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### Instruction: Answer this question truthfully ###Input: Hello doctor,I have erectile dysfunction with no apparent cause. Blood test and ECG are fine.I have never had ED. My sex drive is usually not even too much. For the past eight months, my sex drive is non-existent. I also have no morning erections. Factors that play a role are that I broke up with my wife and also eight months ago, I had serious accessory nerve operation that failed to fix my trapezius palsy, but I think these areas are physically too far apart. But maybe depression? I have not been able to think myself to be turned on. I have tried Zinc, Magnesium ZMA vitamin supplements which seemed to help for one week and I got hard morning erections. However, it stopped working. I have also tried Ginseng which does work as well as Tadalafil prescription works too. I can stimulate the penis with no medication too and ejaculate, but I usually have to look at porn (which I do not do often do because I have no libido, whatsoever). I have failed to have sex with three girls now because of lack of desire. I want to physically get it up, but it does not get up. I have ED, and I simply cannot get it up to beautiful women which is horrible.I have slight pain in both testicles which is I think because I have not masturbated. Feels like blue balls which are there when a man gets turned on but does not cum, so it hurts a little. No lumps are there on or in the testicles or anywhere else. No STDs of which I am sure because I had only five partners of which my ex-wife now was for last four years. All were protected sex. All tests came back normal. Only ECG said signs of hypertrophy but compared to ECG three years ago, not with any significant change so I doubt this is a reason. Also, note that the testosterone levels are fine. I usually get my eight hours of sleep but this may be because of sleep apnea. I never feel too rested. ### Response: Hello, Welcome to Chat Doctor forum. Relax and do not worry. ED (erectile dysfunction) can be because of mainly two causes

Hello doctor,I have erectile dysfunction with no apparent cause. Blood test and ECG are fine.I have never had ED. My sex drive is usually not even too much. For the past eight months, my sex drive is non-existent. I also have no morning erections. Factors that play a role are that I broke up with my wife and also eight months ago, I had serious accessory nerve operation that failed to fix my trapezius palsy, but I think these areas are physically too far apart. But maybe depression? I have not been able to think myself to be turned on. I have tried Zinc, Magnesium ZMA vitamin supplements which seemed to help for one week and I got hard morning erections. However, it stopped working. I have also tried Ginseng which does work as well as Tadalafil prescription works too. I can stimulate the penis with no medication too and ejaculate, but I usually have to look at porn (which I do not do often do because I have no libido, whatsoever). I have failed to have sex with three girls now because of lack of desire. I want to physically get it up, but it does not get up. I have ED, and I simply cannot get it up to beautiful women which is horrible.I have slight pain in both testicles which is I think because I have not masturbated. Feels like blue balls which are there when a man gets turned on but does not cum, so it hurts a little. No lumps are there on or in the testicles or anywhere else. No STDs of which I am sure because I had only five partners of which my ex-wife now was for last four years. All were protected sex. All tests came back normal. Only ECG said signs of hypertrophy but compared to ECG three years ago, not with any significant change so I doubt this is a reason. Also, note that the testosterone levels are fine. I usually get my eight hours of sleep but this may be because of sleep apnea. I never feel too rested.

Hello, Welcome to Chat Doctor forum. Relax and do not worry. ED (erectile dysfunction) can be because of mainly two causes

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 19 year old female. I am a virgin, but I masturbate quite a bit. Before, it was around at least once per day but it has been dying down to mainly the weekends. I use a vibrator and it is not actually a vibrator but a small hand-held massager for the back. I use it on my clitoris and use my fingers for stimulation. I started around 9 years of age but then I had a two year period where I stopped completely, but started again around 12 years and have continued from that. When I was 9 years, I broke my hymen I believe, but only when I was 12 years, I started fingering myself. I use two fingers and actually, I have been bleeding from then. It happens even when I am not on or near my period. My nails are not that sharp, but when I finger myself, I bleed most of the time. The bleeding is very light.Just yesterday I started using a dildo and I was fine. I make sure my things are clean before and after I use them. But today after pumping myself with the dildo I felt a weird liquid flow out of me. I know it was not an orgasm because it did not feel like one. But when it flowed out it was like blood. I have no idea of what is going on. Am I making myself infertile? Does my vagina have some sort of disease? Do I have any health risks from this act? ### Response: Hi, Welcome to ChatDoctor. Masturbation does not generally hold a great risk but it does cause some complications. Frequent masturbation causes addiction. The mild bleeding you experience with the use of the vibrator could be due to local injury to the vaginal mucosa following a stimulating contact. This is alarming as time and again doing this could convert it to a chronic injury and cause ulcers, sores, andinfection. The dildo you are newly using can also lead to similar problems. I suggest you use them very occasionally or not use them at all. Keep the vaginal area always ChatDoctor. Each and everytime you pass urine, wash and

Hi doctor,I am a 19 year old female. I am a virgin, but I masturbate quite a bit. Before, it was around at least once per day but it has been dying down to mainly the weekends. I use a vibrator and it is not actually a vibrator but a small hand-held massager for the back. I use it on my clitoris and use my fingers for stimulation. I started around 9 years of age but then I had a two year period where I stopped completely, but started again around 12 years and have continued from that. When I was 9 years, I broke my hymen I believe, but only when I was 12 years, I started fingering myself. I use two fingers and actually, I have been bleeding from then. It happens even when I am not on or near my period. My nails are not that sharp, but when I finger myself, I bleed most of the time. The bleeding is very light.Just yesterday I started using a dildo and I was fine. I make sure my things are clean before and after I use them. But today after pumping myself with the dildo I felt a weird liquid flow out of me. I know it was not an orgasm because it did not feel like one. But when it flowed out it was like blood. I have no idea of what is going on. Am I making myself infertile? Does my vagina have some sort of disease? Do I have any health risks from this act?

Hi, Welcome to ChatDoctor. Masturbation does not generally hold a great risk but it does cause some complications. Frequent masturbation causes addiction. The mild bleeding you experience with the use of the vibrator could be due to local injury to the vaginal mucosa following a stimulating contact. This is alarming as time and again doing this could convert it to a chronic injury and cause ulcers, sores, andinfection. The dildo you are newly using can also lead to similar problems. I suggest you use them very occasionally or not use them at all. Keep the vaginal area always ChatDoctor. Each and everytime you pass urine, wash and

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was taking Fluoxetine and Escitalopram before two years for around nine months and slowly tapered them, and I stopped taking them. Recently I visited a neurologist for nerve pain and burning feet. The neurologist gave me Trigabantin and Nexito forte. For restless leg syndrome and burning feet. I could not take them and stopped taking Trigabantin cold turkey in two days. After stopping Trigabantin, my legs are feeling slight tremors when I am trying to sleep, and also I experienced muscle spasms, and my muscles were not in control of me when I woke up sometimes.I felt like paralyzed when I woke up suddenly from sleep (this happened twice) after which I went to a psychiatrist, and he gave me Panzep ls. Now I am taking Panzep. Also, he prescribed me Nextril 50, Dicorate er 125 mg and Arifine 5 mg, these three I am not taking out of fear. My body is sometimes shaking on own from left to right when I am tensed or worried.I fear I have Parkinson\\s disease. I fear that Trigabantin may have damaged my GABA receptors as well as dopamine receptors. Please advice me what should I do. Also, I am taking 100 mg Thyroxine for thyroid. Is my tremors due to anxiety or Parkinson\\s please help as I am not able to go to work out of fear. Also, why am I not falling asleep usually and waking up gasping for air in between nights? Please advise. ### Response: Hello. Tremors can be a part of EPS (extrapyramidal symptoms) due to medications which can not be predicted by any doctor beforehand, some medicine can manage them, and if the ChatDoctor. You should meet your psychiatrist and have a second opinion, and please do mention the tremors and your concerns beforehand. About Parkinson\\s disease, do you have any family history of Parkinson\\s or any other neurological disorder in your family? Because your tremors have started after the medicine, it is highly likely that it is EPS. But you should meet the same doctor and get a second opinion.

Hello doctor,I was taking Fluoxetine and Escitalopram before two years for around nine months and slowly tapered them, and I stopped taking them. Recently I visited a neurologist for nerve pain and burning feet. The neurologist gave me Trigabantin and Nexito forte. For restless leg syndrome and burning feet. I could not take them and stopped taking Trigabantin cold turkey in two days. After stopping Trigabantin, my legs are feeling slight tremors when I am trying to sleep, and also I experienced muscle spasms, and my muscles were not in control of me when I woke up sometimes.I felt like paralyzed when I woke up suddenly from sleep (this happened twice) after which I went to a psychiatrist, and he gave me Panzep ls. Now I am taking Panzep. Also, he prescribed me Nextril 50, Dicorate er 125 mg and Arifine 5 mg, these three I am not taking out of fear. My body is sometimes shaking on own from left to right when I am tensed or worried.I fear I have Parkinson\\s disease. I fear that Trigabantin may have damaged my GABA receptors as well as dopamine receptors. Please advice me what should I do. Also, I am taking 100 mg Thyroxine for thyroid. Is my tremors due to anxiety or Parkinson\\s please help as I am not able to go to work out of fear. Also, why am I not falling asleep usually and waking up gasping for air in between nights? Please advise.

Hello. Tremors can be a part of EPS (extrapyramidal symptoms) due to medications which can not be predicted by any doctor beforehand, some medicine can manage them, and if the ChatDoctor. You should meet your psychiatrist and have a second opinion, and please do mention the tremors and your concerns beforehand. About Parkinson\\s disease, do you have any family history of Parkinson\\s or any other neurological disorder in your family? Because your tremors have started after the medicine, it is highly likely that it is EPS. But you should meet the same doctor and get a second opinion.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have been with the same partner for 8 years now. During these all 8 years I have had several UTIs with some leading to severe kidney infections. Last week after almost two years of not having a UTI I felt the horrible symptoms again. When going to the doctors UTI urine test came back positive. The doctor prescribed me seven days Nitrofurantoin antibiotics which cleared the pain and seemed gone entirely. Unfortunately two days later, the symptoms came back (please note that I had sex with my partner the day before) with burning sensation when urinating and painful when standing with the need to go toilet every 2 to 3 minutes. I went back to the clinic the same day to get it checked and take more antibiotics.But to my surprise, the urine test came back clear for UTI, and my symptoms disappeared. Then the doctor advised me to get tested for Chlamydia as the symptoms can sometimes be mistaken to be UTI. I have been diagnosed with Chlamydia at the beginning of this same relationship and was treated for it. My partner was also tested, but his results came back negative. Is it possible that the treatment that I had for Chlamydia 8 years ago did not clear it entirely and this lead to several UTIs and kidney infections? And also, would the antibiotics for UTI clear Chlamydia? Thank you in advance for your help. ### Response: Hi, Welcome to Chat Doctor forum. In UTI, initially, a broad-spectrum empirical antibiotic given and then according to urine culture report, a specific antibiotic prescribed. A certain antibiotic like Azithromycin if prescribed for UTI will be effective against chlamydia as well. For chlamydia, Azithromycin is an effective ChatDoctor. If chlamydia infection present recently then some irritation, itching, discharge like complaint present and swab culture can be done for that if needed. Frequent intercourse, pelvic hygiene if not maintained, stone in the urinary tract, diabetes mellitus, etc., are some causative factor for recurrent UTI. Maintain pelvic cleanliness especially after intercourse. Wash and clean the pelvic area immediately after intercourse. Consume fruit juice like cranberry juice more. Wear loose undergarments rather than tight underwear. Take care.

Hi doctor,I have been with the same partner for 8 years now. During these all 8 years I have had several UTIs with some leading to severe kidney infections. Last week after almost two years of not having a UTI I felt the horrible symptoms again. When going to the doctors UTI urine test came back positive. The doctor prescribed me seven days Nitrofurantoin antibiotics which cleared the pain and seemed gone entirely. Unfortunately two days later, the symptoms came back (please note that I had sex with my partner the day before) with burning sensation when urinating and painful when standing with the need to go toilet every 2 to 3 minutes. I went back to the clinic the same day to get it checked and take more antibiotics.But to my surprise, the urine test came back clear for UTI, and my symptoms disappeared. Then the doctor advised me to get tested for Chlamydia as the symptoms can sometimes be mistaken to be UTI. I have been diagnosed with Chlamydia at the beginning of this same relationship and was treated for it. My partner was also tested, but his results came back negative. Is it possible that the treatment that I had for Chlamydia 8 years ago did not clear it entirely and this lead to several UTIs and kidney infections? And also, would the antibiotics for UTI clear Chlamydia? Thank you in advance for your help.

Hi, Welcome to Chat Doctor forum. In UTI, initially, a broad-spectrum empirical antibiotic given and then according to urine culture report, a specific antibiotic prescribed. A certain antibiotic like Azithromycin if prescribed for UTI will be effective against chlamydia as well. For chlamydia, Azithromycin is an effective ChatDoctor. If chlamydia infection present recently then some irritation, itching, discharge like complaint present and swab culture can be done for that if needed. Frequent intercourse, pelvic hygiene if not maintained, stone in the urinary tract, diabetes mellitus, etc., are some causative factor for recurrent UTI. Maintain pelvic cleanliness especially after intercourse. Wash and clean the pelvic area immediately after intercourse. Consume fruit juice like cranberry juice more. Wear loose undergarments rather than tight underwear. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 32 year old man. I have been experiencing panic disorder, OCD symptoms and excessive levels of anxiety. In the last few months, major changes in my life have happened. For instance; quitting my job and moving to another city triggered my anxiety symptoms. I usually feel drowned in fears, health anxiety, fear of losing my mind or becoming delusional, losing my beloved ones, etc. I cannot get rid of those running thoughts. I learn that I have mild Hashimoto\\s and a kind of mild rheumatologic problems. Also, in the last few days, I feel extreme depersonalization. I strongly feel that I am going to lose my mind and this unreal feeling with dizziness accompany with my anxiety.Three months ago, I visited a neurologist and he prescribed Cymbalta for my neuropathic pain like symptoms and high levels of anxiety. One week later, I visited a psychiatrist to confirm if the medicine is right for me. And, according to my history, the psychiatrist decided to stop Cymbalta and we started Risperdal. I think he had been thinking I have something like borderline disorder. Then, we gradually changed the treatment. I think the psychiatrist thought the responsibility of my anxiety is Duloxetine, however, he could not understand I was more anxious before it. One month, when I took both Cymbalta (30 mg) and Risperdal (0.5 mg to 1 mg) was one of the most peaceful periods of my life. But, the following month I stopped using Cymbalta and my horrible thoughts came back, they are much stronger than before. Nowadays, I am on 1.25 mg Risperdal. Also, I have been on Fluvoxamine for two years for my panic attacks around 15 years ago. Please help me. ### Response: Hi. Thank you for describing your query in detail. Please write back with these details so that we can have a better picture. Meanwhile, I have these thoughts about what you have described in the query. Irrational beliefs. Rational emotive or cognitive behavior therapy. Revert back with more details to a psychiatrist online.-

Hi doctor,I am a 32 year old man. I have been experiencing panic disorder, OCD symptoms and excessive levels of anxiety. In the last few months, major changes in my life have happened. For instance; quitting my job and moving to another city triggered my anxiety symptoms. I usually feel drowned in fears, health anxiety, fear of losing my mind or becoming delusional, losing my beloved ones, etc. I cannot get rid of those running thoughts. I learn that I have mild Hashimoto\\s and a kind of mild rheumatologic problems. Also, in the last few days, I feel extreme depersonalization. I strongly feel that I am going to lose my mind and this unreal feeling with dizziness accompany with my anxiety.Three months ago, I visited a neurologist and he prescribed Cymbalta for my neuropathic pain like symptoms and high levels of anxiety. One week later, I visited a psychiatrist to confirm if the medicine is right for me. And, according to my history, the psychiatrist decided to stop Cymbalta and we started Risperdal. I think he had been thinking I have something like borderline disorder. Then, we gradually changed the treatment. I think the psychiatrist thought the responsibility of my anxiety is Duloxetine, however, he could not understand I was more anxious before it. One month, when I took both Cymbalta (30 mg) and Risperdal (0.5 mg to 1 mg) was one of the most peaceful periods of my life. But, the following month I stopped using Cymbalta and my horrible thoughts came back, they are much stronger than before. Nowadays, I am on 1.25 mg Risperdal. Also, I have been on Fluvoxamine for two years for my panic attacks around 15 years ago. Please help me.

Hi. Thank you for describing your query in detail. Please write back with these details so that we can have a better picture. Meanwhile, I have these thoughts about what you have described in the query. Irrational beliefs. Rational emotive or cognitive behavior therapy. Revert back with more details to a psychiatrist online.-

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 27 year old lady. I started having a sore throat two months back. I just thought it was a flu coming. But then, when I noticed that it had been on for two weeks, I decided to take Amoxicillin. I took it but did not finish the course on the last day. I had traveled and forgotten them at home. The sore throat went away but came back a few days later. I took another full course of Amoxicillin and during the course, the sore throat went away. I finished the full course but a few days later, the sore throat came back again. I went to the clinic and the nurse noticed that my throat was inflamed and prescribed Erythromycin. I took it but the sore throat kept on coming back. The nurse then prescribed Ciprofloxacin. I took the full course but still the sore throat did not go away. When I went back to the clinic, the nurse said it was no longer inflamed but I could feel it, but only that the discomfort seemed to be going deep down the throat. It is like each day I can feel it is moving down. It is not a very painful sore throat. I do not take any painkillers. My body temperature and blood pressure are normal and have been normal throughout the period. Right now, I can feel discomfort in my upper part of the chest. Another thing is that the first episode of sore throat occured after I visited my sister who from time to time gets swollen glands (below the ear). What could it be and how can I get well again? ### Response: Hello, Welcome to Chat Doctor forum. I have gone through your complaints. Repeated attacks of a low-grade sore throat suggest that it could be chronic pharyngitis. The other common causes of chronic sore throat are due to acidity and gastroesophageal reflux. That means stomach acids pop into esophagus silently and burn the throat in the nights. You should undergo upper GI esophagoscopy and a throat swab to rule out infection. Try taking antacids for a week. Do not take antibiotics. I think this would suffice. For more information consult an ENT otolaryngologist online

Hello doctor,I am a 27 year old lady. I started having a sore throat two months back. I just thought it was a flu coming. But then, when I noticed that it had been on for two weeks, I decided to take Amoxicillin. I took it but did not finish the course on the last day. I had traveled and forgotten them at home. The sore throat went away but came back a few days later. I took another full course of Amoxicillin and during the course, the sore throat went away. I finished the full course but a few days later, the sore throat came back again. I went to the clinic and the nurse noticed that my throat was inflamed and prescribed Erythromycin. I took it but the sore throat kept on coming back. The nurse then prescribed Ciprofloxacin. I took the full course but still the sore throat did not go away. When I went back to the clinic, the nurse said it was no longer inflamed but I could feel it, but only that the discomfort seemed to be going deep down the throat. It is like each day I can feel it is moving down. It is not a very painful sore throat. I do not take any painkillers. My body temperature and blood pressure are normal and have been normal throughout the period. Right now, I can feel discomfort in my upper part of the chest. Another thing is that the first episode of sore throat occured after I visited my sister who from time to time gets swollen glands (below the ear). What could it be and how can I get well again?

Hello, Welcome to Chat Doctor forum. I have gone through your complaints. Repeated attacks of a low-grade sore throat suggest that it could be chronic pharyngitis. The other common causes of chronic sore throat are due to acidity and gastroesophageal reflux. That means stomach acids pop into esophagus silently and burn the throat in the nights. You should undergo upper GI esophagoscopy and a throat swab to rule out infection. Try taking antacids for a week. Do not take antibiotics. I think this would suffice. For more information consult an ENT otolaryngologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor, I was diagnosed with dengue towards the end of last month. I was hospitalized for five days. I went through a lot during that period and since coming out of the hospital, I have developed this phobia that I might have dengue again because my area is dengue prone with lots of mosquitoes. Whenever a mosquito bites me, I get filled with this fear that I might have dengue again.When I went to my doctor with this fear, he told me dengue does not happen twice in the same season, it can happen again in the next season, but it cannot happen again this season.I want to ask if this is true? If it is true, then what is the logic behind that? Can you please explain? I am immensely afraid of the disease. ### Response: Hello, Welcome to Chat Doctor forum. The fact that dengue cannot happen in the same season is true to some extent but not absolutely. Let me explain. Dengue is a viral infection caused by the bite of infected ades aegypti mosquito. Every mosquito bite will not lead to dengue fever as for infection to happen. First, the mosquito should be infected by the dengue virus (DEV). By infection of the mosquito I mean, the mosquito just serves as a vector or carrier for virus transfer to humans. Also, every mosquito carrying the dengue virus would not lead to dengue fever, shock, etc. Some people just have subclinical, asymptomatic infections too. There are actually four types of dengue viruses numbered from 1 to 4. Infection with one type, followed by recovery confers immunity to that type of infection. Our body produces antibodies against the virus and protects us from further infection, with time these antibodies fade away. So immunity in DEV is present but is short-lived. It can be said that the infection cannot occur in the same season, but if an infection with another type say (DEV type 1 followed by DEV type 2) occurs, the body does not have antibodies which are protective against type 2, as the body was previously infected by DEV type 1. This type of infection is more dangerous. However, in a season only one type of DEV infection occurs usually. I hope this helps.

Hi doctor, I was diagnosed with dengue towards the end of last month. I was hospitalized for five days. I went through a lot during that period and since coming out of the hospital, I have developed this phobia that I might have dengue again because my area is dengue prone with lots of mosquitoes. Whenever a mosquito bites me, I get filled with this fear that I might have dengue again.When I went to my doctor with this fear, he told me dengue does not happen twice in the same season, it can happen again in the next season, but it cannot happen again this season.I want to ask if this is true? If it is true, then what is the logic behind that? Can you please explain? I am immensely afraid of the disease.

Hello, Welcome to Chat Doctor forum. The fact that dengue cannot happen in the same season is true to some extent but not absolutely. Let me explain. Dengue is a viral infection caused by the bite of infected ades aegypti mosquito. Every mosquito bite will not lead to dengue fever as for infection to happen. First, the mosquito should be infected by the dengue virus (DEV). By infection of the mosquito I mean, the mosquito just serves as a vector or carrier for virus transfer to humans. Also, every mosquito carrying the dengue virus would not lead to dengue fever, shock, etc. Some people just have subclinical, asymptomatic infections too. There are actually four types of dengue viruses numbered from 1 to 4. Infection with one type, followed by recovery confers immunity to that type of infection. Our body produces antibodies against the virus and protects us from further infection, with time these antibodies fade away. So immunity in DEV is present but is short-lived. It can be said that the infection cannot occur in the same season, but if an infection with another type say (DEV type 1 followed by DEV type 2) occurs, the body does not have antibodies which are protective against type 2, as the body was previously infected by DEV type 1. This type of infection is more dangerous. However, in a season only one type of DEV infection occurs usually. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Is HIV RNA, QL TMA accurate after 20 to 21 days of exposure? And also this came with my results. RNA is not detected. No laboratory evidence of HIV infection. The HIV-1 RNA qualitative TMA assay is recommended for use as part of a multi-test HIV-1/HIV-2 screening and diagnostic algorithm. This assay can also be used to resolve indeterminate HIV-1 antibody assay results, and to test for HIV-1 infection in patients less than 2 years old. When a fourth generation HIV multi-test screening and diagnostic algorithm is used, if the test results include a repeatedly reactive HIV-1/2 antigen/antibody (fourth generation) screen, followed by negative confirmatory tests for HIV-1 and 2 antibodies and HIV-1 RNA by TMA, the most likely interpretation is a non-specific (biological false positive) reaction in the fourth generation screening assay. There is no current laboratory evidence of HIV infection. Repeat testing on a second specimen is not generally indicated but may be appropriate if there are known risk factors for recent HIV exposure. If the recent HIV-2 infection is suspected, additional testing by HIV-2 DNA or RNA, qualitative, real-time PCR should also be considered. Can someone explain this to me? ### Response: Hi. HIV RNA PCR test is accurate after 9 to 13 days after the risk exposure. It can be used to detect early infection with HIV when most other screening tests are not yet reliable. However, it is not a confirmatory test and an early screening with RNA PCR should be followed by a more sensitive and specific screening test, this is the fourth generation antigen-antibody HIV screening test at four weeks and at 12 weeks. Therefore, RNA PCR is quite useful in the detection of early infection. Other times this test can be useful as a second test after an indeterminate fourth generation HIV screening test or when a positive HIV screening test is followed by a negative confirmatory test (usually a western blot). In the second scenario, if RNA PCR turns up as negative then it suggests that an earlier positive screening test was most likely a false positive.

