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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

### Instruction: Answer this question truthfully ###Input: Hi doctor,My age is 28 years, female, height 5 feet 4 inches, and current weight 79 kg. I have an issue of irregular periods. I am not sexually active, unmarried. I have started being physically active, do yoga, cardio and walking regularly. Two years ago when the same scenario of irregular periods for about four months happened, I consulted a gynecologist and did thyroid profile and ultrasound scan. TSH was 5.8, vitamin D 21, one 3 mm kidney stone and had one small cyst in ovary then. I was given Regestrone tablets for three days and after getting periods, asked to use Ovral pills two packs and one bottle of Eltroxin 25 mg for regularizing periods. I was also told that this is the treatment whenever periods go missing, I should repeat the same. That is why I do not wish to repeat everything again. This time I would wish to go as naturally as possible and cure myself of the roots. I have body pains all the time, I feel weakness, cannot focus on anything for a longer time, mood swings, anxiety. Also, please suggest vegetarian dietary changes, supplements related to this which solve the issue. ### Response: Hi, Welcome to Chat Doctor forum. I have read your complaints carefully and understand your concern. All these symptoms that you are facing may be due to hormonal imbalances as you had previous PCOD history. It can be managed naturally through ayurvedic medicines and Yoga techniques. Hypothyroidism, PCOD, raised blood sugar or blood pressure, etc. Thyroid profile, lipid profile, blood sugar fasting and PP, blood pressure, USG abdomen. Inflammatory pelvic disease, irregular menstruation. Take the following medicines regularly for two months. In between medications you should provide your feedback.Rx,1. Kuberakshadi Vati two tablets twice a day after meals. 2. Hyponidd one tablet thrice a day after meals. 3. Nityanand Rasa one tablet twice a day after meals. 4. Gokshuradi guggulu one tablet twice a day after meals. 5. Ashokaristam 15 ml twice a day with an equal amount of water after meals. 1. Avoid spicy and fried junk foods. 2. Avoid cold ChatDoctor.

Hi doctor,My age is 28 years, female, height 5 feet 4 inches, and current weight 79 kg. I have an issue of irregular periods. I am not sexually active, unmarried. I have started being physically active, do yoga, cardio and walking regularly. Two years ago when the same scenario of irregular periods for about four months happened, I consulted a gynecologist and did thyroid profile and ultrasound scan. TSH was 5.8, vitamin D 21, one 3 mm kidney stone and had one small cyst in ovary then. I was given Regestrone tablets for three days and after getting periods, asked to use Ovral pills two packs and one bottle of Eltroxin 25 mg for regularizing periods. I was also told that this is the treatment whenever periods go missing, I should repeat the same. That is why I do not wish to repeat everything again. This time I would wish to go as naturally as possible and cure myself of the roots. I have body pains all the time, I feel weakness, cannot focus on anything for a longer time, mood swings, anxiety. Also, please suggest vegetarian dietary changes, supplements related to this which solve the issue.

Hi, Welcome to Chat Doctor forum. I have read your complaints carefully and understand your concern. All these symptoms that you are facing may be due to hormonal imbalances as you had previous PCOD history. It can be managed naturally through ayurvedic medicines and Yoga techniques. Hypothyroidism, PCOD, raised blood sugar or blood pressure, etc. Thyroid profile, lipid profile, blood sugar fasting and PP, blood pressure, USG abdomen. Inflammatory pelvic disease, irregular menstruation. Take the following medicines regularly for two months. In between medications you should provide your feedback.Rx,1. Kuberakshadi Vati two tablets twice a day after meals. 2. Hyponidd one tablet thrice a day after meals. 3. Nityanand Rasa one tablet twice a day after meals. 4. Gokshuradi guggulu one tablet twice a day after meals. 5. Ashokaristam 15 ml twice a day with an equal amount of water after meals. 1. Avoid spicy and fried junk foods. 2. Avoid cold ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I used to be an obedient girl since my childhood as I am the youngest in my family with two elder brothers, which I am till now and I think I should not be so obedient to elders as from childhood I have faced every kind of abuse.I have been into three relationships out of which two relationships ended because of my family and one I ended it myself because he abused me and I could not take. My family tries to support me, scolds me in my failure, and happy when I progress but no one asks me what I have been through so many years.I am currently single, 22. After facing this cruel world for so many years, I have lost faith in people. I have been through many bad things. I had a social life, kind of have it now. But I never feel that connection with someone unless he is my boyfriend.But after having three bad relationships, I do not want to hurt myself more. When I am with my friends, I am the one who is most cheerful. But I want my alone time after some time to get back my energy.I am a private person, I am ambivert in my terms. Also, I never make or want to make new friends. If they approach, I do not have any problems. I guess I have some psychological problem.Also, I have anxiety issues and I have periodical depression. Also, I am always confused about everything, be it my career or anything.I guess I should not be confused because I have always been appreciated for my work everywhere.Recently, I was promoted in my probation period, but still, I feel I do not have confidence. I think that my past ugly experiences pull me back. I wanted to know what is the remedy. ### Response: Hello, Welcome to Chat Doctor forum. You seem to have mild depression and mood swings. You need relationship counseling and career counseling to get out of your confusions. Past failures are only a lesson. Learn the lesson and move on. Past failures do not predict your future. Be it your past career opportunities or past relationships. Look for friends, socialize, find a good conjugal relationship. It is everybody\\s little ChatDoctor. That is our little world. So keep exploring and look positively into the future. For more information consult a psychiatrist online

Hi doctor,I used to be an obedient girl since my childhood as I am the youngest in my family with two elder brothers, which I am till now and I think I should not be so obedient to elders as from childhood I have faced every kind of abuse.I have been into three relationships out of which two relationships ended because of my family and one I ended it myself because he abused me and I could not take. My family tries to support me, scolds me in my failure, and happy when I progress but no one asks me what I have been through so many years.I am currently single, 22. After facing this cruel world for so many years, I have lost faith in people. I have been through many bad things. I had a social life, kind of have it now. But I never feel that connection with someone unless he is my boyfriend.But after having three bad relationships, I do not want to hurt myself more. When I am with my friends, I am the one who is most cheerful. But I want my alone time after some time to get back my energy.I am a private person, I am ambivert in my terms. Also, I never make or want to make new friends. If they approach, I do not have any problems. I guess I have some psychological problem.Also, I have anxiety issues and I have periodical depression. Also, I am always confused about everything, be it my career or anything.I guess I should not be confused because I have always been appreciated for my work everywhere.Recently, I was promoted in my probation period, but still, I feel I do not have confidence. I think that my past ugly experiences pull me back. I wanted to know what is the remedy.

Hello, Welcome to Chat Doctor forum. You seem to have mild depression and mood swings. You need relationship counseling and career counseling to get out of your confusions. Past failures are only a lesson. Learn the lesson and move on. Past failures do not predict your future. Be it your past career opportunities or past relationships. Look for friends, socialize, find a good conjugal relationship. It is everybody\\s little ChatDoctor. That is our little world. So keep exploring and look positively into the future. For more information consult a psychiatrist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 23 years old, male, I have had thyroid issues since a young child, after a few years they concluded it was thyroiditis. Currently I take Eutirox 75 mg and have for about a year, before that I took 50 mg. Ever since 6-8 months (I am not sure about the timeframe) I have had issues with extreme sweating under armpits, for example I am in a 22\\xbaC room and start sweating insanely, I go outside lay on the hot sun and I stop sweating. 2 minutes after putting on a shirt there are considerable sweat marks on my armpits, 10 minutes after it is a huge sweat mark. It is also irregular, some days it is crazy other days not so much. I have never had issues with sweat, ever.On the right side of my head I now have ~8 white hair that definitely were not there a year ago, even 6 months ago it was just ~2 hairs. Attached are my lab results, the doctor said it was normal, However, during the conversation I said my breakfast was a couple eggs, sometimes pancakes, and fresh juice, he replied it should be milk and bread, so I have began looking for another doctor for that reason. What can I do to find the best doctor and would it be ok for me to go back to Eutirox 50 mg while I look for a new doctor or can this cause a serious issue?X-ray resume says the following (translated by me) ### Response: Hi, Welcome to Chat Doctor forum. You are sweating due to the increased dose of Eutirox and that is perfectly normal and expected in a person with thyroiditis being treated with medication. This only means that you are being correctly treated with respect to your thyroid function. The few white hair that you noted could be due to stress that you have in your day to day life or simply without any reason they can occur. They have nothing to do with your thyroid function. Your breakfast is good but maybe the doctor meant to decrease the calories. I do not see anything that should make you search another doctor but ofcourse it is your right to do so if you wish. Try to live a stress free life and you will find many of your symptoms resolving.

Hello doctor,I am 23 years old, male, I have had thyroid issues since a young child, after a few years they concluded it was thyroiditis. Currently I take Eutirox 75 mg and have for about a year, before that I took 50 mg. Ever since 6-8 months (I am not sure about the timeframe) I have had issues with extreme sweating under armpits, for example I am in a 22\\xbaC room and start sweating insanely, I go outside lay on the hot sun and I stop sweating. 2 minutes after putting on a shirt there are considerable sweat marks on my armpits, 10 minutes after it is a huge sweat mark. It is also irregular, some days it is crazy other days not so much. I have never had issues with sweat, ever.On the right side of my head I now have ~8 white hair that definitely were not there a year ago, even 6 months ago it was just ~2 hairs. Attached are my lab results, the doctor said it was normal, However, during the conversation I said my breakfast was a couple eggs, sometimes pancakes, and fresh juice, he replied it should be milk and bread, so I have began looking for another doctor for that reason. What can I do to find the best doctor and would it be ok for me to go back to Eutirox 50 mg while I look for a new doctor or can this cause a serious issue?X-ray resume says the following (translated by me)

Hi, Welcome to Chat Doctor forum. You are sweating due to the increased dose of Eutirox and that is perfectly normal and expected in a person with thyroiditis being treated with medication. This only means that you are being correctly treated with respect to your thyroid function. The few white hair that you noted could be due to stress that you have in your day to day life or simply without any reason they can occur. They have nothing to do with your thyroid function. Your breakfast is good but maybe the doctor meant to decrease the calories. I do not see anything that should make you search another doctor but ofcourse it is your right to do so if you wish. Try to live a stress free life and you will find many of your symptoms resolving.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My mother fell on her right arm. A few days later she noticed a wound on the dorsum of the right arm but was not sure if it was from the fall. She did not care for it nor treat it. About a week later she started disinfecting and covering it but decided to visit a dermatologist as she was afraid it might be something else. Upon the looks of it, the doctor wanted a biopsy as she said it could be cancerous too. While waiting for the results the wound closed and decreased in size and signs of inflammation are gone.Today we got the results and it says \\x80\\x9d hypodermis and dermis with hyperkeratosis, severe dysplasia of the squamous epithelium, chronic inflammatory changes in the dermis\\x80\\x9d. Now I started reading to try and understand and what confuses me is the \\x80\\x9d severe dysplasia of squamous epithelium\\x80\\x9d is that carcinoma in situ? In some literature they differentiate the two in others they claim it is the same.I also came upon the fact that when there is an ulcer or inflammation reactive atypia and dysplasia may look the same hence the dysplasia may be from the inflammation. How is that determined? Is it a wound that is in the stages of healing or is it precancerous? What should be done in this case?Can we wait for one or two weeks to see if the crust will fall as in a healing wound and then perhaps have a biopsy on clean skin or should it be removed immediately with a suspicion that it might progress to cancer? If it should be removed what is the time frame? Should it be done immediately? I also talked to a surgeon friend who thinks if it is cut immediately it would cause a bigger wound which might be slow to heal again. I have attached the progression of the wound. ### Response: Hi. I have seen the attachment. (attachment removed to protect patient identity). This could be cancer. However, there is no harm in waiting for a week or 10 days and then perhaps go for an excision if it does not heal by then. Cutaneous SCC (squamous cell carcinoma) is usually not very aggressive and in most cases excision surgery with a margin of normal skin is curative. Take care.

Hello doctor,My mother fell on her right arm. A few days later she noticed a wound on the dorsum of the right arm but was not sure if it was from the fall. She did not care for it nor treat it. About a week later she started disinfecting and covering it but decided to visit a dermatologist as she was afraid it might be something else. Upon the looks of it, the doctor wanted a biopsy as she said it could be cancerous too. While waiting for the results the wound closed and decreased in size and signs of inflammation are gone.Today we got the results and it says \\x80\\x9d hypodermis and dermis with hyperkeratosis, severe dysplasia of the squamous epithelium, chronic inflammatory changes in the dermis\\x80\\x9d. Now I started reading to try and understand and what confuses me is the \\x80\\x9d severe dysplasia of squamous epithelium\\x80\\x9d is that carcinoma in situ? In some literature they differentiate the two in others they claim it is the same.I also came upon the fact that when there is an ulcer or inflammation reactive atypia and dysplasia may look the same hence the dysplasia may be from the inflammation. How is that determined? Is it a wound that is in the stages of healing or is it precancerous? What should be done in this case?Can we wait for one or two weeks to see if the crust will fall as in a healing wound and then perhaps have a biopsy on clean skin or should it be removed immediately with a suspicion that it might progress to cancer? If it should be removed what is the time frame? Should it be done immediately? I also talked to a surgeon friend who thinks if it is cut immediately it would cause a bigger wound which might be slow to heal again. I have attached the progression of the wound.

Hi. I have seen the attachment. (attachment removed to protect patient identity). This could be cancer. However, there is no harm in waiting for a week or 10 days and then perhaps go for an excision if it does not heal by then. Cutaneous SCC (squamous cell carcinoma) is usually not very aggressive and in most cases excision surgery with a margin of normal skin is curative. Take care.

### Instruction: Answer this question truthfully ###Input: Hello! I am a 20 year old female. I have a few questions regarding my IUD,HPV, and BV. The itch around the genital area I had first last year, and it went away and came back three days ago. The OB said I was spotting (I recently got my IUD when I visited the OB)1. I got my copper IUD last year, and have been experiencing \\x80\\x9cspotting\\x80\\x9d since. It's not everyday but it happens before and after my heavy periods. Is this normal?2. I have been to the OB before that too and they told me I have genital warts inside my vagina. I plan on just letting it go away since there seems to be no other option. I'm concerned if the IUD will make the HPV worse?3. At the same visit, I took a pap smear and results came back positive for BV-like flora. I went undiagnosed. Will my BV go away on its own? I don't have symptoms like grey discharge or fishy odor so I'm not that worried.4. The reason why I went to the OB last time was because I was itching like crazy down there. My discharge was like cottage cheese. It went away for a while but just just now, I checked for the string to myIUD and my finger came out with some cottage-cheese like substance. Do I have a yeast infection? Been itching for a few days too. ### Response: Hi, I understand that your IUD and the vaginal infection is troubling you. Regarding the IUD,it\\s normal to have spotting after putting it in for some time.I assume you are having regular periods .If so wait for a month as your bleeding is not heavy.If it does not normalise,then it\\s wise to see a gynaecologist who will need to check u to see if the position of the IUD is normal 2.Regarding the BV,it would be wise to treat it at the earliest as even if u don\\t have symptoms now ,later it can cause issues. 3.Regarding the HPV,once your BV is treated it would be good to consider taking HPV vaccines (if u r not already vaccinated)

Hello! I am a 20 year old female. I have a few questions regarding my IUD,HPV, and BV. The itch around the genital area I had first last year, and it went away and came back three days ago. The OB said I was spotting (I recently got my IUD when I visited the OB)1. I got my copper IUD last year, and have been experiencing \\x80\\x9cspotting\\x80\\x9d since. It's not everyday but it happens before and after my heavy periods. Is this normal?2. I have been to the OB before that too and they told me I have genital warts inside my vagina. I plan on just letting it go away since there seems to be no other option. I'm concerned if the IUD will make the HPV worse?3. At the same visit, I took a pap smear and results came back positive for BV-like flora. I went undiagnosed. Will my BV go away on its own? I don't have symptoms like grey discharge or fishy odor so I'm not that worried.4. The reason why I went to the OB last time was because I was itching like crazy down there. My discharge was like cottage cheese. It went away for a while but just just now, I checked for the string to myIUD and my finger came out with some cottage-cheese like substance. Do I have a yeast infection? Been itching for a few days too.

Hi, I understand that your IUD and the vaginal infection is troubling you. Regarding the IUD,it\\s normal to have spotting after putting it in for some time.I assume you are having regular periods .If so wait for a month as your bleeding is not heavy.If it does not normalise,then it\\s wise to see a gynaecologist who will need to check u to see if the position of the IUD is normal 2.Regarding the BV,it would be wise to treat it at the earliest as even if u don\\t have symptoms now ,later it can cause issues. 3.Regarding the HPV,once your BV is treated it would be good to consider taking HPV vaccines (if u r not already vaccinated)

### Instruction: Answer this question truthfully ###Input: Hello doctor,Fourteen months ago, my wife went through a C-section delivering a baby girl. After 15 days of surgery, she started feeling lower backache with very local pain in bending, sneezing and coughing. Initially, we thought it is a post-cesarean effect. As she was breastfeeding the baby, she took homeopathic medicines.Afterwards, we consulted an orthopedic as there was no relief of pain. Three months later, we consulted Neuromedicine. With certain blood investigations and an MRI report, they diagnosed it as a Pott's spine in the L4-L5 region.The MRI report said there was an altered T2WI hyperintense and T1WI hypointense signal intensities noted involving the L4 and L5 vertebral bodies with the paradiscal destruction of the L4 vertebral body. A post-contrast study reveals heterogeneous involvement. An irregular peripheral enhancing T2WI hyperintense and T1WI hypointense collection is noted in intraosseous space, prevertebral and paravertebral space extending behind L4 and L5 vertebral level. Small similar collections were noted in the adjacent psoas muscles. Anterior epidural space collection was noted behind L4-L5 level causing spinal canal stenosis. Rest of the vertebrae were normal.Of late, she has started feeling severe pain in her back as well in the right leg. Right now she is feeling difficulty in moving and walking.Can you please prescribe her what to do next? They have started the treatment course and suggested to wear an LS belt. The medications are as follows ### Response: Hello. She has Pott\\s spine that is tuberculosis of the spine and the treatment duration for this is 18 months. Now, the symptom you have mentioned suggests that she has got severe compression of the nerves of the back aggravated by a jerk. In such scenario, she needs to apply Taylor\\s brace on her back to support her back and she may even need rest for a few weeks. In such cases, I also prefer to add up a medicine which helps in reducing the disc edema and that is a tablet Disperzyme (Bromelain, Trypsin, Rutoside). Consult your specialist doctor, discuss with him or her and with their consent take the medicines. Regards. For more information consult a neurologist online Take care.

Hello doctor,Fourteen months ago, my wife went through a C-section delivering a baby girl. After 15 days of surgery, she started feeling lower backache with very local pain in bending, sneezing and coughing. Initially, we thought it is a post-cesarean effect. As she was breastfeeding the baby, she took homeopathic medicines.Afterwards, we consulted an orthopedic as there was no relief of pain. Three months later, we consulted Neuromedicine. With certain blood investigations and an MRI report, they diagnosed it as a Pott's spine in the L4-L5 region.The MRI report said there was an altered T2WI hyperintense and T1WI hypointense signal intensities noted involving the L4 and L5 vertebral bodies with the paradiscal destruction of the L4 vertebral body. A post-contrast study reveals heterogeneous involvement. An irregular peripheral enhancing T2WI hyperintense and T1WI hypointense collection is noted in intraosseous space, prevertebral and paravertebral space extending behind L4 and L5 vertebral level. Small similar collections were noted in the adjacent psoas muscles. Anterior epidural space collection was noted behind L4-L5 level causing spinal canal stenosis. Rest of the vertebrae were normal.Of late, she has started feeling severe pain in her back as well in the right leg. Right now she is feeling difficulty in moving and walking.Can you please prescribe her what to do next? They have started the treatment course and suggested to wear an LS belt. The medications are as follows

Hello. She has Pott\\s spine that is tuberculosis of the spine and the treatment duration for this is 18 months. Now, the symptom you have mentioned suggests that she has got severe compression of the nerves of the back aggravated by a jerk. In such scenario, she needs to apply Taylor\\s brace on her back to support her back and she may even need rest for a few weeks. In such cases, I also prefer to add up a medicine which helps in reducing the disc edema and that is a tablet Disperzyme (Bromelain, Trypsin, Rutoside). Consult your specialist doctor, discuss with him or her and with their consent take the medicines. Regards. For more information consult a neurologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have hyper burning in the stomach to chest area left side only, empty stomach burning much after taken food, cold water, fruits some relief but not full relief. Some belching also comes from the last two months, this issue from the previous 1.5 years. At present, I cannot eat hot foods, hot water, warm milk, and cannot eat spicy foods too. Anything hot tastes or drink immediate feels like heating in the stomach. Comfort zone when drink cold water, milk, cold juices, and very few times after dense food, some pain feels in the exact stomach area. The pain feels like a slow-digesting process after some time, and the pain was gone.Last few months, I have taken the Deltone capsule for two months, then Rekool-L then Nexpro Rd now this month given me Neopride total capsules. But after skip capsules burning again start. Along with Clistar Rt tablet, two times are given, and Nutrilite multi-minerals capsules in the night. Now I do not understand only name change brand change, but every time gastro doctor gives me pills like Dexlansaproazle, Esomeprazole, and Rabeprazole. Now I do not understand what issue I have? ### Response: Hello, Welcome to Chat Doctor forum. I have gone through your query and can understand your health concerns. As your symptoms have started long back, you need proper evaluation. There are many causes of burning in the stomach and belching like gastroesophageal reflux disease, gastritis, peptic ulcer in stomach or duodenum, gall bladder stones, infection of the gall bladder, esophagitis, etc. In my opinion, you need an ultrasound of the abdomen and endoscopy to find out what is the cause of your symptoms. Sometimes inappropriate dietary habits like not taking meals at the proper time, eating a lot of junk food, oily, spicy, fatty food, excessive tea or coffee intake, less water intake can cause acidity and burning. Some infections of the stomach like H.pylori infections or hookworm infestations can also cause such symptoms. I suggest you go for an ultrasound of the abdomen and endoscopy to know the root cause of your symptoms so that proper treatment can be done. ChatDoctor. Avoid tea, coffee, soft

Hello doctor,I have hyper burning in the stomach to chest area left side only, empty stomach burning much after taken food, cold water, fruits some relief but not full relief. Some belching also comes from the last two months, this issue from the previous 1.5 years. At present, I cannot eat hot foods, hot water, warm milk, and cannot eat spicy foods too. Anything hot tastes or drink immediate feels like heating in the stomach. Comfort zone when drink cold water, milk, cold juices, and very few times after dense food, some pain feels in the exact stomach area. The pain feels like a slow-digesting process after some time, and the pain was gone.Last few months, I have taken the Deltone capsule for two months, then Rekool-L then Nexpro Rd now this month given me Neopride total capsules. But after skip capsules burning again start. Along with Clistar Rt tablet, two times are given, and Nutrilite multi-minerals capsules in the night. Now I do not understand only name change brand change, but every time gastro doctor gives me pills like Dexlansaproazle, Esomeprazole, and Rabeprazole. Now I do not understand what issue I have?

