a bone spur, but is instead a calcium deposit . this deposit, or whatever one calls it, appears to have grown considerably in the last two years. all my doctors have told me that this is not a problem, and that the calcium deposit will eventually be re-absorbed into the muscle. again, all my doctors have consistently informed me that this deposit will not cause pain. I have requested a MRI to confirm that it is actually tendonitis, instead of a bone spur, but they have said that a MRI would be a waste of time. these are the best orthopedic doctors in this city (Gainesville Fl) and are well respected. if I were to proceed to the next step, to challenge their diagnosis, I would need to travel to another city. what should I do? ### output:

Hi! I feel that given the fact that the seemingly best Orthopedics of Gainesville, Florida have come to a diagnosis and conclusion that you strongly differ with, you have the full right to contest this diagnosis. If you do not get all the doubts out of your mind, you will feel miserable. Since, it's just a matter of a radiological examination, I suggest that you get this done, the MRI, I mean, in a different city. It is definitely worth the time, money and energy spent to do this. Imagine how good you'll feel at the end of it. Note that I have not argued nor contested any doctors' diagnosis. Please make arrangements to visit a nearby city where you can get this done. Thanks. Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I have had constant pain in lower right abdomen area for the past three months - the pain varies from tolerable to intolerable and depends upon stress and other factors I do not know b.c. i do experience the pain when I am in a low-stress environment. Please also note that I look tired all the time even if I get sleep [pronounced dark circles]. Everyone always tells me I look like crap even if I feel ok at that moment [i.e. the pain is dull or at a tolerable level -mild discomfort is the best it gets]. I have had the following images taken: 1) CT 2) ultrasound. I have had blood work and urine work done more than once. The images show two kidney stones in right side. But, the urologist is CERTAIN that the stones are NOT causing my pain, but he does not know why I have this pain, the source of this pain or how I got this pain. The urologist referred me to the Gastro doctor - we did blood work and urine - ultrasound - took the RX Prilosec ---reviewed the CT -- Gastro says everything [all anatomy depicted in the full abdominal ultrasound] is fine and that he does NOT know why I have this pain - Gastro says next step is to look inside stomach or do a endoscopy on both ends but that he says highly highly unlikely that the endo will shed any light on this right side abdominal pain that is definitely NOT muscular or tied to my obliques. So, here I am, still with this pain and left without answers. I am going for yet another opinion and peak next week at a Cedars Sinai Gastro. Please, any ideas what this pain is due to and why I have it, what it is etc? Also, what should I do at this point. Again, assume urologist is correct in that my stones are NOT at this point lodged in a manner to cause the lower-right ab pain I speak of. WHAT IS THIS?????? Thank you in advance. ### output:

Hi ! Good morning. I am Chat Doctor answering your query. As you have not mentioned anything about the size of the stones in kidney, it might not be possible to opine if they were the culprits for your pain or not. Other investigations being normal, if I were your doctor, I would advise you to stop eating from outside if you do, as many components of food from outside, specially the fast food might contain some ingredients to which your intestines might be more sensitive and give rise to such symptoms. I would advise you to add more of roughage and enough liquids in your diet, and to avoid any alcoholic beverages and smoking if you do. In addition, I would advise you to go for a routine test of your stool for ova and cyst, which when treated surprisingly cure many of the chronic abdominal pain. I am sure your clinician must have examined your abdomen clinically to rule out chances of any recurrent appendicitis. Also, I would go for a routine/microscopic and culture sensitivity test for urine to rule out a silent UTI which is not uncommon. In case of female patients, a PID (pelvic inflammatory disease have to be ruled out) by a gynecologist. Till then, you could go for some anti-spasmodic Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Female, 37, 5 ft 5 about 170 lbs. Medical History. I smoke about 10 cigarettes a day, have never done recreational drugs and only drink occasionally. 4 months ago I passed 3 kidney stones. I gave birth to 3 children and had 3 late term miscarriages (4 to 6 mo along). 2 of my children I had to have progesterone shots in order to carry them to term. After the last one I had severe bleeding issues for over a year causing me to have a partial hysterectomy, I still have my overies. 4 years ago I was diagnosed with high blood pressure and have been on and off medication since, at times it would be under control without medication. For 2 years now I have continually been told that I have a high red blood count and have had to undergo a phlembotomy several times because of it. I currently have high blood pressure, sometimes as high as 190/140 or so. I have a head ache almost all the time. I have noticed times that my heart seems to beat very very hard or flutter for short times and it causes tension in my chest. Different doctors have run so many tests and cant tell me why any of this happens. They dont know what has caused the high red count. I also have leg pain and swelling which worsens in cold weather and it doesnt really change with activity or rest, they feel very heavy at times. Most doctors dismiss this. I am constantly being asked if I have a sunburn even though I dont. I sweat horribly bad very often even from the slightest activity such as vacuuming in a 70 degree house. I am constantly tired no matter how much sleep I get. I have been diagnosed with minor sleep apnea but the machine doesnt seem to help me. I deal with months of diarrhea and then turn around and am severely constipated for a couple weeks. I have an increasing amount of facial hair growth that the doctors also dismiss, where I pluck about 200 hairs a week. They all tell me that my hormone levels are normal although I question that. I have gone through all of this with 3 different doctors now and get no where, I end up getting frustrated and stop going and then end up running out of my blood pressure medicine for months at a time until I finally decide to give another doctor a try. I am lost of what to do since no one can tell me what is wrong. ### output:

Hello, You have provided a details' history who h would help me narrow on some diagnostic possibility. The reason for headache is both high blood pressure and higher RBC s which would cause th3 blood to be more viscous and this per se can cause bad headache. .control the blood pressure and keep your hemoglobin and Packed cell volume under control. The reddening in cold weather may be as a result of Reynolds phenomenon. The miscarriage, Reynolds phenomenon, hypertension, hormonal changes can all be explained by some autoimmune disease, So a rheumatologist opinion is worthwhile, get an ANA done and if positive evaluate it further. Smoking can cause polycythemia which can in turn cause other symptoms. So try omitting the same. Do send the investigation done till now, so I can guide you better. Regards Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hello, I am a 44 year old male who, until relatively recently, has been very fit all of his life, playing various sports, particularly football until only a couple of years ago. My problem started at the beginning of 2009 when suddenly I lost all vision in my right eye. There was no pain and no warning signs this was going to happen as I had no previous health problems. This lasted for about 3 mins until the vision returned as quickly as it went.I had a number of similar episodes over the next few months including what I can only describe as a curtain dropping down in my eye (always the right eye). I was examined by various specialists and was diagnosed with Amaurosis Fugax and placed on medication (aspirin and ezetimibe). Afterwards I felt that my physical strength had diminished a little but still felt relatively fit.I was free of any further symptoms for 3 years until a similar episode of loss of vision in September 2012 and after further examinations my medication was changed ( chlopidigrel and rusovostatin). I felt that I was getting tired very easily and was finding it hard to concentrate at times. Again I was symptom free for about a year until I suffered a further loss of sight in my right eye (October 2013). Not only did I lose my sight, I also lost coordination in my legs, I had tingling in my right fingers and leg. I was admitted to hospital where I was told I was having a stroke. At this point I felt completely drained of all energy, I was sleeping most of the day, I had no strength in my arms or legs and was extremely moody. Over the next few weeks I underwent further examinations including a transoesophogal echocardiogram and it was discovered I had a Patent Foramen Ovale (PFO) which it was explained is a hole in the heart and was probably where small blood clots are forming. I underwent an MRI scan recently and it was found I had a white spot on the left side of my brain which was explained May be a restriction in the blood flow. I have been referred to a cardiologist and a neurologist for further consultation but I have to wait a significant time before my appointments. I am extremely worried as I have never had anything like this before, I am not allowed to work (I am a police officer of 23 years with minimal sickness) and do not know what is likely to happen.Any advice would be welcome.Kind regards,Eamonn ### output:

HAI it is nice that your narration of symptoms is so clear. Initially your symptoms were due to amaurosis fugal i.e. a transient loss of vision. You were advised aspirin, clopidogrel to prevent clotting of blood by their antiplatelet action and also rosuvastatin for cholesterol lowering effect. Your symptoms of defective right eye vision weakness and paresthesia in right upper and lower limb weakness suggests a lesion in the left brain. The white dot in MRI may be due to infarct of the brain, or a granuloma or a tumor.don't worry about that white lesion. Just follow doctors advise. Please do regular physiotherapy and use medication regularly. Avoid smoking alcohol and fatty diet.don't worry about patent foramen oval. Please consult cardiologist, and he may advise devise closure procedure if required.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I m sorry this is so long but thought the details important. In January of 2013, I tripped over my laptop cord and went flying into our dining room table that has a sharp edge and broke my nose. It happened so quickly that I don t know how I also managed to hit the back upper side of my head (maybe on one of the chairs?), nearly broke my left knee and suffered bruising on my right arm, hip and thigh. I didn t go to the ER because when I called them, they said I would be waiting for hours and the waiting room was full of flu patients. The cut across my nose was pretty clean, not gaping. My husband helped get the bleeding stopped. I did look as though I had been beaten severely the next day with major black eyes and bruising in the other areas. I was surprised at how sore the back of my head was since there wasn t even a slight bump. I didn t think much about it as I gradually improved. On July 1 of 2013 my husband and I flew to Wisconsin from Texas and then back again after 6 days. Upon arriving in WI, I started having terrible headaches and confusion. Within 4 days of returning to Texas, my husband had to take me to the ER because the headache pain was unbearable and sudden very high blood pressure. The ER got me stable with BP meds, fluids and 3 doses of morphine. I don t remember any of that. My husband said I kept trying to pull the IV s out. I saw my PCP the next day and he sent me for an MRI which showed I had a subdural hematoma with a thin layer of blood covering my entire brain. I had been taking lots of advil and aspirin for the pain.The neurosurgeon I was referred to said DO NOT take either because of the bleed. He decided not to do surgery but put me on Keppra to reduce the chances of seizures and have follow up CT scans and visits to see him. My PCP put me on Lisinipril for the BP before I saw the NS. I ve had 2 catscans since the MRI and they show improvement. But I m still having periods of confusion, occasional but not constant high BP (I have always had low BP) and mild headaches. I am now off of the Keppra but am taking 1/2 of a 2.5 Lisiniprol when the BP goes up. I am also more depressed than usual (I have fibromylagia, hypothyroidism, and IBS). I am 62, female and concerned that I might never be normal again because of the continuing confusion and memory problems that I didn t have before all of this happened. The neurosurgeon said I may or may not improve further. ### output:

Hi their am ChatDoctorI have read your detailed query And I need to say the information is quite aptly put will start by first stating that the symptoms are probably due to the hematoma. Understand that the skull is a closed space in which the brain is placed. So any added matter in a closed space will increase the pressure. That is a basic law of physics. As long as the blood remains inside, the pressure will be high. This therefore causes pain and discomfort. Headache is due to this. As for improvement, I cannot surely say, because I have not seen the MRI. However, you may talk to your neurosurgeon about elective surgery and Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: i have been hospitalized 2x every yr for the past few yrs. i was dx with rrms in 2008 but they backdated it to 2006 when i first had my symptoms, trying to get help thru my primary physician, then a gastroenterolgist saying i had gastroparesis then a trip to shands. about 6 months later a lost feeling in my feet and legs resorting to using a cane and being referred to a nuerologist at usf i have been thru all medications shots, tysabri (jc positive), and each of the oral medications. my body rejected each treatment. the last was aubagio with 3 hospitalizations this year.when i was taken off this. I had been on steroids several times to treat my relapses but usf changed doctors and this one isnt easy to get calls returned. or getting him to visit me in the hospital which is relatively close to his office. I have been told by this doctor i have progressive ms because of the amount of lesions that are active in my brain- very little brain matter has not been affected by lesions and this past time i had no mobility inmy hips down and was in wheelchair much of my lesions old and none were active and my body was rejecting the medications and i received plasma transfer 5x and over 10 days after 3 days of the steroids before that in the hospital. within hours of my last plasma transfer i was released. i have been in a wheelchair for since june and finally this week i asked my home physical therapist to order me a manual wheelchair since i have been getting around house using transport through my primary physician which is being delivered. I was release from hospital on 6/28th with orders to see my neurologist within 4 weeks but still have not heard back from him to schedule this appointment. what comes after primary ms? are there any medications specifically for primary ms rather than the rrms ### output:

Hi, thank you for providing the brief history of you. As you been in a wheelchair and going through your history I can understand that it is a painful thing to have so many issues and ignorance by the physician. As in my clinical practice we offer the best care and time to queries of the patients, may not be so important according to us but for a patient it is important as the patient is desperate to know how his future is going to be. As you are currently under a physical therapy and also diagnosed with MS. I will advise you to understand that MS is something different to deal with the medication as all Chat Doctor. Regain the functions and also will help the body to reproduce its own internal medicine. In many cases of MS in my clinical practice we have a team approach to help the patient and never ignore the smallest query by patient or a symptom too. In case you need any more assistance I will surely be present to help you. Never give up as many MS cases in my practice I Have seen recovering when a team approach is provided. Also, you can have a look to a YouTube channel of pfizernews and there many doctors have spoken about how better an MS can be handled and fought as well. This is just a single example. As we understand your queries and request you to keep undergoing the physical therapy and make a deep communication between you and the medical team. If you have any queries you can ask me and I will be happy to help you. Regards Jay In

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: MRI brain reveals in my case:Mild diffuse cerebral atrophy.No evidence of acute infarct/acute bleed is seen. I am male of 61 years am reired from Government service 1 year before and live in delhi(INDIA).I am suffering from high diabeties and(10 years) high blood pressure(3 years) enlarge prostat(4years) and little high uric acid(8.4)for last 1 year. Before 15 days I was walking on road and suddenly collapsed on road and remain unconcesuis for 2 hrs and during this i voamted and potted in inner and this was not in my knowledge.Till date im not aware what happened during these 2hrs.Tell me my exact problem treatment and food to be taken or avoided,please ### output:

Hi welcome to ChatDoctorI have gone thru your query reading sudden loss of consciousness It is a matter of concern. You need not worry much. You just have to take action. Your multiple sufferings from high sugar, h BP, uric acid etc. Are certainly the outcome of your weak immune system due to your faulty food habits and derailed lifestyle. It can be a warning sign of a life-threatening situation This may be accompanied by loss of muscle tone that can result in falling or slumping over, can cause injury if the person falls and hurts themselves, or if the faint occurs while participating in an activity like Chat Doctor. Most times, it is a relatively benign situation. There can be many factors.causing loss of consciousness as low BP, dehydration , stress, worry, overexertion - physical and mental or any unexplained fevers, temporary reduction in blood flow and therefore a shortage of oxygen to the brain leads to loss of consciousness. Take care of the causes, Try to remove them. 90% of your problem is solved. Modification in your lifestyle and food habits will help you strengthen your immune system to lead you to healthy disease free life. Proper regular physical activity, Walk, Meditation, Grandam - Deep breathing - Inhale - Hold - Exhale - Hold, Yoga - , to boost your blood circulation and detox your system under guidance of trained guide and balanced diet, including, all essential nutrients as fiber, vitamins, minrals and Antioxidants Ginger, Garlic, AMLA juice20 ml+ Aloe vera juice 30 ml, nuts, Turmeric powder+ Almond oil a spoon each in a cup of hot cows milk at bedtime, Coconut water in the morning, all in natural form help, regain your health and give resistance from diseases. Head massage with Almond oil will strengthen your brain . Avoid food that is high in saturated or trans-fats like fried, fast foods, refined sugars and fine floor products, tea, coffee, alcohol, smoking, sleeplessness, dehydration, constipation.worry, stress all induce toxins in your body and cause you sufferings. It is advisable to consult your doctor, in time, before following any regime so ha proper treatment plan can chalk out. Hope this helps solves your query. Take care, All the best.Don't hesitate to get back if you have any further query

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hallo dr I have been married for 8 months... My inlaws are very eager for me to conceive After marriage I had regular periods for 5 months After that i missed period for one month Since then i am having irregular bleeding For 15 to 16 days and then after a week or two again i am having bleeding I got an ultrasound done..and it says pco And horseshoe kidneys Actually after 3 months of my marriage i had taken duphaston for 3 months and clomid for five days My husband stays abroad So he was coming for 15 days I took clomid right after my periods stopped. then i wasnt feeling much well So after medical examination i came to know that i dint have proper intercourse Now i have stomach cramps and headaches all the time And my periods wont stop Its 17th day today I was undergoing unani treatment from a certain dr But it wasnt effective Then last week i met a gynacologist and shes giving me herbal treatment..still periods dint stop So she is suggesting me duoleton Which i am scared of taking after all this What should i do Please help ### output:

Hello,First, I would like to reassure you that you should not feel disheartened about it. It is important for you to understand that at the peak of her fertility, any healthy woman around thirty years of age has approximately 1 in 5 to 6 chance of becoming pregnant during the fertile period of her cycle. This chance may become less due to a number of factors - increasing age, timing, and frequency of intercourse etcetera. In your case, the fact that you are not staying with your husband regularly, and he is based abroad reduces your chance of becoming pregnant. Besides your marriage is very recent. A guiding principle for starting to investigate for sub-fertility is when a woman has not conceived for twelve months of having regular sex with her partner. This criterion has not been met in your case. However, given your health concerns - diagnosis of horseshoe kidney and PRO, it is important to start an investigation and plan for the conception. Horseshoe kidney is a condition that is there from birth and can occur together with malformations and problems linked to the reproductive parts. It may be worth getting imaging done for the kidneys, ureters, bladders as well as for the uterus, tubes and varied. The blood tests for a renal function should be done and review of results with a Urologist or Gynecologist may be useful. Please get your blood pressure checked as sometimes this can occur with this condition.PRO or polycystic ovaries is a condition that is common, occurring in one out of three women. Sometimes it resolves with correction of weight, lifestyle changes, Sometimes medications may be necessary. Giving combined pills for 3-6 months is sometimes offered to manage irregular periods if fertility is not much of a concern. Moulton is a contraceptive pill, so it might not be the preferred method in your case. Closed and Phaeton might be a better alternative, however, the intercourse has to be properly consummated, timed to the fertile period of your cycle and occur every two days to maximize the chances of conception. I would like to emphasize that for any investigation and management to deal with conception and pregnancy, it is important to include and involve the partner as well. Hope I have answered your query. Let me know if I can assist you further.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, I m a 17 female and for the last few weeks I ve been experiencing nausea and lightheadedness . Two weeks ago, I found somewhat light blood in the water and in my stool but thought maybe it was due to my period. But then the next time I had a bowel, which was a week later, the was blood there again. There was more this time and it concerned me. Since last week, I ve been feeling very dizzy and have really bad balance. I ve also lost a lot of color and am very, very pale when I m usually pretty blushed. I have an appetite , but when I take one bite, I feel it go down and I m immediately greeted with nausea. And even when I haven t eaten, I feel like throwing up. But I can t. Nothing comes and it s usually just a burp that feels like something will come up. My upper abdomen is really tender when touched and it feels like a tight pressure, if that makes sense. Somewhat more in the right side. My stomach also burns sometimes as well. Two days ago I felt like I had to go diarrhea and it burned as it came out and was just mush. When I wiped there were tiny black things on the toilet paper (not sure how to describe them, it freaked me out). I ve also unintentionally lost 12 or so pounds in the last two weeks, and now I m down to 98 lbs. There s a bad taste in my mouth, and I assume it s causing bad breath, and no matter how many times I brush my teeth it just comes back. I have a slight cough and it hurts my entire abdomen when I do cough. It feels tight, like someone is punching me in the upper abdomen. Occasionally I ll get a sharp pain in random places. I ve been to the ER twice in the last week for an IV, my blood work always comes back normal, and they just send me home. I feel like my nausea has gotten worse and worse, and I just don t know what to do anymore. It s like we go to the doctor and get the same tests done and get the same results. When I went to my primary doctor last week, I had a rectal exam done and they had found blood in my upper GI tract. But when I had a rectal in the ER last night, they found nothing. We ve been referred to have an appointment with a gastro specialist, and they have recommended an endoscopy, but I would just like to have another opinion now since every time I ve attempted to go to school for the last two weeks, I want to pass out or want to take a trip to the bathroom. My mother, grandmother, and great grandmother have all had their gallbladder removed. My mother also has ulcers, if that information helps at all. Sorry it s so much information, but I just thought I d include everything that s concerning me. ### output:

Hi, my dairy read carefully all your concerns, I am so sorry for your situation. If I were your caring doctor, I would recommend doing upper endoscopy because:- you have diarrhea with black things (Elena is suspected)- you have already done the rectal exam, and they had found blood is indicative of stomach bleeding-your mother had ulcers. Apart upper endoscopy, I'd recommend taking omeprazole 20 mg twice daily, Chat Doctor. All the best!

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, I was diagnosed with diabetes several years ago and was on metformin. Recently, I lost my health care and couldn t get metformin anymore, but then I also started a diet (it s not low carb or calorie deprivation-I eat @ 1300-1400 a day in 3 hr intervals) and have lost 25 lbs so far. I m still overweight, but I ve felt my sugar has been under control enough that, even though I have a few pills left, I haven t had to use any. Anyway, I ate my normal meals today, and right after eating dinner (fish & asparagus), I felt very faint and confused. I checked my sugar and it was 86. Is this normal? I haven t had any sugar symptoms since starting dieting except the other day, I felt like my sugar was high, so I took half a pill. First time in months. Could this half a pill have affected me that much? Is there anything else that would cause a low reading like that right after eating? ### output:

Hi, After going through your case details, I want to know-1) Your Age.2) Your Height and weight (It is very encouraging that you have lost significant weight with diet and exercise) to evaluate degree of overweight.3) Family history of obesity, diabetes.4) Current medicines other than metformin if any.5) Any associated high blood pressure or cholesterol problem. I would like to advise you - 1) Continue Low calorie diet and regular exercise.2) Better to avoid discontinuation or taking medicine on the basis of your own interpretation or symptoms.3) Quarterly check your HbA1c level that give much better idea regarding your diabetes control. Also check Blood sugar level Fasting and postprandial once in a month or two months.4) If it is feasible for you to do Self monitoring of blood sugar level (BSL done by glucometer at different times of the day (Fasting, 2 hours after breakfast, before lunch, 2 hours after lunch, before dinner, 2 hours after dinner, early morning sugar 3am) all sugar not daily but whole profile in a week at least once in a month. If there are symptoms of low BSL or High BSL you should confirm it.5) Regular BP check, clinical examination to rule out microvascular complications of diabetes (retinopathy - endoscopy, foot examination for neuropathy)6) Check your Lipid profile, it is advisable to take statin (lipid lowering Chat Doctor. 7) It better for you to take metformin in maximal tolerated dose, as it will help in reducing insulin resistance which is a basic pathology of diabetes. Metformin is weight neutral (may help in decreasing weight) and rarely causes hypoglycemia. 8) Depending upon your BSL control and HbA1c level other antidiabetic medicines that are either weight neutral or help in reducing weight can be added. Hypoglycemic blood sugar level in diabetic patient is depended on duration of diabetes, control of diabetes, associated complications. At blood sugar level of 86 you have symptoms of low blood sugar level, so it can be hypoglycemia for you.Also, there are rare chances of developing hypoglycemia after taking metformin alone.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I have pain in the lower portion of my right back extending to my right side a little bit. I did a urine test and there are no infections. I also do not recall doing any activity that could have caused a strained muscle. The pain is really bad when I lay down in bed and try to turn over. ### output:

Hi, Thanks for your query and Welcome to Chat Doctor. I am Chat Doctor. You have mentioned pain in your lower back region with radiation of pain to the Right side, I guess your lower limb. Anyways since you are certain that there was no injury which could have actually caused a muscle strain etc., then we will have to work up in your case to actually rule out a fiscal prolapse or a degeneration etc. Before I can give you some advice I would like you to send me the following details:- What was the cause of onset of this pain if you can recall it?- Duration of the back pain and if present, your leg pain?- Apart from your back pain do you also have any associated numbness, weakness in limbs, paresthesia etc. as well?- Any aggravating or relieving factors of your symptoms?- How much distance can you walk, and what are your analgesic requirements on a daily basis?- What investigations and management has been done till now for your existing problems? I can tell you that lower back pain could be due to many reasons but at your age it is mainly postural and sometimes Fiscal in nature in which the Inter vertebral disc has lost height as a result of which there can be a mechanical back pain which is very discomforting for the patient. Rarely there can be a bony instability like pars defect or something which can lead to pain while doing work or activity involving movements at spine region. But the majority of these conditions actually can be managed conservatively with Posture maintenance, physical therapy and medications. Although I am sure you have tried a lot of medications and alternate form of treatments, but till the time I can see your details, If you have localized back pain with no other neurological symptoms like numbness, weakness, paresthesia etc., then you can start with following recommendations for initial period of 2-3 weeks:- To maintain proper posture of your back while working and sleeping, try maintaining an erect posture as much as possible- If pain is more than you can take a short course of an anti-inflammatory medications which suits you-Physical therapy initially under supervision of a trained physiotherapist, initially concentrating on SWD/IT or LASER therapy for back pain and TENS for your radiating leg pain-Adequate calcium & vitamin D intake if levels are low in body-Hot fomentation can be done at home 3-4 times in a day, if possible-Analgesic spray or ointment for local application can be used after fomentation- Avoid lifting heavyweight/ acute forward bending in mornings and take adequate precautions till pain completely subsides.etc will observe you for next 2-3 weeks how you respond to this conservative management protocol. If there is no clinical improvement, then we will plan for your investigations including blood tests, X-Rays and if your back pain is a long-standing one, then MRI of lower back region. Do not hesitate to contact me if you need any further assistance/SOS with more clinical details and test reportsThanks & Regards

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, I Am mr A chakraborty, here I am writing about My wife.Mrs. Subarna Mukherjee. Age - 30 years Blood group - B+ Married on - April 2002Subarna had 2 missed abortions:First was in Dec 2004. The pregnancy was not planned. When she missed her periods a test confirmed the news. She went straight to the doctor and was put on Folic acid tablets and led a very constricted life. At the same she had a throat infection and slight fever and took some medicines which were preg safe. After four weeks the scan did not show a fetal heart beat and soon after she spotted blood which passing urine. She was put on Susten (100mg 1-0-1 x 7 days) tabs and Protasi (2000 1amp) which reduced the spotting temporarily but shortly afterwards clots of large quantiy appeared and she had to undergo an emergency DNC.Doctor - Indira Reddy; Sagar Apollo Hospital, Bangalore.Second was in late 2006After trying to concieve for two months in vain she consulted the doctor and was suggested Microgest (100mg), EC 350, M2 Tone, A Sugar (500mg), FAS 3 KIT and Clofert (50mg). With the help of above medicines she could conceive in Oct 2006. From day one when the preg test was positive (LMP - 11/9/2006) she was put on ChatDoctor (5000) injection along with Microgest (200mg), Ecosprin (75mg) and ofcourse Folic Acid. After 6 weeks the Ultrasound did not show a fetal heart beat and the report said missed abortion. There was no blood spotting yet. She continued with usual ChatDoctor and Microgest for one more week. The second Ultrasound done at 7 weeks showed normal fetal heart beat (No Corpus Luteum was reported in the scan report). After a week (at the 8th week) blood spotting started and the flow gradually increased leaded to yet another miscarriage. The abortion was done with oral medicines. Doctor - Hema Malini, Jayanagar, Bangalore.after that, we did not try 2yrs any thing..then from july 09 we started again treatment, she was taking letroz for oct to december...but no result .then month of april she has gone for Laprtscopy & dye test..now doctor are telling her 1 tube is ok, but other is block..., after that april to thik aug(10) we r trying..but no positive result..plzzzzz help me what to do now.... ### output:

Hi welcome to Chat Doctor. I have gone through your question. As you had two miscarriages rule out any pathology in both reproductive system. Yes blockage in tube cause infertility. But your one tube is patent so from that your wife can conceive. I would advise making confirm that ovary from patent tube side is ovulating or not. Consult gynecologist for further treatment options like GUI intrauterine insemination or IVF invited fertilization. Hope I answered your question. Would be happy to help you further. Take care.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: please see my ultrasound report and suggest :ULTRASOUND ABDOMEN WHOLE Findings: Mildly enlarged liver measuring 17.2 cm shows moderate increased echogenicity of parenchyma. No focal mass is seen in the liver. Intrahepatic biliary ducts are not dilated. Portal vein appears normal measuring 1.0cm. No evidence of thrombosis. Gallbladder is partially contracted at the time of the scan measuring 4.6x 2.2 cm. An echogenic focus cast shadows seen in the lumen of gallbladder measuring 1.6 cm suggestive of gallstones. No evidence of pericholecystic fluid. Common bile duct has normal caliber measures 0.49cm pancreas is partially obscured due to excessive bowel gases. Spleen is normal in size measuring 9.4 cm. Echotexture is uniform. No mass or cyst is seen in the spleen. Both kidneys appear normal in size, shape and position. Outline is smooth and well demarcated. No renal parenchymal disease is seen on either side. No mass or cyst is noted. No evidence of hydronephrosis on left side. minimal fullness is noted in right kidney. No calculus seen in both sides. Right kidney measures 12.2cm, with cortical thickness measures 1.2cm. Left kidney measures 12.3 cm, with cortical thickness measures 1.4 cm. No evidence of ascites. Urinary bladder has normal walls. No mass or calculus is seen within the urinary bladder. Mild hepatomegaly with moderate fatty changes suggestive of fatty infiltration of the liver would recommend clinical correlation. Gallbladder is partially contracted at the time of the scan. Cholelithiasis with no sonographic evidence to suggest cholecystitis. Minimal fullness is noted in right kidney could be due to infection/obstruction would recommend clinical correlation Pancreas and retroperitoneum are partially obscured due to excessive bowel gases. Rest of the scan is unremarkable incidental finding; Enlarged prostate with approximate volume of 36.5ml Impression: SONOLOGIST ### output:

Hello, In most cases, treatment of gallstones is considered necessary only if you are having symptoms. Of the various conventional treatments that are available, surgical removal of the gallbladder is the most widely used. Some alternative treatments have also been found to be effective in alleviating the symptoms of troublesome gallstones. When deciding what course of action to take for symptomatic gallstones, doctors usually choose from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical removal of the gallbladder. Though a gallstone episode can be extremely painful or frightening, almost a third to half of all people who experience an attack never have a recurrence. In some cases, the stone dissolves or becomes dislodged and thereby resumes its "silence." Because the problem may solve itself without intervention, many doctors take a wait-and-see approach following the initial episode. Hope I have answered your query. Let me know if I can assist you further. Take care Chat Doctor. Rammstein, General Surgeon

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I had a seizure the day before yesterday and spent the day in the ER. It was, I think, my second seizure in 4 mos. I have never had seizures before. I have a long history of an anxiety disorder, and severe migraines. I have a history of breast cancer, and a CT scan came back negative for tumor. The first time I thought I had a severe anxiety attack because at the time I was home along, but I still do not know what happened that caused me to cause an ambulance for myself. Very untypical of me as I would never go to the hospital for myself unless absolutely necessary. On a 1/2 of this past week it happened in front of my boyfriend and what he described was not passing out, not anxiety, it was a seizure. One minute I was sitting up at my desk talking to him, and the next thing I knew I was sitting on an ottoman in my house and he had called an ambulance. He said I was dead....I went into convulsions, I curled my hands and moaned, my body became rigid/almost hard, foam came from my mouth and my face was contorted, then I got very quiet. That is when he thought I had quit breathing. The ER person on the phone with him told him to feel my chest and check if I was breathing and he may need to begin CPR if I wasn t. He said they would talk him through it. Just when he went to check me I flew up off the floor and against the wall. He put me on the ottoman, which is flat, and sat there with me until the ambulance arrived. He said I was moving his fingers apart and pulling on them in a strange manner. I remember nothing....all I remember is he was trying to talk to me but I did not understand what he was telling me, what had happened, and why it seemed we were going somewhere but I couldn t figure out why. He held the picture of my niece/nephews up to my face (a picture I fell up against and hit with my head), and I had no idea who they were. I knew my name, but I did not know my boyfriend s name - and we have been together for 7 years. I didn t know where I was. I used to take medication for chronic pain management for something like 10 years (started with severe migraines in my early 30 s as well, then degenerative disc disease in my c-spine and l-spine. My Oncologist (who had treated me for breast cancer in 1995 and dealt in palliative medicine, was all too willing to write my pain medications until they started cracking down on them....now it is a lot more difficult and I have had to take Tramadol instead. Now I wonder if the Tramadol is causing this. ### output:

Hi, Thank you for posting your query. The description of the episodes seem like convulsions or seizures. Tramadol increases the risk of getting seizures. However, you need to be evaluated to find out the underlying cause of seizures. MRI brain-epilepsy protocol and EEG would be helpful. In the meanwhile, you should be started on anti-epileptic medications to prevent seizure recurrence and prevent injuries due to them. I hope my answer helps. Please get back if you have any follow-up queries or if you require any additional information. Wishing you good health, Chat Doctor. Ly/

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I have a lump larger about the size of a dime on the top back of my head slightly toward right (if one where to put their hair in a pony tail), it s very tender to the touch but does NOT move when I press on it & from what I understand if it were a pilar cyst it would move. I also have had a headache all day (not severe but enough to be annoying). Also have facial numbness, major vision issues past 24 hours (but also have keratoconus). I have significant history of multiple issues as follows that may or may not be pertinent & just want to know if it is something that can wait until I see either my Neuro Doc next week or my Dermatologist the following week for schedule appointments OR if I should take action sooner: I also have had scalp tenderness off & on as well as other strange neurological symptoms (numbness in buttocks that goes down both legs especially after sitting & diminished memory & concentration etc.) ever since I broke my neck roller blading (Genetic Defect: Reverse Curvature of C-Spine at C-4-5 and have had two cervical spine surgeries - first C3-C5 in 2007 then C5-C7 in 2010). Continued to have falls even after second surgery (most of falls occurred while carrying things with my arms). Six months ago w/o having had any falls in previous 90 days woke up one day and couldn t bare to stand or walk more than about five minutes. I have neuropathy in both of my hands plus arm weakness which worsened significantly since and at this point I can barely lift a half gallon due to pain that shoots down into my low back. Was diagnosed with Facet Joint Osteoarthritis in Lumbar Spine and was referred to NeuroSurgeon/Pain Mgmt Specialist to sever nerves that send pain signals to the brain because physical therapy and all other treatment options have failed plus steroid injections have been tried multiple times and each time produced extreme roid rage. NeuroSurgeon/Pain Mgmt Specialist believes I have Failed Back Surgery Syndrome (FBSS) has already done an MRI of my cervical spine as he feels that everything is the result of an issue in that areas and is trying to get to the bottom of ACTUAL cause of symptoms such as Numbness & falling down for what appears to be no reason BEFORE he just treats lumbar symptoms. Also have significant issues with my jaws (both top & bottom jaws out of alignment) and tried wearing customized mouth piece over the past year but was just told by my cosmetic dentistry specialist that he highly suspects Mandibular Condylar breakdown for sure and need to assess the severity to properly treat (& currently awaiting insurance approval for MRI or Cat Scan). ### output:

Hi, Regarding the current issue of facial numbness and mild headache, I think it is safe to say that you can wait till your appointment with your neurologist next week, in order to discuss the issue with. However, if you develop acute deterioration of your symptoms like loss of vision, one-sided body and/or facial paralysis, speech problems you have to visit the nearest emergency room. Hope I have answered your query. Let me know if I can assist you further. Take care

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Dear Dr. Jain Age is 36 years, female, and i want to discuss regarding my medical problem during the pregncncy specialy during the male child. In 1998 I gave birth to the baby boy in 7th month i.e. premature delivery due high BP and Albumin, then in 2001 I gave birth to the baby girl, BP was high but controlled also and everything went well. Then in 2005 I again gave birth to the baby boy in the beginning of the nineth month, but the baby swalloed the liquor and could not survive more than 4 days. Then in last year 2009, I again gave birth to the baby boy which was aborted in the 7th month as I had an eclimsia attack, but htis time my BP was in control, and suddenly I had a pain in my stomach and BP raised to 226/220. As all the parts had stopped working and only heart was working, According to PGI, Chandigarh doctors I was dead. Now the question is that last year my husband was having some BP problem, then we meet some cardiologist, he asked me that do You (I) have problem during the pregenecy, I said yes My BP is very high and whereas in my family history there is BP patient.Then he said sometimes it happens due to genetic problem and it can be because of my husband also. Is this a genetis problem? If yes, then I wish like to concieve again and then can I go for artificial insemination or is there any other solution. Hope to hear soon from you..... Ashima (India) YYYY@YYYY ### output:

Dear AHIMA, its unfortunate you had to go through such a hard time through your pregnancies. Let me help you understand some things.1. High blood pressure during pregnancy with a seizure attack and from what looks like multi organ failure (according to your description)in your previous pregnancy, puts you under extremely high risk to manage your pregnancy safely. You must understand the consequences of future pregnancy on your own health and well-being (the functioning of all important organs like heart, brain, kidney, liver may be compromised and can be even fatal or life-threatening) before attempting one. So you must be fully aware and equipped for any potential consequences of it.2. There could be many reasons why high blood pressure happens in pregnancy. Some women who have a family history of hypertension, and have crossed 35 years are more susceptible to it. And a number of genes are suspected to cause it. Yes, as the baby shares genes of both mother and father, now you can think your body is temporarily handling your husbands' genes. Hypertension can develop if your husbands genes are not efficiently handled.(that's what your doctor explained). This can result in altered placental development and reduced blood supply to the baby. The baby may be thus may be growth restricted, and is prone for premature delivery, and its consequences.3. As even donor insemination may result in similar condition it is extremely hard to predict if that can be free of hypertensive complications.Hence, I suggest you to be rational and take a wise decision if you want to conceive again and obtain very good prenatal care when you attempt it. Hope this information helped. Good luck.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I am 69 years old and have high blood pressure that I have been taking meds for since I was 25. both parents had it as well as my brother. it is well controlled at this time. I have no other serioud medical conditions at this time except for a basil cell carcinoma on my neck that was just diagnoised this week .my concern at this time is about hair loss.. about 3 weeybe ks ago my stylist ask if I had noticed my hair coming out more than usually and I had. the past two weeks it has gotten really bad and coming out by small clumps. I have always had very thick hair so I am very concerned. can you maybe give me any reasons for this ### output:

Hi welcome to ChatDoctorI have gone through your query about hair loss which is a matter of concern. As you have mentioned that you have been taking meds for since you were 25. Medication for long time, distress, worry, lack of intake of proper nutrition, hormones are one of the biggest reasons women lose hair. The sources include pregnancy, birth control pills, hormone therapy, and thyroid hormones , your Basal cell carcinoma and age is also prominent factor to cause hair fall. For your info our body acts as a unit. If one part gets diseased the whole body is affected. So you have to treat the body as a whole so that you don't fall sick Dear in fact, Your body is always fighting something -- an infection, a toxin, an allergen, a food or the stress response -- and somehow it redirects its hostile attack on your joints, your brain, your thyroid, your gut, your skin, or sometimes your whole body. Your immune system is your defense against invaders. But when the immune system becomes weak, the disease cells can grow out of control, the disease overpowers you should not ignore other possibilities, that can be constipation, mental stress, worry, anger. All affect our health badly. So regular exercise and Balanced diet containing essential nutrients as fiber, fruit, green veges vitamins and minerals in natural form - fish, lean meats, cheese, eggs, spinach, and soy. Coconut water, lemon juice with water, nuts, almonds, and supplements full of antioxidants as Aloe vera juice + AMLA juice 2 spoons, A level spoon Turmeric powder + Almond oil is very important for our sound mental and physical health and strengthen immune response naturally. To build collagen, a protein critical for hair growth proper blood circulation. Exercise, yoga, Kapalbhatti Panama -deep breathing, Anglo Film, Calamari are help full for soothing nerves inducing sleep and eliminating toxins from our body and help the natural hormones work, leading towards healthy life. Make sure that you get enough sleep every night. Meditation also helps sooth the mind helps in detoxifying and strengthening the immune system to enhance resistance from diseases and pave way for healthy disease free life. Take Homeopathic Acid Pros 6 & Cascara Pros 6 / alternately / 2 times each. Take 3 hourly. Repeat for 15 days. Apply Til oil on your scalp Hope this helps solves your query. Take care. All the Westmont hesitate to come with further query if you have any.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: a friend of mine had stroke on his right side of the brain and for the past 5 days. Before the stroke, he had fever almost every night after 8PM almost for 7 days. He is now in hospital and has his right hand weakness and TOTALLY SPEECHLESS. When spoke with Doctor, he said that they are taking ct-scan to check if the bleeding is progressing - I don t know what he meant this - is that something that it could get worse... Again, please could you let me know if he would be able to gain back his speech and how long this could take? It may be noted that he is going to toilet alone with the support of the nurse and closes the door behind and opens by himself! Also, I may note that he is 46 years and is diabetes ... Thanks, ### output:

Hello, Im very sorry to hear about your friends stroke. Here is some information relation to hemorrhagic strokes (brain bleeds).First, brain bleeds can happen for different reasons such as a head injury (traumatic), a rupture of an aneurysm and bleed within the brain matter itself (parenchymal hemorrhage). It is very important in your friends' case to determine what caused his bleed. Given his fevers any infections need to be ruled out and an echocardiogram (ultrasound of the heart) should be done to rule out any sort of infection of the heart valves which could send bacteria to the brain which could result in a bleed. He absolutely needs to have blood vessel imaging in the form of either a CT angiogram and MR angiogram to make sure that there are no abnormal collections of blood vessels in the brain and aneurysms that could have cause the bleed. Also, when there is a bleed in the brain a tumor must also be ruled out. All that being said, the most common cause of a bleed in the brain is due to high blood pressure which causes weakening of blood vessels and can result in a hemorrhage. Most commonly management of brain hemorrhages is supportive, meaning that the only things that are done is blood pressure control, pain management and if the person is unconscious then support for breathing. If the bleed is very large then surgical intervention may be necessary. What the doctors are saying as that they want to repeat a CT scan to see if the bleed has become larger, which can sometimes happen. There are several risk factors for the bleed worsening: one is poor blood pressure control, another is if there is an underlying aneurysm or blood vessel that could bleed. That's why it is so important to determine what caused the bleed. For small bleeds with no underlying vascular or malignant pathology the outcome is typically fairly good. The blood causes irritation and pressure on the surrounding brain causing weakness and neurological symptoms, but as the blood subsides the symptoms improve and sometimes there may be a remarkable improvement. The language area of the brain is very delicate, and it is hard to predict how well he will recover, but my best educated guess is that he will recover at least some language function and could even recover close to how he was though probably never quite back to level his language was before the bleed. It sounds like he is doing relatively well overall since he is able to go to the restroom without support, so that is an encouraging sign. Hope I have answered your query. Let me know if I can assist you further.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Dear sir,I am K.Jeyakumar(46years,Male) of south India. I had wound and pain in my tongue left side for the past two months I have been diagnosed as a case of Carcinoma Tongue, through MRI diagnostic investigation.I need your valuable advice. MRI OF NECKTECNIQUE: Axial,sagittal, coronal SET1 and TSE T2 weighted sequences.OBSERVATION:The study shows presence of an irregular ulceration of left lateral border of posterior third and adfacent undersurface of tongue, with thickening and induration of tongue muscles and adjacent of of soft tissues. The lesion appears isointense on T1 and slightlyhyperintense on T2, IR weighted sequencesw. The lesion measure about 3.0X1.7X0.9cms in size.Base, right half of tongue, floor of mouth , oral, buccal, palatal,submandibular soft tissues and RMT show no involvement. No mandibular or maxillary alveolar bony erosions or marrow oedema are seen.Buccinator, ptergoid muscles, nasopharynx, oropharynx, hypopharynx, epiglottis, vallecula, palate, supra glottic, glottic, subglottic regions, trachea, pyriform sinuses, parotid, submandibular and thyroid glands appear normal.No evidence of cervical or supra clavidular lymphadenopathy is seen. Carotid, jugular vessels, sterno mastoid, other muscles, pre and para vertebral soft tissues appear normal.Cervical spondylotic changes are seen. No evildence of bony erosions are seen. Hyoid bone, other bones and cervical spine appear otherwise normal.IMPRESSION: MRI OF NECK SHOWS,SMALL IRREGULAR ULCERATIVE SOFT TISSUE LESION, INVOLVING LEEFT LATERAL ASPECT AND UNDER SURFACE OF TONGUE - SUGGESTIVE OF LIKELY MALIGNANT GROWTH OF TONGUE.NO EVIDENCE OF BASE, FLOOR OF MOUTH, ADJACENT SRTUCTURES INVOLVEMENT, BONY EROSIONS, CERVICAL OR SUPRA CLAVICULAR LYMPHADENOPATHY IS SEEN. ### output:

Hi, Thanks for writing in. The MRI scan says that there is a 3.0 x 1.7 x 0.9 cm mass in the posterior third of tongue on left side. This is a cancerous mass and causing firmness in the muscles attached to the lower portion of the tongue. In the above case, the tumor appears to be stage 3 cancer of tongue. If possible, wide excision surgery is to be done and this is to be followed by multiple cycles of chemotherapy and radiation therapy. As the response rate of tongue cancer is good, there are chances of cure and recovery after treatment. There are no lymph node metastases mentioned in your report, and therefore it is still not spread. Please take complete treatment and closely follow up with your doctor. Please do not worry.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, My name is Wendi and I am 39 yrs old. I have been suffering from chest pains that shoot across my chest for over a year, and lately I have been getting milder versions of this pain throughout my chest, under both breasts (more on the left than the right), and I also have a severe pain under my left arm that causes my entire arm (including hand/fingers) to go numb. I also feel like I have something stuck in my throat constantly and it won t go away. I have had x-rays and an MRI that are normal. My dr. has run all kinds of blood work and everything is normal. I have also had a mammogram that was normal. She thinks I may have a hiatus hernia but I am waiting to have an upper and lower endoscopy to see if there is anything there. All chest/heart tests have also come back normal. Could all of this be releated to a hernia??? Most of the time when I take an attack it feels like I have a golf ball on fire in my throat and I get severe pain in my chest, upper abdomen, and upper back. Also, if I bend over a certain way I the pain under my ribs on the left is so severe that I actually can t breath. My Dr. put me on Ranitidine 150 mg twice daily and that does absolutely nothing, so she put me on Pariet 20 mg once daily and that only dulls the pain when I have an episode of severe throat pain. I have alot of heartburn and no reflux . Any suggestions would be very welcomed at this point. ### output:

Any time an internal body part pushes into an area where it doesn't belong, it's called a hernia. The hiatus is an opening in the diaphragm -- the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening. There are two main types of hiatal hernias: sliding and para esophageal (next to the esophagus). Many people with hiatal hernia have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or HERD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having HERD, and others have HERD without having a hiatal hernia. People with heartburn may experience chest pain that can easily be confused with the pain of a heart attack. That's why it's so important to undergo testing and get properly diagnosed. Most people do not experience any symptoms of their hiatal hernia, so no treatment is necessary. However, the paraesophaeal hernia (when part of the stomach squeezes through the hiatus) can sometimes cause the stomach to be strangled, so surgery is sometimes recommended. Other symptoms that may occur along with the hernia such as chest pain should be properly evaluated. Symptoms of HERD, such as heartburn, should be treated. U can try syrup machine gel 2 SF thrice daily before food for 7 days.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I had arthroscopic rotator cuff surgery 4 months ago on my RIGHT shoulder. A bursa sac was removed and a 3/4 inch partial tear was cleaned up along with every nook and cranny in that area. While in physical therapy, I experienced burning, searing pain starting from the top of my arm and running down my bicep to my elbow, over my forearm, to my thumb and across my wrist. I could not hold a glass without violent, uncontrollable, shaking and trembling. This lasted over the weekend and gradually I was able to hold a glass without the shaking and trembling. I stopped therapy now for about 10 days because any movement causes unbearable pain. The agony from the burning pain remains and I have no strength in my hand. The joint in my thumb clicks and pops and burns. My shoulder pulls and tugs at my elbow. Now, burning pain spreads across my back on both shoulders! There is deep burning in both of my shoulders now that I can t escape from. Now my left shoulder is experiencing similar symptoms as my right! The burning on my back, shoulders and arms is driving me crazy. I have also been experiencing pain and nagging burning in my right leg for 2 months now. Yesterday, I suddenly couldn t stand on my right leg. Burning pain started at my knee, down my shin and over the top of my foot. It hasn t stopped and I can t apply any weight on my leg and foot. The pain is bone deep and I can t bend my ankle without it triggering burning pain that runs up and down the front of my leg. I can t walk on that leg at all. I put a knee brace on my knee and I can hobble for a few minutes at a time. The odd thing is: I DIDN T FALL OR TWIST MY RIGHT LEG AT ALL! Is it just a coincidence that my knee, leg and foot problem just hit without any relationship to my shoulder problems? It s hard not to connect the two because the debilitating pain and symptoms are the same! My bones, joints and muscles burn and stab! Period! And I am quickly going downhill fast! I have not told my doctor or surgeon yet because I can t make any sense of this and I fear them to not take this seriously. But I know that this is NOT normal and I need some insight PLEASE!! I have been taking Celebrex for about a month now and am wondering if, in some weird way, this is part of the problem? Again, please help! ### output:

Hello, I have studied your case. Your knee and shoulder pain may not be related. As per your history there is possibility of soft tissue injury in knee. Most commonly meniscus injury occurs. And MRI may miss meniscus tear, diagnostic arthroscopy can help and cure the problem. As per your symptoms you need to do physiotherapy and knee exercises to improve range of motion. Small meniscus tear can be managed conservatively with physiotherapy with USG and TENS. Meniscus injury can be managed by arthroscopic repair, and same day you can go home. Hope this answers your query. If you have additional questions or follow-up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health. Take care

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi doctor, My name is AAAA writing from Dubai now. I have some doubts and clarifications regarding my daughter who is 17 year old and now studying in Kerala , India in 11 grade.. She is in Convent school hostel now and she is not interested in studies at all. I have two daughters and I brought them up alone as i am separated from my husband from 2001 to 2010.(He was in Muscat at that time and went with some lady means he has some other relations. Because of her behaviour ,I thought of briging him back as per his brothers request if he can live as a family . But again he is leading the old life with many other relations.now he is not with us) She is very much addicted to mobile phones and internet even though i have restricted these 2 upto certain level. she used chat with unknown males in my absence and she is saying they are her friends. I tried my maximum to make her understand the meaning of friends and also the problems of such behaviour. Now whenever I spoke to her in the hostel over phone she is complainig that she cannot continue in the hostel and I know it is because of that strict not having access to internet and mobile. now the way she behaves is creating a lot of problems to me .she used to scribble something daily in her dairy and it is like she is living in fantasy world with her friend. She used to tell other children and warden that she used to go out with him etc which was not happened. the person she is talking about is not even seen her earlier. Earlier two years back i tried to consult a phycologists with her, she came one day and she didnt come for second time. I would be gateful if you can suggest some possible way how to take her to a normal life.Many Thanks,AAAAA ### output:

Hi, Thanks for writing to us, As you have explained, your daughter has had a difficult childhood being brought up by a single mother. She also might have witnessed her fathers' attitude towards the family or towards you who is her mother and as you say he was promiscuous. She has not had a father figure in her life and may have had improper parental supervision for many of these stated reasons. All this can have a negative impact on the development of a children personality. A person can have deviant personality traits which make them more vulnerable to problems like addiction or excessive usage of things like the internet and mobile phones to an extent of neglect of routine activities, seeking fulfillment of emotional needs from strangers, especially of the opposite gender or confabulating or manipulating by making up stories in order to get what they want. Firstly it would be advisable to get a detailed psychiatric evaluation at this point to rule out the possibility of any underlying mental illness. To make sure she does not truly believe the stories she has been telling people. You also need to make sure she is not having any genuine adjustment problems in the hostel. If this happens to be her way of manipulating you into getting her out of hostel then it would be advisable to keep her in the hostel till she gets used to it eventually. Get in touch with her hostel authorities and try to be aware of her behavior and also see if they can help you out by keeping her constantly engaged in some activities by making a schedule for her daily activities till late in the evening, by including sports, studies, projects, monitoring etc. This would help her a great deal. Hope this helps, Chat Doctor.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: WENT TO THE EMERGENCY ROOM DUE TO HEMATURIA..I AM A FEMALE..64 YRS. OLD HYSTRECTOMY IN 1973..HAD PUBO VAGINAL MESH BLADDER SLING SURGERY IN MAY 2012..HAVE BEEN NOTICING SPOTTING..WHEN I REPORT THIS TO UROLOGISTS HE ALWAYS SAYS ..OH JUST A TRACT INFECTION..DOCTOR IN EMERGENGY ROOM SAID..VERY LITTLE WHITE BLOOD CELLS IN URINE BUT EXTREMELY VERY HIGH AMOUNT OF RED BLOOD CELLS IN URINE..SHE TOLD ME TO GO TO MY UROLOGISTS..HE DID NT EVEN EXAMINE ME..TOOK URINE SAMPLE ONLY..GAVE HIM REPORT FROM EMERGENCY ROOM SHOWING HIGH RBC AND TOLD HIM THE DOCTOR IN EMERGENCY ROOM SAID HE SHOULD DO A CYSTO WITH A BIOPSY TO RULE OUT BLADDER CANCER..HE SAID IF YOU HAD CANCER I WOULD HAVE SEEN THAT IN 2012 WHEN I DID THE SURGERY..I WAS WORRIED AND GOT EMERGENY APPT. WITH MY GYN..HE BECAME VERY WORRIED AT THE LACK OF TREATMENT FROM MY UROLOGISTS AND IMMEDIATELY ORDERED KIDNEY SONOGRAM WHICH ONLY SHOWED RENAL CORTICAL THINNING BILATERALLY AND HOOKED ME UP WITH A UROLOGICAL PELVIC SPECIALISTS..HE TOLD ME NOT TO GO BACK TO MY ORIGINAL DOCTOR BECAUSE HE WAS OVERLOOKING PROBLEMS THAT HAD TO BE ANSWERED RIGHT AWAY.I AM VERY LUCKY TO HAVE THIS FINE OB/GYN SHOW SOME COMPASSION.DDDDOES IT SEEM LIKE THE UROLOGISTS IS AFRAID THERE ARE PROBLEMS WITH THE MESH SURGERY AND WANTS TO WASH HIS HANDS OF IT? ### output:

Hi, Thanks for using Chat Doctor. Pubo vaginal mesh bladder sling surgery as you had 1 year back may not be reason for your blood in urine. This surgery can result in blood in urine if there were any damage to bladder during operation. But this will be associated with other acute symptoms. Your symptoms are not suggestive of bladder injury. Blood in urine needs to be evaluated for its cause. Renal infection, Stones or malignant lesions could result in blood in urine. If you are on blood thinning medication they can also cause blood in urine. As you have already got ultrasound done, better to get cystoscopy done for bladder lesions and biopsy from suspicious area. Any symptom should not be overlooked, needs evaluation and management. Hope this helps regards

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: Hi, Ive scalp psoriasis since last 7-8 months and Ive tried all varieties of shampoo, cream all possible things but nothing worked. Now Im getting treated under homeopathy and some ayurvedic medicine and Im yet to see any result. Do you have cure for the same Im scared it should not affect other area of my body. Its causing lot of stress. Please advise if its curable and how many months will it take to cure psoriasis in complete. ### output:

Hello. Thanks for writing to us at Chat Doctor Psoriasis is a chronic disease. Till recently there have been no treatment which cures it permanently; it can recur after seemingly complete cure. However, there is a lot of research going on, and it may be possible that in the near future, we have a permanent cure for psoriasis. Nonetheless, treatments are plenty and well established to manage all grades of psoriasis. I am not sure if you should be trying homeopathic or ayurvedic treatment for psoriasis. I would rather suggest that you visit a dermatologist for a proper assessment, appropriate treatment and follow up at regular intervals. It is important to know about the triggering factors/exacerbation factors and avoid them as far as possible. Various triggering factors are :stress, alcoholism, sore throat, topical irritants like coal tar, pregnancy, certain Chat Doctor. Treatment of psoriasis is guided by the extent of involvement. It may remain limited to a few patches Or may extend to involve vast areas of the body. Limited disease is best managed with just topical applications (creams, ointments, gels, lotions, shampoos); whereas extensive disease (involving >20% body surface area) is usually managed with systemic treatments in addition to topical applications. Psoriasis is steroid responsive; the disease gets better with topical steroids, however, it may recur; sometimes as soon as you stop steroids. One has to be very careful in using steroids because though steroids are effective in psoriasis, one cannot use them forever because steroids can lead to side effects like skin atrophy if used over long term; moreover, steroids if stopped suddenly can lead to a rebound flare, which may be of increased intensity as compared to previous episodes.Therefore, while steroids are good for providing initial rapid improvement, they should be substituted with alternatives like vitamin D analogues like calcitriol, calcitriol once the initial rapid response is attained. Vitamin D analogues are devoid of the side effects of steroids and can also be used safely over long term; moreover rebound flare is not an issue with vitamin D analogues. Scalp involvement requires a coal tar+salicylic acid based shampoo, which can be used thrice weekly. Extensive disease on other hand requires systemic treatment in addition to topical. Methotrexate, Cyclosporin, phototherapy, Biologic response modifiers etc. are the treatment options for systemic use. You may ask more about these treatment options from your treating dermatologist. Psoriasis, as I said before is a recurrent condition, therefore I would suggest that you follow up regularly with your treating dermatologist. Your dermatologist can modify your treatment depending on the response. Regards

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: I am suffering from bone TB with infection and inflammation in my left sacral bone. The diagnosis was done after open biopsy. Therapy: Taking antibiotics from last two months. Started with Rifampicin, Isonizid, Pyrazinamide and Ethambutol. As the organism was found as fully sensitive/susceptible, Ethambutol was stopped after two weeks and the therapy continued with three medicines mentioned above. As, I have completed two months, now the plan is continue with Rifampicin and Isoniazid and stop Pyrazinamide. Observation: I felt a lot of improvement in the first two weeks of treatment but the condition detoriated rapidly after discontinuation of Ehambutol. Pain retuned back and much higher this time. However, new MRI and CT scan showed that the infection was not spreading. So, I was advised that the TB therapy is correct and I should continue with the three antibiotics. Now after completing two months of therapy, I am still in pain and way behind the improvment I was noticing after first two weeks of treatment. Bone abscess: Abscess is formed at the infection site, which is supposed to be treated by the immune system of my body and no external interference is done. Nerve involvement: I have severe pain and weakness in my left leg due to the pressure on the nerve roots caused by the inflammation at the infection site (left saclral bone). I took a lot of pain killers and was on a steroid (prednisone) course also for 20 days but pain and weakness returned back once I stopped taking the steroid. Can you please tell me whether the TB therapy is correct and how long will it take to get relief from pain? Also, how long the bone inflammation will last so that my nerve can get a relief and my left leg will feel better? Thanks a zillion in advance. ### output:

Hello. I appreciate the way you have explained your symptoms in detail, it is very helpful for a physician. The regimen for TB of the bone (whicChatDoctores under extrapulmonary TB) is 2 months of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. This is called the Intensive phase. This is later followed by the maintained phase of 4 months of Isoniazid and Rifampicin only. Total duration of therapy is 6 months. This is the regimen recommended by WHO in DOTS and is also followed in India where TB is very prevalent. We have observed very good results with this regimen in patients with bone TB. Though Ethambutol has side effects affecting the vision, we donor generally stop it only after 2 weeks. Even though it does not kill the TB bacteria but only stops it from multiplying, it is considered an important Chat Doctor. Since it was stopped for you, I presume that it was according to the guidelines which are followed in your country. Generally, it would not be significant, but in the light of reappearance of your symptoms, I would consider it significant. Abscess which is formed due to TB bacteria is called a cold abscess as it does not have any active inflammation. It will gradually disappear with the same treatment. Surgical intervention like

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: My 16 year old daughter is complaining of a cold sensation in her heart followed by a rapid heart rate?? Of course, I have already placed a call to her doctor but I was just curious if anyone has a similar problem. She is 5 6 and 120 pounds. She has asthma and takes meds for that but has not had these symptoms before. She has not changed her meds recently nor has she had any life changes. In the past she has complained once or twice of a sharp knifelike feeling in her heart but that only lasted for about 20 seconds. She sees her pediatrician and a pulmonologist/allergist! I have called both and will see what they have to say. She is an active normal teen with no history of heart problems. She has also started complaining of her vision being odd. She says her eyes have been watering a lot when she tries to focus on something! I appreciate any responses. She is curious if anyone else has these sensations. Thanks! Took her in to see her pediatrician and he listened to her heart and ran an EKG. Both were normal. He wants to give it a few days and if it continues he said we will have to take her to a cardiologist and she will have to wear a Holter Monitor for 24 hours. We still don t have any answers and it is still happening. Thanks for all of the answers! ### output:

The only thing for a cold sensation I can think of is acid reflux. When you get heart burn it feels crazy and can give anxiety (hence the rapid heart rate). You can remedy acid reflux (herd, or heart burn, throat burn or whatever you want to call it) by getting some digestive enzymes (try something like Source Naturals Daily Digestive Enzymes) at a local vitamin store (or try vitacost.com) and till give her enough digestive juices to help grind up her food better. Also, food intolerances will cause problems too. I discovered a food intolerance to wheat, milk and peanuts. But you have to write down how you feel after you eat something and try eliminating it for a while and see how it goes. You can ask a doctor for an Elisa test (for food allergies) but it doesn't tell us much. A food elimination/rotation diet is much better plus it can't hurt. A sharp knife like feeling is definitely heart burn from what I've felt or heard about. Make sure you write down when these things occur, what time and how long (dates) and what she had to eat earlier. Pizza is a biggie on heart burn. Hot dogs, anything with bad fats in it. Bread if she is intolerant to wheat and so on. I would throw in a thyroid (TSH) test for hyper or hypothyroidism. So many symptoms stem from those diseases (difficulty breathing, rapid heart rate, digestion issues and so on)...that it should be warranted just to rule it out. And if it keeps happening see the doc. But sometimes I do believe we have to be our own detectives. My dd has a friend that was ill on and off for a couple of years and saw 11 doctors (hello, aren't they supposed to be intelligent beings?) but no, they couldn't figure out anything. Finally, they figured out she has a gluten-allergy.

If you are a doctor, please answer the medical questions based on the patient's description.

### instruction: If you are a doctor, please answer the medical questions based on the patient's description. ### input: InvestigationResults 27.03.10Results 06/04/10Results 28/04/10Results 14/05/10Results 05/06/10Given valuesHb-13.114.714.114.913-18TLC12600106008300870096004000-11000Lymphocytes21.322.131.73322.525-50ESR102110454340RDW-11.613.9-16.711.6-14SGOT(AST) 20.4132.4717.5519.42SGPT(ALT)31.2348.5775.9425.8331.13S. TSH-2.0203.520--0.27-4.2S. Creatine---0.620.690.7-1.2S. Uric acid---13.4812.143.4-7S. Calcium----10.928.6-10.2C Reactive Protien----positive Titre----12 Dr Palash above are his blood test reports latest being on 05 jun.can u pls advice me on following doubtshis Lymphocytes has again fallen down, reasons? his ESR although has come down but insignificantly. reasons? his RDW has risen. reasons? his uric acid values are worrying me a lot. any suggestion to bring it down pls? reason for S calcium raised values? C Reactive Protien is positive. what it means? Titre is 12 what it means what overall u see ATT medicines are effective?his TB is under control in last 02 months or not yet?regardsrajni ### output:

Hello, First, lab tests without clinical information are practically useless. If the doctor cannot use clinical info to filter the differential diagnosis then the list of potential diagnoses becomes impractical to use, because of its huge size. I understand that tuberculosis is the main problem. Tuberculosis may cause any disorder in the complete blood count. The closet the values return to normal the better for the efficacy of the treatment. There is use in commenting on values like the lymphocytes or the Raw. Perhaps if I knew the complete medical history, there could be a reason for that. The qualitative CRP is also useless. A quantitative measurement would be much more useful. The ESR is a better alternative for tuberculosis, and it seems to get better. His last values are almost normal which is a very encouraging sign about the efficacy of the treatment. The uric acid values are probably related to pyrazinamide use. If he's excretion a lot of it in his urine then he should take Chat Doctor. Regarding treatment efficacy, although the tests seem to get better, These tests are not sufficient to judge it. Radiological and microbiological tests are more important, like a chest x-ray and sputum tests. I hope I've helped! Kind regards!