Hello doctor,Is HIV RNA, QL TMA accurate after 20 to 21 days of exposure? And also this came with my results. RNA is not detected. No laboratory evidence of HIV infection. The HIV-1 RNA qualitative TMA assay is recommended for use as part of a multi-test HIV-1/HIV-2 screening and diagnostic algorithm. This assay can also be used to resolve indeterminate HIV-1 antibody assay results, and to test for HIV-1 infection in patients less than 2 years old. When a fourth generation HIV multi-test screening and diagnostic algorithm is used, if the test results include a repeatedly reactive HIV-1/2 antigen/antibody (fourth generation) screen, followed by negative confirmatory tests for HIV-1 and 2 antibodies and HIV-1 RNA by TMA, the most likely interpretation is a non-specific (biological false positive) reaction in the fourth generation screening assay. There is no current laboratory evidence of HIV infection. Repeat testing on a second specimen is not generally indicated but may be appropriate if there are known risk factors for recent HIV exposure. If the recent HIV-2 infection is suspected, additional testing by HIV-2 DNA or RNA, qualitative, real-time PCR should also be considered. Can someone explain this to me?

Hi. HIV RNA PCR test is accurate after 9 to 13 days after the risk exposure. It can be used to detect early infection with HIV when most other screening tests are not yet reliable. However, it is not a confirmatory test and an early screening with RNA PCR should be followed by a more sensitive and specific screening test, this is the fourth generation antigen-antibody HIV screening test at four weeks and at 12 weeks. Therefore, RNA PCR is quite useful in the detection of early infection. Other times this test can be useful as a second test after an indeterminate fourth generation HIV screening test or when a positive HIV screening test is followed by a negative confirmatory test (usually a western blot). In the second scenario, if RNA PCR turns up as negative then it suggests that an earlier positive screening test was most likely a false positive.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have a long, complicated cardiac history and currently seeing a cardiologist. It started with chest pains, and I ended up having an episode of NSVT last year. I am now on Bisoprolol and Amlodipine. The cardiologist thinks my condition is coronary artery spasm and just an ectopic focus causing the NSVT. I have had a normal CT angiogram with no luminal narrowing and no signs of any blockages or atherosclerotic changes, and a negative stress echo. I have had a normal echo after the NSVT with everything normal and a cardiac MRI. The MRI showed a very mild dilation of left and right ventricle (the cardiologist looked up studies and said mine is not dilated and it falls within the normal range for my age).I had a normal echo just taken yesterday, which showed no dilation ventricle with normal wall thickness, size, and normal function with 66 % EF. The only finding at all on the echo was a mild tri-leaflet aortic valve, normal cusp excursion, and no regurgitation. I also noticed that every time I am stressed or anxious, my T waves in leads III and AVF on ECG flip. As my other echo did not mention this sclerosis of the aortic valve, has this always been here and because of my NSVT does this put me at risk of an SCD? Also, is it likely for me to have blockages in my arteries now even after a clear CT angiogram less than a year ago?Since the one episode of NSVT, it has not happened again although I have had on Holter, premature atrial, junctional ectopics, and ventricular trigeminy, all of which are very infrequent. One episode of trigeminy with emotional stress on three-day Holter. Total ectopic beats in 24 hour period less than 30. I am a 31 year old male, who does not smoke and. All the best. ### Response: Hi, Welcome to Chat Doctor forum. An excellent narrative history. I think you had only one episode of tachycardia of ventricular origin, which was nonsustained. For more information consult a cardiologist online

Hello doctor,I have a long, complicated cardiac history and currently seeing a cardiologist. It started with chest pains, and I ended up having an episode of NSVT last year. I am now on Bisoprolol and Amlodipine. The cardiologist thinks my condition is coronary artery spasm and just an ectopic focus causing the NSVT. I have had a normal CT angiogram with no luminal narrowing and no signs of any blockages or atherosclerotic changes, and a negative stress echo. I have had a normal echo after the NSVT with everything normal and a cardiac MRI. The MRI showed a very mild dilation of left and right ventricle (the cardiologist looked up studies and said mine is not dilated and it falls within the normal range for my age).I had a normal echo just taken yesterday, which showed no dilation ventricle with normal wall thickness, size, and normal function with 66 % EF. The only finding at all on the echo was a mild tri-leaflet aortic valve, normal cusp excursion, and no regurgitation. I also noticed that every time I am stressed or anxious, my T waves in leads III and AVF on ECG flip. As my other echo did not mention this sclerosis of the aortic valve, has this always been here and because of my NSVT does this put me at risk of an SCD? Also, is it likely for me to have blockages in my arteries now even after a clear CT angiogram less than a year ago?Since the one episode of NSVT, it has not happened again although I have had on Holter, premature atrial, junctional ectopics, and ventricular trigeminy, all of which are very infrequent. One episode of trigeminy with emotional stress on three-day Holter. Total ectopic beats in 24 hour period less than 30. I am a 31 year old male, who does not smoke and. All the best.

Hi, Welcome to Chat Doctor forum. An excellent narrative history. I think you had only one episode of tachycardia of ventricular origin, which was nonsustained. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had a root canal five months back and it has caused a lot of problems. The root canal left a gap between the molar and the tooth beside it. Food got stuck inside and it was causing pain. I came back and she said it was the tooth next to my root canal which was causing the gap. Now that tooth had a filling in it so she offered to redo it so the gap would disappear. After the new filling, the gap was still there so she put some kind of hardening fluid in between the gap and told me not to floss on that tooth. A few weeks later and the gap is back and now my tooth with redone filling is very sensitive. I am starting to feel like this is a lost cause and I do not know where to go from here. ### Response: Hi, Welcome to Chat Doctor forum. Your case has become a bit complicated. It would have not gone this bad if the filling of the adjacent tooth would have been done before taking size for the cap, then the gap would have adjusted and you would not be having any food sticking complaint. But do not worry, there is an end to every pain and suffering. You might have to go for these stages of treatment now. First of all, an X-ray of the adjacent tooth that is feeling sensitive should be taken and assessed. The following could be the treatment options you could have. If there is some internal carious activity detected that is causing sensitivity and has not touched the pulp or root of the tooth, then again you have to go for deep filling with some regenerative ChatDoctor. If there is some carious activity that has touched the pulp of tooth then you would be going for root canal treatment and capping as done before. Then cap will be placed and it will fix your gap. You can have an option of capping at sensitive tooth after deep filling if caries has not reached pulp. Cap size will be adjusted to fill the gap and you will be relieved. It would be great if you can provide me with some of your clinical pictures of teeth and X-ray of both RCT treated and sensitive tooth. Then I could suggest better which option will suit you.

Hello doctor,I had a root canal five months back and it has caused a lot of problems. The root canal left a gap between the molar and the tooth beside it. Food got stuck inside and it was causing pain. I came back and she said it was the tooth next to my root canal which was causing the gap. Now that tooth had a filling in it so she offered to redo it so the gap would disappear. After the new filling, the gap was still there so she put some kind of hardening fluid in between the gap and told me not to floss on that tooth. A few weeks later and the gap is back and now my tooth with redone filling is very sensitive. I am starting to feel like this is a lost cause and I do not know where to go from here.

Hi, Welcome to Chat Doctor forum. Your case has become a bit complicated. It would have not gone this bad if the filling of the adjacent tooth would have been done before taking size for the cap, then the gap would have adjusted and you would not be having any food sticking complaint. But do not worry, there is an end to every pain and suffering. You might have to go for these stages of treatment now. First of all, an X-ray of the adjacent tooth that is feeling sensitive should be taken and assessed. The following could be the treatment options you could have. If there is some internal carious activity detected that is causing sensitivity and has not touched the pulp or root of the tooth, then again you have to go for deep filling with some regenerative ChatDoctor. If there is some carious activity that has touched the pulp of tooth then you would be going for root canal treatment and capping as done before. Then cap will be placed and it will fix your gap. You can have an option of capping at sensitive tooth after deep filling if caries has not reached pulp. Cap size will be adjusted to fill the gap and you will be relieved. It would be great if you can provide me with some of your clinical pictures of teeth and X-ray of both RCT treated and sensitive tooth. Then I could suggest better which option will suit you.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have just finished six rounds of chemotherapy for breast cancer treatment. Before starting, I was diagnosed with folate deficiency and prescribed six months of folic acid tablets. However, my oncologist was not happy with me taking it during chemotherapy so I had to stop after one month. I have now finished chemotherapy and I still have a very sore red tongue and no texture to my tongue or roof of the mouth. I cannot use any toothpaste or eat anything with any strong flavor without an extremely sore tongue. I also have fatigue, shortness of breath, resting heart rate of 90 to 100 and also have angular cheilitis.I asked my general physician to re-test my hematinics. Now I have finished chemotherapy three weeks ago as I am keen to start taking supplements to help my body recover and because I am symptomatic of a deficiency of folate and/or B12?Bizarrely, my results say my folate is now 6, hemoglobin is pretty good at 11 but my B12 is 2000. How can this be? It was 500 when they tested me some months ago and told me I had low folate level. I was symptomatic with sore red tongue and loss of texture with tongue sensation. My GP does not understand and is going to ask my oncologist. I am not sure it is his area and I do not want to be fobbed off without it being properly investigated. Do you have any idea what might cause this?I have started FEC chemo four months back and had four rounds of Docetaxel. I was on Fragmin, Rivaroxaban until for PE prevention of recurrence but had to go on to Fragmin during chemo. ### Response: Hello. The folic acid tablets that you had taken for a month helped to raise your folate levels from 4 to 6. The high level of vitamin B12 can only be explained if you were given a single megadose of vitamin as an intramuscular injection during your chemotherapy. Folate levels of 6 are still low and are responsible for angular stomatitis and sore tongue. For more information consult a hematologist online

Hello doctor,I have just finished six rounds of chemotherapy for breast cancer treatment. Before starting, I was diagnosed with folate deficiency and prescribed six months of folic acid tablets. However, my oncologist was not happy with me taking it during chemotherapy so I had to stop after one month. I have now finished chemotherapy and I still have a very sore red tongue and no texture to my tongue or roof of the mouth. I cannot use any toothpaste or eat anything with any strong flavor without an extremely sore tongue. I also have fatigue, shortness of breath, resting heart rate of 90 to 100 and also have angular cheilitis.I asked my general physician to re-test my hematinics. Now I have finished chemotherapy three weeks ago as I am keen to start taking supplements to help my body recover and because I am symptomatic of a deficiency of folate and/or B12?Bizarrely, my results say my folate is now 6, hemoglobin is pretty good at 11 but my B12 is 2000. How can this be? It was 500 when they tested me some months ago and told me I had low folate level. I was symptomatic with sore red tongue and loss of texture with tongue sensation. My GP does not understand and is going to ask my oncologist. I am not sure it is his area and I do not want to be fobbed off without it being properly investigated. Do you have any idea what might cause this?I have started FEC chemo four months back and had four rounds of Docetaxel. I was on Fragmin, Rivaroxaban until for PE prevention of recurrence but had to go on to Fragmin during chemo.

Hello. The folic acid tablets that you had taken for a month helped to raise your folate levels from 4 to 6. The high level of vitamin B12 can only be explained if you were given a single megadose of vitamin as an intramuscular injection during your chemotherapy. Folate levels of 6 are still low and are responsible for angular stomatitis and sore tongue. For more information consult a hematologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have had mild acne for years and it seems to be under control now with an occasional break out here and there, mainly just trying to fix scarring. I am a 26-year-old male. Currently, I am using the Menscience brand facial wash, Mirco scrub, and rosewater toner. I lie to keep things simple. I just started the facial wash and scrub about a couple weeks ago, alternating between the two so that I do not over exfoliate, and it has been good to me. No breakouts or irritation and I can tell slightly that my complexion is better. I also try to do some organic and natural remedies on occasion, like turmeric powder face masks to lighten the dark areas.I was intrigued by the menscience products due to the glycolic ingredient in them as well as salicylic acid. I have researched that these are good ingredients to slough away dead skin cells so I can fade these scars.Now for the big issue, my face looks pretty decent in natural lighting or inside the house but as soon as I step into direct sunlight, I look horrible. It is a complete change from what I see in my mirror at home and I am wondering if I need to add more glycolic products to my regime or what.I see other\\s face and direct sunlight does not show imperfections like it does mine. It makes my face look 10 times worse and I do not know what to do. I do not want to just avoid sunlight to fix my paranoia, I want to fix the problem for good.I get regular microdermabrasion treatments monthly in conjunction with my current products that have the glycolic acid. Do I just need to give these new washes more time to slough away the scars and smooth it out or should I incorporate a glycolic pad to speed up the process? ### Response: Hi. I am glad you asked this. Could you also upload a photo of your face both indoors as well as in natural daylight? I need to have a close-up view to pinpoint the diagnosis and suggest a remedy. I appreciate your concern. For more information consult a dermatologist online Take care.

Hello doctor,I have had mild acne for years and it seems to be under control now with an occasional break out here and there, mainly just trying to fix scarring. I am a 26-year-old male. Currently, I am using the Menscience brand facial wash, Mirco scrub, and rosewater toner. I lie to keep things simple. I just started the facial wash and scrub about a couple weeks ago, alternating between the two so that I do not over exfoliate, and it has been good to me. No breakouts or irritation and I can tell slightly that my complexion is better. I also try to do some organic and natural remedies on occasion, like turmeric powder face masks to lighten the dark areas.I was intrigued by the menscience products due to the glycolic ingredient in them as well as salicylic acid. I have researched that these are good ingredients to slough away dead skin cells so I can fade these scars.Now for the big issue, my face looks pretty decent in natural lighting or inside the house but as soon as I step into direct sunlight, I look horrible. It is a complete change from what I see in my mirror at home and I am wondering if I need to add more glycolic products to my regime or what.I see other\\s face and direct sunlight does not show imperfections like it does mine. It makes my face look 10 times worse and I do not know what to do. I do not want to just avoid sunlight to fix my paranoia, I want to fix the problem for good.I get regular microdermabrasion treatments monthly in conjunction with my current products that have the glycolic acid. Do I just need to give these new washes more time to slough away the scars and smooth it out or should I incorporate a glycolic pad to speed up the process?

Hi. I am glad you asked this. Could you also upload a photo of your face both indoors as well as in natural daylight? I need to have a close-up view to pinpoint the diagnosis and suggest a remedy. I appreciate your concern. For more information consult a dermatologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 24 year old male, suffering from ED since the last one and a half years. I have gone through penile doppler thrice. The test which I took one year ago showed the PSV after 20 minutes as 38 cm/s, the EDV as 0 and the inner caversonal diameter was .15 mm and after the injection it was .70 mm. After the doctor had seen the reports, he advised me to take Tadalafil 10 mg and to masturbate after taking it. While masturbating, on the third day, I got pain in my penis, and it was in the middle of the shaft of the penis at the thumb point. I visited the doctor again, and he prescribed Polycovit, Mynubin-P, Zanocin 300, Trental 400 mg and I also masturbated four times a week. But still, the pain continued. So, I went through the test again eight months back.The value of PSV was 25 cm/s and EDV was 0, but the inner caversonal diameter changed to .44 mm pre-injection and after. The third time I underwent the test again. The values were normal at 25 cm/s, and EDV at 0, and the inner diameter was .6 mm and after injection at 1.2 mm. I still have the pain in the penis at the same point. It has now been a year since the pain has started. There is no bending during erection, but there is a deformation in the penis like an hourglass shape and hard flaccid. Now, I masturbate only once a week. Is the 25 cm/s good or does it mean an arterial insufficiency? Does Peyronie\\s disease obstruct the blood flow in the penile doppler? I have no diabetes, no cholesterol, and I am not a smoker. I want to know why the flow is less. ### Response: Hello, Welcome to Chat Doctor forum. I can understand your concern. If we consider the results of the Doppler

Hello doctor,I am a 24 year old male, suffering from ED since the last one and a half years. I have gone through penile doppler thrice. The test which I took one year ago showed the PSV after 20 minutes as 38 cm/s, the EDV as 0 and the inner caversonal diameter was .15 mm and after the injection it was .70 mm. After the doctor had seen the reports, he advised me to take Tadalafil 10 mg and to masturbate after taking it. While masturbating, on the third day, I got pain in my penis, and it was in the middle of the shaft of the penis at the thumb point. I visited the doctor again, and he prescribed Polycovit, Mynubin-P, Zanocin 300, Trental 400 mg and I also masturbated four times a week. But still, the pain continued. So, I went through the test again eight months back.The value of PSV was 25 cm/s and EDV was 0, but the inner caversonal diameter changed to .44 mm pre-injection and after. The third time I underwent the test again. The values were normal at 25 cm/s, and EDV at 0, and the inner diameter was .6 mm and after injection at 1.2 mm. I still have the pain in the penis at the same point. It has now been a year since the pain has started. There is no bending during erection, but there is a deformation in the penis like an hourglass shape and hard flaccid. Now, I masturbate only once a week. Is the 25 cm/s good or does it mean an arterial insufficiency? Does Peyronie\\s disease obstruct the blood flow in the penile doppler? I have no diabetes, no cholesterol, and I am not a smoker. I want to know why the flow is less.

Hello, Welcome to Chat Doctor forum. I can understand your concern. If we consider the results of the Doppler

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 25-year-old female with no children. My husband and I have been together for six years. We have no extra-marital affairs and I am 100 % sure of that. My right labia is swollen and is very painful to touch, even a slight breeze of air causes extreme pain. The pain is similar to a sunburn. It is painful enough to make me cry. The swelling starts from my right vulva next to my vaginal canal and goes all the way to my anus. The area with the worst pain is next to my perineum. This started as a painless lump in the size of a peanut that could be palpated from within my vagina with a finger but not visible externally. This was about a week ago. Now, it is huge and painful.My labia is three times larger than its normal size and very red. There are no discharges, no foul smells, and it is not itchy. I am managing the pain with Clobetasol topical cream and Mefenamic Acid orally. The pain disappears instantly with the cream but I think it is also making the swelling bigger (steroid?). I am on my third day of Co-Amoxiclav 625 mg (twice a day every 12 hours) but I think this is what caused the swelling in the first place. Also, I tried to do a sitz bath and it only made the condition worse. Just a few hours ago, I had trouble breathing (allergy?). I have never been allergic to any medication before. Any impression or advice would be appreciated. ### Response: Hi. From the symptoms you described, it sounded like you developed Bartholin gland abscess which is an occlusion of the Bartholin gland duct and that turned to be abscess. Steroid cream is not used for treatment. You need to finish the antibiotic and continue a warm sitz bath three times a day. The abscess will get soft and ChatDoctor. If you had this previously and have the abscess at the same location, it would be better to have a procedure called marsupialization. You can continue Motrin for pain.

Hello doctor,I am a 25-year-old female with no children. My husband and I have been together for six years. We have no extra-marital affairs and I am 100 % sure of that. My right labia is swollen and is very painful to touch, even a slight breeze of air causes extreme pain. The pain is similar to a sunburn. It is painful enough to make me cry. The swelling starts from my right vulva next to my vaginal canal and goes all the way to my anus. The area with the worst pain is next to my perineum. This started as a painless lump in the size of a peanut that could be palpated from within my vagina with a finger but not visible externally. This was about a week ago. Now, it is huge and painful.My labia is three times larger than its normal size and very red. There are no discharges, no foul smells, and it is not itchy. I am managing the pain with Clobetasol topical cream and Mefenamic Acid orally. The pain disappears instantly with the cream but I think it is also making the swelling bigger (steroid?). I am on my third day of Co-Amoxiclav 625 mg (twice a day every 12 hours) but I think this is what caused the swelling in the first place. Also, I tried to do a sitz bath and it only made the condition worse. Just a few hours ago, I had trouble breathing (allergy?). I have never been allergic to any medication before. Any impression or advice would be appreciated.

Hi. From the symptoms you described, it sounded like you developed Bartholin gland abscess which is an occlusion of the Bartholin gland duct and that turned to be abscess. Steroid cream is not used for treatment. You need to finish the antibiotic and continue a warm sitz bath three times a day. The abscess will get soft and ChatDoctor. If you had this previously and have the abscess at the same location, it would be better to have a procedure called marsupialization. You can continue Motrin for pain.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 34 years old male. I am married. My weight is 85 kilograms, and the height is 5 feet. My resting BP is 130/80 mmHg, and pulse is 80 beats per minute. I do not have any tension at my home or the office, and I am very relaxed. I am suffering from left side chest pain along with upper back pain (left side only) with left shoulder and sometimes with left-hand pain. When I bend my head forwards, I feel tightness and pain in the upper body and left shoulder backside.I have light-headedness, fatigue, and feel drowsy all over the day while sitting or standing. I have the pain on the left side for about three years. I underwent almost all tests, and all are normal. But the pain persists. I underwent heart tests including CT angiography and MRI brain. All are normal. I am attaching my X-ray of cervical spine and ECG which I underwent two days back. Kindly suggest how to reduce my pain. ### Response: Hi. I have gone through your reports (attachment removed to protect patient identity). Your ECG is fine, and from the description of pain and test you underwent, it is a cervical pain. In the cervical X-ray, there is a straightening of the spine which is the cause for your pain. You should undergo further test like MRI (magnetic resonance imaging) of the cervical spine for the confirmation of diagnosis and the extent of disease. Also, vitamin D test should be done. You need neck physiotherapy, including traction and cervical belt which is better starting after MRI. Also, you should use local Diclofenac gel for the pain relief. Hot water fomentation can be done. Also, you need to take tablet Pregaba M 75 mg (Pregabalin with Mecobalamin) at bedtime, which is a nerve stabilizer and they help in symptoms control. Also, take tablet Flexon MR (Chlorzoxazone with Ibuprofen and Paracetamol) whenever needed up to two times a day for the pain relief. You should visit an Orthopedician to get relieved.

Hi doctor,I am 34 years old male. I am married. My weight is 85 kilograms, and the height is 5 feet. My resting BP is 130/80 mmHg, and pulse is 80 beats per minute. I do not have any tension at my home or the office, and I am very relaxed. I am suffering from left side chest pain along with upper back pain (left side only) with left shoulder and sometimes with left-hand pain. When I bend my head forwards, I feel tightness and pain in the upper body and left shoulder backside.I have light-headedness, fatigue, and feel drowsy all over the day while sitting or standing. I have the pain on the left side for about three years. I underwent almost all tests, and all are normal. But the pain persists. I underwent heart tests including CT angiography and MRI brain. All are normal. I am attaching my X-ray of cervical spine and ECG which I underwent two days back. Kindly suggest how to reduce my pain.