Hello, Welcome to Chat Doctor forum. I have gone through your query and can understand your health concerns. As your symptoms have started long back, you need proper evaluation. There are many causes of burning in the stomach and belching like gastroesophageal reflux disease, gastritis, peptic ulcer in stomach or duodenum, gall bladder stones, infection of the gall bladder, esophagitis, etc. In my opinion, you need an ultrasound of the abdomen and endoscopy to find out what is the cause of your symptoms. Sometimes inappropriate dietary habits like not taking meals at the proper time, eating a lot of junk food, oily, spicy, fatty food, excessive tea or coffee intake, less water intake can cause acidity and burning. Some infections of the stomach like H.pylori infections or hookworm infestations can also cause such symptoms. I suggest you go for an ultrasound of the abdomen and endoscopy to know the root cause of your symptoms so that proper treatment can be done. ChatDoctor. Avoid tea, coffee, soft

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am male, 35 years old and weight 70 kilos, height 173 cm. Every year I do a medical checkup. In a recent medical check-up, there was a note related to heart rate (bradycardia), the result was 49 bpm. I also have checked manually and also using pulse meter, the result around 51 to 55 bpm. In the last eight months, I do morning run three times a week (30 minutes). Actually previously instead of running, I also have done sports exercise (static bike) with the same intensity. One thing that differs with the previous conditon is I lost 8 kilos (in 7 to 8 months time). There is no symptom related to my health, instead, I feel comfortable and fit. I have consulted with the cardiologist and he said it was okay as long as I do not feel any symptom (faint, dizzy, etc). But the doctor quite worried regarding the heart rate at night since based on ECG result (using Holter monitor for a full day), it showed the heart rate plunged to 35 bpm at night (sleeping). The doctor gave me Terbutaline sulfate, with a low dosage (two times a day at 2.5 mg). My question is whether bradycardia is related to my sports activity? Does it relate to my weight loss? Is there any reference related to normal heart rate for atheletes (with sports heart) when sleeping at night? ### Response: Hi. It is quite common and normal for regular athletes to have sinus bradycardia, I saw some with heart rate down to 40 to 45 bpm daytime. At night usually, the HR is slower and it can get down to 35 bpm. As long as you remain asymptomatic that is no lightheadedness and no fainting or collapses, then no further action is required. It is not related to weight loss which could be secondary to increased physical activity and exercises. If weight loss is not deliberate, then this needs to be investigated. Weight loss and bradycardia could be seen in malnutrition patients and people with severe depression sometimes. I do not think it is the case here as you do regular exercise which is a good sign. Please be assured. Take care.

Hello doctor,I am male, 35 years old and weight 70 kilos, height 173 cm. Every year I do a medical checkup. In a recent medical check-up, there was a note related to heart rate (bradycardia), the result was 49 bpm. I also have checked manually and also using pulse meter, the result around 51 to 55 bpm. In the last eight months, I do morning run three times a week (30 minutes). Actually previously instead of running, I also have done sports exercise (static bike) with the same intensity. One thing that differs with the previous conditon is I lost 8 kilos (in 7 to 8 months time). There is no symptom related to my health, instead, I feel comfortable and fit. I have consulted with the cardiologist and he said it was okay as long as I do not feel any symptom (faint, dizzy, etc). But the doctor quite worried regarding the heart rate at night since based on ECG result (using Holter monitor for a full day), it showed the heart rate plunged to 35 bpm at night (sleeping). The doctor gave me Terbutaline sulfate, with a low dosage (two times a day at 2.5 mg). My question is whether bradycardia is related to my sports activity? Does it relate to my weight loss? Is there any reference related to normal heart rate for atheletes (with sports heart) when sleeping at night?

Hi. It is quite common and normal for regular athletes to have sinus bradycardia, I saw some with heart rate down to 40 to 45 bpm daytime. At night usually, the HR is slower and it can get down to 35 bpm. As long as you remain asymptomatic that is no lightheadedness and no fainting or collapses, then no further action is required. It is not related to weight loss which could be secondary to increased physical activity and exercises. If weight loss is not deliberate, then this needs to be investigated. Weight loss and bradycardia could be seen in malnutrition patients and people with severe depression sometimes. I do not think it is the case here as you do regular exercise which is a good sign. Please be assured. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor, I am one week late as of today for my menstrual period. Currently, my cycle is 38 days. I have been having protected sexual intercourse the past month, but just recently (Day 35) of my cycle, the condom of my partner leaked at the base. So I immediately took emergency contraceptive which is four birth control pills at 5 PM, then another four birth control pills at 5 AM the following morning. I started feeling the side effects, but I am worried since my period is a week late already and I just woke up at 2 AM on day 38 unable to sleep with a weird feeling in my stomach and I am extremely constipated, with tender breasts, and feel sick overall.I would like to know if my period will come soon? If there is a possibility I am pregnant, or if I am just feeling all these symptoms due to hormone imbalances? What I should do in this whole situation since I am very worried about it? ### Response: Hello. Yes, you are right, your period will come soon and that is most likely possibility. Your symptoms can be due to both pregnancy and/or hormones. Because in pregnancy there is increase in amount of hormones and you just take higher dose of hormones. And symptoms you are experiencing is due to the higher level of hormones in your body which can be due to both reasons. But it is more likely that symptoms are due to the pills you had taken. Because if it is due to pregnancy then pregnancy must be due to earlier intercourse which was protected. So there are very fewer chances of failure in that case. And right now your periods also get extended due to the pills you had taken. Basically, in this situation you should do a urine pregnancy test and see if it comes positive then it is due to the failure of previous precautions. And if it turns to be negative then just wait for seven more days and periods will come. And even after that if your symptoms are increasing in two days then you need to go for a test for confirmation to clear the confusion. ChatDoctor. And do not take much tension. With your history, it is more likely that it is just delayed menses due to emergency pills and side effects of oral hormones. Your period can be irregular for one or two cycles.

Hello doctor, I am one week late as of today for my menstrual period. Currently, my cycle is 38 days. I have been having protected sexual intercourse the past month, but just recently (Day 35) of my cycle, the condom of my partner leaked at the base. So I immediately took emergency contraceptive which is four birth control pills at 5 PM, then another four birth control pills at 5 AM the following morning. I started feeling the side effects, but I am worried since my period is a week late already and I just woke up at 2 AM on day 38 unable to sleep with a weird feeling in my stomach and I am extremely constipated, with tender breasts, and feel sick overall.I would like to know if my period will come soon? If there is a possibility I am pregnant, or if I am just feeling all these symptoms due to hormone imbalances? What I should do in this whole situation since I am very worried about it?

Hello. Yes, you are right, your period will come soon and that is most likely possibility. Your symptoms can be due to both pregnancy and/or hormones. Because in pregnancy there is increase in amount of hormones and you just take higher dose of hormones. And symptoms you are experiencing is due to the higher level of hormones in your body which can be due to both reasons. But it is more likely that symptoms are due to the pills you had taken. Because if it is due to pregnancy then pregnancy must be due to earlier intercourse which was protected. So there are very fewer chances of failure in that case. And right now your periods also get extended due to the pills you had taken. Basically, in this situation you should do a urine pregnancy test and see if it comes positive then it is due to the failure of previous precautions. And if it turns to be negative then just wait for seven more days and periods will come. And even after that if your symptoms are increasing in two days then you need to go for a test for confirmation to clear the confusion. ChatDoctor. And do not take much tension. With your history, it is more likely that it is just delayed menses due to emergency pills and side effects of oral hormones. Your period can be irregular for one or two cycles.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 26 year old male. My weight is 60 kg and height is 5\\8\". I grown up with great responsibility of family, but never fulfilled it up to the mark besides living my life in fear from society. I managed good academics and some standard over time. But, I have also developed very poor social skill, dependency to some extent and fear while facing anything new. I do not want to move from a situation where I have fixed myself.Three years before I had a breakup and also was idle without job. This had caused me severe stress and crying episode about which I did not share with any one. I got job, but did not feel happy about it. The emptiness and worry followed me. I got into another relationship which was lovely. I got involved in alcohol drinking and smoking. I faced a time where job stress killed me every day and I detached myself from everyone, felt emotionless even with my family, drowsiness and no sense of reality. I became so casual that only thing I wanted is nothing should worry me. If anything worried me I tried to solve it immediately with a step which might be job threatening. I lived without any pleasure, confidence, goal and routine. I did live my life, but never felt any connection as I have become a robot. Forgetfulness, short term memory loss and no attention or interest at all. Today I have improved myself and do not drink regularly; I do exercises, do talk with family and some friends, watch television and got a better job. But still, I am not happy. My forgetfulness and excessive worry is with me still. I find that my brain is continuously busy in something, but I am not aware of that. I feel very tired and lazy. Socially frightened, poor, and I am not clever enough. However, I am very polite, helpful to others and have good moral value. I found that I have not added a strong value and get easily convinced, irritated and people make fool of me. It is like I have got stuck and trapped and I have not moved on. I want to put an end to this. Please help me. ### Response: Hi, Welcome to Chat Doctor forum. I have gone through your query in detail and would like to summarize your current symptoms

Hello doctor,I am a 26 year old male. My weight is 60 kg and height is 5\\8\". I grown up with great responsibility of family, but never fulfilled it up to the mark besides living my life in fear from society. I managed good academics and some standard over time. But, I have also developed very poor social skill, dependency to some extent and fear while facing anything new. I do not want to move from a situation where I have fixed myself.Three years before I had a breakup and also was idle without job. This had caused me severe stress and crying episode about which I did not share with any one. I got job, but did not feel happy about it. The emptiness and worry followed me. I got into another relationship which was lovely. I got involved in alcohol drinking and smoking. I faced a time where job stress killed me every day and I detached myself from everyone, felt emotionless even with my family, drowsiness and no sense of reality. I became so casual that only thing I wanted is nothing should worry me. If anything worried me I tried to solve it immediately with a step which might be job threatening. I lived without any pleasure, confidence, goal and routine. I did live my life, but never felt any connection as I have become a robot. Forgetfulness, short term memory loss and no attention or interest at all. Today I have improved myself and do not drink regularly; I do exercises, do talk with family and some friends, watch television and got a better job. But still, I am not happy. My forgetfulness and excessive worry is with me still. I find that my brain is continuously busy in something, but I am not aware of that. I feel very tired and lazy. Socially frightened, poor, and I am not clever enough. However, I am very polite, helpful to others and have good moral value. I found that I have not added a strong value and get easily convinced, irritated and people make fool of me. It is like I have got stuck and trapped and I have not moved on. I want to put an end to this. Please help me.

Hi, Welcome to Chat Doctor forum. I have gone through your query in detail and would like to summarize your current symptoms

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 21-year-old female. For the past four months, my menstrual cycle was not right. It lasted a whole month and was heavy by the end, and it stopped after I took some vitamin C. Then, after one month, it started again and lasted for two weeks (stopped after I got some vitamin C again, and I was not taking any before).After that, it disappeared for two months, and started again, except this time it appears for a day, the next day it is gone, shows up every couple of days, and there was a very little of blood. None of this ever happened before, although my cycle was never exactly every 30 days, everything was fine. I am not sure what could be causing it, it might be stress related, but I do not have an opportunity to see a doctor for the next three months. Currently I am on Omep 40 g, for duodenal inflammation and Cinnabsin N for sinusitis. ### Response: Hello. At the age of 21 years, possibilities for such irregular cycles are, 1. You have severe physical or mental stress in any form, which would interfere with regular normal ovulation and periods will be haphazard. Try to reduce stress with meditation, breaks, etc. 2. If you have suddenly put on weight. This excess cholesterol will get converted into hormones and interfere with ovulation. So have a healthy lifestyle and diet. You can have cyclical birth control pills for five to six cycles. You have to take pills from day one of the periods for three weeks, then no pills for one week. After eight days start a new pack. Do not wait for next period. 3. You have not mentioned about your sexual activity. If sexually active, then infection could be a cause. If so, you and your partner need to meet a doctor and have a course of antibiotics. 4. If none of these a reason, have a pelvic scan to look for any local problem like polyp or fibroids inside the uterus. 5. Do have a serum thyroid hormone profile and serum prolactin levels to rule out, a hormonal angle. I hope I have clarified your query and do write back if any other questions, and for feedback. Take care.

Hello doctor,I am a 21-year-old female. For the past four months, my menstrual cycle was not right. It lasted a whole month and was heavy by the end, and it stopped after I took some vitamin C. Then, after one month, it started again and lasted for two weeks (stopped after I got some vitamin C again, and I was not taking any before).After that, it disappeared for two months, and started again, except this time it appears for a day, the next day it is gone, shows up every couple of days, and there was a very little of blood. None of this ever happened before, although my cycle was never exactly every 30 days, everything was fine. I am not sure what could be causing it, it might be stress related, but I do not have an opportunity to see a doctor for the next three months. Currently I am on Omep 40 g, for duodenal inflammation and Cinnabsin N for sinusitis.

Hello. At the age of 21 years, possibilities for such irregular cycles are, 1. You have severe physical or mental stress in any form, which would interfere with regular normal ovulation and periods will be haphazard. Try to reduce stress with meditation, breaks, etc. 2. If you have suddenly put on weight. This excess cholesterol will get converted into hormones and interfere with ovulation. So have a healthy lifestyle and diet. You can have cyclical birth control pills for five to six cycles. You have to take pills from day one of the periods for three weeks, then no pills for one week. After eight days start a new pack. Do not wait for next period. 3. You have not mentioned about your sexual activity. If sexually active, then infection could be a cause. If so, you and your partner need to meet a doctor and have a course of antibiotics. 4. If none of these a reason, have a pelvic scan to look for any local problem like polyp or fibroids inside the uterus. 5. Do have a serum thyroid hormone profile and serum prolactin levels to rule out, a hormonal angle. I hope I have clarified your query and do write back if any other questions, and for feedback. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 14-year-old male. Last week, I had really bad pain under, which I realized was my tonsils. I went to a doctor to get it checked out. He said they were definitely infected, but they did not give me any medication. He said it would go away by itself. Now, I have a really bad cough. When I cough, it makes my tonsils hurt like crazy. Last night, I had a really bad coughing fit that I could not breathe, so I ran to the bathroom, and ended up coughing up blood.Also, when I sleep, I feel as if someone was pressing on my chest, and it is hard to breathe and it is also hard to swallow. Currently, when I cough it hurts my tonsils, my chest, and now also my head. Only when I cough, I get a sharp pain on my left temple. I feel awful. My mom said I also look really pale, and my teachers have been asking me if I am fine because I do not look well. I do not want to go see a doctor, because it is a waste of time if I do not get any medication. Please tell me what I can do to feel better. ### Response: Hi, Welcome to Chat Doctor forum. It is surprising that you were not started on medications despite your tonsillitis and throat complaints. It may be possible that your symptoms or findings were subclinical when you saw the doctor and it may have worsened further since then. It sounds like a throat infection for which you may need a course of antibiotics. On an online portal such as this, it is not recommended for me to prescribe antibiotics without an in-person evaluation. However, I can recommend the use of antiseptic gargles such as dilute Betadine gargling (5 ml of Betadine in 50 ml of lukewarm water. Do not swallow) thrice daily before and after meals for about a week along with over the counter available anti-inflammatories such as Paracetamol 500 mg twice daily for three days. If you develop fever or your symptoms worsen, it is advised that you show yourself to a doctor or at the ER and in such a situation I am certain that you will be treated with medications appropriately.

Hello doctor,I am a 14-year-old male. Last week, I had really bad pain under, which I realized was my tonsils. I went to a doctor to get it checked out. He said they were definitely infected, but they did not give me any medication. He said it would go away by itself. Now, I have a really bad cough. When I cough, it makes my tonsils hurt like crazy. Last night, I had a really bad coughing fit that I could not breathe, so I ran to the bathroom, and ended up coughing up blood.Also, when I sleep, I feel as if someone was pressing on my chest, and it is hard to breathe and it is also hard to swallow. Currently, when I cough it hurts my tonsils, my chest, and now also my head. Only when I cough, I get a sharp pain on my left temple. I feel awful. My mom said I also look really pale, and my teachers have been asking me if I am fine because I do not look well. I do not want to go see a doctor, because it is a waste of time if I do not get any medication. Please tell me what I can do to feel better.

Hi, Welcome to Chat Doctor forum. It is surprising that you were not started on medications despite your tonsillitis and throat complaints. It may be possible that your symptoms or findings were subclinical when you saw the doctor and it may have worsened further since then. It sounds like a throat infection for which you may need a course of antibiotics. On an online portal such as this, it is not recommended for me to prescribe antibiotics without an in-person evaluation. However, I can recommend the use of antiseptic gargles such as dilute Betadine gargling (5 ml of Betadine in 50 ml of lukewarm water. Do not swallow) thrice daily before and after meals for about a week along with over the counter available anti-inflammatories such as Paracetamol 500 mg twice daily for three days. If you develop fever or your symptoms worsen, it is advised that you show yourself to a doctor or at the ER and in such a situation I am certain that you will be treated with medications appropriately.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 22 year old female. Why does the area, which I believe is my ovaries, hurt when I stretch? The pain would be in both the left and right side. When I sit down for a long time or when I defecate, it hurts a lot in the area. During my periods, why do my legs go numb? Every month around the time, I experience leg numbness, back pain, pain in the butt area, and pain my stomach. I understand the stomach pain, but why do I have pain in other areas? When all this pain starts, I get panicked, as I do not know what to do. I try sitting down for a few seconds, which helps but then, my back pain starts. I try to walk, but the pain is not relieved.I start feeling sick and throw up. I start getting suicidal thoughts, and I just want to put myself out of this misery. When I take two painkillers for the pain, I end up sleeping the entire day and get up only to use the restroom. I do not eat, and I would end up going days without eating until I feel better. So, I just want to know what is the cause of this. This will help me explain my physician to help me better. I feel like this would affect me trying to go to work. I am trying to find a job, but I feel that if I take so many days off for the pain, my boss will fire me.I was thinking of getting a partial hysterectomy to stop it maybe, so I will have to deal with the pains, and I can stay on the job. But I am not sure if my insurance will cover it. Do you have any suggestions? Sorry for the long query, I just really need help. The last physician I had could not help me in the way that I needed help, so I stopped going to her. I need more of professional help. ### Response: Hi. From the history you have given, it sounds like something is affecting the neuromuscular area on both sides at the pelvic or may I say the deep groin area. Hope I have been of help to you, do write back. All the best. For more information consult an obstetrician and gynaecologist online

Hi doctor,I am a 22 year old female. Why does the area, which I believe is my ovaries, hurt when I stretch? The pain would be in both the left and right side. When I sit down for a long time or when I defecate, it hurts a lot in the area. During my periods, why do my legs go numb? Every month around the time, I experience leg numbness, back pain, pain in the butt area, and pain my stomach. I understand the stomach pain, but why do I have pain in other areas? When all this pain starts, I get panicked, as I do not know what to do. I try sitting down for a few seconds, which helps but then, my back pain starts. I try to walk, but the pain is not relieved.I start feeling sick and throw up. I start getting suicidal thoughts, and I just want to put myself out of this misery. When I take two painkillers for the pain, I end up sleeping the entire day and get up only to use the restroom. I do not eat, and I would end up going days without eating until I feel better. So, I just want to know what is the cause of this. This will help me explain my physician to help me better. I feel like this would affect me trying to go to work. I am trying to find a job, but I feel that if I take so many days off for the pain, my boss will fire me.I was thinking of getting a partial hysterectomy to stop it maybe, so I will have to deal with the pains, and I can stay on the job. But I am not sure if my insurance will cover it. Do you have any suggestions? Sorry for the long query, I just really need help. The last physician I had could not help me in the way that I needed help, so I stopped going to her. I need more of professional help.

Hi. From the history you have given, it sounds like something is affecting the neuromuscular area on both sides at the pelvic or may I say the deep groin area. Hope I have been of help to you, do write back. All the best. For more information consult an obstetrician and gynaecologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 34 years old male. I started having incontinence problems about 4 to 6 months ago (cause unknown). It began with issues only happening at night while sleeping. A month ago it had progressed to occasionally not even being able to make it to the bathroom before I began to pee. Then, about four weeks or so ago, while having sex with my girlfriend, I ended up with a fairly large cut or tear right underneath the head of the penis. It has happened before.About 2 to 3 weeks ago I somehow ended up with a UTI and yeast infection. For whatever reason, I have not taken it seriously (major depression) and two nights ago I started having pain (then ended up realizing these were little white ulcers that have since begun to spread rapidly). They are under the head of the penis, on my scrotum, and also on the shaft of my penis. Along with that, last night I realized the lymph node in my right groin was significantly swollen and painful as well. Today that became my lymph node in both my right and now my left groin as well.)Finally, when I woke up today I had a huge swollen ring of skin, underneath the head of my penis, along with everything else. I have had this same swollen ring one time before in my life. It is seriously swollen and more ulcers are on that skin as well. I did a bit of looking at pictures online and I found a condition that is very similar looking (as far as the swollen ring goes,) called paraphimosis. However, I have been circumcised since I was a baby. So I am not thinking that is it. Anyway, I am in fairly severe pain and I am worried about the lymph nodes in my groin (left and right) being swollen, that there is some bad infection spreading in my blood throughout my body. I guess I could be simply paranoid but I went from ignoring this to now freaking out. So I do not believe that this is the case. Please help. Any ideas or thoughts or suggestions? Currently, I am on Xanax, Adderall, Prozac, Abilify, Cymbalta, Suboxone, and Atenolol. ### Response: Hello. Relax and do not worry. I have some questions for you as follows

Hello doctor,I am 34 years old male. I started having incontinence problems about 4 to 6 months ago (cause unknown). It began with issues only happening at night while sleeping. A month ago it had progressed to occasionally not even being able to make it to the bathroom before I began to pee. Then, about four weeks or so ago, while having sex with my girlfriend, I ended up with a fairly large cut or tear right underneath the head of the penis. It has happened before.About 2 to 3 weeks ago I somehow ended up with a UTI and yeast infection. For whatever reason, I have not taken it seriously (major depression) and two nights ago I started having pain (then ended up realizing these were little white ulcers that have since begun to spread rapidly). They are under the head of the penis, on my scrotum, and also on the shaft of my penis. Along with that, last night I realized the lymph node in my right groin was significantly swollen and painful as well. Today that became my lymph node in both my right and now my left groin as well.)Finally, when I woke up today I had a huge swollen ring of skin, underneath the head of my penis, along with everything else. I have had this same swollen ring one time before in my life. It is seriously swollen and more ulcers are on that skin as well. I did a bit of looking at pictures online and I found a condition that is very similar looking (as far as the swollen ring goes,) called paraphimosis. However, I have been circumcised since I was a baby. So I am not thinking that is it. Anyway, I am in fairly severe pain and I am worried about the lymph nodes in my groin (left and right) being swollen, that there is some bad infection spreading in my blood throughout my body. I guess I could be simply paranoid but I went from ignoring this to now freaking out. So I do not believe that this is the case. Please help. Any ideas or thoughts or suggestions? Currently, I am on Xanax, Adderall, Prozac, Abilify, Cymbalta, Suboxone, and Atenolol.