Hi. I have gone through your reports (attachment removed to protect patient identity). Your ECG is fine, and from the description of pain and test you underwent, it is a cervical pain. In the cervical X-ray, there is a straightening of the spine which is the cause for your pain. You should undergo further test like MRI (magnetic resonance imaging) of the cervical spine for the confirmation of diagnosis and the extent of disease. Also, vitamin D test should be done. You need neck physiotherapy, including traction and cervical belt which is better starting after MRI. Also, you should use local Diclofenac gel for the pain relief. Hot water fomentation can be done. Also, you need to take tablet Pregaba M 75 mg (Pregabalin with Mecobalamin) at bedtime, which is a nerve stabilizer and they help in symptoms control. Also, take tablet Flexon MR (Chlorzoxazone with Ibuprofen and Paracetamol) whenever needed up to two times a day for the pain relief. You should visit an Orthopedician to get relieved.

### Instruction: Answer this question truthfully ###Input: Hello doctor, About six months ago, I developed pain in my lower back mainly in my waistline towards the right side. I visited a doctor and we tried PT but it did not work. I then scheduled an appointment with a chiropractor, however, it was canceled dude to COVID-19. A couple of days ago, I was lifting at the gym and everything was going fine. I started noticing the left side of my back waistline beginning to hurt so I went home. Since then, the pain has worsened a lot. It is a sharp shooting pain that will extend from my waistline into my buttocks. I can barely sleep at night because when I try to turn over the pain is too extreme. I feel it a lot when walking as well, or trying to stand up if I am sitting down. Also, lying on my back causes the area to ache really bad. The pain is at its worse when I need to roll over in bed or when I stand up from being in a lying position, even if I was lying or lounging for a minute or less. I am a 23-year-old male in the military. The initial back pain that started months ago was found to be caused by wearing my sidearm at work for 9-13 hours a day and additional gear such as body armor. However, this new pain is something different. Please help. ### Response: Hello, Welcome to Chat Doctor forum. You will need some investigations to confirm the cause. However, the likely possibility is lumbar spondylosis with nerve compressions. Most importantly, you should avoid heavy activities, lifting heavy weights, etc. You will need an x-ray of spine AP (anteroposterior) and lateral view and may need an MRI (magnetic resonance imaging). Physiotherapy would be helpful. You may continue to have Aleve (Naproxen) according to need. You may use local Diclofenac gel or hot water fomentation. We usually give patients a multivitamin like Neurobion forte (B12) which is good for nerves and next in the line is Pregabalin which is a nerve stabilizer. I hope this helps.

Hello doctor, About six months ago, I developed pain in my lower back mainly in my waistline towards the right side. I visited a doctor and we tried PT but it did not work. I then scheduled an appointment with a chiropractor, however, it was canceled dude to COVID-19. A couple of days ago, I was lifting at the gym and everything was going fine. I started noticing the left side of my back waistline beginning to hurt so I went home. Since then, the pain has worsened a lot. It is a sharp shooting pain that will extend from my waistline into my buttocks. I can barely sleep at night because when I try to turn over the pain is too extreme. I feel it a lot when walking as well, or trying to stand up if I am sitting down. Also, lying on my back causes the area to ache really bad. The pain is at its worse when I need to roll over in bed or when I stand up from being in a lying position, even if I was lying or lounging for a minute or less. I am a 23-year-old male in the military. The initial back pain that started months ago was found to be caused by wearing my sidearm at work for 9-13 hours a day and additional gear such as body armor. However, this new pain is something different. Please help.

Hello, Welcome to Chat Doctor forum. You will need some investigations to confirm the cause. However, the likely possibility is lumbar spondylosis with nerve compressions. Most importantly, you should avoid heavy activities, lifting heavy weights, etc. You will need an x-ray of spine AP (anteroposterior) and lateral view and may need an MRI (magnetic resonance imaging). Physiotherapy would be helpful. You may continue to have Aleve (Naproxen) according to need. You may use local Diclofenac gel or hot water fomentation. We usually give patients a multivitamin like Neurobion forte (B12) which is good for nerves and next in the line is Pregabalin which is a nerve stabilizer. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I apologize for the long message, but I am a concerned mom. I have two sons (ages 3 and 5) and both of them and I have been experiencing chronic sinus or ear issues for the past several months. Their pediatrician has referred us to ENT since she does not know what it is. Both boys (and myself) have inflamed nasal swellings that block the nasal passages. We all have deviated septums. My 3-year-old has dog and cat allergy and is prescribed Nasocort and Zyrtec daily which are ineffective. The 5-year-old tested negative for all allergies. We use top line air purifiers throughout the house but are still experiencing severe symptoms. The boys had tonsillectomies, adenoidectomies tubes last year due to scale 4 with obstructive tonsils or adenoids.Nightly I have extracted sticky, firm clumps from behind the nasal swellings that only appear after massaging sinuses. They do not drain out on their own. Both boys ears are totally blocked. And my 5-year-old had dark brown fluid with strong foul odor leak out of one ear the other night. Both have recently been on Azithromycin (3 day doses of 5 ml per day) but symptoms have not improved. Not sure if any of the following are related, but all occured around the time symptoms began. My dad was at our house with a severe bronchial and sinus related illness and and also diagnosed with candida. We had also just been swimming in a lake. We live directly across from a large scale construction project that produces lots of dust that began around same time. My youngest had a recent staphylococcal infection on his arm treated topically with muciprocin. Any clues about what this could be and if it requires more immediate action vs. wait for ENT appointment? ### Response: Hi. Do not stop Zyrtec (Cetirizine) and nasal corticosteroid spray. The polluted environment around you can harm your chil ChatDoctor. I think that the black plug inside your son\\s ear is a fungal infection. You need a topical antifungal

Hello doctor,I apologize for the long message, but I am a concerned mom. I have two sons (ages 3 and 5) and both of them and I have been experiencing chronic sinus or ear issues for the past several months. Their pediatrician has referred us to ENT since she does not know what it is. Both boys (and myself) have inflamed nasal swellings that block the nasal passages. We all have deviated septums. My 3-year-old has dog and cat allergy and is prescribed Nasocort and Zyrtec daily which are ineffective. The 5-year-old tested negative for all allergies. We use top line air purifiers throughout the house but are still experiencing severe symptoms. The boys had tonsillectomies, adenoidectomies tubes last year due to scale 4 with obstructive tonsils or adenoids.Nightly I have extracted sticky, firm clumps from behind the nasal swellings that only appear after massaging sinuses. They do not drain out on their own. Both boys ears are totally blocked. And my 5-year-old had dark brown fluid with strong foul odor leak out of one ear the other night. Both have recently been on Azithromycin (3 day doses of 5 ml per day) but symptoms have not improved. Not sure if any of the following are related, but all occured around the time symptoms began. My dad was at our house with a severe bronchial and sinus related illness and and also diagnosed with candida. We had also just been swimming in a lake. We live directly across from a large scale construction project that produces lots of dust that began around same time. My youngest had a recent staphylococcal infection on his arm treated topically with muciprocin. Any clues about what this could be and if it requires more immediate action vs. wait for ENT appointment?

Hi. Do not stop Zyrtec (Cetirizine) and nasal corticosteroid spray. The polluted environment around you can harm your chil ChatDoctor. I think that the black plug inside your son\\s ear is a fungal infection. You need a topical antifungal

### Instruction: Answer this question truthfully ###Input: Hello doctor,I went to an eye doctor and did an eye examination because I started feeling dizziness, loss of concentration, neck and shoulder pain, anxiety while driving, in crowds. Dizziness also rises when I am in bed and driving.Not painful, but I can feel the pressure behind the eyes, in the sinus areas. But sinus doctor said nothing is wrong. So I read about vertical heterophoria, and all the symptoms are the same as I have. So I wanted to ask is there a particular test for that? Is there any other ways to relieve while I eventually get the check up again besides prism glasses. ### Response: Hello, Welcome to Chat Doctor forum. I understand your concerns, vertical heterophoria is a disorder of the mechanisms which maintain the balance of the eye muscles, keeping them on target. Although rare, these can lead to significant distress and dizziness as well. The best test to see if you have heterophoria in any direction is the cover or cover-uncover and alternate cover tests. These should be done with glasses first and then without them. You need the help of another person while doing this at home or can be quickly done at the doctor\\s clinic. 1. Cover test or uncover test - close one of your eyes with your hand while trying to look at an image around six meters away first and then held at 50 cm apart, with both your eyes, then take away the covering hand. If you see the eye that was covered moving, then you have a phoria in the direction opposite the direction in which the eye moved. 2. Alternate cover test - is the same as the cover or uncover tests, only that the covering hand is rapidly moved from eye to eye. This gives a more accurate picture of the type or magnitude of the heterophoria. These are two of the best, safest and economical tests that you can use to diagnose heterophoria. In case you need more information about heterophoria or tests or management options, please send me a scanned copy of your doctors reports and test results. I will do my best to help you with this. I hope you get well soon.

Hello doctor,I went to an eye doctor and did an eye examination because I started feeling dizziness, loss of concentration, neck and shoulder pain, anxiety while driving, in crowds. Dizziness also rises when I am in bed and driving.Not painful, but I can feel the pressure behind the eyes, in the sinus areas. But sinus doctor said nothing is wrong. So I read about vertical heterophoria, and all the symptoms are the same as I have. So I wanted to ask is there a particular test for that? Is there any other ways to relieve while I eventually get the check up again besides prism glasses.

Hello, Welcome to Chat Doctor forum. I understand your concerns, vertical heterophoria is a disorder of the mechanisms which maintain the balance of the eye muscles, keeping them on target. Although rare, these can lead to significant distress and dizziness as well. The best test to see if you have heterophoria in any direction is the cover or cover-uncover and alternate cover tests. These should be done with glasses first and then without them. You need the help of another person while doing this at home or can be quickly done at the doctor\\s clinic. 1. Cover test or uncover test - close one of your eyes with your hand while trying to look at an image around six meters away first and then held at 50 cm apart, with both your eyes, then take away the covering hand. If you see the eye that was covered moving, then you have a phoria in the direction opposite the direction in which the eye moved. 2. Alternate cover test - is the same as the cover or uncover tests, only that the covering hand is rapidly moved from eye to eye. This gives a more accurate picture of the type or magnitude of the heterophoria. These are two of the best, safest and economical tests that you can use to diagnose heterophoria. In case you need more information about heterophoria or tests or management options, please send me a scanned copy of your doctors reports and test results. I will do my best to help you with this. I hope you get well soon.

### Instruction: Answer this question truthfully ###Input: Hi doctor,My dad is 60 years old. Before 15 days, he met with an accident and was injured on the right side of the head. There was bleeding on both the ears and some cholesterol like thing was there in one ear. We have noticed that, but not sure what it was. We have admitted him in the hospital and he had a surgery for left FTP contusion and acute SDH. He looks like he has eyeball movement inside, but he did not open his eyes still. What is the reason? How many days will be taken to open his eyes? When we speak something to him there is no response from him. Can we expect that he will get conscious? When we give him a pain he is moving his hand and leg, but when we touch him simply, there is no response. What would be the reason? Can we expect him back as he was earlier? He is not speaking anything. The injury was on the right side head and the operation was done on the left side. Would like to know why the operation done on the opposite side? Otherwise, he is passing the urine and motion regularly. I will also attach the scan report. Please look at that and help me on my doubts and provide me the status of him. ### Response: Hi, Welcome to Chat Doctor forum. I have gone through your query with diligence and would like you to know that I am here to help you. He is in coma. The time to recovery will be longer and we cannot predict that now. As he is in coma, he can only feel the pain and not touch. Also, he will not be able to react much while in coma. While in coma, the patient will be unconscious ans so he cannot speak. Moreover, since the injury is on the left side, the speech areas in the brain may be affected. Some injuries like fracture and EDH (epidural hematoma) occur on the same side. Some like SDH (subdural hematoma) and contusion occur on the opposite side. Since you have mentioned it as SDH and contusion, it would have happened on the opposite side.

Hi doctor,My dad is 60 years old. Before 15 days, he met with an accident and was injured on the right side of the head. There was bleeding on both the ears and some cholesterol like thing was there in one ear. We have noticed that, but not sure what it was. We have admitted him in the hospital and he had a surgery for left FTP contusion and acute SDH. He looks like he has eyeball movement inside, but he did not open his eyes still. What is the reason? How many days will be taken to open his eyes? When we speak something to him there is no response from him. Can we expect that he will get conscious? When we give him a pain he is moving his hand and leg, but when we touch him simply, there is no response. What would be the reason? Can we expect him back as he was earlier? He is not speaking anything. The injury was on the right side head and the operation was done on the left side. Would like to know why the operation done on the opposite side? Otherwise, he is passing the urine and motion regularly. I will also attach the scan report. Please look at that and help me on my doubts and provide me the status of him.

Hi, Welcome to Chat Doctor forum. I have gone through your query with diligence and would like you to know that I am here to help you. He is in coma. The time to recovery will be longer and we cannot predict that now. As he is in coma, he can only feel the pain and not touch. Also, he will not be able to react much while in coma. While in coma, the patient will be unconscious ans so he cannot speak. Moreover, since the injury is on the left side, the speech areas in the brain may be affected. Some injuries like fracture and EDH (epidural hematoma) occur on the same side. Some like SDH (subdural hematoma) and contusion occur on the opposite side. Since you have mentioned it as SDH and contusion, it would have happened on the opposite side.

### Instruction: Answer this question truthfully ###Input: Hello doctor,How do I help my 16-year-old teen brother who refuses to get help? I believe he needs help, but the last time we went to the doctor, they sent him to a counselor who did not do much. When talking to a counselor and other people, he does not show his true colors. At home, he has a very bad temper and tries to fight with everyone. The only one he gets along with is one of his brothers. He has threatened to kill himself because he does not have his laptop anymore, it broke. And he has also stated along the lines that he wants to kill our parents because it is their fault, he is like this. To be fair, our parents are very religious. I do not know how to help him because he does not want help. He says no one cares about him and we all want his life to be bad. What do I do to help? ### Response: Hello, Welcome to Chat Doctor forum. It can be difficult to see your family going through challenging circumstances. From your report, it looks like your teenaged brother is struggling to regulate his behavior, blames others and is not able to take responsibility for his actions. As you may know already, there is no quick fix solution. Try to be supportive and available whenever your brother needs you. He is lucky to have an understanding sister like you. He needs to gently changed when he says no one cares about him. Why does he think so? Is he misinterpreting things? You said he gets on well with one of his brothers. Use it positively and involve this brother in getting help for your troubled sibling. Encourage him to enroll in some course, apprenticeship which will give some positive experience for him. Encourage him to join some sports clubs. Discuss with your parents about adopting a supportive, firm, boundaried relationship with your brother and avoid criticism and confrontational interactions. It may help to have a mentor to talk to him regularly and guide him to make the right choices. It can be any responsible adult whom your brother trusts and will talk to. Finally, encourage him to see a counselor or doctor again if problems persist.

Hello doctor,How do I help my 16-year-old teen brother who refuses to get help? I believe he needs help, but the last time we went to the doctor, they sent him to a counselor who did not do much. When talking to a counselor and other people, he does not show his true colors. At home, he has a very bad temper and tries to fight with everyone. The only one he gets along with is one of his brothers. He has threatened to kill himself because he does not have his laptop anymore, it broke. And he has also stated along the lines that he wants to kill our parents because it is their fault, he is like this. To be fair, our parents are very religious. I do not know how to help him because he does not want help. He says no one cares about him and we all want his life to be bad. What do I do to help?

Hello, Welcome to Chat Doctor forum. It can be difficult to see your family going through challenging circumstances. From your report, it looks like your teenaged brother is struggling to regulate his behavior, blames others and is not able to take responsibility for his actions. As you may know already, there is no quick fix solution. Try to be supportive and available whenever your brother needs you. He is lucky to have an understanding sister like you. He needs to gently changed when he says no one cares about him. Why does he think so? Is he misinterpreting things? You said he gets on well with one of his brothers. Use it positively and involve this brother in getting help for your troubled sibling. Encourage him to enroll in some course, apprenticeship which will give some positive experience for him. Encourage him to join some sports clubs. Discuss with your parents about adopting a supportive, firm, boundaried relationship with your brother and avoid criticism and confrontational interactions. It may help to have a mentor to talk to him regularly and guide him to make the right choices. It can be any responsible adult whom your brother trusts and will talk to. Finally, encourage him to see a counselor or doctor again if problems persist.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I started the process of getting four implants. Last week I went for bone grafting. It has been a living nightmare ever since. I was completely fine, pain-wise, until three days after the grafting. Out of nowhere, I was in excruciating pain. Like deep in the nerve type pain. At that point, it was only my lower right side that was in pain. One of my stitches busted, and the bone grafting material was oozing out. The dentist saw me that evening on an emergency basis and cleaned it up and stitched me back up. Reassured me that my pain would end. He also switched me to a stronger antibiotic. Well, not only did the pain not go away, my left side started in on the same excruciating pain on the next day. The pain is that sharp, stabbing, throbbing pain that increase with each heartbeat. Worst pain of my life. It seems to be coming from teeth next to where the grafting was done. I should also add that I have a bridge on my lower front four teeth, with teeth as my anchoring teeth. No one knows where my pain is coming from, so no one knows how to treat me. I am miserable. Have not eaten anything in three days. Talking, drinking, and eating cause immediate, intense throbbing. It feels like nerve pain to me. Similar to the way I have felt in the past when an infection has reached my nerves. I am wondering if something is now touching my nerves in the teeth next to where the grafting was done? I am at a loss and would love to hear what anyone else thinks. ### Response: Hello, Welcome to Chat Doctor forum. Do you have X-rays of teeth that caused you pain? You seem to have an infection either due to bone grafting procedure or abscess of the roots of those anchoring teeth of the bridge. Get an OPG x-ray done to find out more. Continue antibiotics and painkillers. Use warm salt water gargle twice a day for a week or two. Please attach an X-ray for analysis of your problem. You may need root canal treatment. Do not get an implant done until everything clears up.

Hello doctor,I started the process of getting four implants. Last week I went for bone grafting. It has been a living nightmare ever since. I was completely fine, pain-wise, until three days after the grafting. Out of nowhere, I was in excruciating pain. Like deep in the nerve type pain. At that point, it was only my lower right side that was in pain. One of my stitches busted, and the bone grafting material was oozing out. The dentist saw me that evening on an emergency basis and cleaned it up and stitched me back up. Reassured me that my pain would end. He also switched me to a stronger antibiotic. Well, not only did the pain not go away, my left side started in on the same excruciating pain on the next day. The pain is that sharp, stabbing, throbbing pain that increase with each heartbeat. Worst pain of my life. It seems to be coming from teeth next to where the grafting was done. I should also add that I have a bridge on my lower front four teeth, with teeth as my anchoring teeth. No one knows where my pain is coming from, so no one knows how to treat me. I am miserable. Have not eaten anything in three days. Talking, drinking, and eating cause immediate, intense throbbing. It feels like nerve pain to me. Similar to the way I have felt in the past when an infection has reached my nerves. I am wondering if something is now touching my nerves in the teeth next to where the grafting was done? I am at a loss and would love to hear what anyone else thinks.

Hello, Welcome to Chat Doctor forum. Do you have X-rays of teeth that caused you pain? You seem to have an infection either due to bone grafting procedure or abscess of the roots of those anchoring teeth of the bridge. Get an OPG x-ray done to find out more. Continue antibiotics and painkillers. Use warm salt water gargle twice a day for a week or two. Please attach an X-ray for analysis of your problem. You may need root canal treatment. Do not get an implant done until everything clears up.

### Instruction: Answer this question truthfully ###Input: Hello doctor, To start, I have bipolar disorder type II, social and generalized anxiety disorders. Previously, I failed to SSRI medications such as Zoloft, Prozac, Lexapro. I tried Lithium, Depakote, and Carbamazepine with no success. However currently, I take 50 mg of Lamictal and 75 mg Venlafaxine. This treatment kind fits me because I have lessened anxiety levels for sure. It is my first week on Venlafaxine XR. And the second week on Lamictal. In a few days we will increase Lamictal to 100 mg and after two weeks to 200 mg. I also take Tranxene 10 mg if needed, as well as Olanzapine 10 mg. How come I responded to Venlafaxine XR so fast, when I did not respond to SSRI? I lack energy and motivation, should I increase Venlafaxine XR to 150? If so, will it have more effects on my anxiety and depressive episode? ### Response: Hello, Welcome to Chat Doctor forum. It is good to know that you are responding to your current medication. Venlafaxine XR is an SNRI (serotonin-norepinephrine reuptake inhibitors) which can be helpful when SSRIs (selective serotonin reuptake inhibitors) have not been effective. I note that you have been tried on different SSRIs and mood stabilizers before with no success. It is positive that you have found Venlafaxine XR 75 mg to lessen your anxiety. I will advise to continue with the titration regimen suggested by your prescribing doctor. Do not rush to increase the dose to 150 mg as titration needs to be carefully considered after weighing up your response and any side effects. As you are also on increasing dose of Lamictal it makes sense to do the titration gradually. Have regular follow up with your prescribing doctor as you are on multiple medications and need to monitor. Along with medication, I hope you are also having therapy/counseling to manage your health. I hope this helps.

Hello doctor, To start, I have bipolar disorder type II, social and generalized anxiety disorders. Previously, I failed to SSRI medications such as Zoloft, Prozac, Lexapro. I tried Lithium, Depakote, and Carbamazepine with no success. However currently, I take 50 mg of Lamictal and 75 mg Venlafaxine. This treatment kind fits me because I have lessened anxiety levels for sure. It is my first week on Venlafaxine XR. And the second week on Lamictal. In a few days we will increase Lamictal to 100 mg and after two weeks to 200 mg. I also take Tranxene 10 mg if needed, as well as Olanzapine 10 mg. How come I responded to Venlafaxine XR so fast, when I did not respond to SSRI? I lack energy and motivation, should I increase Venlafaxine XR to 150? If so, will it have more effects on my anxiety and depressive episode?

Hello, Welcome to Chat Doctor forum. It is good to know that you are responding to your current medication. Venlafaxine XR is an SNRI (serotonin-norepinephrine reuptake inhibitors) which can be helpful when SSRIs (selective serotonin reuptake inhibitors) have not been effective. I note that you have been tried on different SSRIs and mood stabilizers before with no success. It is positive that you have found Venlafaxine XR 75 mg to lessen your anxiety. I will advise to continue with the titration regimen suggested by your prescribing doctor. Do not rush to increase the dose to 150 mg as titration needs to be carefully considered after weighing up your response and any side effects. As you are also on increasing dose of Lamictal it makes sense to do the titration gradually. Have regular follow up with your prescribing doctor as you are on multiple medications and need to monitor. Along with medication, I hope you are also having therapy/counseling to manage your health. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 29 years old male. I was suffering from rumination, anxiety, depression, hopelessness and had a panic attack 10 months back due to problems in my career, loneliness and some problems at home all at the same time. I consulted a psychiatrist who diagnosed me with mild depression and OCD 10 months back. He started with Sertraline, but it did not suit me. So, he shifted me to Paroxetine, beginning with 12.5 mg and gradually to 50 mg. As of now, I am on 50 mg Paroxetine and 7.5 mg Tetrafol for four months. Almost 90% of my symptoms are cured and I am no longer feeling depressed. The only problem is that I am still suffering from anxiety which is seriously hampering my studies and concentration. I have borderline high TSH.I also suffer from mood swings, e.g., sometimes I feel very good and confident, but at other times I feel very low and full of anxiety. I want my anxiety to be cured, and the drug should be such that it does not induce sleep as I have to study for long hours. Here I must tell you that I eat healthy food, fruits, nuts and regularly do exercise so such suggestions will not solve my problem. My major concern is the day-to-day anxiety which is hampering my studies, and I want that to be cured. ### Response: Hi. Now your main concern is anxiety. There are few options available such as increasing the dose of Paroxetine CR to 75 mg or adding Propranolol or Buspirone. You can try any of the options. Consult your specialist doctor, discuss with him or her and take medications with their consent. Another thing is that you need to do regular exercise, progressive muscle relaxation techniques or yoga, as these things improve your mood as well as induces relaxation thus decreasing anxiety. Also, try to feel the anxiety and do not react to that, live in present moment. By doing this, you will be better able to tolerate anxiety. For more information consult a psychiatrist online

Hello doctor,I am 29 years old male. I was suffering from rumination, anxiety, depression, hopelessness and had a panic attack 10 months back due to problems in my career, loneliness and some problems at home all at the same time. I consulted a psychiatrist who diagnosed me with mild depression and OCD 10 months back. He started with Sertraline, but it did not suit me. So, he shifted me to Paroxetine, beginning with 12.5 mg and gradually to 50 mg. As of now, I am on 50 mg Paroxetine and 7.5 mg Tetrafol for four months. Almost 90% of my symptoms are cured and I am no longer feeling depressed. The only problem is that I am still suffering from anxiety which is seriously hampering my studies and concentration. I have borderline high TSH.I also suffer from mood swings, e.g., sometimes I feel very good and confident, but at other times I feel very low and full of anxiety. I want my anxiety to be cured, and the drug should be such that it does not induce sleep as I have to study for long hours. Here I must tell you that I eat healthy food, fruits, nuts and regularly do exercise so such suggestions will not solve my problem. My major concern is the day-to-day anxiety which is hampering my studies, and I want that to be cured.

Hi. Now your main concern is anxiety. There are few options available such as increasing the dose of Paroxetine CR to 75 mg or adding Propranolol or Buspirone. You can try any of the options. Consult your specialist doctor, discuss with him or her and take medications with their consent. Another thing is that you need to do regular exercise, progressive muscle relaxation techniques or yoga, as these things improve your mood as well as induces relaxation thus decreasing anxiety. Also, try to feel the anxiety and do not react to that, live in present moment. By doing this, you will be better able to tolerate anxiety. For more information consult a psychiatrist online

### Instruction: Answer this question truthfully ###Input: Hello doctor, I am 29 years old. I had my tubes tied nearly four years ago but have been displaying symptoms of pregnancy for two months including weight gain in my stomach, nausea, sore breasts fluttering abnormal feelings in my stomach. It is believed I had a miscarriage nearly four months ago due to the sudden onset of my period and the extreme pain that was contributed to it.My cycles usually came to between one and two set days and last for four to five days with a heavier flow. Recently they have been sporadic in their comings lasting anywhere from two to seven days with a lighter flow and a change in color with no clotting as used to be normal. I went to my gynecologist after the first incident and as per him, my cervix was soft and sensitive causing me discomfort when applying pressure.My stomach now is still the same with a harder to touch feel with pain in my lower right hip side that radiates up towards the bottom of my ribs lasting seconds to minutes and recurring frequently. I have taken an OTC test that has came back negative and my blood pressure has been very low ranging around 83/67 mmHg. Can you please help me to figure out what is going on? ### Response: Hello. With the description you have given, I understand that with the tubal ligation done four years ago and the urine pregnancy test negative and you are having your menses each month (bleeding lasting between 2-7 days), with heaviness and pain over the right iliac region and off and on extending towards the ribs indicate an ovarian cause. It could be possibly a developing ovarian cyst which is duly enlarging in size. Oligo and hypomenorrhea are a feature in such cases. This is definitely not pregnancy. Ovarian cysts are known to produce estrogenic symptoms like sore tender breasts, nausea and bloating sensation as well. The softness of the cervix could be attributed to the same. My advice would be to undergo a pelvic ultrasound at the earliest to rule out right-sided ovarian cyst formation or probably an endometrioma accompanied. The size would further decide the course of treatment. you may contact me for further opinion. Take care.

Hello doctor, I am 29 years old. I had my tubes tied nearly four years ago but have been displaying symptoms of pregnancy for two months including weight gain in my stomach, nausea, sore breasts fluttering abnormal feelings in my stomach. It is believed I had a miscarriage nearly four months ago due to the sudden onset of my period and the extreme pain that was contributed to it.My cycles usually came to between one and two set days and last for four to five days with a heavier flow. Recently they have been sporadic in their comings lasting anywhere from two to seven days with a lighter flow and a change in color with no clotting as used to be normal. I went to my gynecologist after the first incident and as per him, my cervix was soft and sensitive causing me discomfort when applying pressure.My stomach now is still the same with a harder to touch feel with pain in my lower right hip side that radiates up towards the bottom of my ribs lasting seconds to minutes and recurring frequently. I have taken an OTC test that has came back negative and my blood pressure has been very low ranging around 83/67 mmHg. Can you please help me to figure out what is going on?

Hello. With the description you have given, I understand that with the tubal ligation done four years ago and the urine pregnancy test negative and you are having your menses each month (bleeding lasting between 2-7 days), with heaviness and pain over the right iliac region and off and on extending towards the ribs indicate an ovarian cause. It could be possibly a developing ovarian cyst which is duly enlarging in size. Oligo and hypomenorrhea are a feature in such cases. This is definitely not pregnancy. Ovarian cysts are known to produce estrogenic symptoms like sore tender breasts, nausea and bloating sensation as well. The softness of the cervix could be attributed to the same. My advice would be to undergo a pelvic ultrasound at the earliest to rule out right-sided ovarian cyst formation or probably an endometrioma accompanied. The size would further decide the course of treatment. you may contact me for further opinion. Take care.

### Instruction: Answer this question truthfully ###Input: Hello,I\\m looking and would like to discuss my treatment options for my conditions.I\\ve bipolar disorder II, social and generalised anxiety disorders, panic attacks and agoraphobia due to it.In past, I used escitalopram, venlafaxine, fluoxetine, sertraline, lithium, depakote, quetiapine, risperidone, anxiolytics. Venlafaxine was effective but had to discontinue it due to high blood pressure it caused. Other treatments mentioned didn\\t work for me. Anxiolytics worked, but now i don\\t have such options to continue this treatment because I\\m getting used to Tranxene.Currently I\\m taking Lamictal 200 mg and 10 mg olanzapine.I am afraid to go out from my flat, I am constantly alarmed, nervous, anxious, can\\t eat because of constant lump in my throat. Anxiety is debilitating, I can\\t work outside my home. At work I get so anxious that I have to take some free days from work, if I don\\t do that, I vomit from this anxiety.1) Can duloxetine be effective? Is it common that it can increase pulse and blood pressure as Venlafaxine did?2) How long does it take for escitalopram to take effect?3) Can prozac decrease anxiety?4) Is paroxetine an good option for me? ### Response: thank you for taking help from psychiatrist. you should continue medications on which you are stable at present. 1)duloxetine may be good option for you. it does not increases blood pressure. 2)tablet escitalopram takes around 4 weeks for full effect after starting medications. 3) yup,prozac can decrease anxiety but it belongs to same group as tablet escitalopram. 4) yup,paroxetine is good anti anxiety but tablet escitalopram is better than tablet paroxetine. you should follow below advice which can help your anxiety. hope you get your answer. thank you

Hello,I\\m looking and would like to discuss my treatment options for my conditions.I\\ve bipolar disorder II, social and generalised anxiety disorders, panic attacks and agoraphobia due to it.In past, I used escitalopram, venlafaxine, fluoxetine, sertraline, lithium, depakote, quetiapine, risperidone, anxiolytics. Venlafaxine was effective but had to discontinue it due to high blood pressure it caused. Other treatments mentioned didn\\t work for me. Anxiolytics worked, but now i don\\t have such options to continue this treatment because I\\m getting used to Tranxene.Currently I\\m taking Lamictal 200 mg and 10 mg olanzapine.I am afraid to go out from my flat, I am constantly alarmed, nervous, anxious, can\\t eat because of constant lump in my throat. Anxiety is debilitating, I can\\t work outside my home. At work I get so anxious that I have to take some free days from work, if I don\\t do that, I vomit from this anxiety.1) Can duloxetine be effective? Is it common that it can increase pulse and blood pressure as Venlafaxine did?2) How long does it take for escitalopram to take effect?3) Can prozac decrease anxiety?4) Is paroxetine an good option for me?

thank you for taking help from psychiatrist. you should continue medications on which you are stable at present. 1)duloxetine may be good option for you. it does not increases blood pressure. 2)tablet escitalopram takes around 4 weeks for full effect after starting medications. 3) yup,prozac can decrease anxiety but it belongs to same group as tablet escitalopram. 4) yup,paroxetine is good anti anxiety but tablet escitalopram is better than tablet paroxetine. you should follow below advice which can help your anxiety. hope you get your answer. thank you

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am undergoing the fifth cycle of chemotherapy for my left breast. For the past five months, I am undergoing this treatment. Prior to chemotherapy, I was taking ayurvedic medicine for the same problem. I took the medicine for about eight months, but it did not have any benefit. At that time, I was not aware of the exact problem. I was advised to remove the breast completely, but by the god\\s grace, I was referred to a doctor in oncology. The surgery has not been performed. They started with chemotherapy. Till now, I have completed five cycles. Still, how many cycles are needed for me? Will rest be given to me after the cycles? I am unable to eat, swallow or drink. I have lost my appetite. I have vomiting. Motions are happening from when I start eating my regular diet. I am feeling very depressed and demotivated. I have lost hope from the past five months. My left breast is healing and dressing is done over it. The skin is removed over a part. My breast looks flat as if it is removed. There is itching over the breast. Are there any chances for the regrowth of my breast? If yes, how many months will it take? If it does not regrow, what is the alternative for that? ### Response: Hi, Welcome to Chat Doctor forum. From your description, I fear that you have metastatic breast cancer. Usually, the surgery is done after four cycles of chemotherapy for locally advanced breast cancer. As you have undergone five cycles, you must be on palliative chemotherapy to control the disease. Usually, it is reassessed at every three cycles to know the response and treatment is based on it, which may include a change in the type of chemotherapy, hormonal therapy, etc. You may require toilet mastectomy at some stage for your ulceration of the breast or it may be controlled with radiotherapy. These decisions are made by your oncologist and kindly ask him or her in detail. I am answering this based on your description. I can better answer if all reports are presented. Revert back with the reports to a surgical oncologist online

Hello doctor,I am undergoing the fifth cycle of chemotherapy for my left breast. For the past five months, I am undergoing this treatment. Prior to chemotherapy, I was taking ayurvedic medicine for the same problem. I took the medicine for about eight months, but it did not have any benefit. At that time, I was not aware of the exact problem. I was advised to remove the breast completely, but by the god\\s grace, I was referred to a doctor in oncology. The surgery has not been performed. They started with chemotherapy. Till now, I have completed five cycles. Still, how many cycles are needed for me? Will rest be given to me after the cycles? I am unable to eat, swallow or drink. I have lost my appetite. I have vomiting. Motions are happening from when I start eating my regular diet. I am feeling very depressed and demotivated. I have lost hope from the past five months. My left breast is healing and dressing is done over it. The skin is removed over a part. My breast looks flat as if it is removed. There is itching over the breast. Are there any chances for the regrowth of my breast? If yes, how many months will it take? If it does not regrow, what is the alternative for that?

Hi, Welcome to Chat Doctor forum. From your description, I fear that you have metastatic breast cancer. Usually, the surgery is done after four cycles of chemotherapy for locally advanced breast cancer. As you have undergone five cycles, you must be on palliative chemotherapy to control the disease. Usually, it is reassessed at every three cycles to know the response and treatment is based on it, which may include a change in the type of chemotherapy, hormonal therapy, etc. You may require toilet mastectomy at some stage for your ulceration of the breast or it may be controlled with radiotherapy. These decisions are made by your oncologist and kindly ask him or her in detail. I am answering this based on your description. I can better answer if all reports are presented. Revert back with the reports to a surgical oncologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,1. What causes acne scarring? 2. What ingredients should people be looking for to diminish them (In the products they use)? 3. Is scarring more difficult to get rid of on darker skin tones? If so, please explain why. 4. Is it possible to achieve complete removal of this without getting something like a chemical peel? 5. How effective are peels and other cosmetic procedures for this issue? Which procedures would you say are the most effective? 6. For people who do not want to undergo a cosmetic procedure, what are some things they can do on their own to help? Sunscreen? 7. Is there any way to prevent scarring from occurring? If so, please explain. ### Response: Hello. 1. During severe active acne, inflammatory process leads to scarring if it is not properly treated or treated late during course of acne. So treatment of acne is very important both early and according to recommendations. Because inflammation leads to destruction of collagen fires in skin, resulting in scar formation. 2. People should use products that contain collagen, hyaluronic acid, elastin (the natural ingredients present in our skin and maintain its contour and give it even surface). 3. Scarring can be more difficult to treat in darker skin type because of heavy melanin pigmentation present naturally in their skin which also take part in inflammatory process occurring during acne. 4. Once scarring occur, it is not possible that it get improved on its own or without any treatment. Different options available for scars are topical gels and chemical peeling. Apart from that Co2 fractional laser is also available to get rid of it. 5. Chemical peeling is a method by which skin is stimulated to produce more collagen and making the skin scar free and improving its texture. The more effective treatment is fractional laser that helps in stimulating fibroblasts, increasing collagen production and improving acne scars. 6. People can use topical gels containing collagen if they do not want to undergo procedures. Sunscreen do not have much role to play. 7. For prevention of scarring, early and proper treatment of acne is needed. Oral Retinoids are recommended to prevent scarring.

Hello doctor,1. What causes acne scarring? 2. What ingredients should people be looking for to diminish them (In the products they use)? 3. Is scarring more difficult to get rid of on darker skin tones? If so, please explain why. 4. Is it possible to achieve complete removal of this without getting something like a chemical peel? 5. How effective are peels and other cosmetic procedures for this issue? Which procedures would you say are the most effective? 6. For people who do not want to undergo a cosmetic procedure, what are some things they can do on their own to help? Sunscreen? 7. Is there any way to prevent scarring from occurring? If so, please explain.

Hello. 1. During severe active acne, inflammatory process leads to scarring if it is not properly treated or treated late during course of acne. So treatment of acne is very important both early and according to recommendations. Because inflammation leads to destruction of collagen fires in skin, resulting in scar formation. 2. People should use products that contain collagen, hyaluronic acid, elastin (the natural ingredients present in our skin and maintain its contour and give it even surface). 3. Scarring can be more difficult to treat in darker skin type because of heavy melanin pigmentation present naturally in their skin which also take part in inflammatory process occurring during acne. 4. Once scarring occur, it is not possible that it get improved on its own or without any treatment. Different options available for scars are topical gels and chemical peeling. Apart from that Co2 fractional laser is also available to get rid of it. 5. Chemical peeling is a method by which skin is stimulated to produce more collagen and making the skin scar free and improving its texture. The more effective treatment is fractional laser that helps in stimulating fibroblasts, increasing collagen production and improving acne scars. 6. People can use topical gels containing collagen if they do not want to undergo procedures. Sunscreen do not have much role to play. 7. For prevention of scarring, early and proper treatment of acne is needed. Oral Retinoids are recommended to prevent scarring.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a writer, so I use my computer a lot. Pretty sure I have a repetitive stress injury. My father has Carpal tunnel, so it would not be a surprise at all if I have something similar. The pain is triggered when I type, and more so when I use my trackball. More than anything, my arm burns, the skin is hot, red and rashy. I can feel the same thing in my left arm, but it is more milder and takes more strain to hurt. I know I should back off and rest, but I feel like I cannot do that without giving up on writing. I wrap it and ice it. I take a couple of Aspirin every day to deal with inflammation, nothing seems to be helping. If I go to a doctor, I am afraid they will just tell me to do what I am already doing. Is there any point in seeing a doctor, or is there something more I should be doing at home? I am willing to see a doctor, I am quite short on money, and if I am just going to be advised to ice it and rest, I would rather save my money. ### Response: Hi, Welcome to ChatDoctor. Sorry to see that you have persistent symptoms. It is not clear from your description that you actually have any hand symptoms with crampy pain on typing with index thumb and middle fingers most affected as that would fit into a carpal tunnel like picture. If it is your arms that are bothering with burning pain, then it seems more like a neck problem with cervical spondylosis most likely possibility especially if you have morning neck stiffness or pain and stiffness after a period of rest. The treatment of which is going to be strengthening your neck along with neck exercises, posture correction, using the laptop or desktop for shorter durations, analgesia, Pregabalin tablets 75 mg twice a day and moist heat to the neck rather than the arms. You also can take Diclofenac tablets 75 mg two times a day after meals if you have no asthma, hypertension and no known allergy to this tablet. I hope this helps.

Hello doctor,I am a writer, so I use my computer a lot. Pretty sure I have a repetitive stress injury. My father has Carpal tunnel, so it would not be a surprise at all if I have something similar. The pain is triggered when I type, and more so when I use my trackball. More than anything, my arm burns, the skin is hot, red and rashy. I can feel the same thing in my left arm, but it is more milder and takes more strain to hurt. I know I should back off and rest, but I feel like I cannot do that without giving up on writing. I wrap it and ice it. I take a couple of Aspirin every day to deal with inflammation, nothing seems to be helping. If I go to a doctor, I am afraid they will just tell me to do what I am already doing. Is there any point in seeing a doctor, or is there something more I should be doing at home? I am willing to see a doctor, I am quite short on money, and if I am just going to be advised to ice it and rest, I would rather save my money.

Hi, Welcome to ChatDoctor. Sorry to see that you have persistent symptoms. It is not clear from your description that you actually have any hand symptoms with crampy pain on typing with index thumb and middle fingers most affected as that would fit into a carpal tunnel like picture. If it is your arms that are bothering with burning pain, then it seems more like a neck problem with cervical spondylosis most likely possibility especially if you have morning neck stiffness or pain and stiffness after a period of rest. The treatment of which is going to be strengthening your neck along with neck exercises, posture correction, using the laptop or desktop for shorter durations, analgesia, Pregabalin tablets 75 mg twice a day and moist heat to the neck rather than the arms. You also can take Diclofenac tablets 75 mg two times a day after meals if you have no asthma, hypertension and no known allergy to this tablet. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 25 years old and my menstruation cycles had been irregular since the start. After 1.5 years of irregularity (missing periods for many months), I visited the gynecologist and after seeing all my tests results, my doctor told me because of my obesity I had irregularity in my periods. He prescribed me Diane 35 for the first 21 days post that I got my menses and thereafter he asked me to continue with the normal course of Krimson 35 of one tablet a day for 21 days. Thereafter my menses became regular while being on the medicine. After one year, I discontinued the medicine out of fear of side effects and thereafter my menses continued irregularly again.During my late teens and early 20\\s my menses were highly irregular (missing for more than 4 to 6 months) but from last two years, it occurs monthly either with heavy bleeding for 1 to 2 days or very light bleeding or spotting for 10 to 15 days. I am not on any medication right now nor do I have any other symptoms like cramps or nausea or any other menstrual symptoms. However, I still continue to be obese and did develop some levels of facial hair around my chin area. Could you please let me know, if I could go back to starting Krimson 35 to get everything back on track? Will there be any kind of side effects? Will there be any difficulty in conceiving at a later stage of my life? ### Response: Hello. With your history, it seems that you need to decrease your weight which is the single most important factor in your menses. There are others but first, we have to control this. Yes, of course with irregular menses it can be difficult to get pregnant. No need to start Krimson 35 (Cyproterone Acetate and Ethinyl Estradiol) but need to do some test may be. And try to reduce weight. From history, it seems that you have PCOS. Do one sonography and consult a nearby gynecologist for a good advice. ChatDoctor.

Hi doctor,I am 25 years old and my menstruation cycles had been irregular since the start. After 1.5 years of irregularity (missing periods for many months), I visited the gynecologist and after seeing all my tests results, my doctor told me because of my obesity I had irregularity in my periods. He prescribed me Diane 35 for the first 21 days post that I got my menses and thereafter he asked me to continue with the normal course of Krimson 35 of one tablet a day for 21 days. Thereafter my menses became regular while being on the medicine. After one year, I discontinued the medicine out of fear of side effects and thereafter my menses continued irregularly again.During my late teens and early 20\\s my menses were highly irregular (missing for more than 4 to 6 months) but from last two years, it occurs monthly either with heavy bleeding for 1 to 2 days or very light bleeding or spotting for 10 to 15 days. I am not on any medication right now nor do I have any other symptoms like cramps or nausea or any other menstrual symptoms. However, I still continue to be obese and did develop some levels of facial hair around my chin area. Could you please let me know, if I could go back to starting Krimson 35 to get everything back on track? Will there be any kind of side effects? Will there be any difficulty in conceiving at a later stage of my life?

Hello. With your history, it seems that you need to decrease your weight which is the single most important factor in your menses. There are others but first, we have to control this. Yes, of course with irregular menses it can be difficult to get pregnant. No need to start Krimson 35 (Cyproterone Acetate and Ethinyl Estradiol) but need to do some test may be. And try to reduce weight. From history, it seems that you have PCOS. Do one sonography and consult a nearby gynecologist for a good advice. ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 30 year old female. I have a minor issue. About a month and a half ago, there was an incident where the condom broke. About 36 hours later, my husband got me four of the morning-after pills, and I took them all at once. Three days later, I started experiencing nausea, soreness of the breasts, lower back as well as abdominal pain, frequent urination, and tiredness. This carried on for almost a week. I then noticed a light brown discharge. And, from the next day, I bled for six days. I usually bleed for seven days. After my periods, I still had the symptoms.Nearly a month later, I got my periods again, but on the first day I had severe cramps and used a tampon. On the third day, there was a slight discharge which was brown in color. On the fourth day, there was some bleeding, but not at night. Today would be day five, and I still do not see blood. My main concern is that my vagina feels different. It is more firm than usual and feels tight. I sometimes feel a pulling sensation. Could it be due to the morning-after pills? I did home pregnancy tests, and it came back negative. It has been a month and 18 days now, since the intercourse. ### Response: Hello. Please let me know if you were previously pregnant. Since you took the emergency contraception pill within 36 hours, and you got your period after the intercourse, you are not pregnant. The emergency contraception pills are progesterone tablets. It is a hormone normally present in the body, which is secreted in the second half of your menstrual cycle. It gradually decreases in concentration due to which you get your menses. This gradual ChatDoctor. When you take progesterone orally in a higher dose to prevent pregnancy, some females experience the side effects of the tablets. Although your menses were on time, some patients may experience irregular menses for two to three months. Hope this helps. For more information consult an obstetrician and gynaecologist online Take care.

Hi doctor,I am a 30 year old female. I have a minor issue. About a month and a half ago, there was an incident where the condom broke. About 36 hours later, my husband got me four of the morning-after pills, and I took them all at once. Three days later, I started experiencing nausea, soreness of the breasts, lower back as well as abdominal pain, frequent urination, and tiredness. This carried on for almost a week. I then noticed a light brown discharge. And, from the next day, I bled for six days. I usually bleed for seven days. After my periods, I still had the symptoms.Nearly a month later, I got my periods again, but on the first day I had severe cramps and used a tampon. On the third day, there was a slight discharge which was brown in color. On the fourth day, there was some bleeding, but not at night. Today would be day five, and I still do not see blood. My main concern is that my vagina feels different. It is more firm than usual and feels tight. I sometimes feel a pulling sensation. Could it be due to the morning-after pills? I did home pregnancy tests, and it came back negative. It has been a month and 18 days now, since the intercourse.