Hello. Relax and do not worry. I have some questions for you as follows

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 20 years old and suffering from a rash on my face. The first breakout was around five weeks ago. I noticed a red spot above my left eyebrow after hearing a stressful news and eventually it spread to my chin and above my lip. I was at the beach and after around three days, the rash hardened and left. The skin was kind of dry. The rash has a blister look to it up close and is red. It looks like a ton of little pimples and some of the spots even have what look like whiteheads. It is not painful but does itch somewhat. One week later, the rash came back and I decided to see a dermatologist. The dermatologist said I had seborrheic dermatitis, but did not take a sample to have a lab test or anything. She basically just looked at my face and told me what I had. She prescribed me Ketoconazole for two weeks day and night. It kind of came and went. The Ketoconazole cream I guess worked because I did not break for around two weeks. Well, I just stopped the Ketoconazole five days ago and today, I woke up to the same blister-looking rash again. This literally happened overnight. It has just gotten worse throughout the day. Now I have it above my left eyebrow up onto my forehead, the bridge of my nose and around my right eye, chin, above the lip, and some on the right cheek. I need help. Was the dermatologist right when she said it is SD? Or could this be something else? I know they say the skin is scaly with SD but I am not sure my skin has a scaly look. It is more like pimply. To be honest, my skin most resembles a heat rash in the pictures. The pictures do not do it justice. ### Response: Hello, Welcome to Chat Doctor forum. It could be seborrheic dermatitis or photodermatitis. Allergies may be playing a role. All these are visual diagnosis and the lab tests or biopsies have limited or no role. Seborrheic dermatitis is more commonly present with dan ChatDoctor. Photodermatitis would be present over the sun-exposed areas. In all of these conditions, a mild steroid cream would be useful if applied for a few days. You can apply Hy

Hello doctor,I am 20 years old and suffering from a rash on my face. The first breakout was around five weeks ago. I noticed a red spot above my left eyebrow after hearing a stressful news and eventually it spread to my chin and above my lip. I was at the beach and after around three days, the rash hardened and left. The skin was kind of dry. The rash has a blister look to it up close and is red. It looks like a ton of little pimples and some of the spots even have what look like whiteheads. It is not painful but does itch somewhat. One week later, the rash came back and I decided to see a dermatologist. The dermatologist said I had seborrheic dermatitis, but did not take a sample to have a lab test or anything. She basically just looked at my face and told me what I had. She prescribed me Ketoconazole for two weeks day and night. It kind of came and went. The Ketoconazole cream I guess worked because I did not break for around two weeks. Well, I just stopped the Ketoconazole five days ago and today, I woke up to the same blister-looking rash again. This literally happened overnight. It has just gotten worse throughout the day. Now I have it above my left eyebrow up onto my forehead, the bridge of my nose and around my right eye, chin, above the lip, and some on the right cheek. I need help. Was the dermatologist right when she said it is SD? Or could this be something else? I know they say the skin is scaly with SD but I am not sure my skin has a scaly look. It is more like pimply. To be honest, my skin most resembles a heat rash in the pictures. The pictures do not do it justice.

Hello, Welcome to Chat Doctor forum. It could be seborrheic dermatitis or photodermatitis. Allergies may be playing a role. All these are visual diagnosis and the lab tests or biopsies have limited or no role. Seborrheic dermatitis is more commonly present with dan ChatDoctor. Photodermatitis would be present over the sun-exposed areas. In all of these conditions, a mild steroid cream would be useful if applied for a few days. You can apply Hy

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 46 years old and never had any indication of herpes. No new exposure, same partner for over a year and neither have strayed. 20 days ago I got up with some redness and uncomfortable feeling on left side of vulva. I have an anxiety disorder and super high stress level right now. For some reason, I decided this was herpes and started looking at myself with a mirror and flashlight. Never really saw anything. I have been obsessed ever since. Tingling and numbness in buttocks and down backs of thighs off and on for 20 days. Uncomfortable but not red in vulva area. No signs of herpes. Went to a gynecologist, she did a pelvic scan and said no signs of herpes in or out.I still cannot stop thinking about whether they missed something. I also went to my chiropractor who did an adjustment and said lower back can cause tingling and numbness even in the genital region. Yesterday a little red pimple looking bump popped out on my inner thigh. I decided it must be the sore that never came out before. It does not hurt or itch but I am obsessed with it now. It is smaller today. Question is that does prodrome last 20 days (tingling numb butt area) and can one sore pop out after 19 days? The gynecologist I saw said I need to be treating my anxiety again and to get back on the Zoloft I took for two years for that. ### Response: Hi, Welcome to Chat Doctor forum. Herpes has many myths asssociated with it. No, it is unusual to get a blister after 19 to 20 days like this. Blister may be due to some other skin disease or any other reason. It does not seem to be the pro ChatDoctor. Still worried, you may go for a PCR for herpes blood test and you may consult me back with the reports of the test. Secondly, if this blister or sore does not heal up in a couple of days, increases in size or number, you should go to a physician for taking a sample of this sore (few cells will be taken on a swab) and send it to the laboratory for herpes testing. The final suggestion is that relax and do not worry much.

Hello doctor,I am 46 years old and never had any indication of herpes. No new exposure, same partner for over a year and neither have strayed. 20 days ago I got up with some redness and uncomfortable feeling on left side of vulva. I have an anxiety disorder and super high stress level right now. For some reason, I decided this was herpes and started looking at myself with a mirror and flashlight. Never really saw anything. I have been obsessed ever since. Tingling and numbness in buttocks and down backs of thighs off and on for 20 days. Uncomfortable but not red in vulva area. No signs of herpes. Went to a gynecologist, she did a pelvic scan and said no signs of herpes in or out.I still cannot stop thinking about whether they missed something. I also went to my chiropractor who did an adjustment and said lower back can cause tingling and numbness even in the genital region. Yesterday a little red pimple looking bump popped out on my inner thigh. I decided it must be the sore that never came out before. It does not hurt or itch but I am obsessed with it now. It is smaller today. Question is that does prodrome last 20 days (tingling numb butt area) and can one sore pop out after 19 days? The gynecologist I saw said I need to be treating my anxiety again and to get back on the Zoloft I took for two years for that.

Hi, Welcome to Chat Doctor forum. Herpes has many myths asssociated with it. No, it is unusual to get a blister after 19 to 20 days like this. Blister may be due to some other skin disease or any other reason. It does not seem to be the pro ChatDoctor. Still worried, you may go for a PCR for herpes blood test and you may consult me back with the reports of the test. Secondly, if this blister or sore does not heal up in a couple of days, increases in size or number, you should go to a physician for taking a sample of this sore (few cells will be taken on a swab) and send it to the laboratory for herpes testing. The final suggestion is that relax and do not worry much.

### Instruction: Answer this question truthfully ###Input: Hi doctor,About four years ago, when I was self-conscious about the size of my penis, I started looking into ways to increase the size of my penis. Never long-term, but I tried penis water pump and penis extenders. A few times that I used the penis extenders, the ring may have been very tightly packed around my penis while I was using it and due to the stretch it caused, and tightness, I lost circulation to my penis tip to a point the tip went numb and cold. After that, I started noticing my erections are much weaker and sensitivity has gone down significantly. Besides that, I also became very self-conscious and psychologically worried that I may have made my ED worse.I did not have problems getting an erection, but maintaining one was more difficult and my erections were softer. I stopped having sex. After three to four years, when I masturbate, the quality of the erection is much better and I am able to keep the erection but the sensitivity is not quite back. Also, my climaxes are much weaker and they do not feel as good. In the last year that I have masturbated, I have not had issues maintaining an erection when I am masturbating but I believe the sensitivity is not back. I am worried having sex, I will begin to lose the erection fast. I have red skin marks under the skin at my penis tip that is not going away. Is this due to dead cells? Have I done irreversible damage? Is there any treatment as I now am hoping to become sexually active? Many of my problems are from using the extenders and penis pump aggressively even though it was short usage and regretful decisions. ### Response: Hello, Welcome to Chat Doctor forum. I saw the pictures (attachment removed to protect patient identity). The penis looks almost normal. As you are able to masturbate, post-marriage, sexual activity will not be an issue (rather it is better). Aggressive stretching may have caused some damage but from your description, it appears it will not affect your married life. Feeling an orgasm is also dynamic. It may become better after marriage and is unrelated to stretching. Do not worry. If after marriage there is any issue, you can consult again at that time. For more information consult a urologist online

Hi doctor,About four years ago, when I was self-conscious about the size of my penis, I started looking into ways to increase the size of my penis. Never long-term, but I tried penis water pump and penis extenders. A few times that I used the penis extenders, the ring may have been very tightly packed around my penis while I was using it and due to the stretch it caused, and tightness, I lost circulation to my penis tip to a point the tip went numb and cold. After that, I started noticing my erections are much weaker and sensitivity has gone down significantly. Besides that, I also became very self-conscious and psychologically worried that I may have made my ED worse.I did not have problems getting an erection, but maintaining one was more difficult and my erections were softer. I stopped having sex. After three to four years, when I masturbate, the quality of the erection is much better and I am able to keep the erection but the sensitivity is not quite back. Also, my climaxes are much weaker and they do not feel as good. In the last year that I have masturbated, I have not had issues maintaining an erection when I am masturbating but I believe the sensitivity is not back. I am worried having sex, I will begin to lose the erection fast. I have red skin marks under the skin at my penis tip that is not going away. Is this due to dead cells? Have I done irreversible damage? Is there any treatment as I now am hoping to become sexually active? Many of my problems are from using the extenders and penis pump aggressively even though it was short usage and regretful decisions.

Hello, Welcome to Chat Doctor forum. I saw the pictures (attachment removed to protect patient identity). The penis looks almost normal. As you are able to masturbate, post-marriage, sexual activity will not be an issue (rather it is better). Aggressive stretching may have caused some damage but from your description, it appears it will not affect your married life. Feeling an orgasm is also dynamic. It may become better after marriage and is unrelated to stretching. Do not worry. If after marriage there is any issue, you can consult again at that time. For more information consult a urologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 26 year old male. My height is 190 cm and weight is 85 kg. I do exercise with weights regularly. I have noticed that I have reduced feeling in the skin on my shaft. I cannot feel normal touch, but I can feel the pain if I pinch it with my nails. To best describe it; it feels like my penis is not there when the head was covered by foreskin. I just noticed it two weeks ago. Is this due to nerve impingement? I do not have any back pain or radiating pain down the legs. There is no trouble or pain with defecation or urinating. There is no tingling or pins and needles on the shaft. Rarely, I feel some burning or numbness feeling. I do not notice any discoloration or anatomical abnormalities. Is this a sign of diabetes? But, there are no symptoms such as polydipsia, polyuria, etc. I do not remember any trauma to the penis. I do not ride bicycles at all. I have been to a urologist and done an ultrasound of the penis and testicles along with a Doppler. But, there is no finding to be worried.My libido is very low. I get erections during the night or if I really concentrate on erotic thoughts. I have not tested testosterone levels, but I suspect them to be normal. I do not really mind the reduced feeling in the shaft. But, it would be nice to get it back. I am worried by thinking that it may spread or this is a start of a more serious disease. What is your opinion? Thanks in advance. ### Response: Hi, Welcome to Chat Doctor forum. This is a localized numbness that we are bothered with. Disease starting from this region without any other associated symptoms is quite rare and without them we may not think of a systemic pathology right away. Have you tried nerve tonics? I suggest back strengthening exercises and Pregabalin 75 mg once a day for two weeks. Vitamin B12 levels and HbA1c should be helpful. Consult a specialist doctor, discuss with him or her and take the medicine with consent. Lack of erections may suggest a more systemic disease, but we need to have more a detailed talk before we can attribute symptoms.

Hello doctor,I am a 26 year old male. My height is 190 cm and weight is 85 kg. I do exercise with weights regularly. I have noticed that I have reduced feeling in the skin on my shaft. I cannot feel normal touch, but I can feel the pain if I pinch it with my nails. To best describe it; it feels like my penis is not there when the head was covered by foreskin. I just noticed it two weeks ago. Is this due to nerve impingement? I do not have any back pain or radiating pain down the legs. There is no trouble or pain with defecation or urinating. There is no tingling or pins and needles on the shaft. Rarely, I feel some burning or numbness feeling. I do not notice any discoloration or anatomical abnormalities. Is this a sign of diabetes? But, there are no symptoms such as polydipsia, polyuria, etc. I do not remember any trauma to the penis. I do not ride bicycles at all. I have been to a urologist and done an ultrasound of the penis and testicles along with a Doppler. But, there is no finding to be worried.My libido is very low. I get erections during the night or if I really concentrate on erotic thoughts. I have not tested testosterone levels, but I suspect them to be normal. I do not really mind the reduced feeling in the shaft. But, it would be nice to get it back. I am worried by thinking that it may spread or this is a start of a more serious disease. What is your opinion? Thanks in advance.

Hi, Welcome to Chat Doctor forum. This is a localized numbness that we are bothered with. Disease starting from this region without any other associated symptoms is quite rare and without them we may not think of a systemic pathology right away. Have you tried nerve tonics? I suggest back strengthening exercises and Pregabalin 75 mg once a day for two weeks. Vitamin B12 levels and HbA1c should be helpful. Consult a specialist doctor, discuss with him or her and take the medicine with consent. Lack of erections may suggest a more systemic disease, but we need to have more a detailed talk before we can attribute symptoms.

### Instruction: Answer this question truthfully ###Input: Hello doctor,One week ago, my mother had a CBC done, and the results were all perfectly normal. However, the lab forgot to order a peripheral smear review (which her doctor requested). So a week later, the CBC was repeated with a smear.Oddly, the results of this new CBC were,Low WBC.Low RBC.Low neutrophils.(The smear was normal).At the time of this second lab draw, the lab tech commented this is going to bruise, and it did. A huge dark bruise and bump formed on my mother\\s arm very soon after the blood was drawn. I assume this is a hematoma. My question is, can a lab draw technique error (as evidenced by the large bruise and hematoma painful) be the cause or reason for the low WBC, low RBC, and low neutrophils? Please keep in mind the Smear result was normal (unremarkable). I should also point out that this CBC was manual (versus automated).I know it is essential to repeat the CBC with smear again to verify, but I like to know if improper drawing or lab techniques could cause the odd results and if so, what the mechanism of action would be. I can show you her actual results, plus a photo of the bruise or hematoma. ### Response: Hello, Welcome to the ChatDoctor. I have reviewed your query and attached images as well. You are having superficial thrombophlebitis most likely as per given history and attached image. It can be most likely due to a technical error during collection. However, your low red blood cell count, low ANC, and the low total count could not be due to a technical fault. It can be temporary finding due to some unnoticed infection. I suggest you repeat CBC (complete blood count) after few days approximately after 7 to 10 days and it will come standard mostly. Your peripheral smear examination report is normal, so no need to worry. You can revert with reports once done after a few days. For thrombophlebitis or bruise, I suggest you apply ice wrapped in thin cloth frequently like five to six times a day. Thrombophleb gel also can be beneficial. I hope I have answered your question. Let me know if you have another problem in mind. Take care.

Hello doctor,One week ago, my mother had a CBC done, and the results were all perfectly normal. However, the lab forgot to order a peripheral smear review (which her doctor requested). So a week later, the CBC was repeated with a smear.Oddly, the results of this new CBC were,Low WBC.Low RBC.Low neutrophils.(The smear was normal).At the time of this second lab draw, the lab tech commented this is going to bruise, and it did. A huge dark bruise and bump formed on my mother\\s arm very soon after the blood was drawn. I assume this is a hematoma. My question is, can a lab draw technique error (as evidenced by the large bruise and hematoma painful) be the cause or reason for the low WBC, low RBC, and low neutrophils? Please keep in mind the Smear result was normal (unremarkable). I should also point out that this CBC was manual (versus automated).I know it is essential to repeat the CBC with smear again to verify, but I like to know if improper drawing or lab techniques could cause the odd results and if so, what the mechanism of action would be. I can show you her actual results, plus a photo of the bruise or hematoma.

Hello, Welcome to the ChatDoctor. I have reviewed your query and attached images as well. You are having superficial thrombophlebitis most likely as per given history and attached image. It can be most likely due to a technical error during collection. However, your low red blood cell count, low ANC, and the low total count could not be due to a technical fault. It can be temporary finding due to some unnoticed infection. I suggest you repeat CBC (complete blood count) after few days approximately after 7 to 10 days and it will come standard mostly. Your peripheral smear examination report is normal, so no need to worry. You can revert with reports once done after a few days. For thrombophlebitis or bruise, I suggest you apply ice wrapped in thin cloth frequently like five to six times a day. Thrombophleb gel also can be beneficial. I hope I have answered your question. Let me know if you have another problem in mind. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Last night and today I have been experiencing a sharp pain just left of the sternum which is not deep, seemingly on top of the rib where it joins the sternum. It lasts a second or two but may repeat several times before stopping in five minutes or so. I went out in the garden today to dig a bit and wearing my HR monitor (I have got health anxiety, anxiety disorder as well as depression). As I was digging, the pain started hurting with each heartbeat. I looked at my monitor and it read 138 bpm. I am 70 years old and have been on medication (Benzodiazepines) for over 50 years for panic attacks and general anxiety. Two years ago I felt similar pain but not to this extent. I went to ER but nothing was found (the doctor said it could be costochondritis but definitely not my heart). I get bloodwork quarterly and everything was fine except cholesterol which was 235. I tried a statin but the muscle pain was too great. In my EKG I have RBBB or LAFB which 14 years back after a stress test I was told that I was probably born with it. I had gone to see the cardiologist then because of getting skipped beats and GERD he told me to ignore them. Last time I had an EKG was in the ER for six months when I had a weird pain in back and side. They checked out heart anyway and said it was fine. Probably just a colicky gallbladder. I have had stones for more than 20 years and had no surgery. So I hesitate to go to the ER again. My local doctor just closed. HR is still 88 while lying down right now. Usually, my resting heart rate is under 67. Currently, I am on Lorazepam 2 mg, Prevacid 15 mg and baby Aspirin. ### Response: Hello. I have gone through your history and it does not appear to be an ischemic pain. Ischemic pain will not be sharp and so short lasting. So the possibilities are costochon ChatDoctor. Do you get an increase in pain on application of pressure at the same site, if yes it supports the diagnosis of costochon Take care.

Hello doctor,Last night and today I have been experiencing a sharp pain just left of the sternum which is not deep, seemingly on top of the rib where it joins the sternum. It lasts a second or two but may repeat several times before stopping in five minutes or so. I went out in the garden today to dig a bit and wearing my HR monitor (I have got health anxiety, anxiety disorder as well as depression). As I was digging, the pain started hurting with each heartbeat. I looked at my monitor and it read 138 bpm. I am 70 years old and have been on medication (Benzodiazepines) for over 50 years for panic attacks and general anxiety. Two years ago I felt similar pain but not to this extent. I went to ER but nothing was found (the doctor said it could be costochondritis but definitely not my heart). I get bloodwork quarterly and everything was fine except cholesterol which was 235. I tried a statin but the muscle pain was too great. In my EKG I have RBBB or LAFB which 14 years back after a stress test I was told that I was probably born with it. I had gone to see the cardiologist then because of getting skipped beats and GERD he told me to ignore them. Last time I had an EKG was in the ER for six months when I had a weird pain in back and side. They checked out heart anyway and said it was fine. Probably just a colicky gallbladder. I have had stones for more than 20 years and had no surgery. So I hesitate to go to the ER again. My local doctor just closed. HR is still 88 while lying down right now. Usually, my resting heart rate is under 67. Currently, I am on Lorazepam 2 mg, Prevacid 15 mg and baby Aspirin.

Hello. I have gone through your history and it does not appear to be an ischemic pain. Ischemic pain will not be sharp and so short lasting. So the possibilities are costochon ChatDoctor. Do you get an increase in pain on application of pressure at the same site, if yes it supports the diagnosis of costochon Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My 59 year old father has hypertension from the past nine years and acidity problem. He got an acute MI last month. Prior to this, from past 10 days, he was suffering from a low blood pressure and our family doctor asked him to stop the BP tablet for a few days. At morning 5 AM, he got high acidity and chest pain, but we thought it was acidity and gave him Rantac and other home remedies. But, he started sweating and got severe pain in the chest. We took him to a nearby hospital and the doctor immediately did the angiography and found the main coronary artery was 100 % blocked which had to be stented immediately. But, he said it is very risky as you have reached late. The damage has already happened. He processed with the angioplasty. There were a total of three blockages on the left side. Two were done via balloon and the 100 % blockage one was stented. Post the surgery, on the next day, my dad started feeling high acidity, big burps, and heaviness in the chest and his heart rate was very high. From then, we were in the hospital for ten days until his heart rate and BP and other things got normal. He had little breathlessness also.Post returning home, he felt very weak and again a week later, he got readmitted for low blood pressure as my dad fainted at home and we checked the BP was very low and hence we got him to the hospital. The doctors admitted him to the ICCU and started giving fluids to bring up his BP. The doctors said low BP was due to dehydration as my father had gone for motions thrice that particular morning and since the intake of fluids is restricted to 1.5 liters max.Previous medication when we got discharged ### Response: Hello, Welcome to Chat Doctor forum. Your father presented to the hospital late after the episode of acute MI (myocardial infarction) with a total occlusion of LAD. So, before intervention itself, a major part of his anterior heart muscle was damaged. Even after angioplasty, his LVEF deteriorated and your father is now suffering from heart failure with reduced ejection fraction. Ideally, according to the recent ESC guidelines, the medicines should be

Hello doctor,My 59 year old father has hypertension from the past nine years and acidity problem. He got an acute MI last month. Prior to this, from past 10 days, he was suffering from a low blood pressure and our family doctor asked him to stop the BP tablet for a few days. At morning 5 AM, he got high acidity and chest pain, but we thought it was acidity and gave him Rantac and other home remedies. But, he started sweating and got severe pain in the chest. We took him to a nearby hospital and the doctor immediately did the angiography and found the main coronary artery was 100 % blocked which had to be stented immediately. But, he said it is very risky as you have reached late. The damage has already happened. He processed with the angioplasty. There were a total of three blockages on the left side. Two were done via balloon and the 100 % blockage one was stented. Post the surgery, on the next day, my dad started feeling high acidity, big burps, and heaviness in the chest and his heart rate was very high. From then, we were in the hospital for ten days until his heart rate and BP and other things got normal. He had little breathlessness also.Post returning home, he felt very weak and again a week later, he got readmitted for low blood pressure as my dad fainted at home and we checked the BP was very low and hence we got him to the hospital. The doctors admitted him to the ICCU and started giving fluids to bring up his BP. The doctors said low BP was due to dehydration as my father had gone for motions thrice that particular morning and since the intake of fluids is restricted to 1.5 liters max.Previous medication when we got discharged

Hello, Welcome to Chat Doctor forum. Your father presented to the hospital late after the episode of acute MI (myocardial infarction) with a total occlusion of LAD. So, before intervention itself, a major part of his anterior heart muscle was damaged. Even after angioplasty, his LVEF deteriorated and your father is now suffering from heart failure with reduced ejection fraction. Ideally, according to the recent ESC guidelines, the medicines should be

### Instruction: Answer this question truthfully ###Input: I am suffering from severe skin red rash problem in both inner thighs. The rash is so itchy and it has completely destroyed my life. It looks like fugal like ringworm or jock itch. at past also, i was suffering from same thing but that time it was scaly like liquid was coming out with foul smell. And i visited a doctor and the medicine i used had cured me. i forgot the medicine tablet taken but had use itraconazole dusting powder and fluconazole lotion. At that time my mother and i have visited the doctor at same time coz she also ha d fungal infection but completely different then mine. Now the current situation is very bad. it is so irritating and itches a lot. but no scaly liquid is coming out now. The same thing now can be seen in my neck and face. Please i need a good dermatologist attention. I am in great suffer in this pandemic and lockdown so i am searching online for medication. I have recently taken arzole capsule once weekly for 3 weeks. And used dipsalic ointment and also clotrimazole cream which shows no better treatment. I was so depressed and used steroid cream called dermicom oc plus only two times as it shows some severe bad red rash so i discontnued it. I live in hot and humid climate and had wore tight clothes in past. The area of rash is always at little more tempreature. ### Response: Hi, Welcome to Chat Doctor forum. Thanks for sharing your query. You seem to be very distressed by the problem. As I can see in the picture it is Tinea. Since it is extensive it is important to start proper treatment with oral antifungals for a good length of time to clear the infection. You have been using steroid creams which is going to worsen the infection and make it spread further. So you should stop using dipsalic and other steroid applications and start proper treatment. You should get your LFT and KFT done and you can follow up with dermatologist. Usually itraconazole or terbinafine are given orally along with some creams like luliconazole or sertaconazole, etc. Itching can be controlled with antiallergics. Treatment of family members with infection is equally important. Let me know if you have more queries Hope this helps.