Hello. Please let me know if you were previously pregnant. Since you took the emergency contraception pill within 36 hours, and you got your period after the intercourse, you are not pregnant. The emergency contraception pills are progesterone tablets. It is a hormone normally present in the body, which is secreted in the second half of your menstrual cycle. It gradually decreases in concentration due to which you get your menses. This gradual ChatDoctor. When you take progesterone orally in a higher dose to prevent pregnancy, some females experience the side effects of the tablets. Although your menses were on time, some patients may experience irregular menses for two to three months. Hope this helps. For more information consult an obstetrician and gynaecologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 20 year old female and had sex for the first time. I took Regestrone to delay my periods because I planned to get intimate the same day as my periods. I took them for three to four days before my expected period date and had the tablet two to three times a day. Last dose I had it just the night before having sex. I had sex many times the next night but with protection and took an i-pill to be sure. Next week got light periods that were very painful. But ignored it thinking it was because of hormonal imbalance. Both of us were affected by flu and it turned into a stomach infection with alternate periods of diarrhea and constipation that was accompanied with mild nausea but had no vomiting. I became very weak and then eventually recovered by taking Pantocid, Digene and Zandu pancharishta. I am six days overdue and had slight back pain, nausea and increased urination. I do have migraine issues as well as I am quite obese with a BMI of 33.8. I got two home pregnancy tests done and both of them turned out to be negative. However, I still have not got my periods yet and I have been insisted to check for PCOS and get an ultrasound done. I am worried if the ultrasound shows that I am pregnant. I have gained about 4 kg. Is it possible to get a false negative six weeks after having sex? What can I do to get my periods early? Please advice. ### Response: Hi, Welcome to Chat Doctor forum. It is impossible for a urine pregnancy test to show false negative six weeks after sex. Delay in periods may be as a result of anovulation due to stress or infection as well as because of gaining weight. For regular ovulation and to avoid hormonal imbalance, it is advisable to maintain your weight. Healthy BMI (body mass index) is essential for our overall health as well as reproductive health. No pregnancy will be seen in ultrasound when a urine pregnancy test is negative. If you had regular periods previously, you can wait for a week for the start of menses. Or can induce with ChatDoctor.

Hello doctor,I am a 20 year old female and had sex for the first time. I took Regestrone to delay my periods because I planned to get intimate the same day as my periods. I took them for three to four days before my expected period date and had the tablet two to three times a day. Last dose I had it just the night before having sex. I had sex many times the next night but with protection and took an i-pill to be sure. Next week got light periods that were very painful. But ignored it thinking it was because of hormonal imbalance. Both of us were affected by flu and it turned into a stomach infection with alternate periods of diarrhea and constipation that was accompanied with mild nausea but had no vomiting. I became very weak and then eventually recovered by taking Pantocid, Digene and Zandu pancharishta. I am six days overdue and had slight back pain, nausea and increased urination. I do have migraine issues as well as I am quite obese with a BMI of 33.8. I got two home pregnancy tests done and both of them turned out to be negative. However, I still have not got my periods yet and I have been insisted to check for PCOS and get an ultrasound done. I am worried if the ultrasound shows that I am pregnant. I have gained about 4 kg. Is it possible to get a false negative six weeks after having sex? What can I do to get my periods early? Please advice.

Hi, Welcome to Chat Doctor forum. It is impossible for a urine pregnancy test to show false negative six weeks after sex. Delay in periods may be as a result of anovulation due to stress or infection as well as because of gaining weight. For regular ovulation and to avoid hormonal imbalance, it is advisable to maintain your weight. Healthy BMI (body mass index) is essential for our overall health as well as reproductive health. No pregnancy will be seen in ultrasound when a urine pregnancy test is negative. If you had regular periods previously, you can wait for a week for the start of menses. Or can induce with ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 24-year-old female and I was on the birth control pill Aviane for almost two years. I never had any negative symptoms and had an overall good experience but I decided to stop taking it after ending my relationship because I would no longer be sexually active. About four weeks after my withdrawal bleed, I had my first period again and everything seemed to go right back to normal. I have been off the pill for a year now, and my periods are totally regular, but I have noticed some slight differences. Before BC, my cervical mucus seemed to change throughout the month but now it stays the exact same. Thick and milky. Occasionally, it will be a little more watery, but it used to get that egg white consistency around ovulation and such. It does not seem to do that much anymore, if at all. Although I am pretty certain I still have ovulation pain around the middle of my cycle. Should I be worried? Did BC mess up my body? Or is that not cause for concern? Everything else is completely normal. My cycle is a perfect 28 days and my periods are back to how they were before. The only difference is that I used to still have some light spotting on day five, but now it is mostly gone by day four other than a bit of light spotting. I am not trying to conceive, but I was wondering if this was something I should be worried about. Thanks in advance. ### Response: Hello. Firstly, birth control pills do not have this kind of lasting effect which might be over or after a year, so the change in discharge is not because of pills. Secondly, changes in consistency of vaginal discharge over the cycle are totally normal. These changes are due to hormonal changes which are taking place in different phases of the cycle. Thirdly, if the discharge is not smelly, itchy or associated with any abdominal pain or painful voiding then it is nothing to worry about. If any of these problems arise, you have to seek expert advice then only. Another general advice is to use cotton undergarments and wash area frequently with plain water only. Take care.

Hello doctor,I am a 24-year-old female and I was on the birth control pill Aviane for almost two years. I never had any negative symptoms and had an overall good experience but I decided to stop taking it after ending my relationship because I would no longer be sexually active. About four weeks after my withdrawal bleed, I had my first period again and everything seemed to go right back to normal. I have been off the pill for a year now, and my periods are totally regular, but I have noticed some slight differences. Before BC, my cervical mucus seemed to change throughout the month but now it stays the exact same. Thick and milky. Occasionally, it will be a little more watery, but it used to get that egg white consistency around ovulation and such. It does not seem to do that much anymore, if at all. Although I am pretty certain I still have ovulation pain around the middle of my cycle. Should I be worried? Did BC mess up my body? Or is that not cause for concern? Everything else is completely normal. My cycle is a perfect 28 days and my periods are back to how they were before. The only difference is that I used to still have some light spotting on day five, but now it is mostly gone by day four other than a bit of light spotting. I am not trying to conceive, but I was wondering if this was something I should be worried about. Thanks in advance.

Hello. Firstly, birth control pills do not have this kind of lasting effect which might be over or after a year, so the change in discharge is not because of pills. Secondly, changes in consistency of vaginal discharge over the cycle are totally normal. These changes are due to hormonal changes which are taking place in different phases of the cycle. Thirdly, if the discharge is not smelly, itchy or associated with any abdominal pain or painful voiding then it is nothing to worry about. If any of these problems arise, you have to seek expert advice then only. Another general advice is to use cotton undergarments and wash area frequently with plain water only. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 26 year old female, who has an inflamed looking foliate papillae on right side of the tongue towards the back, it has been like this for more than three weeks now. It has not gotten better or worse, pretty much looks the same.It creates this feeling of something stuck in the back of my throat, and this feeling gets worse after I eat food or talk a lot. When I wake up in the morning the feeling of something stuck in the throat is less obvious. But as the day progresses, the feeling is more obvious. I think it is because of the enlarged foliate papillae rubbing the back of the throat when I talk and chew.There is an ulcer like a hole in the middle of the swollen foliate papillae as well, and I am not sure if it is because the papillae is swollen. I do not have pain at all, but sometimes there is this burning sensation. The area looks the same for the past three weeks, and it did not change in appearance or size.Everywhere I read online says sores that do not heal within 2 to 3 weeks can indicate oral or tongue cancer, so I am terrified. I do not smoke or drink. But I had bad oral hygiene before which resulted in a tooth infection and abscess (on the right upper tooth) about six weeks ago, which has since gotten better but never completely healed. The dentist suggested root canal, but due to the expenses I am not able to get it done anytime soon, so I am just managing the tooth with antibiotics, salt water, and colloidal silver until I can get a root canal. ### Response: Hi, Welcome to Chat Doctor forum. The lesion on the tongue (attachment removed to protect patient identity) appears to be an ulcerative lesion. You should get yourself examined by an ENT specialist because I think a biopsy might be required. As you might have taken antibiotics for tooth infection, the tongue lesion must have improved. I suggest you try doing the following. Consult your specialist doctor, discuss with him or her and start using the medicines after their consent. Any further questions are always welcome.

Hello doctor,I am a 26 year old female, who has an inflamed looking foliate papillae on right side of the tongue towards the back, it has been like this for more than three weeks now. It has not gotten better or worse, pretty much looks the same.It creates this feeling of something stuck in the back of my throat, and this feeling gets worse after I eat food or talk a lot. When I wake up in the morning the feeling of something stuck in the throat is less obvious. But as the day progresses, the feeling is more obvious. I think it is because of the enlarged foliate papillae rubbing the back of the throat when I talk and chew.There is an ulcer like a hole in the middle of the swollen foliate papillae as well, and I am not sure if it is because the papillae is swollen. I do not have pain at all, but sometimes there is this burning sensation. The area looks the same for the past three weeks, and it did not change in appearance or size.Everywhere I read online says sores that do not heal within 2 to 3 weeks can indicate oral or tongue cancer, so I am terrified. I do not smoke or drink. But I had bad oral hygiene before which resulted in a tooth infection and abscess (on the right upper tooth) about six weeks ago, which has since gotten better but never completely healed. The dentist suggested root canal, but due to the expenses I am not able to get it done anytime soon, so I am just managing the tooth with antibiotics, salt water, and colloidal silver until I can get a root canal.

Hi, Welcome to Chat Doctor forum. The lesion on the tongue (attachment removed to protect patient identity) appears to be an ulcerative lesion. You should get yourself examined by an ENT specialist because I think a biopsy might be required. As you might have taken antibiotics for tooth infection, the tongue lesion must have improved. I suggest you try doing the following. Consult your specialist doctor, discuss with him or her and start using the medicines after their consent. Any further questions are always welcome.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I (female, 38 years) had my first outbreak of corneal herpes five months back. It was treated incorrectly by a GP first with Cortisone and antibiotics. The eye doctor put me on Acyclovir cream and later added Cortisone drops to prevent scars. After a month, while on vacation (lots of sun and salt water) it came back. I did not recognize the signs at first and thought the redness was only due to irritation. It lingered, so after coming back home, I was put on Acyclovir orally. Two months back, the dye did not show any active ulcers, so I could lower the oral dose to 400 mg and use Cortisone drops again. Last week for a check up the dye showed two active ulcers again.I am really shocked and scared now. My doctor did not say if it was stromal keratitis or not. Is there a way to tell? I have always had 100 % vision since the lesions are not in front of the pupil. But I do not know why I had a recurrence even while on Acyclovir. Could the Cortisone drops be detrimental? My doctor said to increase the dose back to 800 mg and stop Cortisone. Is there a way to clear this for now? I do not know if I had two relapses or if this never really healed in the first place. Is there a way to prevent such frequent outbreaks at all? It is difficult not to stress when I fear I will go blind. ### Response: Hello. Please do not panic. You will not go blind. I assume this is herpes simplex and you have herpes epithelial keratitis. Epithelium keratitis is usually treated with antiviral and lubricating eye ChatDoctor. The steroid has no role in epithelial keratitis. Steroid increases the risk of recurrence. That is why steroid is instilled undercover of antiviral. If there are more than two attacks in a single year, then we may need to continue prophylactic oral Acyclovir for a very long period (maybe years). With recurrent attacks, there may be scars which may blur your vision.

Hi doctor,I (female, 38 years) had my first outbreak of corneal herpes five months back. It was treated incorrectly by a GP first with Cortisone and antibiotics. The eye doctor put me on Acyclovir cream and later added Cortisone drops to prevent scars. After a month, while on vacation (lots of sun and salt water) it came back. I did not recognize the signs at first and thought the redness was only due to irritation. It lingered, so after coming back home, I was put on Acyclovir orally. Two months back, the dye did not show any active ulcers, so I could lower the oral dose to 400 mg and use Cortisone drops again. Last week for a check up the dye showed two active ulcers again.I am really shocked and scared now. My doctor did not say if it was stromal keratitis or not. Is there a way to tell? I have always had 100 % vision since the lesions are not in front of the pupil. But I do not know why I had a recurrence even while on Acyclovir. Could the Cortisone drops be detrimental? My doctor said to increase the dose back to 800 mg and stop Cortisone. Is there a way to clear this for now? I do not know if I had two relapses or if this never really healed in the first place. Is there a way to prevent such frequent outbreaks at all? It is difficult not to stress when I fear I will go blind.

Hello. Please do not panic. You will not go blind. I assume this is herpes simplex and you have herpes epithelial keratitis. Epithelium keratitis is usually treated with antiviral and lubricating eye ChatDoctor. The steroid has no role in epithelial keratitis. Steroid increases the risk of recurrence. That is why steroid is instilled undercover of antiviral. If there are more than two attacks in a single year, then we may need to continue prophylactic oral Acyclovir for a very long period (maybe years). With recurrent attacks, there may be scars which may blur your vision.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My father (aged 70) is suffering from coughing and light fever (varying between 99 to 101) for the past 10 days now. Medical tests (attached) do not seem to reveal anything, and the prescribed medicines (see below) do not improve things. Coughing is now also accompanied by wheezing sometimes, and is at the peak during the dawn hours and causes extreme difficulty in sleeping.Since my mother and I have a slight problem of asthma, is there any chance he might be suffering from the same? I have to take Asthalin/Foracort Rotacaps occasionally which immediately relieves the coughing. Would it be advisable for him to try Asthalin/Foracort when he faces wheezing?Any other suggestions/remedies?Do note that he takes regular medicines for maintaining his blood pressure ### Response: Hello, Welcome to Chat Doctor forum. I have gone through the reports (attachment removed to protect patient identity). It appears to be bronchitis, likely viral. Has his fever settled now or still continuing? Wheezing and coughing may continue for some more days up to one to three weeks. Yes, he can and he should use the inhaler. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. Initially, he should have MDI (metered dose inhaler) or Rotahaler Asthalin (Salbutamol/ Albuterol) two puffs or one Rotacap whenever needed, up to four to six times a day. If coughing and shortness of breath are not relieved then he should also have Foracort (Formoterol and Budesonide) two times a day. He should also have tablet Montair LC (Monteleukast and Levocetirizine) once a day at bedtime for 10 days. If there is no improvement in fever for another four to five days, then he should have chest X-ray to find out the other cause of his fever. Hope this helps you and get back if you have any doubts. For more information consult a general medicine physician online

Hello doctor,My father (aged 70) is suffering from coughing and light fever (varying between 99 to 101) for the past 10 days now. Medical tests (attached) do not seem to reveal anything, and the prescribed medicines (see below) do not improve things. Coughing is now also accompanied by wheezing sometimes, and is at the peak during the dawn hours and causes extreme difficulty in sleeping.Since my mother and I have a slight problem of asthma, is there any chance he might be suffering from the same? I have to take Asthalin/Foracort Rotacaps occasionally which immediately relieves the coughing. Would it be advisable for him to try Asthalin/Foracort when he faces wheezing?Any other suggestions/remedies?Do note that he takes regular medicines for maintaining his blood pressure

Hello, Welcome to Chat Doctor forum. I have gone through the reports (attachment removed to protect patient identity). It appears to be bronchitis, likely viral. Has his fever settled now or still continuing? Wheezing and coughing may continue for some more days up to one to three weeks. Yes, he can and he should use the inhaler. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. Initially, he should have MDI (metered dose inhaler) or Rotahaler Asthalin (Salbutamol/ Albuterol) two puffs or one Rotacap whenever needed, up to four to six times a day. If coughing and shortness of breath are not relieved then he should also have Foracort (Formoterol and Budesonide) two times a day. He should also have tablet Montair LC (Monteleukast and Levocetirizine) once a day at bedtime for 10 days. If there is no improvement in fever for another four to five days, then he should have chest X-ray to find out the other cause of his fever. Hope this helps you and get back if you have any doubts. For more information consult a general medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 22 years old. I have been observing that since last 3-4 period cycles, I have been having blood in urine. Just an hour before periods then it is normal once I get my period and the urine is again clear. Recently, I got my period and an hour back I urinated with little blood but the last few drops after I was done wer really red. I have lower back pain that comes and goes and sometimes when I walk I get pain in left buttock. 10 days back I had UTI which is treated now. 10 days back I also had a really bad pain in lower abdomen and I placed a hot water bag on it and the pain was gone. I will be going for a scan and urine test after my periods are over.I had posted this query on a health app and was told by the doctor that I may have bladder endometrosis. It has terrified me now. It is so scary q nd needs surgery. I am healthy, do yoga and never smoked nor am I sexually active. I wanted to get a second opinion whether I could have this. I Can understand that a doctor cannot give an opinion till the reports are out. And I still have to wait for 3-4 days till my periods are over to go fr the test. But for my peace of mind an experienced doctor\\s insight could help me relax a bit. Do I really have a major problem? My doctor who told me to go for scan told me that it could be an infection or kidney stone. ### Response: Hello. Endometriosis is not so common. Although you have a pattern of bleeding which goes in favor of bladder endometriosis. First thing which needs to be ruled out is a stone disease. Get an NCCT KUB done which will confirm or rule out stone disease. If it is not there then next step is a cystoscopy that means having a look inside the bladder by passing a small telescope through urinary passage. In any case these things are treatable and you should not worry much. Revert after the scan . Take care.

Hello doctor,I am 22 years old. I have been observing that since last 3-4 period cycles, I have been having blood in urine. Just an hour before periods then it is normal once I get my period and the urine is again clear. Recently, I got my period and an hour back I urinated with little blood but the last few drops after I was done wer really red. I have lower back pain that comes and goes and sometimes when I walk I get pain in left buttock. 10 days back I had UTI which is treated now. 10 days back I also had a really bad pain in lower abdomen and I placed a hot water bag on it and the pain was gone. I will be going for a scan and urine test after my periods are over.I had posted this query on a health app and was told by the doctor that I may have bladder endometrosis. It has terrified me now. It is so scary q nd needs surgery. I am healthy, do yoga and never smoked nor am I sexually active. I wanted to get a second opinion whether I could have this. I Can understand that a doctor cannot give an opinion till the reports are out. And I still have to wait for 3-4 days till my periods are over to go fr the test. But for my peace of mind an experienced doctor\\s insight could help me relax a bit. Do I really have a major problem? My doctor who told me to go for scan told me that it could be an infection or kidney stone.

Hello. Endometriosis is not so common. Although you have a pattern of bleeding which goes in favor of bladder endometriosis. First thing which needs to be ruled out is a stone disease. Get an NCCT KUB done which will confirm or rule out stone disease. If it is not there then next step is a cystoscopy that means having a look inside the bladder by passing a small telescope through urinary passage. In any case these things are treatable and you should not worry much. Revert after the scan . Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have had fluctuating elevated blood pressure for three to four years between 135-180/85-112 mmHg. I did not take any medication. I have had episodes of sudden fainting, pain and burning in the chest. When tested, ECG was fine. But four days ago, it was different. I had felt extremely fatigued for two days, then I felt pain in my center and left side of my chest. My hands seemed numb. I had periodic episodes of cold sweats on the back of my head and neck, as well as a dull ache in my left upper shoulder. The heaviness was there also. This stayed off and on all evening, during which I took two baby Aspirin, which provided a little relief. The next day, I was still very tired and my chest was sore. The pain was sporadic in my chest, like a quick stinging pain. When I tried to do anything, it would try to start again. During this time, my blood pressure reached its highest at 167/112 mmHg. The third day I felt better. I am currently on Zoloft 100 mg once daily.Does this sound like a heart attack? I was terrified. ### Response: Hello, Welcome to Chat Doctor forum. Your symptoms are not typical of a heart attack. They seem to indicate musculoskeletal pain or inflammation. Is the pain triggered by deep breathing or body movements? This would be another argument in favor of a musculo-skeletal pain. The increase in blood pressure values during these episodes is a normal physiological reaction to the pain. So, there is nothing to worry about. Anyways, an exercise cardiac stress test would help reassure you that nothing bad is going on. Regarding your blood pressure values, I would recommend you to measure your blood pressure frequently during a week and write those values down. If blood pressure values are frequently above the normal ranges (140/90 mmHg), antihypertensive therapy may be needed. Some blood lab tests are also necessary to investigate for other possible metabolic causes that may lead to this symptomatology

Hello doctor,I have had fluctuating elevated blood pressure for three to four years between 135-180/85-112 mmHg. I did not take any medication. I have had episodes of sudden fainting, pain and burning in the chest. When tested, ECG was fine. But four days ago, it was different. I had felt extremely fatigued for two days, then I felt pain in my center and left side of my chest. My hands seemed numb. I had periodic episodes of cold sweats on the back of my head and neck, as well as a dull ache in my left upper shoulder. The heaviness was there also. This stayed off and on all evening, during which I took two baby Aspirin, which provided a little relief. The next day, I was still very tired and my chest was sore. The pain was sporadic in my chest, like a quick stinging pain. When I tried to do anything, it would try to start again. During this time, my blood pressure reached its highest at 167/112 mmHg. The third day I felt better. I am currently on Zoloft 100 mg once daily.Does this sound like a heart attack? I was terrified.

Hello, Welcome to Chat Doctor forum. Your symptoms are not typical of a heart attack. They seem to indicate musculoskeletal pain or inflammation. Is the pain triggered by deep breathing or body movements? This would be another argument in favor of a musculo-skeletal pain. The increase in blood pressure values during these episodes is a normal physiological reaction to the pain. So, there is nothing to worry about. Anyways, an exercise cardiac stress test would help reassure you that nothing bad is going on. Regarding your blood pressure values, I would recommend you to measure your blood pressure frequently during a week and write those values down. If blood pressure values are frequently above the normal ranges (140/90 mmHg), antihypertensive therapy may be needed. Some blood lab tests are also necessary to investigate for other possible metabolic causes that may lead to this symptomatology

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had a few lesions on my penis and suspecting as HPV. I remember first I noticed these before five months after a lady in massage center rubbed my penis with her buttock for her tips. I did not have any intercourse at that time. Last month, I gave HPV swab and biopsy tests, but nothing got diagnosed. I do not think there is an FDA approved screening test for males.Last month doctor removed those lesions using laser, now my doubt is these lesions can lead to cancer? If yes, only penile cancer or this virus can transfer to throat and head and can cause head/neck cancers? Now if I have HPV vaccination, that will be helpful? Any immunity supplements can help to cure HPV? For the safer side, I have given HIV antigen and antibody test twice after 14, and 28 days of my last sexual encounter (had oral sex with a condom) results are negative.1 st test value is 0.18 and the second test value is 0.36 and as per the lab report it of the index. Increase in antibodies value in the later test is fine or abnormal? ### Response: Hello. The HPV infection is caused by a group of viruses called Human papillomaviruses. Majority of them are self-limiting and do not produce any symptoms. Most common viruses that cause warts are type 6 and 11, and they are harmless, whereas types 16 and 18 cause cancer. Now in your case, I need to know the type of virus found in the lesion. If that is negative for HPV, you need not worry. HPV spreads sexually and can spread to genitals, rectum, mouth or throat, and condom can offer protection though not complete.The HPV vaccine does offer protection, and you can go for it. There are no provided supplements that can enhance immunity. Your HIV antigen as well antibody titers are within normal limits, and you need not worry about it. My only suggestion is to avoid high-risk sexual behavior, which reduces sexually transmitted altogether. Please get back to me if you need any more clarification.

Hello doctor,I had a few lesions on my penis and suspecting as HPV. I remember first I noticed these before five months after a lady in massage center rubbed my penis with her buttock for her tips. I did not have any intercourse at that time. Last month, I gave HPV swab and biopsy tests, but nothing got diagnosed. I do not think there is an FDA approved screening test for males.Last month doctor removed those lesions using laser, now my doubt is these lesions can lead to cancer? If yes, only penile cancer or this virus can transfer to throat and head and can cause head/neck cancers? Now if I have HPV vaccination, that will be helpful? Any immunity supplements can help to cure HPV? For the safer side, I have given HIV antigen and antibody test twice after 14, and 28 days of my last sexual encounter (had oral sex with a condom) results are negative.1 st test value is 0.18 and the second test value is 0.36 and as per the lab report it of the index. Increase in antibodies value in the later test is fine or abnormal?