I am suffering from severe skin red rash problem in both inner thighs. The rash is so itchy and it has completely destroyed my life. It looks like fugal like ringworm or jock itch. at past also, i was suffering from same thing but that time it was scaly like liquid was coming out with foul smell. And i visited a doctor and the medicine i used had cured me. i forgot the medicine tablet taken but had use itraconazole dusting powder and fluconazole lotion. At that time my mother and i have visited the doctor at same time coz she also ha d fungal infection but completely different then mine. Now the current situation is very bad. it is so irritating and itches a lot. but no scaly liquid is coming out now. The same thing now can be seen in my neck and face. Please i need a good dermatologist attention. I am in great suffer in this pandemic and lockdown so i am searching online for medication. I have recently taken arzole capsule once weekly for 3 weeks. And used dipsalic ointment and also clotrimazole cream which shows no better treatment. I was so depressed and used steroid cream called dermicom oc plus only two times as it shows some severe bad red rash so i discontnued it. I live in hot and humid climate and had wore tight clothes in past. The area of rash is always at little more tempreature.

Hi, Welcome to Chat Doctor forum. Thanks for sharing your query. You seem to be very distressed by the problem. As I can see in the picture it is Tinea. Since it is extensive it is important to start proper treatment with oral antifungals for a good length of time to clear the infection. You have been using steroid creams which is going to worsen the infection and make it spread further. So you should stop using dipsalic and other steroid applications and start proper treatment. You should get your LFT and KFT done and you can follow up with dermatologist. Usually itraconazole or terbinafine are given orally along with some creams like luliconazole or sertaconazole, etc. Itching can be controlled with antiallergics. Treatment of family members with infection is equally important. Let me know if you have more queries Hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 44 year old female, mother of 2, 165 cm tall and 75 kg weight. Two months ago, I fell ill with a bad flu (may have been also an acute viral infection) with high temp (39 degrees), probable inflammation in the sinuses, nose, and throat and sinuses pain. The first antibiotic (Klacid) did not help much and low temp of 37.3 to 37.5 persisted for weeks. Then a throat swab analysis showed the presence of streptococcal pneumonia. However, X-rays of sinuses and lungs did not show any problems.In the meantime, a month ago, the nose cleared, and the pain in sinuses subsided. However, the right ear got clogged for a week, and as it unclogged, the left one got clogged. In the meantime, local doctors gave the diagnosis of post-viral infection-caused inflammation of the eustachian tubes. A second antibiotic was prescribed and taken two weeks ago - Augmentin. After the second antibiotic, temperature normalized. However, the left ear clogging persisted.Additionally, three weeks ago, shortly after the clogging of the left ear, a high-pitched noise in the left ear appeared (tinnitus ?), which is particularly audible at night and has caused me sleeplessness, stress, and depression. Audio tests performed by local doctors have proved that the hearing and hearing nerves are intact for both ears.I have taken for two weeks now Flixonase spray (corticosteroid like Nasonex), spraying once per nostril every morning. However, as a result, I developed an extreme dryness in my mouth and throat, and after three days, I stopped that. Now, my left ear feels better but is still clogged and ringing. What would you advise us to do? ### Response: Hello. The clogging of ears and ringing sensation (tinnitus) are probably due to accumulation of fluid in your middle ear post eustachian tube blockage, as a result of the upper respiratory tract infection you had had previously, a condition known as serous otitis media. I suggest doing tympanometry (if not already done) to confirm the diagnosis. If tympanometry confirms the diagnosis, then I suggest

Hello doctor,I am a 44 year old female, mother of 2, 165 cm tall and 75 kg weight. Two months ago, I fell ill with a bad flu (may have been also an acute viral infection) with high temp (39 degrees), probable inflammation in the sinuses, nose, and throat and sinuses pain. The first antibiotic (Klacid) did not help much and low temp of 37.3 to 37.5 persisted for weeks. Then a throat swab analysis showed the presence of streptococcal pneumonia. However, X-rays of sinuses and lungs did not show any problems.In the meantime, a month ago, the nose cleared, and the pain in sinuses subsided. However, the right ear got clogged for a week, and as it unclogged, the left one got clogged. In the meantime, local doctors gave the diagnosis of post-viral infection-caused inflammation of the eustachian tubes. A second antibiotic was prescribed and taken two weeks ago - Augmentin. After the second antibiotic, temperature normalized. However, the left ear clogging persisted.Additionally, three weeks ago, shortly after the clogging of the left ear, a high-pitched noise in the left ear appeared (tinnitus ?), which is particularly audible at night and has caused me sleeplessness, stress, and depression. Audio tests performed by local doctors have proved that the hearing and hearing nerves are intact for both ears.I have taken for two weeks now Flixonase spray (corticosteroid like Nasonex), spraying once per nostril every morning. However, as a result, I developed an extreme dryness in my mouth and throat, and after three days, I stopped that. Now, my left ear feels better but is still clogged and ringing. What would you advise us to do?

Hello. The clogging of ears and ringing sensation (tinnitus) are probably due to accumulation of fluid in your middle ear post eustachian tube blockage, as a result of the upper respiratory tract infection you had had previously, a condition known as serous otitis media. I suggest doing tympanometry (if not already done) to confirm the diagnosis. If tympanometry confirms the diagnosis, then I suggest

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 32 year old unmarried man. I recently had sex with a girl whom I met through an online dating site. It happened one week ago. I knew her from the last three months and had very good communication with her. She said to be working in a good company. We went out one day and had sex. I used a condom while doing it. But during that time I had a cut in my hand and I had once put my finger in her vagina and also the used condom. I also happened to put my tongue in her vagina. The girl is in good health and I even asked her twice if she is HIV positive but she told she is not. I had this anxiety in my mind. I searched the online sites for the early signs and found that I a had little back pain and numbness and throat is feeling little strange. I have little dizziness sometimes. When I am trying to sleep I am shaking from the inside and not able to sleep. It is just seven days since I had sex. I am too scared and not sure what to do. Yesterday, I was feeling a little bad today it is little better for me, but my hands shake a little. Do you think it is possible that I have any symptoms of HIV? Should I look for a common symptom? As I said before the girl is just fine, no noticeable health issues. Do you still think it is possible for me to get HIV from her? What step should I take now? ### Response: Hello. I have noted your concern. I would say that you have a very low risk of HIV due to unprotected oral sex. Unprotected oral sex is still less of a risk as compared to unprotected vaginal or anal sex but the risk is not zero with oral sex. Protected vaginal sex is safe and a skin cut on the finger that is not freshly bleeding is not a risk. A cut that is a few hours old is self-sealing. As far as your symptoms are concerned they are non-specific and partly due to anxiety. Anyways you should take an antigen/antibody HIV screening test (P24Ag and anti-HIV antibody test) at four weeks and at six weeks for a conclusive result. Regards. For more information consult a dermatologist online

Hello doctor,I am a 32 year old unmarried man. I recently had sex with a girl whom I met through an online dating site. It happened one week ago. I knew her from the last three months and had very good communication with her. She said to be working in a good company. We went out one day and had sex. I used a condom while doing it. But during that time I had a cut in my hand and I had once put my finger in her vagina and also the used condom. I also happened to put my tongue in her vagina. The girl is in good health and I even asked her twice if she is HIV positive but she told she is not. I had this anxiety in my mind. I searched the online sites for the early signs and found that I a had little back pain and numbness and throat is feeling little strange. I have little dizziness sometimes. When I am trying to sleep I am shaking from the inside and not able to sleep. It is just seven days since I had sex. I am too scared and not sure what to do. Yesterday, I was feeling a little bad today it is little better for me, but my hands shake a little. Do you think it is possible that I have any symptoms of HIV? Should I look for a common symptom? As I said before the girl is just fine, no noticeable health issues. Do you still think it is possible for me to get HIV from her? What step should I take now?

Hello. I have noted your concern. I would say that you have a very low risk of HIV due to unprotected oral sex. Unprotected oral sex is still less of a risk as compared to unprotected vaginal or anal sex but the risk is not zero with oral sex. Protected vaginal sex is safe and a skin cut on the finger that is not freshly bleeding is not a risk. A cut that is a few hours old is self-sealing. As far as your symptoms are concerned they are non-specific and partly due to anxiety. Anyways you should take an antigen/antibody HIV screening test (P24Ag and anti-HIV antibody test) at four weeks and at six weeks for a conclusive result. Regards. For more information consult a dermatologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,From the start of this month, I have been suffering hip pain and some tightness around the lumbar region. I had a steriod injection and thereafter the pain reduced to 80%. I was on Aceclofenac 100 mg two times a day after 15 days. I had an MRI and the report is attached. I have a major complaint of hip pain. There is no thigh or back pain and no tingling, no numbness. I am able to walk after taking painkillers and I am able to do physiotherapy.Kindly guide as I am still with pain and on painkillers. I am attaching MRI images and report. Also, see remarks about L3. Is it serious? What do I need to do? My current medications include a steroid injection 1000 mg Methylprednisolone, Aceclofenac 100 mg twice a day, Pantoprazole twice a day, and Etodolac400 mg twice a day, and Pantoprazole twice a day. ### Response: Hello, Welcome to Chat Doctor forum. I have gone through the attachments (attachment removed to protect patient identity) Your MRI (magnetic resonance imaging) report suggests disc changes at L5-S1 and hemangioma of L3 body. You should understand that MRI is a very sensitive investigation and picks up many features whether they are the cause of a problem or not. Hemangioma is picked up very commonly during the MRI of the spine or abdomen. These are benign lesions from birth and are not operated unless they are the cause of symptoms, which is in very few number of cases. Disc changes too can be seen in a number of individuals as it is a sign of aging. Only those disc lesions which cause a backache or neurological symptoms need to be ad ChatDoctor. In your case, you only have hip pain with no backache or neurological symptoms so you don\\t need to be concerned of any of the findings reported on the MRI. Only when you have neurological symptoms of tingling, numbness, muscle weakness, backache radiating to then legs then repeat clinical examination and MRI might be required. I have a few questions for you. For more information consult an orthopaedician and traumatologist online

Hello doctor,From the start of this month, I have been suffering hip pain and some tightness around the lumbar region. I had a steriod injection and thereafter the pain reduced to 80%. I was on Aceclofenac 100 mg two times a day after 15 days. I had an MRI and the report is attached. I have a major complaint of hip pain. There is no thigh or back pain and no tingling, no numbness. I am able to walk after taking painkillers and I am able to do physiotherapy.Kindly guide as I am still with pain and on painkillers. I am attaching MRI images and report. Also, see remarks about L3. Is it serious? What do I need to do? My current medications include a steroid injection 1000 mg Methylprednisolone, Aceclofenac 100 mg twice a day, Pantoprazole twice a day, and Etodolac400 mg twice a day, and Pantoprazole twice a day.

Hello, Welcome to Chat Doctor forum. I have gone through the attachments (attachment removed to protect patient identity) Your MRI (magnetic resonance imaging) report suggests disc changes at L5-S1 and hemangioma of L3 body. You should understand that MRI is a very sensitive investigation and picks up many features whether they are the cause of a problem or not. Hemangioma is picked up very commonly during the MRI of the spine or abdomen. These are benign lesions from birth and are not operated unless they are the cause of symptoms, which is in very few number of cases. Disc changes too can be seen in a number of individuals as it is a sign of aging. Only those disc lesions which cause a backache or neurological symptoms need to be ad ChatDoctor. In your case, you only have hip pain with no backache or neurological symptoms so you don\\t need to be concerned of any of the findings reported on the MRI. Only when you have neurological symptoms of tingling, numbness, muscle weakness, backache radiating to then legs then repeat clinical examination and MRI might be required. I have a few questions for you. For more information consult an orthopaedician and traumatologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have been having trouble with my weight recently. I am a female with a height of 5\\7\" hoping to be 125 lbs. The lowest I have hit was 126.6 lbs, but that was about a month ago. Now, it ranges from 127-128 lbs. I am eating 1800 calories a day on days I do not workout intentionally (three days a week) and 1900 on days I do. My workout routine is quite different. I do two workouts a day, four days a week. My first workout consists of 70 minutes of brisk walking, and 20 minutes of abdomen exercises afterward. My second workout (which is about six hours later) is 10 minutes of squats, lunges, sit-ups, etc, and 20 minutes of brisk walking. All in all, that is eight hours of exercise a week, not including unintended exercise like skating, shopping, being on my feet all day, etc. I would love to be 125 lbs. My waist ranges from 26 inches to 26.5 inches, but I would love to get it to a steady 26 inches. I have toned my abs, but again, I would love to lose these last few pounds. What do I do? ### Response: Hi, Welcome to ChatDoctor. I have understood your concern about losing weight and you are working hard also for that. Your protocol for doing exercise workout is quite satisfactory but you can add 20 more minutes of aerobic exercise and resistance exercise combined. See weight reduction and gaining both depends upon your metabolism and energy intake and expense. Even though you work out well but not maintaining the diet then, you may not get the results that you need. Proper vegetable diet is compulsory. Avoid non-vegetarian diet, bakery items, and outside junk foods which will reduce unwanted calories. Take homemade food whatever and how much ever you want. Just do daily exercise and add yogasanas for 10 minutes, pranayama practice 10minutes at the end of each exercise sessions. So collectively I prefer you need to do daily exercise and pranayama practice.

Hello doctor,I have been having trouble with my weight recently. I am a female with a height of 5\\7\" hoping to be 125 lbs. The lowest I have hit was 126.6 lbs, but that was about a month ago. Now, it ranges from 127-128 lbs. I am eating 1800 calories a day on days I do not workout intentionally (three days a week) and 1900 on days I do. My workout routine is quite different. I do two workouts a day, four days a week. My first workout consists of 70 minutes of brisk walking, and 20 minutes of abdomen exercises afterward. My second workout (which is about six hours later) is 10 minutes of squats, lunges, sit-ups, etc, and 20 minutes of brisk walking. All in all, that is eight hours of exercise a week, not including unintended exercise like skating, shopping, being on my feet all day, etc. I would love to be 125 lbs. My waist ranges from 26 inches to 26.5 inches, but I would love to get it to a steady 26 inches. I have toned my abs, but again, I would love to lose these last few pounds. What do I do?

Hi, Welcome to ChatDoctor. I have understood your concern about losing weight and you are working hard also for that. Your protocol for doing exercise workout is quite satisfactory but you can add 20 more minutes of aerobic exercise and resistance exercise combined. See weight reduction and gaining both depends upon your metabolism and energy intake and expense. Even though you work out well but not maintaining the diet then, you may not get the results that you need. Proper vegetable diet is compulsory. Avoid non-vegetarian diet, bakery items, and outside junk foods which will reduce unwanted calories. Take homemade food whatever and how much ever you want. Just do daily exercise and add yogasanas for 10 minutes, pranayama practice 10minutes at the end of each exercise sessions. So collectively I prefer you need to do daily exercise and pranayama practice.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 30 years old. For the past few years, I have been suffering with itching on my groin and surrounding areas. I usually use Cloritamazole dusting powder on and off. But, when the itch really increases, I use Quadriderm ointment for 1-2 days. Once the problem reduces, I stop using it. For one year, I have used one tube of the ointment and about 2-3 boxes of the powder. I have never consulted a doctor regarding this. But, now the problem has increased and I am looking for a right treatment. Since, six months, the itching has become severe on the groin, scrotum and penis. I can notice, there is a lot of flaking and chafing of the skin around it. Sometimes, I can find blood spots in that region. I have itching sensation even while sleeping. Generally, I wear loose clothing or no undergarments and spend most of the time at the comfort of AC. I have no other skin problems. Since a month, I am using pears soap and washing the area with lukewarm water twice a day. Occasionally I take tablet Allegra for itching. For last fifteen days, I am using Clocip dusting powder continuously. I am under homeopathic medicine for chronic sinusitis. But, need to take antibiotics once every 3-4 months. Four years back, I was diagnosed with internal hemorrhoids. As of now, I have no problem associated with it. I have attached the recent pictures. Please check and suggest a permanent treatment for the same and also let me know what precautions I need to follow. Thank you in advance. ### Response: Hi. I can very well understand what you are going through. I will give my best shot to treat your problem. I examined the photographs (attachment removed to protect patient identity) and found the original fungal lesions have been converted to the present appearance because of medicine. It is a common tendency for a person to use local steroids like Qua ChatDoctor. This is when the problem gets complicated. My advice would be to never use such products. But if already used no need to worry. Once a physical examination is done we can find a good solution. My suggestions for you to follow are

Hi doctor,I am 30 years old. For the past few years, I have been suffering with itching on my groin and surrounding areas. I usually use Cloritamazole dusting powder on and off. But, when the itch really increases, I use Quadriderm ointment for 1-2 days. Once the problem reduces, I stop using it. For one year, I have used one tube of the ointment and about 2-3 boxes of the powder. I have never consulted a doctor regarding this. But, now the problem has increased and I am looking for a right treatment. Since, six months, the itching has become severe on the groin, scrotum and penis. I can notice, there is a lot of flaking and chafing of the skin around it. Sometimes, I can find blood spots in that region. I have itching sensation even while sleeping. Generally, I wear loose clothing or no undergarments and spend most of the time at the comfort of AC. I have no other skin problems. Since a month, I am using pears soap and washing the area with lukewarm water twice a day. Occasionally I take tablet Allegra for itching. For last fifteen days, I am using Clocip dusting powder continuously. I am under homeopathic medicine for chronic sinusitis. But, need to take antibiotics once every 3-4 months. Four years back, I was diagnosed with internal hemorrhoids. As of now, I have no problem associated with it. I have attached the recent pictures. Please check and suggest a permanent treatment for the same and also let me know what precautions I need to follow. Thank you in advance.

Hi. I can very well understand what you are going through. I will give my best shot to treat your problem. I examined the photographs (attachment removed to protect patient identity) and found the original fungal lesions have been converted to the present appearance because of medicine. It is a common tendency for a person to use local steroids like Qua ChatDoctor. This is when the problem gets complicated. My advice would be to never use such products. But if already used no need to worry. Once a physical examination is done we can find a good solution. My suggestions for you to follow are

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am suffering from a continuous pain, sensation in the whole right half of my body with an epicenter of this chronic pain somewhat near to my last rib, backside, in right side near to corner end of lung or near to liver. This chronic pain started with a fever eight and half years back since then it has been with me. Sometimes it soars for 10-15 days once in six months. Symptoms are chronic pain, cough and sore throat, pain in the jaw, pain in the eye (burning sensation) like some inflammation starts in right half of my body, fever due to this cough, sore throat (not high but 99-100), the repetitive urge of micturition in worse days. The situation worsens when micturition get delayed due to sleep, in travel or class or meeting, etc.I consulted with a urologist three years back, and he suggested me to go for a cystoscopy, in which I got confirmed as having IC (PBS) (please see reports in images attached). I had Elmiron 100 mg for two months after getting diagnosed three years back. The reports and previous consultation I am attaching herewith. Nowadays it gives me the same pain, but my concern is why it is limited to the right side of the body only? Is there anything we have not diagnosed so far? ### Response: Hello. I have seen your reports (attachment removed to protect patient identity) and I have some questions for you. Do you have the urge to pass urine? If you cannot pass for some reason what will happen? Do you get severe pain? Do you leak urine? I feel you may have an overactive bladder or regional pain syn ChatDoctor. Again it is a diagnosis of exclusion. I would suggest you start on tablet Soliten (Solifenacin) 5 mg morning and evening for seven days and see how do you feel. Somewhere in your reports, you have mentioned that you have RBC in urine? If that is there, then it is not normal. So do the urine routine and microscopy test. I think regarding your other symptoms like pain in chest and cough or throat pain; they are all related to regional pain syn Take care.

Hello doctor,I am suffering from a continuous pain, sensation in the whole right half of my body with an epicenter of this chronic pain somewhat near to my last rib, backside, in right side near to corner end of lung or near to liver. This chronic pain started with a fever eight and half years back since then it has been with me. Sometimes it soars for 10-15 days once in six months. Symptoms are chronic pain, cough and sore throat, pain in the jaw, pain in the eye (burning sensation) like some inflammation starts in right half of my body, fever due to this cough, sore throat (not high but 99-100), the repetitive urge of micturition in worse days. The situation worsens when micturition get delayed due to sleep, in travel or class or meeting, etc.I consulted with a urologist three years back, and he suggested me to go for a cystoscopy, in which I got confirmed as having IC (PBS) (please see reports in images attached). I had Elmiron 100 mg for two months after getting diagnosed three years back. The reports and previous consultation I am attaching herewith. Nowadays it gives me the same pain, but my concern is why it is limited to the right side of the body only? Is there anything we have not diagnosed so far?

Hello. I have seen your reports (attachment removed to protect patient identity) and I have some questions for you. Do you have the urge to pass urine? If you cannot pass for some reason what will happen? Do you get severe pain? Do you leak urine? I feel you may have an overactive bladder or regional pain syn ChatDoctor. Again it is a diagnosis of exclusion. I would suggest you start on tablet Soliten (Solifenacin) 5 mg morning and evening for seven days and see how do you feel. Somewhere in your reports, you have mentioned that you have RBC in urine? If that is there, then it is not normal. So do the urine routine and microscopy test. I think regarding your other symptoms like pain in chest and cough or throat pain; they are all related to regional pain syn Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 53-year-old male with no previous medical history. For the past two years, I observed my semen to be slightly pinkish in color (now I realized it was due to traces of blood) but I did not pay much attention. Since the last two to three months, I have been seeing blood in my ejaculate specifically if I have sex or masturbate on consecutive days (the second day the amount of blood and redness is much more). If I give a gap of 15-20 days then on the first day I do not see any blood but on the second day, it is quite distinct.I do not feel any sort of pain during or after sex or while masturbation. I do not pass blood in the urine. I do not feel any burning or itching sensation while ejaculating or urinating. I have had no injury in my pelvic area or to my testicles. I do not suffer from diabetes or hypertension. I have been having sex and masturbation two to three times a month. Recently I took Levofloxin 500 OD for six days thinking if it was due to a urinary infection the antibiotic might help but it has not helped. So far I have not consulted any clinician on the subject. ### Response: Hello. The condition you described is known as hematospermia which means blood in semen. Although, it is considered a benign symptom in men but if for any person above 40 years of age the possibility of carcinoma should be ruled out. In two-third of the cases, no cause is found and treatment is not indicated. In many of the cases there is no intervention required but with increasing age chance of prostate tumor are high. I request you to visit a urologist as soon as possible. The purpose of visiting urologist is to rule out the possibility of prostate malignancy. The other common cause of this condition is a sexually transmitted disease. You did not describe anything else in association with blood in semen, so the possibility is very low. In case, if you have any sexual exposure to some unknown or commercial sex worker in the recent past or you are having other symptoms of sexually transmitted disease it is wise to get physician consultation. I hope this helps.