Hello. The HPV infection is caused by a group of viruses called Human papillomaviruses. Majority of them are self-limiting and do not produce any symptoms. Most common viruses that cause warts are type 6 and 11, and they are harmless, whereas types 16 and 18 cause cancer. Now in your case, I need to know the type of virus found in the lesion. If that is negative for HPV, you need not worry. HPV spreads sexually and can spread to genitals, rectum, mouth or throat, and condom can offer protection though not complete.The HPV vaccine does offer protection, and you can go for it. There are no provided supplements that can enhance immunity. Your HIV antigen as well antibody titers are within normal limits, and you need not worry about it. My only suggestion is to avoid high-risk sexual behavior, which reduces sexually transmitted altogether. Please get back to me if you need any more clarification.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was operated for cryptorchidism when I was nine years. My left testicle is 3.5 by 2.5 cm. I feel this is too small.Please suggest tablets to increase its size. I have epididymal cysts 7 cm long in both testicles. I have burning sensation and numbness and pain. Suggest tablets for this as well.Some days ago I put Flexabenz or Chlorobenzene and Linseed oil cream for joint pain by mistake on my right testicle side, but I washed it immediately. Will it cause any damage or shrinkage of my right testicle? I am worried.Also, I have white spots called elevated Meissner\\s corpuscles on the left side of the urethral opening on the glans penis. I have elevated lunar and semilunar elevated papillae on inner foreskin. I have white spots on inner foreskin also.I have numbness, loss of sensation, itching and burning sensation on both glans and inner foreskin. Please suggest medicines for all these.Please do not suggest topical gels or creams. I am scared of those. Please suggest only tablets. ### Response: Hello, Welcome to Chat Doctor forum. The normal size of an adult testis is 3 by 4 cm with an approximate volume of 12 to 19 cc. Patients with a history of cryptorchidism may have a slightly smaller size of the testis at adult stage. However, the size of the testis does not matter as long as the semen functional tests are normal. Moreover, there are no medicines available to increase the size of a small testis. In your case, the size is just borderline and nothing to worry. I would advise you get a semen analysis done to see the functioning of the testis. Also, the spots that you have mentioned are physiological and represent the oil glands on the genitalia. They do not warrant any treatment. With regards to the use of Chlorobenzene and other oils, they can at times lead to an allergic contact dermatitis. But otherwise, do not affect the testicular size. For more information consult a cosmetologist online

Hello doctor,I was operated for cryptorchidism when I was nine years. My left testicle is 3.5 by 2.5 cm. I feel this is too small.Please suggest tablets to increase its size. I have epididymal cysts 7 cm long in both testicles. I have burning sensation and numbness and pain. Suggest tablets for this as well.Some days ago I put Flexabenz or Chlorobenzene and Linseed oil cream for joint pain by mistake on my right testicle side, but I washed it immediately. Will it cause any damage or shrinkage of my right testicle? I am worried.Also, I have white spots called elevated Meissner\\s corpuscles on the left side of the urethral opening on the glans penis. I have elevated lunar and semilunar elevated papillae on inner foreskin. I have white spots on inner foreskin also.I have numbness, loss of sensation, itching and burning sensation on both glans and inner foreskin. Please suggest medicines for all these.Please do not suggest topical gels or creams. I am scared of those. Please suggest only tablets.

Hello, Welcome to Chat Doctor forum. The normal size of an adult testis is 3 by 4 cm with an approximate volume of 12 to 19 cc. Patients with a history of cryptorchidism may have a slightly smaller size of the testis at adult stage. However, the size of the testis does not matter as long as the semen functional tests are normal. Moreover, there are no medicines available to increase the size of a small testis. In your case, the size is just borderline and nothing to worry. I would advise you get a semen analysis done to see the functioning of the testis. Also, the spots that you have mentioned are physiological and represent the oil glands on the genitalia. They do not warrant any treatment. With regards to the use of Chlorobenzene and other oils, they can at times lead to an allergic contact dermatitis. But otherwise, do not affect the testicular size. For more information consult a cosmetologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 33 year old male. I am from prickling, numbness, warm sensation in my feet and hands and tingling in my lips and mouth for the past two years. I had a severe cough for around two years and recently, it got resolved. My issue, initially started with prickling and burning sensations in feet and after that both palms. Now, it has increased above knee. I visited a neurologist, but the problem was not solved. Presently, I am suffering from numbness and tingling in the mouth on lip area, prickling, burning sensations and numbness in feet, legs and palms, getting tired after moving through staircase, feeling some discomfort in chest area like heaviness for some time, gas problem and recurrent mouth ulcer. My sugar test, BP, NCV, ANA profile, TMT and ECG are normal. ACE 69, HSV1 positive, vitamin D 17 deficient and uric acid 8.2.I am completely blank now; I am not getting any hope of good treatment for my problem. I had unprotected sex 9 years ago. My CMIA test and rapid HIV test came back negative that time. I had medicine for herpes simplex for a month, vitamin D3 60K once in a week for four weeks and then once a month for six months. But, my problem remains the same. I will be highly obliged to you. I am struggling because of my present health condition. Kindly advise the treatment. ### Response: Hi, Welcome to Chat Doctor forum. Your problem still could be due to a nerve problem, even though your NCV test is normal (nerve conduction velocity). Also, you might be having calcium deficiency, which is very common associated with vitamin D deficiency. I suggest you calcium supplements like tablet Shelcal HD daily once for three months. Apart from vitamin D and herpes medication, have you taken any medicines for your problem? Kindly let me know that. If not done, then kindly get serum vitamin B12 levels tested and revert back with the report. Revert back with the reports to an internal medicine physician online

Hi doctor,I am a 33 year old male. I am from prickling, numbness, warm sensation in my feet and hands and tingling in my lips and mouth for the past two years. I had a severe cough for around two years and recently, it got resolved. My issue, initially started with prickling and burning sensations in feet and after that both palms. Now, it has increased above knee. I visited a neurologist, but the problem was not solved. Presently, I am suffering from numbness and tingling in the mouth on lip area, prickling, burning sensations and numbness in feet, legs and palms, getting tired after moving through staircase, feeling some discomfort in chest area like heaviness for some time, gas problem and recurrent mouth ulcer. My sugar test, BP, NCV, ANA profile, TMT and ECG are normal. ACE 69, HSV1 positive, vitamin D 17 deficient and uric acid 8.2.I am completely blank now; I am not getting any hope of good treatment for my problem. I had unprotected sex 9 years ago. My CMIA test and rapid HIV test came back negative that time. I had medicine for herpes simplex for a month, vitamin D3 60K once in a week for four weeks and then once a month for six months. But, my problem remains the same. I will be highly obliged to you. I am struggling because of my present health condition. Kindly advise the treatment.

Hi, Welcome to Chat Doctor forum. Your problem still could be due to a nerve problem, even though your NCV test is normal (nerve conduction velocity). Also, you might be having calcium deficiency, which is very common associated with vitamin D deficiency. I suggest you calcium supplements like tablet Shelcal HD daily once for three months. Apart from vitamin D and herpes medication, have you taken any medicines for your problem? Kindly let me know that. If not done, then kindly get serum vitamin B12 levels tested and revert back with the report. Revert back with the reports to an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My mother is 97 years old. She had a minor heart failure with a BNP of 110. Recently, she had a bad UTI and asthma. Up to that point, her O2 saturation levels without supplemental oxygen were 95 to 96. Now that she is recovering from UTI, her O2 levels are 97 to 98 with 2 liters of supplemental O2 and her O2 level without supplemental O2 are between 88 and 92. All of these numbers are at rest. She does not do too much activity. What can be the contributing factor to this change? She had a chest CT scan and it did not show COPD. Should she stay on the O2? It is somewhat of a hazard. The tubing is difficult for her to handle. We must have someone with her all the time even throughout the night. We are concerned if she gets up to use the bathroom her foot will get caught on the tubing. She had a complete blood workup done. All the results were normal except that she is anemic. Currently, she is using nebulizer given by the primary care physician containing Ipratropium, Levalbuterol, Budesonide and antibiotics for recurrent UTI. ### Response: Hi. I do not understand the correlation between urinary tract infection (UTI) and low oxygen saturation. If the UTI has caused sepsis and multiorgan failure, then only it can affect lungs and saturation would ChatDoctor. Asthma is a chronic disease and does not occur suddenly. She either had pre-existing asthma that got exacerbated by UTI or she had acute bronchitis or lower respiratory tract infection. I would recommend you go for a re-evaluation of her heart by 2D echocardiogram for her ejection fraction and for any signs of pulmonary embolism. If we do not treat the basic cause of falling saturation, we will not be able to come out of this problem. I would like to know whether you are treating her at home or hospital. Also, mention if you have her latest blood counts and urine test reports. Take care.

Hello doctor,My mother is 97 years old. She had a minor heart failure with a BNP of 110. Recently, she had a bad UTI and asthma. Up to that point, her O2 saturation levels without supplemental oxygen were 95 to 96. Now that she is recovering from UTI, her O2 levels are 97 to 98 with 2 liters of supplemental O2 and her O2 level without supplemental O2 are between 88 and 92. All of these numbers are at rest. She does not do too much activity. What can be the contributing factor to this change? She had a chest CT scan and it did not show COPD. Should she stay on the O2? It is somewhat of a hazard. The tubing is difficult for her to handle. We must have someone with her all the time even throughout the night. We are concerned if she gets up to use the bathroom her foot will get caught on the tubing. She had a complete blood workup done. All the results were normal except that she is anemic. Currently, she is using nebulizer given by the primary care physician containing Ipratropium, Levalbuterol, Budesonide and antibiotics for recurrent UTI.

Hi. I do not understand the correlation between urinary tract infection (UTI) and low oxygen saturation. If the UTI has caused sepsis and multiorgan failure, then only it can affect lungs and saturation would ChatDoctor. Asthma is a chronic disease and does not occur suddenly. She either had pre-existing asthma that got exacerbated by UTI or she had acute bronchitis or lower respiratory tract infection. I would recommend you go for a re-evaluation of her heart by 2D echocardiogram for her ejection fraction and for any signs of pulmonary embolism. If we do not treat the basic cause of falling saturation, we will not be able to come out of this problem. I would like to know whether you are treating her at home or hospital. Also, mention if you have her latest blood counts and urine test reports. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 44 years old male. I am attaching pictures of my seven year CBC history. Here is what happened this year. On my annual physical 11 months back, my WBC was low. Three months back, my GP checked it again. WBC came back in range but platelets were low. Over seven years, platelets have been between 134 and 165. GP sent my CBC history to two oncologists for review of low platelets. One said do test for H.pylori, hepatitis c, and HIV. Did the tests, all came negative. Both the oncologists asked to follow CBC. My father died of multiple myeloma at age of 64. The other day, I noticed a small bruise on my hip. Probably no big deal but have a heightened awareness now. My question is due to my father dying of MM and/or my CBC history, am I at a higher risk of blood cancer? What or when should I be concerned, what to look for? I certainly do not want to go to an oncologist with a single bruise. ### Response: Hello, Welcome to Chat Doctor forum. Your CBC does not suggest multiple myeloma (attachment removed to protect patient identity). In the case of multiple myeloma, anemia can be there and clinical symptoms like a constant headache, kidney system related symptoms, etc., can be present. But as your father was having a history of multiple myeloma, you are also at risk. But it does not necessarily mean that you will develop cancer in the future, the risk can be there but exact percentage cannot be predicted. So if you suffer from any unusual symptoms related to multiple myeloma like a headache, affected vision, weight loss, bone fractures, fever, etc., then you have to consult a nearby doctor for detailed evaluation. Your CBC is not showing any dangerous finding but still, I suggest you investigate with peripheral smear examination report and serum immunofixation electrophoresis for further work up. Peripheral smear examination will show any abnormal cells if present and electrophoresis will help in identifying monoclonal M band if present. You can revert back with that report.

Hello doctor,I am 44 years old male. I am attaching pictures of my seven year CBC history. Here is what happened this year. On my annual physical 11 months back, my WBC was low. Three months back, my GP checked it again. WBC came back in range but platelets were low. Over seven years, platelets have been between 134 and 165. GP sent my CBC history to two oncologists for review of low platelets. One said do test for H.pylori, hepatitis c, and HIV. Did the tests, all came negative. Both the oncologists asked to follow CBC. My father died of multiple myeloma at age of 64. The other day, I noticed a small bruise on my hip. Probably no big deal but have a heightened awareness now. My question is due to my father dying of MM and/or my CBC history, am I at a higher risk of blood cancer? What or when should I be concerned, what to look for? I certainly do not want to go to an oncologist with a single bruise.

Hello, Welcome to Chat Doctor forum. Your CBC does not suggest multiple myeloma (attachment removed to protect patient identity). In the case of multiple myeloma, anemia can be there and clinical symptoms like a constant headache, kidney system related symptoms, etc., can be present. But as your father was having a history of multiple myeloma, you are also at risk. But it does not necessarily mean that you will develop cancer in the future, the risk can be there but exact percentage cannot be predicted. So if you suffer from any unusual symptoms related to multiple myeloma like a headache, affected vision, weight loss, bone fractures, fever, etc., then you have to consult a nearby doctor for detailed evaluation. Your CBC is not showing any dangerous finding but still, I suggest you investigate with peripheral smear examination report and serum immunofixation electrophoresis for further work up. Peripheral smear examination will show any abnormal cells if present and electrophoresis will help in identifying monoclonal M band if present. You can revert back with that report.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My friend undergoes frequent delusions and nightmares about some men raping her. She is 20 years old now. When she was around 10 years old, she went to a wedding ceremony. She made friends with a boy much older than her. He took her to someplace on the very same day telling her something nice and all. Then she saw four to five boys standing outside a dark construction site. She fainted then and after that, she only remembers waking up. She says that all these are coming back now because she is curious about what happened to her that night. Her delusions and nightmares were triggered by a rape scene she was seeing in a daily soap recently which made her remember the incident.What is worse is that if she gets to know what happened that night, and if it is really something that bad, she might commit suicide or hurt herself. Recently while I was at her place, talking about these problems, suddenly she felt dizzy and sat down, and then she stared intently at the entrance for at least five minutes if not ten, after which again she was normal but she does not know any part of the time when she was looking at the door and thinking something. I am very much worried about her. Please I need some advice about what can I do about and how can I help her? She is in so much of pain. Please help. ### Response: Hi, Welcome to Chat Doctor forum. It appears more of an anxiety spectrum disorder rather than an actual delusion. Which antianxiety ChatDoctor. 25 mg Clonazepam at night, if there are severe nightmares there is also an option of Prazosin 1 mg at night, you could meet a local psychiatrist for these. I would recommend you to not actively talk about the rape thing to her or do any online therapy since it can make her focus too much on the topic. Try to distract her and keep her engaged. Yoga and muscle relaxation exercises can help. If there is a clinical psychologist near your area, she can be started on a cognitive behavior therapy but again I would recommend the above options before trying it out.

Hello doctor,My friend undergoes frequent delusions and nightmares about some men raping her. She is 20 years old now. When she was around 10 years old, she went to a wedding ceremony. She made friends with a boy much older than her. He took her to someplace on the very same day telling her something nice and all. Then she saw four to five boys standing outside a dark construction site. She fainted then and after that, she only remembers waking up. She says that all these are coming back now because she is curious about what happened to her that night. Her delusions and nightmares were triggered by a rape scene she was seeing in a daily soap recently which made her remember the incident.What is worse is that if she gets to know what happened that night, and if it is really something that bad, she might commit suicide or hurt herself. Recently while I was at her place, talking about these problems, suddenly she felt dizzy and sat down, and then she stared intently at the entrance for at least five minutes if not ten, after which again she was normal but she does not know any part of the time when she was looking at the door and thinking something. I am very much worried about her. Please I need some advice about what can I do about and how can I help her? She is in so much of pain. Please help.

Hi, Welcome to Chat Doctor forum. It appears more of an anxiety spectrum disorder rather than an actual delusion. Which antianxiety ChatDoctor. 25 mg Clonazepam at night, if there are severe nightmares there is also an option of Prazosin 1 mg at night, you could meet a local psychiatrist for these. I would recommend you to not actively talk about the rape thing to her or do any online therapy since it can make her focus too much on the topic. Try to distract her and keep her engaged. Yoga and muscle relaxation exercises can help. If there is a clinical psychologist near your area, she can be started on a cognitive behavior therapy but again I would recommend the above options before trying it out.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 21-year-old male, and I was suffering from inflammatory bowel disease (IBD) before a year. After taking medications, my condition got better. So I stopped taking medicines, and I took Pantop-D (Pantoprazole) only for the gas relief. Before a month, I developed a fungal infection in my groin area, and the doctor prescribed me Itraconazole 200 mg. When I started taking medicine, my stools became hard, and I developed constipation. But I have not stopped taking it. Before five days, my problem got worse, and I stopped taking Itraconazole.Now, I have diarrhea with blood in the stool. There is bloating (gas) in the abdomen. Sometimes I have pain on the left side of the lower abdomen. I have a feeling of nausea. I am currently taking Pantop-D (Pantoprazole), Metrogyl (Metronidazole) 400 mg (started taking today only) and high fiber diet. I have a few questions. Does blood in the stool occur due to diverticulitis? Does taking Pantoprazole show any side effects on diverticulitis? Can I take ORS or electoral for rehydration? Please suggest your advice. ### Response: Hi, Welcome to Chat Doctor forum. There are two causes for the blood in the stool. The reason can be due to infection and reactivation of inflammatory bowel disease. In such condition, we should treat the infection first. The common infection seen is bacterial, sometimes viral infection may also occur like CMV (cytomegalovirus). It is diagnosed by colonoscopy guided with biopsy examination. If there is no infection, then we have to take a biopsy for IBD activity, and we can increase the immune suppression. I think you are not taking immune suppression medications. Uncontrolled IBD has a poor prognosis, and the risk of complications is very high. I will suggest a course of IV antibiotics in the form of Ceftriaxone and Metronidazole. You can take ORS (oral rehy ChatDoctor.

Hi doctor,I am a 21-year-old male, and I was suffering from inflammatory bowel disease (IBD) before a year. After taking medications, my condition got better. So I stopped taking medicines, and I took Pantop-D (Pantoprazole) only for the gas relief. Before a month, I developed a fungal infection in my groin area, and the doctor prescribed me Itraconazole 200 mg. When I started taking medicine, my stools became hard, and I developed constipation. But I have not stopped taking it. Before five days, my problem got worse, and I stopped taking Itraconazole.Now, I have diarrhea with blood in the stool. There is bloating (gas) in the abdomen. Sometimes I have pain on the left side of the lower abdomen. I have a feeling of nausea. I am currently taking Pantop-D (Pantoprazole), Metrogyl (Metronidazole) 400 mg (started taking today only) and high fiber diet. I have a few questions. Does blood in the stool occur due to diverticulitis? Does taking Pantoprazole show any side effects on diverticulitis? Can I take ORS or electoral for rehydration? Please suggest your advice.

Hi, Welcome to Chat Doctor forum. There are two causes for the blood in the stool. The reason can be due to infection and reactivation of inflammatory bowel disease. In such condition, we should treat the infection first. The common infection seen is bacterial, sometimes viral infection may also occur like CMV (cytomegalovirus). It is diagnosed by colonoscopy guided with biopsy examination. If there is no infection, then we have to take a biopsy for IBD activity, and we can increase the immune suppression. I think you are not taking immune suppression medications. Uncontrolled IBD has a poor prognosis, and the risk of complications is very high. I will suggest a course of IV antibiotics in the form of Ceftriaxone and Metronidazole. You can take ORS (oral rehy ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 25 year old uncircumcised male. My condition is not disturbing my life, but for the sake of clarity, it would be nice to consult for a primary opinion on whether it is necessary to physically visit a urologist. I had a minor yeast infection a few months back. While clearing them off, I just found out for the first time in my life that I had a partial phimosis. For the past few weeks, I tried doing retraction exercise and now I can easily retract my foreskin, to view the whole glans and clear off the excessive smegma. The smegma softens after a period of time and gets lesser every time I shower for the past few weeks. However, I am a bit troubled by the fact that the bottom end of my urethral opening appears swollen. Previously, when I was not able to retract my foreskin, the appearance is like a small red bump. Upon revealing the whole glans, I see that it is a red part of the penile opening and it is like a straight line of red skin from the bottom end of the urethra opening until the end of the glans.When I raised this issue with my GP, who treated my fungal infection, he said it was probably a birth variation or minor inflammation. I told him (from what I recall), I had always had this since probably teenage or even younger. It does not concern me, but I just want to be more informed of my own well being. I have not been sexually active and just very recently solved my phimosis. Could it have been caused by the residual urine on my penile tip, since I am uncircumcised? Does this condition require serious medical attention? ### Response: Hi, I think the red line you are referring to is nothing but frenulum. It is a normal structure and since you do not have any symptoms attributable to it, I really do not think that you need to see a urologist in person. It would add better clarity, if you can attach a photo of your penis showing the lesion. Revert back with the urologist online

Hi doctor,I am a 25 year old uncircumcised male. My condition is not disturbing my life, but for the sake of clarity, it would be nice to consult for a primary opinion on whether it is necessary to physically visit a urologist. I had a minor yeast infection a few months back. While clearing them off, I just found out for the first time in my life that I had a partial phimosis. For the past few weeks, I tried doing retraction exercise and now I can easily retract my foreskin, to view the whole glans and clear off the excessive smegma. The smegma softens after a period of time and gets lesser every time I shower for the past few weeks. However, I am a bit troubled by the fact that the bottom end of my urethral opening appears swollen. Previously, when I was not able to retract my foreskin, the appearance is like a small red bump. Upon revealing the whole glans, I see that it is a red part of the penile opening and it is like a straight line of red skin from the bottom end of the urethra opening until the end of the glans.When I raised this issue with my GP, who treated my fungal infection, he said it was probably a birth variation or minor inflammation. I told him (from what I recall), I had always had this since probably teenage or even younger. It does not concern me, but I just want to be more informed of my own well being. I have not been sexually active and just very recently solved my phimosis. Could it have been caused by the residual urine on my penile tip, since I am uncircumcised? Does this condition require serious medical attention?

Hi, I think the red line you are referring to is nothing but frenulum. It is a normal structure and since you do not have any symptoms attributable to it, I really do not think that you need to see a urologist in person. It would add better clarity, if you can attach a photo of your penis showing the lesion. Revert back with the urologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,After three miscarriages, my doctor suggested me for torch test and it came out positive with high values of rubella IgG 272, toxoplasma IgG 78.6 and CMV IgG 12.1 and herpes IgG 46.1. My doctor gave me Acylex 200 mg two times a day for two months and advised us to not try for a baby for two months. After two months medicine course, I did this test again today and again it is positive with rubella IgG 223, toxoplasma IgG 101, CMV IgG is 13.6 and herpes IgG is 47.9. We cannot understand the reports. My uterus, ovaries, hormones, everything is fine. Please tell me when we can plan a pregnancy? And what are the chances of miscarriage again because of torch test positive results? All torch test IgM values are normal. ### Response: Hello, Welcome to Chat Doctor forum. I have gone through your case summary. Please tell me about the miscarriage at what time of gestation did they occur. Have you got an ultrasound done in those previous pregnancies? Was any shadow of the baby seen at that time? Was heartbeat seen in the baby? Next is your TORCH test. First of all, it is not responsible for recurrent miscarriages. All high values of IgG suggest that you are immune and now nothing is to be done. If we want to know a fresh infection, then only IgM or avidity testing is required. Did you have any history of fever, sore throat or any eruptions on your skin at the time of first miscarriage? Now, just do not bother about these tests. The important test required to be done. If not done earlier are thyroid profile, fasting, and postprandial blood sugar, V ChatDoctor. Get all these tests and accordingly, she can plan a pregnancy after another month. Pre-conceptionally, she should take tablet Folvite 1 mg and tablet Ecosprin 75 mg once a day. Could be anti-phospholipid antibody syn

Hello doctor,After three miscarriages, my doctor suggested me for torch test and it came out positive with high values of rubella IgG 272, toxoplasma IgG 78.6 and CMV IgG 12.1 and herpes IgG 46.1. My doctor gave me Acylex 200 mg two times a day for two months and advised us to not try for a baby for two months. After two months medicine course, I did this test again today and again it is positive with rubella IgG 223, toxoplasma IgG 101, CMV IgG is 13.6 and herpes IgG is 47.9. We cannot understand the reports. My uterus, ovaries, hormones, everything is fine. Please tell me when we can plan a pregnancy? And what are the chances of miscarriage again because of torch test positive results? All torch test IgM values are normal.

Hello, Welcome to Chat Doctor forum. I have gone through your case summary. Please tell me about the miscarriage at what time of gestation did they occur. Have you got an ultrasound done in those previous pregnancies? Was any shadow of the baby seen at that time? Was heartbeat seen in the baby? Next is your TORCH test. First of all, it is not responsible for recurrent miscarriages. All high values of IgG suggest that you are immune and now nothing is to be done. If we want to know a fresh infection, then only IgM or avidity testing is required. Did you have any history of fever, sore throat or any eruptions on your skin at the time of first miscarriage? Now, just do not bother about these tests. The important test required to be done. If not done earlier are thyroid profile, fasting, and postprandial blood sugar, V ChatDoctor. Get all these tests and accordingly, she can plan a pregnancy after another month. Pre-conceptionally, she should take tablet Folvite 1 mg and tablet Ecosprin 75 mg once a day. Could be anti-phospholipid antibody syn

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am here today to finally address my problem. I am an 18 year old male, who plays football and loves to play golf. I am here today to say, and I have an eating disorder. In this case, I am assuming it is an eating disorder or some type of phobia. But anyway, my problem is eating in public. I never had a problem with it when I was young, but it probably started when I was 13 years old. I cannot eat out if I go to a restaurant or a fast food place, I feel like throwing up instantly when I sit down with my food. I cannot eat at school and the worst one is when I receive the body of Christ, I almost jump out of my shoes to try and not to throw up. But luckily that never happened.It is probably been about two years since I ate out of my house. I do not understand how it just happened. I mean like I was fine when I was younger, and now I have this problem. What should I do? My family does not really believe me when I tell them, they just say it is nerves. But since it has been two years, I think it is buried in my head. Now I have some questions. Can this be fixed? What exactly is my problem? Will I ever be able to eat at a restaurant or fast food place again? Can this be fixed without actually going to the doctor? You honestly do not know how much I would love to go sit down with my family at a restaurant and enjoy a meal. I need help and a confidence booster. I can eat perfectly fine at my own house and that is why I am confused. Please help me. ### Response: Hi, Welcome to Chat Doctor forum. I think it is not an eating disorder because, in the case of an eating disorder, the problem should be everywhere including your home. However, your problem of eating in public could be because of social anxiety disorder or because of Obsessive-Compulsive Disorder (OCD). So, I would like to seek more clarification regarding the following points

Hello doctor,I am here today to finally address my problem. I am an 18 year old male, who plays football and loves to play golf. I am here today to say, and I have an eating disorder. In this case, I am assuming it is an eating disorder or some type of phobia. But anyway, my problem is eating in public. I never had a problem with it when I was young, but it probably started when I was 13 years old. I cannot eat out if I go to a restaurant or a fast food place, I feel like throwing up instantly when I sit down with my food. I cannot eat at school and the worst one is when I receive the body of Christ, I almost jump out of my shoes to try and not to throw up. But luckily that never happened.It is probably been about two years since I ate out of my house. I do not understand how it just happened. I mean like I was fine when I was younger, and now I have this problem. What should I do? My family does not really believe me when I tell them, they just say it is nerves. But since it has been two years, I think it is buried in my head. Now I have some questions. Can this be fixed? What exactly is my problem? Will I ever be able to eat at a restaurant or fast food place again? Can this be fixed without actually going to the doctor? You honestly do not know how much I would love to go sit down with my family at a restaurant and enjoy a meal. I need help and a confidence booster. I can eat perfectly fine at my own house and that is why I am confused. Please help me.

Hi, Welcome to Chat Doctor forum. I think it is not an eating disorder because, in the case of an eating disorder, the problem should be everywhere including your home. However, your problem of eating in public could be because of social anxiety disorder or because of Obsessive-Compulsive Disorder (OCD). So, I would like to seek more clarification regarding the following points

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 9 weeks 3 days pregnant. My doctor has diagnosed me with gestational diabetes. At my 1 hour test, my levels were at 170, which was high, but they told me it was low. I was scheduled for 3 hours test and was told to eat sugar treats and sugar drinks three days before my test and then to fast on the day of the test. I failed all the three tests. I have been told that I was obviously going to have sugar in my system, so that is why it came out high. Was the test done right? ### Response: Hi, Welcome to Chat Doctor forum. Let me make a few corrections in the methods done. I have not heard of the methods done. Gestational diabetes is caused by the hormones of the pregnancy, which appears in pregnancy only after 26 to 28 weeks, the time when pregnancy hormones are at the highest level. So, any diabetes occurring before 28 weeks is called pregestational diabetes. It is important to know because in gestational diabetes mellitus (GDM) by 28 weeks the baby is fully formed and abnormal sugars cannot lead to any abnormalities in babies other than an increase in birth weight and amniotic fluid. But, if the sugar rises early as in your case (before 28 weeks) this can affect the normal growth of baby\\s tissue. You will need to be put on Insulin to correct sugar before any damage is done. We do not need to give such challenges in pregnancy to know that your sugar level is high. I would suggest you undergo HbA1c (glycated hemoglobin) as this checks your blood sugar level of last three months. Your level should be less than 6.5 %. If it is more than this, then you need to be treated with Insulin. Have fasting blood sugar at the morning after the overnight fast of 8 hours and postprandial sugar after 2 hours of food. These two blood levels will help you decide the doses of Insulin. Also, you can take a second opinion from another doctor.

Hi doctor,I am 9 weeks 3 days pregnant. My doctor has diagnosed me with gestational diabetes. At my 1 hour test, my levels were at 170, which was high, but they told me it was low. I was scheduled for 3 hours test and was told to eat sugar treats and sugar drinks three days before my test and then to fast on the day of the test. I failed all the three tests. I have been told that I was obviously going to have sugar in my system, so that is why it came out high. Was the test done right?

Hi, Welcome to Chat Doctor forum. Let me make a few corrections in the methods done. I have not heard of the methods done. Gestational diabetes is caused by the hormones of the pregnancy, which appears in pregnancy only after 26 to 28 weeks, the time when pregnancy hormones are at the highest level. So, any diabetes occurring before 28 weeks is called pregestational diabetes. It is important to know because in gestational diabetes mellitus (GDM) by 28 weeks the baby is fully formed and abnormal sugars cannot lead to any abnormalities in babies other than an increase in birth weight and amniotic fluid. But, if the sugar rises early as in your case (before 28 weeks) this can affect the normal growth of baby\\s tissue. You will need to be put on Insulin to correct sugar before any damage is done. We do not need to give such challenges in pregnancy to know that your sugar level is high. I would suggest you undergo HbA1c (glycated hemoglobin) as this checks your blood sugar level of last three months. Your level should be less than 6.5 %. If it is more than this, then you need to be treated with Insulin. Have fasting blood sugar at the morning after the overnight fast of 8 hours and postprandial sugar after 2 hours of food. These two blood levels will help you decide the doses of Insulin. Also, you can take a second opinion from another doctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Two years back, after a routine blood test I was diagnosed with fatty liver due to raised liver enzymes ALT 53 ALP 66 and GGT188. I later underwent a liver scan and the conclusion was Child A Cirrhosis-possibly secondary to NASH. Advised to lose weight with no medication prescribed. Yesterday, I underwent a FibroTouch scan and result showed liver stiffness of 19.9 kPa and UAP(dB/m) of 279. Meanwhile, for the past one year I have been taking daily supplements of Milk Thistle, Gluthathione and lately Magnesium Bisglycinate, (for cramps and muscle weakness), and Vitamin E. I was also once told that I may have high inflammation due to autoimmune-related problem possibly due to a weak gut (leaky gut). All not really validated through any test. Apart from deciding to go aggressive with my weight loss initiative and eating more plant based food, I am at a loss as to what to do to reverse the stage 4 fibrosis from worsening. I am going plant based because of the testimonies of those who adopted the diet lifestyle and had a change for the better in their conditions. My family is worried that I may not have the chance to live long. I am almost 62 now. What do you advice that I should do to recover from this? ### Response: Hi. You have investigated by fibroscan report (attachment removed to protect patient identity). The 19 kpa is suggestive of grade 4 fibrosis in liver. The fibrosis can from due to chronic inflammation. The NASH is form of hepatitis due to overweight. So, fibrosis can develop in NASH as well and so liver can be more stiff. However, your high kpa and UAP are suggestive of early cirrhosis change. So, you need to lose weight first. The Ursodeoxycholic acid can be prescribed for your condition. You need to be monitored regularly by gastroenterologist. No further aggressive treatment needed just now. I suggest you consult gastroenterologist for detailed evaluation and do regular follow up.

Hello doctor,Two years back, after a routine blood test I was diagnosed with fatty liver due to raised liver enzymes ALT 53 ALP 66 and GGT188. I later underwent a liver scan and the conclusion was Child A Cirrhosis-possibly secondary to NASH. Advised to lose weight with no medication prescribed. Yesterday, I underwent a FibroTouch scan and result showed liver stiffness of 19.9 kPa and UAP(dB/m) of 279. Meanwhile, for the past one year I have been taking daily supplements of Milk Thistle, Gluthathione and lately Magnesium Bisglycinate, (for cramps and muscle weakness), and Vitamin E. I was also once told that I may have high inflammation due to autoimmune-related problem possibly due to a weak gut (leaky gut). All not really validated through any test. Apart from deciding to go aggressive with my weight loss initiative and eating more plant based food, I am at a loss as to what to do to reverse the stage 4 fibrosis from worsening. I am going plant based because of the testimonies of those who adopted the diet lifestyle and had a change for the better in their conditions. My family is worried that I may not have the chance to live long. I am almost 62 now. What do you advice that I should do to recover from this?

Hi. You have investigated by fibroscan report (attachment removed to protect patient identity). The 19 kpa is suggestive of grade 4 fibrosis in liver. The fibrosis can from due to chronic inflammation. The NASH is form of hepatitis due to overweight. So, fibrosis can develop in NASH as well and so liver can be more stiff. However, your high kpa and UAP are suggestive of early cirrhosis change. So, you need to lose weight first. The Ursodeoxycholic acid can be prescribed for your condition. You need to be monitored regularly by gastroenterologist. No further aggressive treatment needed just now. I suggest you consult gastroenterologist for detailed evaluation and do regular follow up.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I and my partner had intercourse two days ago. He used a condom but can I still have a chance with pregnancy. But two days after intercourse my stomach starts to hurt and I am spotting blood. I have read about spotting to be a sign of pregnancy but after a week after intercourse can it just be my period? My period had to start in nine days, but my periods are irregular. Can they come up to more than a week early or late? Please suggest I do not know what is going on. ### Response: Hello, Welcome to ChatDoctor. I have gone through your query with diligence and would like you to know that I am here to help. Based on the information provided, I would like to rightfully start by saying that condoms are 98.9 % effective in preventing conception. The 1.1 % is due to a poorly manufactured condom or due to inadequate care taken to follow the instructions of use. In my opinion, if you followed the instructions of use, there should be nothing to worry about. As for the spotting, this could purely be due to the sexual act itself. Many women have mild spotting after sexual intercourse, some simply due to the excessive contraction and relaxation of the muscles and some due to rough sexual intercourse. As for an implantation bleed, this takes place quite a few days after the sexual act, so it cannot be assumed to be a sign of pregnancy. This, in my opinion, is most probably due to the sexual act itself, or due to an early onset of your period. Wait and watch for a few more days, and if the spotting subsides then this was purely due to the sexual act. If it gets heavier then this is an early-onset period triggered by sexual intercourse. Please also make sure you keep track of your menstrual cycle if at all you do not experience your period now. If there is a delay in your periods, then conduct a home pregnancy test around two weeks after the sexual act and write back to me for further guidance. Do not worry, pregnancy is unlikely. I hope this helps. Take care.

Hello doctor,I and my partner had intercourse two days ago. He used a condom but can I still have a chance with pregnancy. But two days after intercourse my stomach starts to hurt and I am spotting blood. I have read about spotting to be a sign of pregnancy but after a week after intercourse can it just be my period? My period had to start in nine days, but my periods are irregular. Can they come up to more than a week early or late? Please suggest I do not know what is going on.

Hello, Welcome to ChatDoctor. I have gone through your query with diligence and would like you to know that I am here to help. Based on the information provided, I would like to rightfully start by saying that condoms are 98.9 % effective in preventing conception. The 1.1 % is due to a poorly manufactured condom or due to inadequate care taken to follow the instructions of use. In my opinion, if you followed the instructions of use, there should be nothing to worry about. As for the spotting, this could purely be due to the sexual act itself. Many women have mild spotting after sexual intercourse, some simply due to the excessive contraction and relaxation of the muscles and some due to rough sexual intercourse. As for an implantation bleed, this takes place quite a few days after the sexual act, so it cannot be assumed to be a sign of pregnancy. This, in my opinion, is most probably due to the sexual act itself, or due to an early onset of your period. Wait and watch for a few more days, and if the spotting subsides then this was purely due to the sexual act. If it gets heavier then this is an early-onset period triggered by sexual intercourse. Please also make sure you keep track of your menstrual cycle if at all you do not experience your period now. If there is a delay in your periods, then conduct a home pregnancy test around two weeks after the sexual act and write back to me for further guidance. Do not worry, pregnancy is unlikely. I hope this helps. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor, I am 36 years old. I am a vegetarian. Before three years due to stomach disturbance, yellowish urine, pain and some popup and cracker sound in my legs and knee joints. I visited a doctor and he suggest me for liver function test and all reports in normal range except for sugar which was 138 mg/dL at that time, he gave some medicines and referred to an orthopedic for joint pain. I visited an ortho specialist and he took an x-ray of both leg knees and tell that it is an early stage of osteoarthritis of knee and suggest for MRI. I had done an MRI and in the report it is mentioned that the left knee has affected with osteoarthritis. After that he give some medicines for 10 days and refers to a physiotherapist for exercise and weight loss. I have visited as he told and I reduced my weight and now there is very little pain remain in my left knee.But now my other joints, hips joints, both hand knee has popup sound when movement including neck, jaws, all have some very mild cracking and popping sound, as there is no pain, but as it seems to be taken care of in the next few years, so I prefer to consult a specialist like ortho and gastro doctors. Still I did not found any reason behind my current health situation, still, I have yellowish urine. Kindly interpret all the reports. ### Response: Hello. Well I have gone through your history. I would like to ask you a few more questions to confirm the probable diagnosis. Do you experience a lot of fatigue? Is the sleep pattern normal or is it disturbed? Any feelings of tiredness in the mornings after sleep also? Any history of recent irritability, forgetfulness? When you say stomach complaints does it mean loose stools or increased frequency of stools or constipation? Any history of weight loss? I have gone through your reports (attachment removed to protect patient identity). Most of them seem to be normal except for mild ANA positive. You are right that it all looks connected and we need to reach the diagnosis, as management gets easier then. Take care.

Hello doctor, I am 36 years old. I am a vegetarian. Before three years due to stomach disturbance, yellowish urine, pain and some popup and cracker sound in my legs and knee joints. I visited a doctor and he suggest me for liver function test and all reports in normal range except for sugar which was 138 mg/dL at that time, he gave some medicines and referred to an orthopedic for joint pain. I visited an ortho specialist and he took an x-ray of both leg knees and tell that it is an early stage of osteoarthritis of knee and suggest for MRI. I had done an MRI and in the report it is mentioned that the left knee has affected with osteoarthritis. After that he give some medicines for 10 days and refers to a physiotherapist for exercise and weight loss. I have visited as he told and I reduced my weight and now there is very little pain remain in my left knee.But now my other joints, hips joints, both hand knee has popup sound when movement including neck, jaws, all have some very mild cracking and popping sound, as there is no pain, but as it seems to be taken care of in the next few years, so I prefer to consult a specialist like ortho and gastro doctors. Still I did not found any reason behind my current health situation, still, I have yellowish urine. Kindly interpret all the reports.

Hello. Well I have gone through your history. I would like to ask you a few more questions to confirm the probable diagnosis. Do you experience a lot of fatigue? Is the sleep pattern normal or is it disturbed? Any feelings of tiredness in the mornings after sleep also? Any history of recent irritability, forgetfulness? When you say stomach complaints does it mean loose stools or increased frequency of stools or constipation? Any history of weight loss? I have gone through your reports (attachment removed to protect patient identity). Most of them seem to be normal except for mild ANA positive. You are right that it all looks connected and we need to reach the diagnosis, as management gets easier then. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,About a year ago, I had a long break from doing any type of fitness. About five months ago, I started doing more things again, mainly little things like going out to hang out with my horses, and going to a therapist for a bit. Then around two or three months ago, I decided to go to a fitness trainer to get myself even more fit for my horse riding. I have been held back quite a bit by an issue, what tends to happen is normally when I do something strenuous (but it also happens when temperature switches or the air just becomes more humid) I will start feeling my heart rate become quite rapid and heavy feeling, then I feel dizzy (my head feels really weird) and I will quite quickly feel sick and have to throw up or at least dry-retch. The doctor thought it might be something to do with my thyroid glands so took a full blood test, everything looked normal, my trainer thought it might be anxiety but it has happened at times where I am at my calmest, and my parents thought it might be because I am unfit, but after doing training and my fitness is pretty much back up to where it was before my break, it is still happening and has not improved at all. I have always done sports for most of my life before the break, the main two being athletics and horse ridings (though I only do horse riding now as well as fitness training). ### Response: Hi, Welcome to Chat Doctor forum. As per your symptoms, you feel dizzy when you do strenuous work or when the temperature changes (I guess when it becomes hotter) and when it is humid. As you feel nauseated. And you said that all blood reports with thyroid reports are also normal. The chances are this is due to vasodilation, that is the blood vessels dilate so the adequate amount is not reaching heart which in turn reduces blood supply to organs. Vasodilation. 1.Vasovagal syncope.2.Hypovolemia.3.Postural orthostatic tachycardia syn ChatDoctor. Postural orthostatic tachycardia syn

Hello doctor,About a year ago, I had a long break from doing any type of fitness. About five months ago, I started doing more things again, mainly little things like going out to hang out with my horses, and going to a therapist for a bit. Then around two or three months ago, I decided to go to a fitness trainer to get myself even more fit for my horse riding. I have been held back quite a bit by an issue, what tends to happen is normally when I do something strenuous (but it also happens when temperature switches or the air just becomes more humid) I will start feeling my heart rate become quite rapid and heavy feeling, then I feel dizzy (my head feels really weird) and I will quite quickly feel sick and have to throw up or at least dry-retch. The doctor thought it might be something to do with my thyroid glands so took a full blood test, everything looked normal, my trainer thought it might be anxiety but it has happened at times where I am at my calmest, and my parents thought it might be because I am unfit, but after doing training and my fitness is pretty much back up to where it was before my break, it is still happening and has not improved at all. I have always done sports for most of my life before the break, the main two being athletics and horse ridings (though I only do horse riding now as well as fitness training).

Hi, Welcome to Chat Doctor forum. As per your symptoms, you feel dizzy when you do strenuous work or when the temperature changes (I guess when it becomes hotter) and when it is humid. As you feel nauseated. And you said that all blood reports with thyroid reports are also normal. The chances are this is due to vasodilation, that is the blood vessels dilate so the adequate amount is not reaching heart which in turn reduces blood supply to organs. Vasodilation. 1.Vasovagal syncope.2.Hypovolemia.3.Postural orthostatic tachycardia syn ChatDoctor. Postural orthostatic tachycardia syn

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have unprotected vaginal and oral sex with a sex worker three weeks ago. I do not know her status of HIV although she said she is clean. Exactly after seven days of my exposure, I feel something wrong with my body as it is feeling uncomfortable. I had oral thrush, loss of appetite, swollen lymph nodes in neck, body aches, needles like pain all over my body, night sweat although no fever but I can feel the temperature is high, it is 98.5-99.3 degrees for the next couple of days. So I suspected that I got infected with HIV.Due to anxiety, I took the HIV antibody test on the 9th day of my exposure which I know is a bit early come out negative. But then on the 10th day (exactly after 9 days 10 hours), I took HIV 1 RNA TMA test on stdcheck.com which they said 95-99% accurate in 9-11 days after exposure. I got the result yesterday, as negative no HIV 1 RNA detected.Now, still I am in confusion because I am 100% sure I got infected with HIV. I do not know if these tests are conclusive or not. I do not have guts to do another test. Please help. And also some of my symptoms are gone but I discovered some additional like pain in kidneys, lower abdomen, chest pain, joint pain, and extreme fatigue for two to three days. ### Response: Hi, Welcome to Chat Doctor forum. I have gone through the details and reports. (attachment removed to protect patient identity). All the tests are negative is a good sign. The chances of transmission of HIV by unprotected intercourse with an HIV positive person is too low. If negative it is nil. You can allay fears. HIV RNA PCR is negative and is a good sign. It is almost conclusive. The chances of tests coming positive later are nil. But it is better to get tested for HIV 1 and 2 antibodies after three months to have conclusive results.

Hello doctor,I have unprotected vaginal and oral sex with a sex worker three weeks ago. I do not know her status of HIV although she said she is clean. Exactly after seven days of my exposure, I feel something wrong with my body as it is feeling uncomfortable. I had oral thrush, loss of appetite, swollen lymph nodes in neck, body aches, needles like pain all over my body, night sweat although no fever but I can feel the temperature is high, it is 98.5-99.3 degrees for the next couple of days. So I suspected that I got infected with HIV.Due to anxiety, I took the HIV antibody test on the 9th day of my exposure which I know is a bit early come out negative. But then on the 10th day (exactly after 9 days 10 hours), I took HIV 1 RNA TMA test on stdcheck.com which they said 95-99% accurate in 9-11 days after exposure. I got the result yesterday, as negative no HIV 1 RNA detected.Now, still I am in confusion because I am 100% sure I got infected with HIV. I do not know if these tests are conclusive or not. I do not have guts to do another test. Please help. And also some of my symptoms are gone but I discovered some additional like pain in kidneys, lower abdomen, chest pain, joint pain, and extreme fatigue for two to three days.

Hi, Welcome to Chat Doctor forum. I have gone through the details and reports. (attachment removed to protect patient identity). All the tests are negative is a good sign. The chances of transmission of HIV by unprotected intercourse with an HIV positive person is too low. If negative it is nil. You can allay fears. HIV RNA PCR is negative and is a good sign. It is almost conclusive. The chances of tests coming positive later are nil. But it is better to get tested for HIV 1 and 2 antibodies after three months to have conclusive results.