Hello doctor,I am a 53-year-old male with no previous medical history. For the past two years, I observed my semen to be slightly pinkish in color (now I realized it was due to traces of blood) but I did not pay much attention. Since the last two to three months, I have been seeing blood in my ejaculate specifically if I have sex or masturbate on consecutive days (the second day the amount of blood and redness is much more). If I give a gap of 15-20 days then on the first day I do not see any blood but on the second day, it is quite distinct.I do not feel any sort of pain during or after sex or while masturbation. I do not pass blood in the urine. I do not feel any burning or itching sensation while ejaculating or urinating. I have had no injury in my pelvic area or to my testicles. I do not suffer from diabetes or hypertension. I have been having sex and masturbation two to three times a month. Recently I took Levofloxin 500 OD for six days thinking if it was due to a urinary infection the antibiotic might help but it has not helped. So far I have not consulted any clinician on the subject.

Hello. The condition you described is known as hematospermia which means blood in semen. Although, it is considered a benign symptom in men but if for any person above 40 years of age the possibility of carcinoma should be ruled out. In two-third of the cases, no cause is found and treatment is not indicated. In many of the cases there is no intervention required but with increasing age chance of prostate tumor are high. I request you to visit a urologist as soon as possible. The purpose of visiting urologist is to rule out the possibility of prostate malignancy. The other common cause of this condition is a sexually transmitted disease. You did not describe anything else in association with blood in semen, so the possibility is very low. In case, if you have any sexual exposure to some unknown or commercial sex worker in the recent past or you are having other symptoms of sexually transmitted disease it is wise to get physician consultation. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor, A few days ago I jumped off a gate that was about 10 feet tall. Upon landing, I landed flat on my feet, a surge of excruciating pain took over my feet. Since then, I have trouble walking and the pain has not yet subsided. Though it hurts a lot when I am walking and putting pressure on my feet when I am in a resting position they do not hurt much. I was unable to walk the next day but a day after I was able to start walking.I am having semester and having a lot of work to do. I may have pushed my feet further and both of my feet of purple bruises on them around the arches of my feet as well as the inner heel. I went to see a doctor yesterday and he said that if I had a broken bone that I would be screaming every time I tried to walk or touch my feet. He said that I likely have muscle contusions and the pain is due to the immediate shock in foot muscles while landing. I have been trying to walk on the outer sides of my feet when I need but I am trying to stay grounded as much as possible. Is there any chance the doctor may have missed something? What should I do? My classes are starting shortly and I am worried that getting around is going to be a major challenge for me. ### Response: Hi, Welcome to Chat Doctor forum. Without examining you it is very difficult to be precise but I can say with confidence that you have a significant injury as bruising is a hallmark of either a fracture or a significant soft tissue trauma. Weight-bearing is the second thing we look at and if you cannot bear full weight with your foot flat and walk at least five to seven steps, then again you need to be cautious. Thirdly, if you have pain at a localized area rather than over a large area then again it is an indication for an x-ray. Looks like you need an x-ray. Not only will it rule out a fracture but also if you have no fracture but have the above symptoms then you need to look after yourself as some times the soft tissues take longer to heal than bony injuries. Also, sometimes you may need an MRI (magnetic resonance imaging) to be absolutely sure. I hope this helps.

Hello doctor, A few days ago I jumped off a gate that was about 10 feet tall. Upon landing, I landed flat on my feet, a surge of excruciating pain took over my feet. Since then, I have trouble walking and the pain has not yet subsided. Though it hurts a lot when I am walking and putting pressure on my feet when I am in a resting position they do not hurt much. I was unable to walk the next day but a day after I was able to start walking.I am having semester and having a lot of work to do. I may have pushed my feet further and both of my feet of purple bruises on them around the arches of my feet as well as the inner heel. I went to see a doctor yesterday and he said that if I had a broken bone that I would be screaming every time I tried to walk or touch my feet. He said that I likely have muscle contusions and the pain is due to the immediate shock in foot muscles while landing. I have been trying to walk on the outer sides of my feet when I need but I am trying to stay grounded as much as possible. Is there any chance the doctor may have missed something? What should I do? My classes are starting shortly and I am worried that getting around is going to be a major challenge for me.

Hi, Welcome to Chat Doctor forum. Without examining you it is very difficult to be precise but I can say with confidence that you have a significant injury as bruising is a hallmark of either a fracture or a significant soft tissue trauma. Weight-bearing is the second thing we look at and if you cannot bear full weight with your foot flat and walk at least five to seven steps, then again you need to be cautious. Thirdly, if you have pain at a localized area rather than over a large area then again it is an indication for an x-ray. Looks like you need an x-ray. Not only will it rule out a fracture but also if you have no fracture but have the above symptoms then you need to look after yourself as some times the soft tissues take longer to heal than bony injuries. Also, sometimes you may need an MRI (magnetic resonance imaging) to be absolutely sure. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 24 year old female. I am in a relationship since three years. I am not treated with the same love and dignity by the person. In this duration of our relationship, he left me twice for two months without communication, and he used to text when he needed anything. It is always me, who has to give and make efforts. Whereas on the other end, he seems happy, and he does not bother nor miss me till he wants to have fun or money. He often treats me as an option. If I call, he gets irritated, and if I message, he just ignores them. I think it is time to put a stop to this. He does not give any commitment. He often says that some day our paths will be different. He wants materialistic things from me, rather than wanting me.Whenever I talk about marriage, he says that his family will not support us. Still, he wants to keep a relationship with me. I have left my close ones, and I have changed my personality for him. He was good before, but now I do not recognize him. I feel like a beggar, who begs for his time. I know that I am holding on to someone whose does not even care about me, but I am unable to get over it. I tried to divert myself with my hobbies and interests. I left my job, and now I do not have money. And he is earning well now. All this frustration is ruining me. I have insomnia, and I cannot sleep at nights. I have got hypothyroidism. This lonely feeling is eating me. I have many things to do, but I am not able to work on anything. Though I train myself to be strong, ultimately I land up getting fooled by his messages or the thought of seeing him with somebody else. But, I cannot take this kind of behavior from him. Please help. ### Response: Hi. I read your query and understand your concerns. I hope this answers you. If you have more questions or need to discuss in details about anything related to it, feel free to write back to me. I will be glad to assist you. Thanks and regards. For more information consult a psychologist counsellor online Take care.

Hi doctor,I am a 24 year old female. I am in a relationship since three years. I am not treated with the same love and dignity by the person. In this duration of our relationship, he left me twice for two months without communication, and he used to text when he needed anything. It is always me, who has to give and make efforts. Whereas on the other end, he seems happy, and he does not bother nor miss me till he wants to have fun or money. He often treats me as an option. If I call, he gets irritated, and if I message, he just ignores them. I think it is time to put a stop to this. He does not give any commitment. He often says that some day our paths will be different. He wants materialistic things from me, rather than wanting me.Whenever I talk about marriage, he says that his family will not support us. Still, he wants to keep a relationship with me. I have left my close ones, and I have changed my personality for him. He was good before, but now I do not recognize him. I feel like a beggar, who begs for his time. I know that I am holding on to someone whose does not even care about me, but I am unable to get over it. I tried to divert myself with my hobbies and interests. I left my job, and now I do not have money. And he is earning well now. All this frustration is ruining me. I have insomnia, and I cannot sleep at nights. I have got hypothyroidism. This lonely feeling is eating me. I have many things to do, but I am not able to work on anything. Though I train myself to be strong, ultimately I land up getting fooled by his messages or the thought of seeing him with somebody else. But, I cannot take this kind of behavior from him. Please help.

Hi. I read your query and understand your concerns. I hope this answers you. If you have more questions or need to discuss in details about anything related to it, feel free to write back to me. I will be glad to assist you. Thanks and regards. For more information consult a psychologist counsellor online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My 8-year-old daughter continues to have strong abdominal pains. Couple of months before, it was really bad and was also coupled with mono and fifths disease. At that time her levels were crazy high. AST = 1312, ALT = 1692. These levels freaked out the doctors so we went back the next week, still high but much lower AST = 394, ALT = 807, GGT = 84. We also did a sonogram at that point which was inconclusive. We went back two weeks later and not better AST = 532, ALT = 682, GGT = 71. Doctors have no answers and no idea about what was going on. The doctors seem to phone it in at that point.My daughter started feeling better so we did not push it for a couple of months and went back in and the levels seem close to normal AST = 57, ALT = 42, GGT = 12. We were given no comfort as to what caused it. My daughter does complain a couple of times a week about her stomach hurting, but she is not in the extreme pain she was in until this week. She is back to waking up in pain, spending most of the school day in the nurse\\s office. So now we are heading back to the hospital for more blood as we did not get any answers from the first 37 vials of blood they have taken. Any clues what might be causing this? ### Response: Hi, Welcome to Chat Doctor forum. I can understand your concerns. This appears to be a case of obstructive jaundice. The main cause of obstructive jaundice is gallstones. Since GGT (gamma-glutamyl transferase) levels are raised more than 70 in the first report it suggests an obstructive cause. AST (aspartate aminotransferase) and ALT (alanine aminotransferase) can increase in both hepatic and obstructive causes. In obstructive jaundice, the level of direct bilirubin increases more as compared to indirect bilirubin levels. Gallstones are easily visible on the ultrasound abdomen. It also causes severe acute abdominal pain. There are some syn ChatDoctor.

Hello doctor,My 8-year-old daughter continues to have strong abdominal pains. Couple of months before, it was really bad and was also coupled with mono and fifths disease. At that time her levels were crazy high. AST = 1312, ALT = 1692. These levels freaked out the doctors so we went back the next week, still high but much lower AST = 394, ALT = 807, GGT = 84. We also did a sonogram at that point which was inconclusive. We went back two weeks later and not better AST = 532, ALT = 682, GGT = 71. Doctors have no answers and no idea about what was going on. The doctors seem to phone it in at that point.My daughter started feeling better so we did not push it for a couple of months and went back in and the levels seem close to normal AST = 57, ALT = 42, GGT = 12. We were given no comfort as to what caused it. My daughter does complain a couple of times a week about her stomach hurting, but she is not in the extreme pain she was in until this week. She is back to waking up in pain, spending most of the school day in the nurse\\s office. So now we are heading back to the hospital for more blood as we did not get any answers from the first 37 vials of blood they have taken. Any clues what might be causing this?

Hi, Welcome to Chat Doctor forum. I can understand your concerns. This appears to be a case of obstructive jaundice. The main cause of obstructive jaundice is gallstones. Since GGT (gamma-glutamyl transferase) levels are raised more than 70 in the first report it suggests an obstructive cause. AST (aspartate aminotransferase) and ALT (alanine aminotransferase) can increase in both hepatic and obstructive causes. In obstructive jaundice, the level of direct bilirubin increases more as compared to indirect bilirubin levels. Gallstones are easily visible on the ultrasound abdomen. It also causes severe acute abdominal pain. There are some syn ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My husband has a heart condition that means his arteries build up a plaque at a much higher rate than normal. He had to have a stent put in his heart and will be medicated for the rest of his life. He has been told that it is vital he eats low fat and low cholesterol diet. I cook for him and I am worried whether I feed him the wrong things. I know that meat is not good for the heart, so we limit it and always go for lean cuts, but I am confused about the difference between animal-based saturated fats and plant-based saturated fats.For example, everyone raves about the health benefits of coconut oil and coconut milk, but both are extremely high in saturated fat. I googled this and find reports stating that it is a different kind of saturated fat and does not affect the heart badly, but I do not know if this is true. For someone like my husband, is all saturated fat bad? Also, is chicken really healthier meat than beef? It seems to have a high cholesterol content so I do not know if he should be eating it. Any advice would be much appreciated.He is currently Rosuvastatin, Bystolic, and Aspirin. ### Response: Hi. I understand your concern on the high-fat diet and follow the mentioned points below. Just to make it easy, we need some fat which is good and HDL (high-density lipoprotein) like almonds and walnuts are good as these are rich in omega 3 and 6 fatty acids. Similarly, the fat we have in coconut oil is different. The fat in the chicken can be removed by removing the skin, where as beef has inbuilt fat which cannot be removed easily hence we suggest to include fish and chicken avoiding beef. Considering fat, we miss out on other nutrients too, so it is advised to reduce the oil intake like healthy individuals can take half a liter of oil per month if you are two your cooking should be within 1 liter of oil only. Coconut oil is having saturated fat but it burns easily in high humidity areas. If we live in high humidity area it is better to include coconut oil to protect our joints and skin. If we leave apart from high humidity area it is better to use refined oil.

Hello doctor,My husband has a heart condition that means his arteries build up a plaque at a much higher rate than normal. He had to have a stent put in his heart and will be medicated for the rest of his life. He has been told that it is vital he eats low fat and low cholesterol diet. I cook for him and I am worried whether I feed him the wrong things. I know that meat is not good for the heart, so we limit it and always go for lean cuts, but I am confused about the difference between animal-based saturated fats and plant-based saturated fats.For example, everyone raves about the health benefits of coconut oil and coconut milk, but both are extremely high in saturated fat. I googled this and find reports stating that it is a different kind of saturated fat and does not affect the heart badly, but I do not know if this is true. For someone like my husband, is all saturated fat bad? Also, is chicken really healthier meat than beef? It seems to have a high cholesterol content so I do not know if he should be eating it. Any advice would be much appreciated.He is currently Rosuvastatin, Bystolic, and Aspirin.

Hi. I understand your concern on the high-fat diet and follow the mentioned points below. Just to make it easy, we need some fat which is good and HDL (high-density lipoprotein) like almonds and walnuts are good as these are rich in omega 3 and 6 fatty acids. Similarly, the fat we have in coconut oil is different. The fat in the chicken can be removed by removing the skin, where as beef has inbuilt fat which cannot be removed easily hence we suggest to include fish and chicken avoiding beef. Considering fat, we miss out on other nutrients too, so it is advised to reduce the oil intake like healthy individuals can take half a liter of oil per month if you are two your cooking should be within 1 liter of oil only. Coconut oil is having saturated fat but it burns easily in high humidity areas. If we live in high humidity area it is better to include coconut oil to protect our joints and skin. If we leave apart from high humidity area it is better to use refined oil.

### Instruction: Answer this question truthfully ###Input: Hello doctor,When I was 11 years old, I was knocked off my bike and cracked my front tooth in half horizontally, shortly after the dentist fixed it. Since then I have had no problems with it and had multiple x-rays to check on it. When it happened, the color of the tooth changed very slightly, to a very slightly more yellow shade than the rest of my teeth. I am curious to know what happened when the trauma occurred. Did my tooth die? What are they checking for when they x-ray the tooth? ### Response: Hello. I have been through your query and can understand your concern. Any trauma to the tooth generally has long-term consequences like tooth discoloration, etc. As you said that your tooth was fractured, it might have led to a slight injury to the pulp or even if not so, the fracture line would have been close to the pulp. In both cases, the pulp over time starts to become non-vital sometimes due to injury and sometimes due to the restorative material lying in close proximity to the pulp. This over time results in the discoloration of the tooth. The characteristic feature of this discoloration will be that only the involved tooth will be discolored and other teeth will be normal or not discolored. If that is the case, it generally means that the tooth is in the process of becoming non-vital till the tooth becomes slight brownish black which means the tooth is entirely non-vital. It is generally not associated with any kind of pain as the process is chronic and takes time to set in. I would advise you to have a visit to your nearest dentist. He would prescribe a vitality test of the tooth and also would get an x-ray for the tooth. By that way, he would come to know if the tooth is dead or still vital and accordingly will propose treatment. If the tooth is vital, he will put some medication over the pulp to let it heal and then fill with the pulp friendly restoration. However, if the tooth is dead, I would suggest you to go for the root canal treatment (after evaluating the condition of the tooth and soft tissue). Meanwhile, keep your oral hygiene good, brush twice daily and floss regularly. Use mouth rinses to clean the mouth after meals.

Hello doctor,When I was 11 years old, I was knocked off my bike and cracked my front tooth in half horizontally, shortly after the dentist fixed it. Since then I have had no problems with it and had multiple x-rays to check on it. When it happened, the color of the tooth changed very slightly, to a very slightly more yellow shade than the rest of my teeth. I am curious to know what happened when the trauma occurred. Did my tooth die? What are they checking for when they x-ray the tooth?

Hello. I have been through your query and can understand your concern. Any trauma to the tooth generally has long-term consequences like tooth discoloration, etc. As you said that your tooth was fractured, it might have led to a slight injury to the pulp or even if not so, the fracture line would have been close to the pulp. In both cases, the pulp over time starts to become non-vital sometimes due to injury and sometimes due to the restorative material lying in close proximity to the pulp. This over time results in the discoloration of the tooth. The characteristic feature of this discoloration will be that only the involved tooth will be discolored and other teeth will be normal or not discolored. If that is the case, it generally means that the tooth is in the process of becoming non-vital till the tooth becomes slight brownish black which means the tooth is entirely non-vital. It is generally not associated with any kind of pain as the process is chronic and takes time to set in. I would advise you to have a visit to your nearest dentist. He would prescribe a vitality test of the tooth and also would get an x-ray for the tooth. By that way, he would come to know if the tooth is dead or still vital and accordingly will propose treatment. If the tooth is vital, he will put some medication over the pulp to let it heal and then fill with the pulp friendly restoration. However, if the tooth is dead, I would suggest you to go for the root canal treatment (after evaluating the condition of the tooth and soft tissue). Meanwhile, keep your oral hygiene good, brush twice daily and floss regularly. Use mouth rinses to clean the mouth after meals.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 23 year old male who has just returned home from a year\\s trip to a country known for high rates of pollution. I am currently experiencing shortness of breath (no coughing) and excessive burping. I will try to provide you as much detail as possible. When I went, I did not have any symptoms. Three months had passed with no problem. Then I slowly started to become tired while working out and eventually at the five-month mark I was exhausted. The main symptoms I had were fatigue (unable to exercise at all), shortness of breath, pain/discomfort in the upper back, and excessive burping. Now after returning (been back for two weeks), I only have shortness of breath and burping. I still feel some discomfort in upper back but not as severe. I went to the ER and got a chest X-ray and blood work (I have listed the tests), all came back fine. So as of now I do not know what to think and I am debating whether to return there as it is known for its high pollution rate in most cities, and at times it seemed that my symptoms fluctuated with the pollution level. I do not know what to think about the shortness of breath. It feels as though I need to take deeper breaths. I am able to exercise again though. I am currently using Omeprazole for the burping. I have been using it for almost two weeks and it is not helping at all. I also have antacid and digestive enzymes that I use occasionally. What are your suggestions for tests I should take or in general? I honestly want to know if it would be a good idea to return given the information I have provided. Thanks for your help. ### Response: Hello, Welcome to Chat Doctor forum. In case all your investigations are normal then you probably have acute bronchitis or associated anxiety. In your case scenario, my suggestion would be antiallergic like Levocetirizine and Montelukast once daily. Addition of Etizolam as an antianxiety ChatDoctor. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. I hope it helps you. For more information consult a pulmonologist online

Hello doctor,I am a 23 year old male who has just returned home from a year\\s trip to a country known for high rates of pollution. I am currently experiencing shortness of breath (no coughing) and excessive burping. I will try to provide you as much detail as possible. When I went, I did not have any symptoms. Three months had passed with no problem. Then I slowly started to become tired while working out and eventually at the five-month mark I was exhausted. The main symptoms I had were fatigue (unable to exercise at all), shortness of breath, pain/discomfort in the upper back, and excessive burping. Now after returning (been back for two weeks), I only have shortness of breath and burping. I still feel some discomfort in upper back but not as severe. I went to the ER and got a chest X-ray and blood work (I have listed the tests), all came back fine. So as of now I do not know what to think and I am debating whether to return there as it is known for its high pollution rate in most cities, and at times it seemed that my symptoms fluctuated with the pollution level. I do not know what to think about the shortness of breath. It feels as though I need to take deeper breaths. I am able to exercise again though. I am currently using Omeprazole for the burping. I have been using it for almost two weeks and it is not helping at all. I also have antacid and digestive enzymes that I use occasionally. What are your suggestions for tests I should take or in general? I honestly want to know if it would be a good idea to return given the information I have provided. Thanks for your help.

Hello, Welcome to Chat Doctor forum. In case all your investigations are normal then you probably have acute bronchitis or associated anxiety. In your case scenario, my suggestion would be antiallergic like Levocetirizine and Montelukast once daily. Addition of Etizolam as an antianxiety ChatDoctor. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. I hope it helps you. For more information consult a pulmonologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 30 year old male. My height is 5 feet and 7 inches, and I weigh about 87 kg. For the past 4 to 5 years, I am suffering from indigestion. This got more serious in the recent years. It used to occur three to four times every week, especially after lunch. I sought medical help and went to see a general physician, who ordered for blood tests. It revealed most of the levels to be normal, except for a mild elevation of ALT and AST levels. Then he ordered an ultrasound which showed I have a fatty liver, though I rarely drink alcohol. Also, H. pyroli came out as negative. He asked me to take a healthy diet and avoid alcohol. For indigestion, he prescribed Rabeprazole 20 mg every day, which seemed to help, since I did not get any indigestion anymore.More recently, I developed frequent loose motions. On some days, I pass stools thrice and have excessive gas. Over this period, I had four to five blood tests, which revealed that my hemoglobin was gradually decreasing. The first blood work done three years ago, showed my Hb to be 152 g/L, then 148, 143 and now in the last month it was 137 g/L. Also, my RBC count dropped from 4.89 to 4.5 million cells. My latest ferritin level was 194 ug/L. I asked my doctor here, and he ordered FOBT test. All three samples showed negative and no blood was found in the stool. Recently, he has ordered for a colonoscopy which I am waiting on, and I am really worried that I might have colon/rectal cancer. My question is, does negative FOBT and normal ferritin rule out any cancerous growth in the bowel and intestine? I have hypothyroidism and sleep apnea. I have no family history of bowel cancer. ### Response: Hello, Welcome to Chat Doctor forum. So, discuss the above mentioned information with your treating physician. Follow up if you need more information regarding any thing else. Hope this helps. For more information consult a surgical gastroenterologist online

Hello doctor,I am a 30 year old male. My height is 5 feet and 7 inches, and I weigh about 87 kg. For the past 4 to 5 years, I am suffering from indigestion. This got more serious in the recent years. It used to occur three to four times every week, especially after lunch. I sought medical help and went to see a general physician, who ordered for blood tests. It revealed most of the levels to be normal, except for a mild elevation of ALT and AST levels. Then he ordered an ultrasound which showed I have a fatty liver, though I rarely drink alcohol. Also, H. pyroli came out as negative. He asked me to take a healthy diet and avoid alcohol. For indigestion, he prescribed Rabeprazole 20 mg every day, which seemed to help, since I did not get any indigestion anymore.More recently, I developed frequent loose motions. On some days, I pass stools thrice and have excessive gas. Over this period, I had four to five blood tests, which revealed that my hemoglobin was gradually decreasing. The first blood work done three years ago, showed my Hb to be 152 g/L, then 148, 143 and now in the last month it was 137 g/L. Also, my RBC count dropped from 4.89 to 4.5 million cells. My latest ferritin level was 194 ug/L. I asked my doctor here, and he ordered FOBT test. All three samples showed negative and no blood was found in the stool. Recently, he has ordered for a colonoscopy which I am waiting on, and I am really worried that I might have colon/rectal cancer. My question is, does negative FOBT and normal ferritin rule out any cancerous growth in the bowel and intestine? I have hypothyroidism and sleep apnea. I have no family history of bowel cancer.

Hello, Welcome to Chat Doctor forum. So, discuss the above mentioned information with your treating physician. Follow up if you need more information regarding any thing else. Hope this helps. For more information consult a surgical gastroenterologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have chronic neck and back pain that can cause either severe neck stiffness or sharp pain. Most of the pain seems to originate in the front of the neck (SCM muscle) or the cervical spine area. Pain radiates to mid-back and causes spasms of my shoulder blades. Lots of popping when turning my head. This also flares up every couple or few months to the point of being unbearable and requiring a visit to urgent care.Lots of other symptoms some of which include, profuse night sweats, sweating during the day for no reason (profuse), weakness in shoulders and arms (very hard to play tennis anymore), occasional stiffness in ribs, tightness in chest, jaw pain and weakness, forehead numbness, random movement of limbs during day but usually at night (kind of like little seizures but has not been diagnosed) and general neck swelling (neck looks big).I know it is a lot of symptoms, but it is so frustrating. I have a copy of a cervical MRI with me. Curious to know if these symptoms stand out as anything in particular. Working with doctor\\s now, but I am mentally and emotionally drained as I have been dealing with this for years with no answer, and it is difficult for the family to understand. Being an athlete could not compete in college anymore due to this. My body could not perform anymore. ### Response: Hello, Welcome to Chat Doctor forum. I have studied your case. Due to compression of this nerve root, there can be a sharp pain in your arm and back with a shoulder. I will advise you to send your MRI cervical spine for better diagnosis. For these symptoms, analgesic and neurotropic medication can be started. Till the time, avoid lifting weights, Sit with support to the back. You can consult a physiotherapist for help. Physiotherapy like ultrasound and interferential therapy will give quick relief. I will advise checking your vitamin B12 and vitamin D3 level. Shoulder symptoms can be due to rotator cuff injury or arthropathy. If required MRI shoulder may help in diagnosis. I 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.

Hello doctor,I have chronic neck and back pain that can cause either severe neck stiffness or sharp pain. Most of the pain seems to originate in the front of the neck (SCM muscle) or the cervical spine area. Pain radiates to mid-back and causes spasms of my shoulder blades. Lots of popping when turning my head. This also flares up every couple or few months to the point of being unbearable and requiring a visit to urgent care.Lots of other symptoms some of which include, profuse night sweats, sweating during the day for no reason (profuse), weakness in shoulders and arms (very hard to play tennis anymore), occasional stiffness in ribs, tightness in chest, jaw pain and weakness, forehead numbness, random movement of limbs during day but usually at night (kind of like little seizures but has not been diagnosed) and general neck swelling (neck looks big).I know it is a lot of symptoms, but it is so frustrating. I have a copy of a cervical MRI with me. Curious to know if these symptoms stand out as anything in particular. Working with doctor\\s now, but I am mentally and emotionally drained as I have been dealing with this for years with no answer, and it is difficult for the family to understand. Being an athlete could not compete in college anymore due to this. My body could not perform anymore.

Hello, Welcome to Chat Doctor forum. I have studied your case. Due to compression of this nerve root, there can be a sharp pain in your arm and back with a shoulder. I will advise you to send your MRI cervical spine for better diagnosis. For these symptoms, analgesic and neurotropic medication can be started. Till the time, avoid lifting weights, Sit with support to the back. You can consult a physiotherapist for help. Physiotherapy like ultrasound and interferential therapy will give quick relief. I will advise checking your vitamin B12 and vitamin D3 level. Shoulder symptoms can be due to rotator cuff injury or arthropathy. If required MRI shoulder may help in diagnosis. I 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.

### Instruction: Answer this question truthfully ###Input: Hi doctor, Before two months, I had one stent put in the complete blocked artery. Scans showed heart muscle damage from an old heart attack this was caused by me not taking my BP drugs. So for the first time in my life I have stuck to taking all my prescribed drugs, these were Aspirin 75 mg, Amlodipine 10 mg, Atorvastatin 80 mg, Bisoprolol 1.25 mg, Ticagrelor 90 mg. It has been eight weeks I felt a great minus few chest niggles presumed this was stent settling and I am still smoking 20 a day. Now for the last one week I have a severe dry mouth all the time despite drinking and my urine output is 5 liters to my input of 1 liter. At night I am going after every two to three minutes. My doctor is thinking I have a UTI despite being negative for it. Now they are testing me for gonorrhea and chlamydia. My suspicions are that the drugs I am taking causing this? I feel like stopping them all together or halving the dosage I cannot see my cardiologist until next year. Is there a link between my drugs and these symptoms? And am I safe to temporarily stop a few of them to rule them out? If so which ones are crucial and which are not? I am eternally grateful for your help. ### Response: Hello, Welcome to Chat Doctor forum. All the medicines you are taking are essential medicines and should not be stopped except in case of severe allergy. None of these medicines cause increased urination. Amlodipine is a blood pressure lowering medicine, it can be changed to some other medicine. This medicine may cause fluid retention and swelling of feet in some patients. Regarding increased urination possibilities include maybe you are taking medicines called water pills or diuretics which are sometimes given in heart patients, these increase urine output. Please review your medicines. UTI (urinary tract infection) may cause increased urination. Raised BP itself may cause increased urination. Keep BP (blood pressure) in control. Please reduce weight. Take Mediterranean diet, do regular exercise, and have a proper sleep. Never stop or switch to any medicine without consulting a cardiologist.

Hi doctor, Before two months, I had one stent put in the complete blocked artery. Scans showed heart muscle damage from an old heart attack this was caused by me not taking my BP drugs. So for the first time in my life I have stuck to taking all my prescribed drugs, these were Aspirin 75 mg, Amlodipine 10 mg, Atorvastatin 80 mg, Bisoprolol 1.25 mg, Ticagrelor 90 mg. It has been eight weeks I felt a great minus few chest niggles presumed this was stent settling and I am still smoking 20 a day. Now for the last one week I have a severe dry mouth all the time despite drinking and my urine output is 5 liters to my input of 1 liter. At night I am going after every two to three minutes. My doctor is thinking I have a UTI despite being negative for it. Now they are testing me for gonorrhea and chlamydia. My suspicions are that the drugs I am taking causing this? I feel like stopping them all together or halving the dosage I cannot see my cardiologist until next year. Is there a link between my drugs and these symptoms? And am I safe to temporarily stop a few of them to rule them out? If so which ones are crucial and which are not? I am eternally grateful for your help.

Hello, Welcome to Chat Doctor forum. All the medicines you are taking are essential medicines and should not be stopped except in case of severe allergy. None of these medicines cause increased urination. Amlodipine is a blood pressure lowering medicine, it can be changed to some other medicine. This medicine may cause fluid retention and swelling of feet in some patients. Regarding increased urination possibilities include maybe you are taking medicines called water pills or diuretics which are sometimes given in heart patients, these increase urine output. Please review your medicines. UTI (urinary tract infection) may cause increased urination. Raised BP itself may cause increased urination. Keep BP (blood pressure) in control. Please reduce weight. Take Mediterranean diet, do regular exercise, and have a proper sleep. Never stop or switch to any medicine without consulting a cardiologist.

### Instruction: Answer this question truthfully ###Input: Hello doctor, I am 26 years old. I am going to get married in another four months. I started masturbating six years back to give it a try. Later, I got addicted to it. So much so that some days I even masturbated for seven to eight times. Along with this, I am not having proper diet like skipping breakfast and dinner, sometimes skipping lunch also. This happens daily. Now I am facing weakness in my body, severe stresses, lack of concentration, dizziness. I tried hard to stop it. From morning till night I kept thinking healthy, but at night I masturbate. I will stop this for sure, but I want to make my mindset more strong. I request you to help me in this regard. I am a vegetarian. Please help me with proper medication and proper diet.Due to stress, I am unable to work at my work place. Else I had worked very efficiently in the past. Now I cannot do small things which are very easy at my work place. Please help me. What all the foods I need to take? I have heard Shilajit, as a medicine for this, but do not know. Also, please help me with early ejaculation and making the private part strong. ### Response: Hi. I understand your symptoms well. The only problem with you is you have been anxious about the whole issue. Believe me, there are no other problems with you. Physiologically or hormonally there are no problems with you. Anxiety is a vicious cycle. You become anxious, you disrupt your normal habits, then it makes even more anxious. Well, you need to start with a schedule. Either in the morning or in the evening you have to workout for at least 45 minutes. You start with this, the rest of it will follow. Because when you workout well, your physiology would be stabilized, you will get more sleep and by default, you would take enough diet. Once you are focused on other things to do definitely you will not feel like masturbating the whole day. For premature ejaculation you can take tablet Tramadol roughly three hours before sex, it delays ejaculation. But beware, this medicine causes nausea in many patients. Take care.

Hello doctor, I am 26 years old. I am going to get married in another four months. I started masturbating six years back to give it a try. Later, I got addicted to it. So much so that some days I even masturbated for seven to eight times. Along with this, I am not having proper diet like skipping breakfast and dinner, sometimes skipping lunch also. This happens daily. Now I am facing weakness in my body, severe stresses, lack of concentration, dizziness. I tried hard to stop it. From morning till night I kept thinking healthy, but at night I masturbate. I will stop this for sure, but I want to make my mindset more strong. I request you to help me in this regard. I am a vegetarian. Please help me with proper medication and proper diet.Due to stress, I am unable to work at my work place. Else I had worked very efficiently in the past. Now I cannot do small things which are very easy at my work place. Please help me. What all the foods I need to take? I have heard Shilajit, as a medicine for this, but do not know. Also, please help me with early ejaculation and making the private part strong.

Hi. I understand your symptoms well. The only problem with you is you have been anxious about the whole issue. Believe me, there are no other problems with you. Physiologically or hormonally there are no problems with you. Anxiety is a vicious cycle. You become anxious, you disrupt your normal habits, then it makes even more anxious. Well, you need to start with a schedule. Either in the morning or in the evening you have to workout for at least 45 minutes. You start with this, the rest of it will follow. Because when you workout well, your physiology would be stabilized, you will get more sleep and by default, you would take enough diet. Once you are focused on other things to do definitely you will not feel like masturbating the whole day. For premature ejaculation you can take tablet Tramadol roughly three hours before sex, it delays ejaculation. But beware, this medicine causes nausea in many patients. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My baby girl is 3 months old and her weight is 4.5 kg. The cesarean was done at 37 weeks. She was 2.5 kg at the time of birth. I am using Lactogen 1, as the breast milk of my wife is very very low. I informed the pediatrician who takes care of my baby that we are giving 3oz but my baby after taking 1.5-2.5oz is refusing to accept as she is sleepy and we are unable to intake her anymore. Sometimes the baby is sleeping for four to five hours without consuming and sometimes she is sucking her fingers after two to three hours and when we are giving the feeding bottle she is taking 1.5-2 oz. The main problem is that we failed to understand whether my baby is hungry or she is sleepy as in both the cases baby sucks her finger. After explaining the same, the pediatrician said that she has not gained much weight and advised to have urine and blood test for CBC and TSH. When I asked him that whether can I change the formula milk he said that all are same and if we wish, we can change but has not given any suggestion. Please help me whether I need to change the formula milk and can use Dexolac 1 by replacing Lactogen 1? I cannot afford costly formula milk. Also, please guide me that how much oz I have to give and how much gaping is needed? Also when the baby is sleeping, shall I awake her and give the feeding? Please suggest. ### Response: Hello. No need to change the formula milk, continue the same formula milk, as the baby grows there is no hard and fast rule that the baby takes milk every two hours. The feeding should be on demand, whenever the baby wants milk she will cry. The best method to see whether milk is enough or not is to see the number of times the baby is passing urine. If it is six times a day that means the milk is enough. Since your baby was preterm the growth might be a little slow, you should be worried only if the baby is not tolerating feeds like if she is vomiting too much or having too much of loose stools.

Hello doctor,My baby girl is 3 months old and her weight is 4.5 kg. The cesarean was done at 37 weeks. She was 2.5 kg at the time of birth. I am using Lactogen 1, as the breast milk of my wife is very very low. I informed the pediatrician who takes care of my baby that we are giving 3oz but my baby after taking 1.5-2.5oz is refusing to accept as she is sleepy and we are unable to intake her anymore. Sometimes the baby is sleeping for four to five hours without consuming and sometimes she is sucking her fingers after two to three hours and when we are giving the feeding bottle she is taking 1.5-2 oz. The main problem is that we failed to understand whether my baby is hungry or she is sleepy as in both the cases baby sucks her finger. After explaining the same, the pediatrician said that she has not gained much weight and advised to have urine and blood test for CBC and TSH. When I asked him that whether can I change the formula milk he said that all are same and if we wish, we can change but has not given any suggestion. Please help me whether I need to change the formula milk and can use Dexolac 1 by replacing Lactogen 1? I cannot afford costly formula milk. Also, please guide me that how much oz I have to give and how much gaping is needed? Also when the baby is sleeping, shall I awake her and give the feeding? Please suggest.

Hello. No need to change the formula milk, continue the same formula milk, as the baby grows there is no hard and fast rule that the baby takes milk every two hours. The feeding should be on demand, whenever the baby wants milk she will cry. The best method to see whether milk is enough or not is to see the number of times the baby is passing urine. If it is six times a day that means the milk is enough. Since your baby was preterm the growth might be a little slow, you should be worried only if the baby is not tolerating feeds like if she is vomiting too much or having too much of loose stools.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I wanted to know if you could answer one question for me. I experienced an episode that lasted roughly about two to three minutes where I felt that I could not seem to catch my breath and it felt as if my heart had stopped beating. I checked my heart rate roughly three minutes after the incident and it was at 60 bpm and my oxygen was at 99 % under two weeks ago. I had a routine 24 tape which was clear (ectopic beats picked up but were benign). I suffer from anxiety and panic attacks. However, they generally come on during stressful situations. Could this be a panic attack symptom? I also wanted to add that this happened during intercourse (I am a 35-year-old male, height is 174 cm and weight is 100 kg). I look forward to your response and suggestions. ### Response: Hello, Welcome to Chat Doctor forum. This can be a cardiac arrhythmia like PSVT (paroxysmal supraventricular tachycardia) or atrial fibrillation, in which heart rate suddenly goes up and also suddenly decreases. And one may get symptoms like shortness of breath, chest pain or heaviness, dizziness, etc. Are you having ventricular or atrial ectopics? Have you undergone echo? Presence of ectopics also suggests the possibility of these arrhythmias. Usually, ECG is normal (attachment removed to protect patient identity) as it is done in between the episodes or may show ectopics. ECG done during episodes will show abnormality. You may request for portable cardiac monitor either Holter or another mobile-based rhythm monitor especially during intercourse to see the rhythm is recurring. Alternatively, you may undergo treadmill test and we can see if it recurs during the running. Also, thyroid test should be done if not had recently. ln order to abort such episodes you should try to cough hard. Next time, you have this, focus on heart rate and measure pulse rate. These arrhythmias are not life-threatening. So overall, that episode may be an episode atrial arrhythmia rather than panic attack and our priority is to confirm it by investigations. Hope this helps you and get back if you have any doubts. For more information consult a cardiologist online

Hello doctor,I wanted to know if you could answer one question for me. I experienced an episode that lasted roughly about two to three minutes where I felt that I could not seem to catch my breath and it felt as if my heart had stopped beating. I checked my heart rate roughly three minutes after the incident and it was at 60 bpm and my oxygen was at 99 % under two weeks ago. I had a routine 24 tape which was clear (ectopic beats picked up but were benign). I suffer from anxiety and panic attacks. However, they generally come on during stressful situations. Could this be a panic attack symptom? I also wanted to add that this happened during intercourse (I am a 35-year-old male, height is 174 cm and weight is 100 kg). I look forward to your response and suggestions.

Hello, Welcome to Chat Doctor forum. This can be a cardiac arrhythmia like PSVT (paroxysmal supraventricular tachycardia) or atrial fibrillation, in which heart rate suddenly goes up and also suddenly decreases. And one may get symptoms like shortness of breath, chest pain or heaviness, dizziness, etc. Are you having ventricular or atrial ectopics? Have you undergone echo? Presence of ectopics also suggests the possibility of these arrhythmias. Usually, ECG is normal (attachment removed to protect patient identity) as it is done in between the episodes or may show ectopics. ECG done during episodes will show abnormality. You may request for portable cardiac monitor either Holter or another mobile-based rhythm monitor especially during intercourse to see the rhythm is recurring. Alternatively, you may undergo treadmill test and we can see if it recurs during the running. Also, thyroid test should be done if not had recently. ln order to abort such episodes you should try to cough hard. Next time, you have this, focus on heart rate and measure pulse rate. These arrhythmias are not life-threatening. So overall, that episode may be an episode atrial arrhythmia rather than panic attack and our priority is to confirm it by investigations. Hope this helps you and get back if you have any doubts. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My fiancee took four Yasmin pills as emergency contraception. But after that, she felt so weak and had heavy breathing. So due to that, we decided not to take another four pills after 12 hours. Will the first four pills stop unplanned pregnancy? That was taken within less than 30 hours after we had sexual intercourse. Looking for your kind advice. She is feeling better now but I am afraid to continue with another four pills. Also, I have read that Yasmin can increase blood clot which can be deadly. Please advise. ### Response: Hello, Welcome to Chat Doctor forum. Using Yasmin pills for emergency contraception follows the Yuzpe regimen where oral contraceptive pills are used as ECP within 72 hours of last intercourse. As the first four pills have been taken by her after 30 hours of intercourse as per the regimen, so the next should be taken after 12 hours and should not be missed. The side effects can vary from mild nausea to vomiting, headache, bloating, belching, breast tenderness or even spotting. These effects are secondary to Progesterone and Estrogen in the pills. These can be countered by taking an anti-emetic pill like Metoclopramide10 mg, an hour before starting the regimen and also before the second dose after 12 hours. This shall prevent nausea and Progesterone side effects can be countered by increasing the water intake which can neutralize the Progesterone side effects. To help prevent you from feeling nauseous, one should take pills with food. It also helps if she would timer second dose such that she takes it just before bed. That way, she will sleep through nausea. The clotting is a known rare side effect of OC pills if OC pills are being used for years together for contraception, then predisposition for clotting increases. But the regimen needs to be completed as per protocol to achieve the desired result. After taking the second dose, with ChatDoctor. The best would have been emergency contraceptive pills like an Ipill or Plan-B, but if it is banned in your country, Regimen is still a reliable means for emergency contraception with OC pills. Emergency contraception through Yuzpe regimen. Yuzpe regimen.

Hello doctor,My fiancee took four Yasmin pills as emergency contraception. But after that, she felt so weak and had heavy breathing. So due to that, we decided not to take another four pills after 12 hours. Will the first four pills stop unplanned pregnancy? That was taken within less than 30 hours after we had sexual intercourse. Looking for your kind advice. She is feeling better now but I am afraid to continue with another four pills. Also, I have read that Yasmin can increase blood clot which can be deadly. Please advise.

Hello, Welcome to Chat Doctor forum. Using Yasmin pills for emergency contraception follows the Yuzpe regimen where oral contraceptive pills are used as ECP within 72 hours of last intercourse. As the first four pills have been taken by her after 30 hours of intercourse as per the regimen, so the next should be taken after 12 hours and should not be missed. The side effects can vary from mild nausea to vomiting, headache, bloating, belching, breast tenderness or even spotting. These effects are secondary to Progesterone and Estrogen in the pills. These can be countered by taking an anti-emetic pill like Metoclopramide10 mg, an hour before starting the regimen and also before the second dose after 12 hours. This shall prevent nausea and Progesterone side effects can be countered by increasing the water intake which can neutralize the Progesterone side effects. To help prevent you from feeling nauseous, one should take pills with food. It also helps if she would timer second dose such that she takes it just before bed. That way, she will sleep through nausea. The clotting is a known rare side effect of OC pills if OC pills are being used for years together for contraception, then predisposition for clotting increases. But the regimen needs to be completed as per protocol to achieve the desired result. After taking the second dose, with ChatDoctor. The best would have been emergency contraceptive pills like an Ipill or Plan-B, but if it is banned in your country, Regimen is still a reliable means for emergency contraception with OC pills. Emergency contraception through Yuzpe regimen. Yuzpe regimen.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 31 years old female, 5\\8\", 175 lbs. Three days ago I started getting a really sharp pain in the lower left abdomen. It came on sudden and was gone within seconds but still bad enough to have me doubled over in pain. Thought it was related to period that was due following day. Happened on and off all day.Next day period did start as expected. Normal flow, normal cramps, etc. Then the sharp stabbing pain came back. It is stabbing in a very precise location, down and to the left from the belly button, kind of in-line with the hip. It was radiating hellfire to my low back, groin, thigh, hip, and left flank. I was on the floor in pain for four hours before it faded away enough for me to even stand.That night it happened again waking me from sleep. Lasted for hours, stabbing in the same spot, burning pain spread to the other areas. Later that day my toddler laid across me and his elbow got that same spot and started the pain up all over again but it only lasted about an hour. The area is very tender. I still get the brief stabbing pain when walking or coughing or bending over. I am thinking it is a ruptured cyst. I have never been diagnosed with one before but I think it fits the bill. But can they rupture multiple times within days? Is it likely to happen again? Could it be something related to period or just coincidence it started at the same time? What can I do at home for it, since I am unable to go in to see a doctor? ### Response: Hi. I went through your complain which I must say you have very nicely written down. As per the location of the pain that you mentioned, there are some conditions that need to be ruled out. First is appendicitis. It is followed by vomiting and constipation. Second is renal calculi or stones. This pain comes from behind while passing urine. Third, as you mentioned ovarian cyst but the ruptured cyst is a medical emergency and is unlikely. Get an abdomen and renal ultrasound is done to get a proper diagnosis. If you can, then do it after your periods.

Hello doctor,I am 31 years old female, 5\\8\", 175 lbs. Three days ago I started getting a really sharp pain in the lower left abdomen. It came on sudden and was gone within seconds but still bad enough to have me doubled over in pain. Thought it was related to period that was due following day. Happened on and off all day.Next day period did start as expected. Normal flow, normal cramps, etc. Then the sharp stabbing pain came back. It is stabbing in a very precise location, down and to the left from the belly button, kind of in-line with the hip. It was radiating hellfire to my low back, groin, thigh, hip, and left flank. I was on the floor in pain for four hours before it faded away enough for me to even stand.That night it happened again waking me from sleep. Lasted for hours, stabbing in the same spot, burning pain spread to the other areas. Later that day my toddler laid across me and his elbow got that same spot and started the pain up all over again but it only lasted about an hour. The area is very tender. I still get the brief stabbing pain when walking or coughing or bending over. I am thinking it is a ruptured cyst. I have never been diagnosed with one before but I think it fits the bill. But can they rupture multiple times within days? Is it likely to happen again? Could it be something related to period or just coincidence it started at the same time? What can I do at home for it, since I am unable to go in to see a doctor?

Hi. I went through your complain which I must say you have very nicely written down. As per the location of the pain that you mentioned, there are some conditions that need to be ruled out. First is appendicitis. It is followed by vomiting and constipation. Second is renal calculi or stones. This pain comes from behind while passing urine. Third, as you mentioned ovarian cyst but the ruptured cyst is a medical emergency and is unlikely. Get an abdomen and renal ultrasound is done to get a proper diagnosis. If you can, then do it after your periods.

### Instruction: Answer this question truthfully ###Input: Hi doctor,About two and a half months ago, I was at work with one leg tucked under the other in a computer chair. When I got up to use the restroom, I noticed tingling in my lower leg and developed drop foot as a result. My first visit was to a podiatrist and he suggested me to visit a neurologist. The neurologist did not run any scientific test and determined I likely crushed my peroneal nerve and said to return in four to six weeks for physical therapy. About two weeks later, while lying in bed on my side, I noticed my arm tingle a bit and when I got up to shake it out the tingling eventually subsided. But, I have experienced weakness in that arm. Last night while sitting upright on my bed, my left leg began to experience a similar sensation. The limbs are still functional and the tingling does not persist, but it feels weak. The uncertainty due to the lack of scientific testing is weighing very heavily on me and the troubling issue is the onset of additional symptoms which are causing occasional unsettling stomach feelings due to the mental anguish I have been experiencing. Mainly the fact that all of my limbs feel weak are making me very concerned. ### Response: Hi. I have read your complaints and first of all I should compliment you for having patiently written a thorough history of events. Let us analyze your problems You have tingling in all four limbs and weakness in all four limbs. That is upper limbs and lower limbs on both sides, but onset on various days. The next important point which you have told is the mode of onset and the tingling eventually subsided. The following parameters can be found out only by a clinical examination and they are most important to fix the diagnosis. In the same way, need to get at least two investigations, nerve conduction studies and MRI spine. It can be either a peripheral vascular disease leading to low perfusion or a peripheral neuropathy. I would strongly recommend as well as request you to consult your neurologist immediately and treat these symptoms as top priority. 1. Nerve conduction studies.2. MRI spine. The symptoms suggest either it could be peripheral neuropathy or peripheral vascular disease. Revert back with the investigation report to a neurologist online.- Take care.

Hi doctor,About two and a half months ago, I was at work with one leg tucked under the other in a computer chair. When I got up to use the restroom, I noticed tingling in my lower leg and developed drop foot as a result. My first visit was to a podiatrist and he suggested me to visit a neurologist. The neurologist did not run any scientific test and determined I likely crushed my peroneal nerve and said to return in four to six weeks for physical therapy. About two weeks later, while lying in bed on my side, I noticed my arm tingle a bit and when I got up to shake it out the tingling eventually subsided. But, I have experienced weakness in that arm. Last night while sitting upright on my bed, my left leg began to experience a similar sensation. The limbs are still functional and the tingling does not persist, but it feels weak. The uncertainty due to the lack of scientific testing is weighing very heavily on me and the troubling issue is the onset of additional symptoms which are causing occasional unsettling stomach feelings due to the mental anguish I have been experiencing. Mainly the fact that all of my limbs feel weak are making me very concerned.

Hi. I have read your complaints and first of all I should compliment you for having patiently written a thorough history of events. Let us analyze your problems You have tingling in all four limbs and weakness in all four limbs. That is upper limbs and lower limbs on both sides, but onset on various days. The next important point which you have told is the mode of onset and the tingling eventually subsided. The following parameters can be found out only by a clinical examination and they are most important to fix the diagnosis. In the same way, need to get at least two investigations, nerve conduction studies and MRI spine. It can be either a peripheral vascular disease leading to low perfusion or a peripheral neuropathy. I would strongly recommend as well as request you to consult your neurologist immediately and treat these symptoms as top priority. 1. Nerve conduction studies.2. MRI spine. The symptoms suggest either it could be peripheral neuropathy or peripheral vascular disease. Revert back with the investigation report to a neurologist online.- Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,About 45 days ago, I received a trauma to my right eye in a street fight, after which a large part of the cornea became blood red. After three weeks, the redness went away and the eye started looking normal, but I am still having a lot of discomforts. I am listing all the symptoms below. There is a pain in the whole eyeball and sometimes in the bony region surrounding the eye. A mild dull pain which goes away on some days. It is particularly noticeable after spending a few hours looking at the phone or a computer screen. There are difficulty and mild pain in eye movement and focusing. There is a slightly blurry vision and increased watering of the eye. There is a feeling of something caught in the eye. Photo-sensitivity in the affected region of the eye especially noticeable upon opening the eye first time in the morning. A tiny light grey scar in the affected area of the eye. Awareness of the affected eye. It also feels like I am seeing with only the unaffected eye. The eye becomes slightly red after taking bath or splashing water and remains so for about an hour. None of the above symptoms were present before the trauma. The unaffected eye is free from all those symptoms. Both eyes look perfectly normal and white except for the tiny scar in the affected eye, though I am not sure if it is a scar.I went to an ophthalmologist earlier this month and he said that there was swelling in the eye and everything would become normal soon. He prescribed two eyedrops which I am attaching here. After the treatment, the symptoms became milder and less noticeable than before but did not heal completely. So, I went to another ophthalmologist two days back. He examined the eye and said it was normal and only prescribed artificial tear drops. He checked power too and said there has been no vision loss in the affected eye but things do look more blurry with that eye. I was not convinced with his opinion because I am feeling all the symptoms I listed above. I do not know what to do. Please help. ### Response: Hello. I went through the attachment (attachment removed to protect patient identity). For more information consult an eye care ophthalmologist online Take care.

Hello doctor,About 45 days ago, I received a trauma to my right eye in a street fight, after which a large part of the cornea became blood red. After three weeks, the redness went away and the eye started looking normal, but I am still having a lot of discomforts. I am listing all the symptoms below. There is a pain in the whole eyeball and sometimes in the bony region surrounding the eye. A mild dull pain which goes away on some days. It is particularly noticeable after spending a few hours looking at the phone or a computer screen. There are difficulty and mild pain in eye movement and focusing. There is a slightly blurry vision and increased watering of the eye. There is a feeling of something caught in the eye. Photo-sensitivity in the affected region of the eye especially noticeable upon opening the eye first time in the morning. A tiny light grey scar in the affected area of the eye. Awareness of the affected eye. It also feels like I am seeing with only the unaffected eye. The eye becomes slightly red after taking bath or splashing water and remains so for about an hour. None of the above symptoms were present before the trauma. The unaffected eye is free from all those symptoms. Both eyes look perfectly normal and white except for the tiny scar in the affected eye, though I am not sure if it is a scar.I went to an ophthalmologist earlier this month and he said that there was swelling in the eye and everything would become normal soon. He prescribed two eyedrops which I am attaching here. After the treatment, the symptoms became milder and less noticeable than before but did not heal completely. So, I went to another ophthalmologist two days back. He examined the eye and said it was normal and only prescribed artificial tear drops. He checked power too and said there has been no vision loss in the affected eye but things do look more blurry with that eye. I was not convinced with his opinion because I am feeling all the symptoms I listed above. I do not know what to do. Please help.

Hello. I went through the attachment (attachment removed to protect patient identity). For more information consult an eye care ophthalmologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My mother is a patient of epilepsy for 22 years. Earlier she was diagnosed as GTCS (generalized tonic-clonic seizures) and CPS (complex partial seizures) and given Eptoin 100mg BD at first, then Zeptol CR 400mg BD with Cloba 10mg for fits, convulsions, and senselessness. But still, it was going on. Now, for the last two years, we consulted another doctor, who diagnosed that her treatment was not in the right way. He said that the seizure was idiopathic generalized epilepsy with absence seizures and she was given Encorate Chrono 500mg BD with Cloba 10mg.After this, she was good for two years. Then she again developed fits, senselessness, and convulsions this year. So, we went to the doctor and this time the diagnosis is combination of multiple seizures with psychogenic non-epileptic seizure and was given Encorate Chrono 500mg BD, Levipil 500mg BD, Cloba 10mg HS, Nexito 10mg HS. But still fits and convulsion is going on after coming back from the hospital. Please advise what has to be done. Is the treatment going in the right way? Is there any need for medicines such as Topiramate or Lacosamide or Tiagabine medicines? ### Response: Hello. Your mother\\s situation seems to be very complicated. I would like to explain that it is true that Carbamazepine (Zeptol) can have no good effect or even worsen idiopathic generalized seizures. The valproate plasma levels should also be performed, to know if she is being treated with the right doses of Encorate Chrono. I would recommend performing a brain MRI and a careful EEG to establish any possible cause of these seizures, which could be treated by a possible brain intervention. I would also reconsider the treatment with Escitalopram (Nexito), as it is an SSRI(Selective Serotonin Reuptake Inhibitor) and in rare cases has been shown to aggravate the seizures. Hope it was helpful. Take care.

Hello doctor,My mother is a patient of epilepsy for 22 years. Earlier she was diagnosed as GTCS (generalized tonic-clonic seizures) and CPS (complex partial seizures) and given Eptoin 100mg BD at first, then Zeptol CR 400mg BD with Cloba 10mg for fits, convulsions, and senselessness. But still, it was going on. Now, for the last two years, we consulted another doctor, who diagnosed that her treatment was not in the right way. He said that the seizure was idiopathic generalized epilepsy with absence seizures and she was given Encorate Chrono 500mg BD with Cloba 10mg.After this, she was good for two years. Then she again developed fits, senselessness, and convulsions this year. So, we went to the doctor and this time the diagnosis is combination of multiple seizures with psychogenic non-epileptic seizure and was given Encorate Chrono 500mg BD, Levipil 500mg BD, Cloba 10mg HS, Nexito 10mg HS. But still fits and convulsion is going on after coming back from the hospital. Please advise what has to be done. Is the treatment going in the right way? Is there any need for medicines such as Topiramate or Lacosamide or Tiagabine medicines?

Hello. Your mother\\s situation seems to be very complicated. I would like to explain that it is true that Carbamazepine (Zeptol) can have no good effect or even worsen idiopathic generalized seizures. The valproate plasma levels should also be performed, to know if she is being treated with the right doses of Encorate Chrono. I would recommend performing a brain MRI and a careful EEG to establish any possible cause of these seizures, which could be treated by a possible brain intervention. I would also reconsider the treatment with Escitalopram (Nexito), as it is an SSRI(Selective Serotonin Reuptake Inhibitor) and in rare cases has been shown to aggravate the seizures. Hope it was helpful. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,My girlfriend has severe period pains that are certainly endometriosis. Her recent scan showed endometrium was 16 mm thick. She has crippling pains, and she is completely immobile during her period, and sometimes in between. It is getting worse month by month. She is infertile. It is painful going to the toilet when on her period. She often has migraines. She has huge agonizing pain, that does not feel better with Ibuprofen or Paracetamol. The pain starts two days before her period and majority of it ending 1 to 2 days after she starts bleeding. She describes the pain as an extremely heavy weight pushing down on her abdomen, vagina, and bottom.This is happening from the past 6 to 7 years, but it is getting worse over the past 6 to 7 months. A local doctor prescribed Clotrimazole and Tinidazole. I personally think a Progesterone cream is the best course of action, yet it interferes with the Clotrimazole, so I do not know what course of action to take. We did try the Minidril pill, but it messed up her hormones pretty bad, and she started feeling suicidal, so we stopped. The pain has started happening midway through her cycle now and is getting worse and worse. She becomes completely immobile, not even able to get herself to the toilet, and I have to carry her. I will attach the ultrasound scans so you can see for yourself. Unfortunately, the imagery is the best we have. Please let me know what you think the best course of treatment we should try without having to see a gynecologist. ### Response: Hello. I did go through the ultrasound report (attachment removed to protect patient identity). Although it reads normal, endometriosis is a laparosocpic or operative finding. The symptoms she has correlates with the condition. She may be helped with hormonal medicines. However, in cases which do not respond, surgery is needed. A laparoscopy-guided surgery, which includes removal of the endometriotic nodule and breakage of adhesions may help followed by oral contraception pills for few months. Regards. For more information consult an obstetrician and gynaecologist online Take care.

Hi doctor,My girlfriend has severe period pains that are certainly endometriosis. Her recent scan showed endometrium was 16 mm thick. She has crippling pains, and she is completely immobile during her period, and sometimes in between. It is getting worse month by month. She is infertile. It is painful going to the toilet when on her period. She often has migraines. She has huge agonizing pain, that does not feel better with Ibuprofen or Paracetamol. The pain starts two days before her period and majority of it ending 1 to 2 days after she starts bleeding. She describes the pain as an extremely heavy weight pushing down on her abdomen, vagina, and bottom.This is happening from the past 6 to 7 years, but it is getting worse over the past 6 to 7 months. A local doctor prescribed Clotrimazole and Tinidazole. I personally think a Progesterone cream is the best course of action, yet it interferes with the Clotrimazole, so I do not know what course of action to take. We did try the Minidril pill, but it messed up her hormones pretty bad, and she started feeling suicidal, so we stopped. The pain has started happening midway through her cycle now and is getting worse and worse. She becomes completely immobile, not even able to get herself to the toilet, and I have to carry her. I will attach the ultrasound scans so you can see for yourself. Unfortunately, the imagery is the best we have. Please let me know what you think the best course of treatment we should try without having to see a gynecologist.

Hello. I did go through the ultrasound report (attachment removed to protect patient identity). Although it reads normal, endometriosis is a laparosocpic or operative finding. The symptoms she has correlates with the condition. She may be helped with hormonal medicines. However, in cases which do not respond, surgery is needed. A laparoscopy-guided surgery, which includes removal of the endometriotic nodule and breakage of adhesions may help followed by oral contraception pills for few months. Regards. For more information consult an obstetrician and gynaecologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 24 year old male. Last year, I had a few molluscum contagiosum in my lower abdomen. I took the treatment, and they were gone. After two to three months, I got one skin tag on the skin around my penis. I applied a lotion (Salicylic acid 16.7% and Lactic acid 16.7%), and the skin tag was removed. But, it came back after three months. Currently, I am suffering from genital warts and taking treatment.My doctor told me to get some test and here are the results. Lipid profile - triglycerides 125 mg/dL, HDL 35 mg/dL and LDL 113 mg/dL, CBC - lymphocyte 44%, serum amylase 121 IU/L, Helicobacter pylori IgA 0.45 (negative) and urine test - pus cells 3 to 4/HPF. Currently, I am taking these medicine as advised by my doctor. Zincolak one tablet twice daily, Zycolchin one tablet twice daily and Dicaris 150 mg one tablet once a day for three days.My question is that I am a healthy man with high immunity. I never get sick all around the year. How did I catch this infection? I have multiple sex partner, but I never had sex without a condom, or my condom never broke. Please give me a detailed answer and also give me advice for the treatment. ### Response: Hello, Welcome to Chat Doctor forum. Warts and molluscum are common sexually acquired infections and can occur in healthy individuals. Warts spread by touch and condoms will only protect the covered area. Base of the penis, thighs, lower abdomen are all exposed. So, both warts and molluscum can be transmitted even with condom usage. For treatment, I suggest you Imiquimod 5% cream. Apply it over the affected area thrice a week and leave it overnight and wash in the morning. Use it for 16 weeks. Consult your specialist doctor, discuss with him or her and take treatment with consent. Also, you should get tested for HIV and hepatitis.

Hello doctor,I am a 24 year old male. Last year, I had a few molluscum contagiosum in my lower abdomen. I took the treatment, and they were gone. After two to three months, I got one skin tag on the skin around my penis. I applied a lotion (Salicylic acid 16.7% and Lactic acid 16.7%), and the skin tag was removed. But, it came back after three months. Currently, I am suffering from genital warts and taking treatment.My doctor told me to get some test and here are the results. Lipid profile - triglycerides 125 mg/dL, HDL 35 mg/dL and LDL 113 mg/dL, CBC - lymphocyte 44%, serum amylase 121 IU/L, Helicobacter pylori IgA 0.45 (negative) and urine test - pus cells 3 to 4/HPF. Currently, I am taking these medicine as advised by my doctor. Zincolak one tablet twice daily, Zycolchin one tablet twice daily and Dicaris 150 mg one tablet once a day for three days.My question is that I am a healthy man with high immunity. I never get sick all around the year. How did I catch this infection? I have multiple sex partner, but I never had sex without a condom, or my condom never broke. Please give me a detailed answer and also give me advice for the treatment.

Hello, Welcome to Chat Doctor forum. Warts and molluscum are common sexually acquired infections and can occur in healthy individuals. Warts spread by touch and condoms will only protect the covered area. Base of the penis, thighs, lower abdomen are all exposed. So, both warts and molluscum can be transmitted even with condom usage. For treatment, I suggest you Imiquimod 5% cream. Apply it over the affected area thrice a week and leave it overnight and wash in the morning. Use it for 16 weeks. Consult your specialist doctor, discuss with him or her and take treatment with consent. Also, you should get tested for HIV and hepatitis.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have complicated migraines, simple partial seizures and are controlled by Lamictal. I have a long time pain from sound intake and it has worsened into my face. Other sensory triggers the pain. It has become just way too much to handle. I sought advice from friends and groups and nurses, that have trigeminal neuralgia and they suggest Carbamazepine.I learned it lowers Lamictal. I contacted pharmacy that said many will test blood serum of Lamictal and then add Carbamazepine and adjust Lamictal to therapeutic levels.My doctor is a bit concerned. She is not a pain doctor or neurologist. I am waiting to see one. But my condition makes it hard to travel in a car. My doctor asked I seek advice. Do you agree that checking the serum and adjusting is fine to do, in order to take Carbamazepine?The second option is Oxcarbazepine. In your experience is it a good pain drug for TN and does it mess up Lamictal? I found a study that said it did not.I was thinking I could start it now while I wait on Lamictal levels. And see if it helps. Just really struggling. Pain cream not helping much in certain places. My old neurologist wanted me to lower Glutamate as much as I could and suggested Namenda at one point. I know many people are on two and three drugs. I hope to try injections for the pain soon. Do you have any suggestions? ### Response: Hello, Welcome to Chat Doctor forum. Firstly, we need to be sure if your pain is really Trigeminal neuralgia (TN) as there can be other causes of facial pain like idiopathic facial pain, Post-herpetic neuralgia. Sometimes dental causes of facial pain can mimic TN. Trigeminal neuralgia has sharp, shooting episodes of pain in any distribution of the trigeminal nerve. Pain is mostly along one side of pain and lasts for a few seconds. Pain can be triggered by brushing teeth, cold air, chewing of food. Mostly there is no baseline pain. For TN medications, Carbamazepine is the first line FDA (food and ChatDoctor.

Hello doctor,I have complicated migraines, simple partial seizures and are controlled by Lamictal. I have a long time pain from sound intake and it has worsened into my face. Other sensory triggers the pain. It has become just way too much to handle. I sought advice from friends and groups and nurses, that have trigeminal neuralgia and they suggest Carbamazepine.I learned it lowers Lamictal. I contacted pharmacy that said many will test blood serum of Lamictal and then add Carbamazepine and adjust Lamictal to therapeutic levels.My doctor is a bit concerned. She is not a pain doctor or neurologist. I am waiting to see one. But my condition makes it hard to travel in a car. My doctor asked I seek advice. Do you agree that checking the serum and adjusting is fine to do, in order to take Carbamazepine?The second option is Oxcarbazepine. In your experience is it a good pain drug for TN and does it mess up Lamictal? I found a study that said it did not.I was thinking I could start it now while I wait on Lamictal levels. And see if it helps. Just really struggling. Pain cream not helping much in certain places. My old neurologist wanted me to lower Glutamate as much as I could and suggested Namenda at one point. I know many people are on two and three drugs. I hope to try injections for the pain soon. Do you have any suggestions?

Hello, Welcome to Chat Doctor forum. Firstly, we need to be sure if your pain is really Trigeminal neuralgia (TN) as there can be other causes of facial pain like idiopathic facial pain, Post-herpetic neuralgia. Sometimes dental causes of facial pain can mimic TN. Trigeminal neuralgia has sharp, shooting episodes of pain in any distribution of the trigeminal nerve. Pain is mostly along one side of pain and lasts for a few seconds. Pain can be triggered by brushing teeth, cold air, chewing of food. Mostly there is no baseline pain. For TN medications, Carbamazepine is the first line FDA (food and ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was diagnosed with dysphonia about a month ago. I have had a couple of speech therapy sessions but progress is glacial. I am still hoarse and in pain. I have been on 40 mg of Omeprazole for a month and Gaviscon Double Action for two weeks. I feel like the back of my throat is still swollen and I have pain in the corners of my throat. This only briefly eases when I really do some throat opening exercises. I cannot talk for very long without everything getting sore still. I have been like this since the beginning of the year since I had a chest infection and pneumonia. My mouth is now getting sore from all the Gaviscon tablets as the liquid irritates the corners of my throat. I really do not know what else I can do. I am having panic attacks and starting to feel like the only option is to take my life. I had a post nasal drip for most of the year so far and I am trying to get my salivary glands to work again properly. ### Response: Hello, Welcome to Chat Doctor forum. Muscle tension dysphonia takes time to get cured. A few sessions of speech therapy are not going to rid you of the problem. Muscle tension dysphonia occurs due to various reasons and can be present after laryngitis or pneumonia as in your case. As an ENT surgeon, I would like to see the laryngoscopy video myself to ascertain if indeed the false vocal cords are producing voice instead of the true ones. Dysphonia plica ventricularis is the grade 2 of muscle tension dysphonia. Dysphonia plica ventricularis is when the false cords medialize to produce voice. Continue the speech therapy and anti-reflux treatment like your ENT surgeon and audiologist has prescribed. The speech therapy is aimed at suppressing maladaptive phonatory mechanisms and learn techniques designed to minimize muscular tension. Do write back to us if you need any further information on this. But at the same time please be patient with this problem to get resolved. Take adequate voice rest and whenever you use voice take care not to raise the voice or use unnatural frequencies. For more information consult an ENT otolaryngologist online

Hello doctor,I was diagnosed with dysphonia about a month ago. I have had a couple of speech therapy sessions but progress is glacial. I am still hoarse and in pain. I have been on 40 mg of Omeprazole for a month and Gaviscon Double Action for two weeks. I feel like the back of my throat is still swollen and I have pain in the corners of my throat. This only briefly eases when I really do some throat opening exercises. I cannot talk for very long without everything getting sore still. I have been like this since the beginning of the year since I had a chest infection and pneumonia. My mouth is now getting sore from all the Gaviscon tablets as the liquid irritates the corners of my throat. I really do not know what else I can do. I am having panic attacks and starting to feel like the only option is to take my life. I had a post nasal drip for most of the year so far and I am trying to get my salivary glands to work again properly.

Hello, Welcome to Chat Doctor forum. Muscle tension dysphonia takes time to get cured. A few sessions of speech therapy are not going to rid you of the problem. Muscle tension dysphonia occurs due to various reasons and can be present after laryngitis or pneumonia as in your case. As an ENT surgeon, I would like to see the laryngoscopy video myself to ascertain if indeed the false vocal cords are producing voice instead of the true ones. Dysphonia plica ventricularis is the grade 2 of muscle tension dysphonia. Dysphonia plica ventricularis is when the false cords medialize to produce voice. Continue the speech therapy and anti-reflux treatment like your ENT surgeon and audiologist has prescribed. The speech therapy is aimed at suppressing maladaptive phonatory mechanisms and learn techniques designed to minimize muscular tension. Do write back to us if you need any further information on this. But at the same time please be patient with this problem to get resolved. Take adequate voice rest and whenever you use voice take care not to raise the voice or use unnatural frequencies. For more information consult an ENT otolaryngologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 13-year-old female and my height is 5 feet. I weigh about 106 pounds. I have been having stomach issues. The main issue is stomach rumbling. It happens when I wake up, after eating almost anything and before I sleep. I have tried skipping one of the meals but to no avail. It still causes the same result the best working being no dinner but having breakfast and lunch. I very rarely have soda, fast food items, or frozen dinners. I have searched up for gassy foods to avoid for example broccoli) but it still does not help. I sometimes do 35 to 45 minutes of crunches, which kind of help. Sometimes it feels uncomfortable and hurts a little but that is not my biggest concern. The rumbling starts at about 10 o\\ clock onwards. It is so embarrassing to hear it go off every day during my class. Nobody is rude or talks about it, but still, it is distracting and annoying to deal with. I do not want to be dependant on gas pills unless there is literally nothing else to do.I have no food allergies, I am not lactose intolerant, and I am not a vegetarian. I eat raw almonds daily, so I do get a good amount of fiber. Same with graham crackers, is that a bad thing to eat? I am an active swimmer, usually one hour to 45 minutes four days a week. I walk my dog for about 30 minutes.Are there any foods or diets to suggest?Anything to stay away from?Anything to eat more of?Any exercises that would help?Should I be asking a doctor this? ### Response: Hello. If you are not ChatDoctor. Sometimes gluten intolerance could be causing symptoms similar to what you have described. Gluten intolerance can start at any age even if you have never had it before. I just checked the ingredients in Graham crackers and it contains flour and wheat bran. I suggest you try and avoid foods containing wheat and gluten. You do not have to skip any meal. Go gluten free for two weeks and see if that helps you. For more information consult a nutritionist online

Hello doctor,I am a 13-year-old female and my height is 5 feet. I weigh about 106 pounds. I have been having stomach issues. The main issue is stomach rumbling. It happens when I wake up, after eating almost anything and before I sleep. I have tried skipping one of the meals but to no avail. It still causes the same result the best working being no dinner but having breakfast and lunch. I very rarely have soda, fast food items, or frozen dinners. I have searched up for gassy foods to avoid for example broccoli) but it still does not help. I sometimes do 35 to 45 minutes of crunches, which kind of help. Sometimes it feels uncomfortable and hurts a little but that is not my biggest concern. The rumbling starts at about 10 o\\ clock onwards. It is so embarrassing to hear it go off every day during my class. Nobody is rude or talks about it, but still, it is distracting and annoying to deal with. I do not want to be dependant on gas pills unless there is literally nothing else to do.I have no food allergies, I am not lactose intolerant, and I am not a vegetarian. I eat raw almonds daily, so I do get a good amount of fiber. Same with graham crackers, is that a bad thing to eat? I am an active swimmer, usually one hour to 45 minutes four days a week. I walk my dog for about 30 minutes.Are there any foods or diets to suggest?Anything to stay away from?Anything to eat more of?Any exercises that would help?Should I be asking a doctor this?

Hello. If you are not ChatDoctor. Sometimes gluten intolerance could be causing symptoms similar to what you have described. Gluten intolerance can start at any age even if you have never had it before. I just checked the ingredients in Graham crackers and it contains flour and wheat bran. I suggest you try and avoid foods containing wheat and gluten. You do not have to skip any meal. Go gluten free for two weeks and see if that helps you. For more information consult a nutritionist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My son has developed anxiety symptoms about four years ago. They came completely out of the blue. He was with someone who now has heart palpitations, sweaty palms and feet, and lightheadedness sitting in the living room. We ran a battery of tests when it first happened including TSH, EKG, lung scans, blood panels, etc. and everything was normal. So we went down the path of anxiety. Four years later, the symptoms continued. As my son now has a terrible fear of doctors, we tried a home blood test to get a full thyroid panel. I have attached the results.The blood work came back normal. Low normal TSH, but low normal T4 and lower normal free T4 and free T3. There is nothing that shows an abnormality. However, his urine test showed moderately low iodine and slightly low selenium. I have read that abnormalities in these measures could cause thyroid problems. What am I wondering is if these two indicators are worth further exploration with an endocrinologist knowing that going to the doctor will cause my son a severe panic.Also, is it possible that low iodine could have been a temporary diet thing and it is masking the signs of hyperthyroidism in the blood work? He has all of the symptoms of someone with hyperthyroidism. On a side note, I am hypothyroid, my sister is hypothyroid and my two nieces had Hashimoto\\s with my younger niece having thyroid cancer and got her thyroid removed at age of 22. So everyone on my side of the family has thyroid issues. We were wondering if you could please give us some guidance. Looking to see if we need to eliminate thyroid as a possible cause of his symptoms or if it is worth further pursuit. ### Response: Hello, Welcome to Chat Doctor forum. Based on the details and the labs attached (attachment removed to protect patient identity), it seems very unlikely that the symptoms are coming from a thyroid issue. Urine iodine is really not helpful clinically in this case. Given the family history, I would ask you to monitor TSH (thyroid-stimulating hormone) once a year but that does not explain the severity of the symptoms at all. For more information consult a diabetologist online

Hello doctor,My son has developed anxiety symptoms about four years ago. They came completely out of the blue. He was with someone who now has heart palpitations, sweaty palms and feet, and lightheadedness sitting in the living room. We ran a battery of tests when it first happened including TSH, EKG, lung scans, blood panels, etc. and everything was normal. So we went down the path of anxiety. Four years later, the symptoms continued. As my son now has a terrible fear of doctors, we tried a home blood test to get a full thyroid panel. I have attached the results.The blood work came back normal. Low normal TSH, but low normal T4 and lower normal free T4 and free T3. There is nothing that shows an abnormality. However, his urine test showed moderately low iodine and slightly low selenium. I have read that abnormalities in these measures could cause thyroid problems. What am I wondering is if these two indicators are worth further exploration with an endocrinologist knowing that going to the doctor will cause my son a severe panic.Also, is it possible that low iodine could have been a temporary diet thing and it is masking the signs of hyperthyroidism in the blood work? He has all of the symptoms of someone with hyperthyroidism. On a side note, I am hypothyroid, my sister is hypothyroid and my two nieces had Hashimoto\\s with my younger niece having thyroid cancer and got her thyroid removed at age of 22. So everyone on my side of the family has thyroid issues. We were wondering if you could please give us some guidance. Looking to see if we need to eliminate thyroid as a possible cause of his symptoms or if it is worth further pursuit.

Hello, Welcome to Chat Doctor forum. Based on the details and the labs attached (attachment removed to protect patient identity), it seems very unlikely that the symptoms are coming from a thyroid issue. Urine iodine is really not helpful clinically in this case. Given the family history, I would ask you to monitor TSH (thyroid-stimulating hormone) once a year but that does not explain the severity of the symptoms at all. For more information consult a diabetologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor, First of all, I have an anxiety disorder so I got shaken up by bad news a lot and I just want to ask you about this. I am afraid of this and please can you give me an answer that does not scare me more. I have had sensitive nasal passages and mild ETD for about 12 years. I get very dry sinuses when the temperature is low and it can sometimes clog up my ears and nose. I keep it in check by using nasal rinse with Neilmed purified salt and alkalol all natural products. These work great. We live in a small island country where we get water from mountains straight into a commercial cleaning station with filters and laser. I have always used this clean tap water in a netipot and then pour a little bit of boiled water into the netipot to get the temperature perfect. But now, this morning, when my sinus feel dry and just by accident I googled what is the best water is to use in netipot, and all kinds of warnings pop put that you should never use tap water for netipot. A google report says that ### Response: Hello, Welcome to Chat Doctor forum. Thanks for the detailed history. First of all, netipot nasal washes are a great way to keep your nose and sinuses clean, this method is used in India from ancient times it is a part of yoga practice. Now you can understand that neti pot washes what was used centuries back were always from tap water and there are no complications written anywhere in the older textbooks and even in yoga literature. It is the duty of health department of the country to warn the citizens regarding the use of regular tap water because in some places it may be impure. It should not be generalized. Our body and nose in particular, have tremendous local defense mechanisms against bacteria and they can very well take care of small amounts of bacteria if at all they are present in normal water. Since you have not developed any significant signs and symptoms of infection there is no need to worry, tap water has not caused any problems. In future, you can use boiled and cooled tap water for nasal washes that could take care of bacteria and any remote chance of infection.

Hello doctor, First of all, I have an anxiety disorder so I got shaken up by bad news a lot and I just want to ask you about this. I am afraid of this and please can you give me an answer that does not scare me more. I have had sensitive nasal passages and mild ETD for about 12 years. I get very dry sinuses when the temperature is low and it can sometimes clog up my ears and nose. I keep it in check by using nasal rinse with Neilmed purified salt and alkalol all natural products. These work great. We live in a small island country where we get water from mountains straight into a commercial cleaning station with filters and laser. I have always used this clean tap water in a netipot and then pour a little bit of boiled water into the netipot to get the temperature perfect. But now, this morning, when my sinus feel dry and just by accident I googled what is the best water is to use in netipot, and all kinds of warnings pop put that you should never use tap water for netipot. A google report says that

Hello, Welcome to Chat Doctor forum. Thanks for the detailed history. First of all, netipot nasal washes are a great way to keep your nose and sinuses clean, this method is used in India from ancient times it is a part of yoga practice. Now you can understand that neti pot washes what was used centuries back were always from tap water and there are no complications written anywhere in the older textbooks and even in yoga literature. It is the duty of health department of the country to warn the citizens regarding the use of regular tap water because in some places it may be impure. It should not be generalized. Our body and nose in particular, have tremendous local defense mechanisms against bacteria and they can very well take care of small amounts of bacteria if at all they are present in normal water. Since you have not developed any significant signs and symptoms of infection there is no need to worry, tap water has not caused any problems. In future, you can use boiled and cooled tap water for nasal washes that could take care of bacteria and any remote chance of infection.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I would like to know what does my lab tells you about my current liver function.I began to struggle with daily gout pain a few months ago and finally gave in to taking the traditional drugs about one and a half months ago. Both allopurinol and probenecid caused worrisome impacts on my body. I began to experience flank pain, confused thinking, and fatigue. Around this time, I was also compelled to have my A1C checked because I was struggling with headaches, insomnia, and various degrees of itching after eating. My A1C turned out to be 5.7.I stopped taking the drugs, and did a lot of research, and was fortunate to find some supplements that seem to be effective at the intersection of both metabolic syndrome and gout. Presently, I have found that Berberine (approximately 1000mg/day) works. Gout pain is essentially gone, and blood sugar seems to be coming under control with each day, though my caloric intake in unsustainably low. Admittedly, I have taken some hesperidin, ALA, chromium, NAC, ECGC, nigella sativa oil, or triple strength turmeric occasioanally if I was having a momentary concern (not all at once), or even all in a day, but occasionally.My concern is for my ongoing liver function. Though things seem to be getting better, as the day goes on and I have taken some supplements, I will start to feel pressure in the middle of my back, kidney area, and left flank discomfort. It tends to have gone away by the time I wake up in the morning. On looking at my labs, the markers for liver function have fluctuated, but my primary care doctor never made mention of them. Is there anything you can tell me about what the changes in these ratios say? ### Response: Hi. I have seen your blood works. (attachment removed to protect patient identity). It is all normal. Usually, during the acute attack of gout, we do not start Allopurinol or uric acid decreasing medications as it can exaggerate the situation. We usually start after the acute situation is treated with ChatDoctor.

Hi doctor,I would like to know what does my lab tells you about my current liver function.I began to struggle with daily gout pain a few months ago and finally gave in to taking the traditional drugs about one and a half months ago. Both allopurinol and probenecid caused worrisome impacts on my body. I began to experience flank pain, confused thinking, and fatigue. Around this time, I was also compelled to have my A1C checked because I was struggling with headaches, insomnia, and various degrees of itching after eating. My A1C turned out to be 5.7.I stopped taking the drugs, and did a lot of research, and was fortunate to find some supplements that seem to be effective at the intersection of both metabolic syndrome and gout. Presently, I have found that Berberine (approximately 1000mg/day) works. Gout pain is essentially gone, and blood sugar seems to be coming under control with each day, though my caloric intake in unsustainably low. Admittedly, I have taken some hesperidin, ALA, chromium, NAC, ECGC, nigella sativa oil, or triple strength turmeric occasioanally if I was having a momentary concern (not all at once), or even all in a day, but occasionally.My concern is for my ongoing liver function. Though things seem to be getting better, as the day goes on and I have taken some supplements, I will start to feel pressure in the middle of my back, kidney area, and left flank discomfort. It tends to have gone away by the time I wake up in the morning. On looking at my labs, the markers for liver function have fluctuated, but my primary care doctor never made mention of them. Is there anything you can tell me about what the changes in these ratios say?

Hi. I have seen your blood works. (attachment removed to protect patient identity). It is all normal. Usually, during the acute attack of gout, we do not start Allopurinol or uric acid decreasing medications as it can exaggerate the situation. We usually start after the acute situation is treated with ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had an unprotected relation two months ago, which led to urethritis three days after that was treated with a 10 days course of Levaquin. The urethritis disappeared, but at the end of the treatment, I started to feel neurological symptoms, numbness, tingling burning sensation in my arms and allodynia in my foot. Then a few weeks later, I began to experience diarrhea (muddy stools) after digestion (mainly in the morning, sometimes at night or the end of the afternoon). I lost a lot of weight (nearly 10 kg). I got an MRI (cerebral and medular) and an EMG that came back normal. I got STD (hepatitis, syphilis, HIV, gonorrhea, chlamydia) lab test 43 days after exposure, which came back negative. As I was worried about all these symptoms, I got multiple HIV fourth-generation testing at 21 days, 28, 35, 43, and 51 days that all came back negative.My doctor gave me this week a complete blood test, and everything came back healthy except slightly high albumin level (53g/L) probably due to dehydration but also a somewhat low gamma globulin with a level of 7.4g/L while the lab norms range from 8 to 13.5 g/L. The conclusion stated hypogammaglobulinemia. Now I am worried because I read that hypogammaglobulinemia can delay the seroconversion and then give false negative antibody results. Do you know if such level of gamma globulin can indeed affect HIV testing? ### Response: Hello. As you have done all the test which came normal. Hiv antibodies while detecting in initial phase generally came negative, as it is in window period for three months. So have to recheck HIV antibody test post three months of exposure. And if it comes negative after then no need to worry. As you explained, you have hypogammaglobulinemia, As lab report showing lower level, but the value not that much decreased. You go for thyroid profile testing also and connect me if you have further questions.

Hello doctor,I had an unprotected relation two months ago, which led to urethritis three days after that was treated with a 10 days course of Levaquin. The urethritis disappeared, but at the end of the treatment, I started to feel neurological symptoms, numbness, tingling burning sensation in my arms and allodynia in my foot. Then a few weeks later, I began to experience diarrhea (muddy stools) after digestion (mainly in the morning, sometimes at night or the end of the afternoon). I lost a lot of weight (nearly 10 kg). I got an MRI (cerebral and medular) and an EMG that came back normal. I got STD (hepatitis, syphilis, HIV, gonorrhea, chlamydia) lab test 43 days after exposure, which came back negative. As I was worried about all these symptoms, I got multiple HIV fourth-generation testing at 21 days, 28, 35, 43, and 51 days that all came back negative.My doctor gave me this week a complete blood test, and everything came back healthy except slightly high albumin level (53g/L) probably due to dehydration but also a somewhat low gamma globulin with a level of 7.4g/L while the lab norms range from 8 to 13.5 g/L. The conclusion stated hypogammaglobulinemia. Now I am worried because I read that hypogammaglobulinemia can delay the seroconversion and then give false negative antibody results. Do you know if such level of gamma globulin can indeed affect HIV testing?

Hello. As you have done all the test which came normal. Hiv antibodies while detecting in initial phase generally came negative, as it is in window period for three months. So have to recheck HIV antibody test post three months of exposure. And if it comes negative after then no need to worry. As you explained, you have hypogammaglobulinemia, As lab report showing lower level, but the value not that much decreased. You go for thyroid profile testing also and connect me if you have further questions.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I believe that I have symptoms of MPD. Some are from my past and some are present. For examples, I see things in black and white, low self-esteem, feeling evil, substance abuse (weed and alcohol), feeling empty, not sure how to react to emotional or social situations and unhealthy relationships. I have never tried to harm or kill myself, but I put myself in risk or high endurance situations, depression, anxiety. I was binged and purged between ages 13 and 20. I have controlling impulses such as pulling out hair, over picking skin and masturbation. All that started back between the ages of 5 and 11. I also believe it could have something to do with genetics or upbringing because my mother and grandmother show these signs as well.I visited a psychologist for the first time last year and he diagnosed me with depression and severe social anxiety. I did not get In detail about my past or present problems other than hair pulling and anxiety. He asked me about my history with drugs. At first, I did not mind, but then I started to get embarrassed and had a panic attack. Then, he made his diagnosis. I stopped treatment after a couple of months. I find it is often hard for me to follow through with plans, but I would like to try moving forward again. ### Response: Hi. I can understand your concern. Some of the symptoms you have mentioned suggest depression and anxiety. Low self-esteem, feeling low, etc., are classical depression symptoms. Hair pulling is one of the anxiety symptoms. Under unconscious anxiety, individuals develop a habit of pulling hair. You have never developed an idea of self-harm, but there is a practice of putting into a risky situation. This could be a feature of bipolar but should be evaluated. History of abuse of weed also increases such risk-taking behavior. If your day-to-day functioning is impaired, then I would advise you to please get yourself evaluated by a psychiatrist. A proper evaluation will help in making a diagnosis. Mood stabilisers can be used for treatment and will treat the symptoms. Avoid using weed because this might cause the development of acute psychotic symptoms.

Hi doctor,I believe that I have symptoms of MPD. Some are from my past and some are present. For examples, I see things in black and white, low self-esteem, feeling evil, substance abuse (weed and alcohol), feeling empty, not sure how to react to emotional or social situations and unhealthy relationships. I have never tried to harm or kill myself, but I put myself in risk or high endurance situations, depression, anxiety. I was binged and purged between ages 13 and 20. I have controlling impulses such as pulling out hair, over picking skin and masturbation. All that started back between the ages of 5 and 11. I also believe it could have something to do with genetics or upbringing because my mother and grandmother show these signs as well.I visited a psychologist for the first time last year and he diagnosed me with depression and severe social anxiety. I did not get In detail about my past or present problems other than hair pulling and anxiety. He asked me about my history with drugs. At first, I did not mind, but then I started to get embarrassed and had a panic attack. Then, he made his diagnosis. I stopped treatment after a couple of months. I find it is often hard for me to follow through with plans, but I would like to try moving forward again.

Hi. I can understand your concern. Some of the symptoms you have mentioned suggest depression and anxiety. Low self-esteem, feeling low, etc., are classical depression symptoms. Hair pulling is one of the anxiety symptoms. Under unconscious anxiety, individuals develop a habit of pulling hair. You have never developed an idea of self-harm, but there is a practice of putting into a risky situation. This could be a feature of bipolar but should be evaluated. History of abuse of weed also increases such risk-taking behavior. If your day-to-day functioning is impaired, then I would advise you to please get yourself evaluated by a psychiatrist. A proper evaluation will help in making a diagnosis. Mood stabilisers can be used for treatment and will treat the symptoms. Avoid using weed because this might cause the development of acute psychotic symptoms.

### Instruction: Answer this question truthfully ###Input: Hi doctor,Just over a week ago, I developed severe swelling and soreness on the left side of my throat, particularly at the base of my tongue. My left ear is also in a lot of pain. Swallowing is extremely difficult and I went to see local urgent care where they prescribed me with Amoxicillin 500 mg and said it was most likely pharyngitis even though I have not had tonsils for many years.My main concern, even though it is a worse case scenario, is esophageal cancer through HPV can occur, as my girlfriend was recently diagnosed with HPV. Again, I know this is the worst case scenario, but since she was diagnosed I really been concerned about HPV-related cancers. From what I read and what I\\ve been told, there are no real tests to check in men for HPV and even though there is the vaccine it is not recommended for men ages 26 to 45 years.I have already been taking Amoxicillin for about four days now and nothing improves. I have also tried taking regular over the counter cough drops and gargling with salt water. This has not helped at all either I have also been told that throat cancer from HPV can usually be spotted unless you have lesions in your oral area. Right now I am at a loss of what I really need to do? Any help or advice would seriously be appreciated. I am also under Amlodipine 5 mg. ### Response: Hello. Your problem can be due to pharyngitis. It is possible that Amoxicillin is not effective enough in your case. You may need some other antibiotics. I want to see your throat myself. Can you send me a picture of your throat? (I should be able to see posterior pharyngeal wall and tonsils). We can think of HPV-related problems only after ruling out other infections. Did you lose your weight? Are you having any swelling in the neck (lymph node enlargement)? The only way of ruling out HPV-related oral cancers is by taking an oral biopsy. Before concluding anything please send me a picture of your throat. I will be able to guide you in a better way. Take care.

Hi doctor,Just over a week ago, I developed severe swelling and soreness on the left side of my throat, particularly at the base of my tongue. My left ear is also in a lot of pain. Swallowing is extremely difficult and I went to see local urgent care where they prescribed me with Amoxicillin 500 mg and said it was most likely pharyngitis even though I have not had tonsils for many years.My main concern, even though it is a worse case scenario, is esophageal cancer through HPV can occur, as my girlfriend was recently diagnosed with HPV. Again, I know this is the worst case scenario, but since she was diagnosed I really been concerned about HPV-related cancers. From what I read and what I\\ve been told, there are no real tests to check in men for HPV and even though there is the vaccine it is not recommended for men ages 26 to 45 years.I have already been taking Amoxicillin for about four days now and nothing improves. I have also tried taking regular over the counter cough drops and gargling with salt water. This has not helped at all either I have also been told that throat cancer from HPV can usually be spotted unless you have lesions in your oral area. Right now I am at a loss of what I really need to do? Any help or advice would seriously be appreciated. I am also under Amlodipine 5 mg.

Hello. Your problem can be due to pharyngitis. It is possible that Amoxicillin is not effective enough in your case. You may need some other antibiotics. I want to see your throat myself. Can you send me a picture of your throat? (I should be able to see posterior pharyngeal wall and tonsils). We can think of HPV-related problems only after ruling out other infections. Did you lose your weight? Are you having any swelling in the neck (lymph node enlargement)? The only way of ruling out HPV-related oral cancers is by taking an oral biopsy. Before concluding anything please send me a picture of your throat. I will be able to guide you in a better way. Take care.