### Instruction: Answer this question truthfully ###Input: Hello doctor,We are both 18 years old and we were wondering if you could answer some of our questions for school. We are required to consult with a psychiatrist, but we do not have money to consult with any. Our topic is psychopathy and how psychopaths are developed. The questions are as follows.How do you diagnose someone as a psychopath? What kind of therapy is needed to aid the brain condition of a psychopath? Is psychopathy a genetic condition? Are sociopaths and psychopaths developed the same way? What kind of environment is the most likely to form psychopaths? Are psychopaths more self-sufficient compared to an average person? If psychopaths are unable to feel strong emotions, what are their goals or aspirations in life? What are the signs of a psychopath targeting you? Do psychopaths lack the concept of sexuality since they are unable to form deep emotional connections? If a psychopath is able to form a family, what would be the effect on his or her children? ### Response: Hi. I would be happy to help you. What you are referring to as a psychopath is known as antisocial personality disorder in psychiatry. It is diagnosed using certain standard guidelines and criteria. These people show a persistent disregard for laws and the rights of others. Such people do not generally seek professional help unless it is for comorbid problems like substance use or mood disorder or they are in prison and brought by the police. These people have impulsive traits and extreme irritability which can be reduced with the help of psychiatric medication. Therapy may be helpful but more often than not. There is no permanent treatment because many of them do not follow up and majority do not feel there is anything wrong with them. People who have first degree relatives with psychopathy have higher chances of the same but social, economic and cultural factors also play a role. Sociopaths can be best described as a milder form of antisocial personality disorder. Psychopaths are highly intelligent but they lack empathy. So they do not generally have long lasting relationships or gain satisfaction from interpersonal relations. Take care.

Hello doctor,We are both 18 years old and we were wondering if you could answer some of our questions for school. We are required to consult with a psychiatrist, but we do not have money to consult with any. Our topic is psychopathy and how psychopaths are developed. The questions are as follows.How do you diagnose someone as a psychopath? What kind of therapy is needed to aid the brain condition of a psychopath? Is psychopathy a genetic condition? Are sociopaths and psychopaths developed the same way? What kind of environment is the most likely to form psychopaths? Are psychopaths more self-sufficient compared to an average person? If psychopaths are unable to feel strong emotions, what are their goals or aspirations in life? What are the signs of a psychopath targeting you? Do psychopaths lack the concept of sexuality since they are unable to form deep emotional connections? If a psychopath is able to form a family, what would be the effect on his or her children?

Hi. I would be happy to help you. What you are referring to as a psychopath is known as antisocial personality disorder in psychiatry. It is diagnosed using certain standard guidelines and criteria. These people show a persistent disregard for laws and the rights of others. Such people do not generally seek professional help unless it is for comorbid problems like substance use or mood disorder or they are in prison and brought by the police. These people have impulsive traits and extreme irritability which can be reduced with the help of psychiatric medication. Therapy may be helpful but more often than not. There is no permanent treatment because many of them do not follow up and majority do not feel there is anything wrong with them. People who have first degree relatives with psychopathy have higher chances of the same but social, economic and cultural factors also play a role. Sociopaths can be best described as a milder form of antisocial personality disorder. Psychopaths are highly intelligent but they lack empathy. So they do not generally have long lasting relationships or gain satisfaction from interpersonal relations. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My friend and I had sex on the 29th of last month. Her last periods started on the 15th of last month. We used a condom the whole time, but I was worried there could have been a leak and got her an I-pill within 18 hours of intercourse. She has had no bleeding whatsoever since then and not even had her periods yet. Is there anything to worry? She normally gets her periods in 28 days. Please help. ### Response: Hello. How are you doing? The act of sex was on day-15 of the period, that is, very close to the ovulation date. But as you said that a condom had been used all the time and you only have a doubt of spill, the chances of a pregnancy is very very low. As the pill was taken within 24 hours of sex, its success is also very high. This pill is a progesterone hormone in a high dose. So, the period would be slightly delayed. Some do get their periods within 10 days of the pill, but I would suggest you wait until seven to 10 days of the expected date. So, wait until the 25th of this month. She should get her periods by then. If still no periods, it is due to the deranged hormonal levels due to the pill. If still doubtful about condom failure, have a home urine pregnancy test. Once confirmed as negative, have tablet Duoluton-L (Ethinylestradiol and Levonorgestrel) or Intimacy plus 3 (Ethinylestradiol and Desogestrel) or Novelon or Ovral-G - one tablet twice a day for 10 days (throw away the 21st pill). No matter what the cause is (except pregnancy) she will have her periods within seven to 10 days. Hope I have clarified your query, do write back if any more queries. All the best. For more information consult an obstetrician and gynaecologist online Take care.

Hello doctor,My friend and I had sex on the 29th of last month. Her last periods started on the 15th of last month. We used a condom the whole time, but I was worried there could have been a leak and got her an I-pill within 18 hours of intercourse. She has had no bleeding whatsoever since then and not even had her periods yet. Is there anything to worry? She normally gets her periods in 28 days. Please help.

Hello. How are you doing? The act of sex was on day-15 of the period, that is, very close to the ovulation date. But as you said that a condom had been used all the time and you only have a doubt of spill, the chances of a pregnancy is very very low. As the pill was taken within 24 hours of sex, its success is also very high. This pill is a progesterone hormone in a high dose. So, the period would be slightly delayed. Some do get their periods within 10 days of the pill, but I would suggest you wait until seven to 10 days of the expected date. So, wait until the 25th of this month. She should get her periods by then. If still no periods, it is due to the deranged hormonal levels due to the pill. If still doubtful about condom failure, have a home urine pregnancy test. Once confirmed as negative, have tablet Duoluton-L (Ethinylestradiol and Levonorgestrel) or Intimacy plus 3 (Ethinylestradiol and Desogestrel) or Novelon or Ovral-G - one tablet twice a day for 10 days (throw away the 21st pill). No matter what the cause is (except pregnancy) she will have her periods within seven to 10 days. Hope I have clarified your query, do write back if any more queries. All the best. For more information consult an obstetrician and gynaecologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 46 year old male. I have a desk job where I need to be sitting for eight hours continuously at the computer. I am suffering from these problems since 27 years. When I was 19, I did heavy exercises once and suddenly the heartbeat increased to approximately 180 times per minute. It came back to the normal rate in a minute. But, from that day I have been having heart palpitations. I stopped all the exercises. I tested ECG and 2D. Both the tests were normal. The doctor said my heart is \\almost\\ normal. But another doctor said that it may be a valve problem. He said this just without testings. But my experiences are \\heart palpitations\\ and I feel some \\weight\\ in the heart continuously for four to five months.Then I felt normal and tried doing the exercise again. I feel the same experience. So, again I stopped exercising. So many times these repeated. Three months back, I experienced the symptoms. I felt giddy too. So, I feel very afraid. I immediately consulted the cardiologist. But ECG, 2D, and treadmill (this is first time tested) came normal. I did not test the angiogram. Now I have breathing difficulty, dizziness, and uneven heartbeats when I lie on my side. I quit exercises completely. I am only walking. I do not understand what is going on. Am I straining myself during exercise? Or is it a serious problem? Please help me. ### Response: Hello, Welcome to Chat Doctor forum. You have done some tests already related to the heart and found it to be normal. I suggest you do free T4, T3, TSH, Holter monitoring, and Hb %. Based on the reports, the next course of action could be taken. I think you need not worry. Try to control your stress. Do breathing exercise for five minutes two times daily and Yoga for half an hour. Listen to music, spend quality times with friends and family. For more information consult a cardiologist online

Hello doctor,I am a 46 year old male. I have a desk job where I need to be sitting for eight hours continuously at the computer. I am suffering from these problems since 27 years. When I was 19, I did heavy exercises once and suddenly the heartbeat increased to approximately 180 times per minute. It came back to the normal rate in a minute. But, from that day I have been having heart palpitations. I stopped all the exercises. I tested ECG and 2D. Both the tests were normal. The doctor said my heart is \\almost\\ normal. But another doctor said that it may be a valve problem. He said this just without testings. But my experiences are \\heart palpitations\\ and I feel some \\weight\\ in the heart continuously for four to five months.Then I felt normal and tried doing the exercise again. I feel the same experience. So, again I stopped exercising. So many times these repeated. Three months back, I experienced the symptoms. I felt giddy too. So, I feel very afraid. I immediately consulted the cardiologist. But ECG, 2D, and treadmill (this is first time tested) came normal. I did not test the angiogram. Now I have breathing difficulty, dizziness, and uneven heartbeats when I lie on my side. I quit exercises completely. I am only walking. I do not understand what is going on. Am I straining myself during exercise? Or is it a serious problem? Please help me.

Hello, Welcome to Chat Doctor forum. You have done some tests already related to the heart and found it to be normal. I suggest you do free T4, T3, TSH, Holter monitoring, and Hb %. Based on the reports, the next course of action could be taken. I think you need not worry. Try to control your stress. Do breathing exercise for five minutes two times daily and Yoga for half an hour. Listen to music, spend quality times with friends and family. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was diagnosed with palmer erythema last year. I am 28 years old, however, I started drinking moderately from 16-20 then stayed sober for a year and a half. However started drinking again at 22 and have been more of a binge drinker consuming on average of 20-50 drinks a week over the last 5 years. I never drank everyday usually 6-10 one day during the week but would drink alot on Friday annd Saturdays. Since my PE diagnosis I have had my liver enzymes checked 3 times along with CBC and autoimmune diseases and just about every kind of blood work that could cause along with an ultrasound and everything has came back normal except my cholesterol and triglycrides were a high.Since I have gotten my triglycrides in healthy range but cholesterol is still a little high. My question is how accurate is all of this in detecting liver damage. I do not have any symptoms of disease except the red palms. And should I be concerned? Since I am now sober as I have talked to several people in the cirrohsis and and fatty liver disease community and it definitely scared the heck out of me how dangerous alcohol really is. So I am just hoping to get some advice and if there is anything else I can do to be certain? Or what is your opinion on my story? Definitely never drinking again and totally not worth the risk of developing some kind of liver disease. ### Response: Hello, Welcome to Chat Doctor forum. Do not worry. You may have anxiety more than disease itself. For raised total cholesterol you may take low cholesterol diet with regular exercise. Quitting of alcohol may be useful. Get it done ultrasound abdomen and liver scan. Avoid alcohol intake. Use tablet Pantoprazole before breakfast for one week. Eat green leafy vegetables, do yoga and meditation. Be happy and do not worry. If cholesterol is still high, then you may take antihyperlipidemic ChatDoctor. Please consult your physician, he will examine and treat you accordingly. Take care.

Hello doctor,I was diagnosed with palmer erythema last year. I am 28 years old, however, I started drinking moderately from 16-20 then stayed sober for a year and a half. However started drinking again at 22 and have been more of a binge drinker consuming on average of 20-50 drinks a week over the last 5 years. I never drank everyday usually 6-10 one day during the week but would drink alot on Friday annd Saturdays. Since my PE diagnosis I have had my liver enzymes checked 3 times along with CBC and autoimmune diseases and just about every kind of blood work that could cause along with an ultrasound and everything has came back normal except my cholesterol and triglycrides were a high.Since I have gotten my triglycrides in healthy range but cholesterol is still a little high. My question is how accurate is all of this in detecting liver damage. I do not have any symptoms of disease except the red palms. And should I be concerned? Since I am now sober as I have talked to several people in the cirrohsis and and fatty liver disease community and it definitely scared the heck out of me how dangerous alcohol really is. So I am just hoping to get some advice and if there is anything else I can do to be certain? Or what is your opinion on my story? Definitely never drinking again and totally not worth the risk of developing some kind of liver disease.

Hello, Welcome to Chat Doctor forum. Do not worry. You may have anxiety more than disease itself. For raised total cholesterol you may take low cholesterol diet with regular exercise. Quitting of alcohol may be useful. Get it done ultrasound abdomen and liver scan. Avoid alcohol intake. Use tablet Pantoprazole before breakfast for one week. Eat green leafy vegetables, do yoga and meditation. Be happy and do not worry. If cholesterol is still high, then you may take antihyperlipidemic ChatDoctor. Please consult your physician, he will examine and treat you accordingly. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My age is 40. Currently, I am having less erection when trying to have sex. Sometimes, not able to get an erection at all. It is a very embarrassing situation. I am married for the last 11 years. We were having great sex before our marriage. After marriage and with our kid, sex has become boring. Now when I am trying to have sex, I am not getting enough erection. Sometimes, it is zero. In between, I tried Manforce 50 and after that DT Manforce 100. Sometimes, it works and sometimes not. I do not have diabetes or hypertension. I do not have any bad habits. I do not smoke and I drink once in six months. My doctor has advised me to take Nano Leo capsules twice daily after food and tablet Duroplus twice a week 30 minutes before sex and go for sex after two hours. I am taking these pills for last 25 days. Duroplus I had only taken twice. My problem is previously my erection was less but when erected, it used to last long. Now I am getting erection immediately and it is hard erection but not able to maintain it. Now I am able to get my morning eraction sometimes. I have checked my testosterone level. It is 501. Please suggest medication and let me know whether I need to stop Nano Leo tabelt or not which I am taking right now. I am doing some regular workout 45 minutes to 1 hour per day. Eating healthy diets, avidoing junk food, spicy food. Taking almonds, wall nuts, lemon, honey, banana, resins, cummins, ginger, onion, garlic, pomegranate, apple, carrort, spinach in more quantity in my food. What else life style modifaication and diet I can follow? Please advise accordingly. ### Response: Hello. I can understand your concern. Nano Leo consists of L-arginine and is a good supplement. But with the ChatDoctor. This could be due to a short duration of action of

Hello doctor,My age is 40. Currently, I am having less erection when trying to have sex. Sometimes, not able to get an erection at all. It is a very embarrassing situation. I am married for the last 11 years. We were having great sex before our marriage. After marriage and with our kid, sex has become boring. Now when I am trying to have sex, I am not getting enough erection. Sometimes, it is zero. In between, I tried Manforce 50 and after that DT Manforce 100. Sometimes, it works and sometimes not. I do not have diabetes or hypertension. I do not have any bad habits. I do not smoke and I drink once in six months. My doctor has advised me to take Nano Leo capsules twice daily after food and tablet Duroplus twice a week 30 minutes before sex and go for sex after two hours. I am taking these pills for last 25 days. Duroplus I had only taken twice. My problem is previously my erection was less but when erected, it used to last long. Now I am getting erection immediately and it is hard erection but not able to maintain it. Now I am able to get my morning eraction sometimes. I have checked my testosterone level. It is 501. Please suggest medication and let me know whether I need to stop Nano Leo tabelt or not which I am taking right now. I am doing some regular workout 45 minutes to 1 hour per day. Eating healthy diets, avidoing junk food, spicy food. Taking almonds, wall nuts, lemon, honey, banana, resins, cummins, ginger, onion, garlic, pomegranate, apple, carrort, spinach in more quantity in my food. What else life style modifaication and diet I can follow? Please advise accordingly.

Hello. I can understand your concern. Nano Leo consists of L-arginine and is a good supplement. But with the ChatDoctor. This could be due to a short duration of action of

### Instruction: Answer this question truthfully ###Input: Hello doctor,For the past eight months or so, I have had some problems with unusual headaches and sort of momentary feelings of lightheadedness, vertigo but it is like everything just shifts for a second instead of spinning. I have a background of stable migraine headache. I have had some face pressure as well and some momentary stabbing headaches. Some chronic low-grade nausea that can disappear for weeks at a time and is not usually accompanied by a headache. I went through the gamut with GP, he then referred me to an ENT, and then to a neurologist. I am still getting some headaches but have had a clear CT scan of sinuses. A full neurological exam was done and that was normal, and the neurologist did not seem to think that additional imaging (MRI) was needed because my exam was normal.Even though it was a CT scan of the sinuses, they would have seen the brain (particularly frontal lobe) and notified of any abnormalities they could see. I had a clear MRI approximately one year ago for some twitching and muscle pain. Do you agree that further examination is not warranted? In other words, with the above information is a structural problem unlikely? ### Response: Hello. You have been elaborate in providing your medical history and that always helps to form an opinion. Coming to your straightforward query, I really do not see any indication for a fresh brain imaging study like CT (computed tomography) or MRI (magnetic resonance imaging) in view of your transient, very short lasting symptoms and a normal MRI brain, just one year back. Instead, I would suggest here to get one electroencephalogram (EEG) done to look for abnormal electrical discharges in the brain during those episodes. EEG done during the time frame when you are frequently having those episodes will be more rewarding in terms of diagnostic importance. With a normal neurological examination and normal MRI, you should stay calm and assured that it is nothing serious. Lastly and importantly, anxiety is the commonest cause of such symptoms. Please start doing mental relaxation exercises, meditation, yoga and observe for improvement. I hope this helps. Take care.

Hello doctor,For the past eight months or so, I have had some problems with unusual headaches and sort of momentary feelings of lightheadedness, vertigo but it is like everything just shifts for a second instead of spinning. I have a background of stable migraine headache. I have had some face pressure as well and some momentary stabbing headaches. Some chronic low-grade nausea that can disappear for weeks at a time and is not usually accompanied by a headache. I went through the gamut with GP, he then referred me to an ENT, and then to a neurologist. I am still getting some headaches but have had a clear CT scan of sinuses. A full neurological exam was done and that was normal, and the neurologist did not seem to think that additional imaging (MRI) was needed because my exam was normal.Even though it was a CT scan of the sinuses, they would have seen the brain (particularly frontal lobe) and notified of any abnormalities they could see. I had a clear MRI approximately one year ago for some twitching and muscle pain. Do you agree that further examination is not warranted? In other words, with the above information is a structural problem unlikely?

Hello. You have been elaborate in providing your medical history and that always helps to form an opinion. Coming to your straightforward query, I really do not see any indication for a fresh brain imaging study like CT (computed tomography) or MRI (magnetic resonance imaging) in view of your transient, very short lasting symptoms and a normal MRI brain, just one year back. Instead, I would suggest here to get one electroencephalogram (EEG) done to look for abnormal electrical discharges in the brain during those episodes. EEG done during the time frame when you are frequently having those episodes will be more rewarding in terms of diagnostic importance. With a normal neurological examination and normal MRI, you should stay calm and assured that it is nothing serious. Lastly and importantly, anxiety is the commonest cause of such symptoms. Please start doing mental relaxation exercises, meditation, yoga and observe for improvement. I hope this helps. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 44-year-old female. I get random chest pain either on the left side or on the right side that is painful to touch. There are some instances when it feels like my chest is going to collapse. This feeling lasts for a second or two. Almost like a lightning bolt has shocked me. There are other times where I feel like something is pinching or pressing on my left or right side of the chest.I have been diagnosed with costochondritis and GERD and prescribed anti-inflammatory pills plus Omeprazole. I also have high blood pressure and high cholesterol for which I take Losartan 25 mg, Hydrocholorithazide 25 mg, and Fenofibrate 145 mg once daily. I had an EKG done and that turned out normal.I went to the clinic two weeks ago as I had pain in the middle of my chest that lasted less than a minute. I had an EKG done again and it turned out abnormal. My blood pressure was elevated at 130/100 mmHg and I was having an anxiety attack. Although EKG was abnormal, blood tests came out normal and Troponin was negative. I am totally freaking out. Doctor says that I am fine but I should see a cardiologist to rule out heart problems. I am worried because several months ago my EKG was perfectly fine but now it is abnormal. Please help. ### Response: Hello, Welcome to Chat Doctor forum. I understand your concern. Your troponin was normal, this is good because that was not heart attack. Regarding your ECG (electrocardiogram), I do not know what was the abnormality. I want to see your ECG to guide you accordingly. One thing I would stress that please reduce your weight as obesity is the most to many unwelcomed diseases. Obesity is a field in which cardiac diseases grow. Only reducing weight will solve many of your symptoms and worries. Regarding your chest pain, it is atypical and does not seem to be related to the heart. Take painkillers when you have pain.

Hello doctor,I am a 44-year-old female. I get random chest pain either on the left side or on the right side that is painful to touch. There are some instances when it feels like my chest is going to collapse. This feeling lasts for a second or two. Almost like a lightning bolt has shocked me. There are other times where I feel like something is pinching or pressing on my left or right side of the chest.I have been diagnosed with costochondritis and GERD and prescribed anti-inflammatory pills plus Omeprazole. I also have high blood pressure and high cholesterol for which I take Losartan 25 mg, Hydrocholorithazide 25 mg, and Fenofibrate 145 mg once daily. I had an EKG done and that turned out normal.I went to the clinic two weeks ago as I had pain in the middle of my chest that lasted less than a minute. I had an EKG done again and it turned out abnormal. My blood pressure was elevated at 130/100 mmHg and I was having an anxiety attack. Although EKG was abnormal, blood tests came out normal and Troponin was negative. I am totally freaking out. Doctor says that I am fine but I should see a cardiologist to rule out heart problems. I am worried because several months ago my EKG was perfectly fine but now it is abnormal. Please help.

Hello, Welcome to Chat Doctor forum. I understand your concern. Your troponin was normal, this is good because that was not heart attack. Regarding your ECG (electrocardiogram), I do not know what was the abnormality. I want to see your ECG to guide you accordingly. One thing I would stress that please reduce your weight as obesity is the most to many unwelcomed diseases. Obesity is a field in which cardiac diseases grow. Only reducing weight will solve many of your symptoms and worries. Regarding your chest pain, it is atypical and does not seem to be related to the heart. Take painkillers when you have pain.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 32 years old. Last year, I had a cyst on my ovary and I had to undergo an operation to remove it. The doctors ended up removing both my ovaries. I was told to take Microgynon to balance my hormones. I have been very forgetful with my intake of the tablet for the whole year and have not been consistent. Now recently, as usual, I forgot to take tablets for a few days and started bleeding. I was worried it could be something more serious, but doctors told me that it was fine and it was because of the missed tablets. I have gained weight and my stomach appears bloated. At one point I was convinced that I was pregnant as I felt weird movements. The doctors did a scan and there was nothing wrong. I also went through a phase of fatigue. I sometimes get pain in my lower abdomen. I went to another doctor for advice as my cyst was never tested for cancer. He told me to go for thyroid, menopause and cholesterol test. I have not done them yet. They said that it may be the symptoms of menopause. I just wanted to enquire about my health, whether if this is really a menopause and the further steps to be taken. Please advise. ### Response: Hi. Yes, it is right. You can have these symptoms if you are going through a menopause. As both your ovaries are removed, you are going to end up in menopause. This is called surgical menopause. To decrease the symptoms of menopause your doctor prescribed you Microgynon (combination of Ethinylestradiol and Levonorgestrel). This is called hormone replacement therapy. Because of the absence of both the ovaries, the hormones are not produced in your body. Hence, it is replaced from outside in the form of tablets. Since you are not taking it on time, you are experiencing these symptoms. Thyroid problem and cholesterol levels are the other correlated problems that can be associated, so your doctor has asked you to do these tests. So remove your confusion. If both the ovaries are removed, then you cannot be pregnant.

Hello doctor,I am 32 years old. Last year, I had a cyst on my ovary and I had to undergo an operation to remove it. The doctors ended up removing both my ovaries. I was told to take Microgynon to balance my hormones. I have been very forgetful with my intake of the tablet for the whole year and have not been consistent. Now recently, as usual, I forgot to take tablets for a few days and started bleeding. I was worried it could be something more serious, but doctors told me that it was fine and it was because of the missed tablets. I have gained weight and my stomach appears bloated. At one point I was convinced that I was pregnant as I felt weird movements. The doctors did a scan and there was nothing wrong. I also went through a phase of fatigue. I sometimes get pain in my lower abdomen. I went to another doctor for advice as my cyst was never tested for cancer. He told me to go for thyroid, menopause and cholesterol test. I have not done them yet. They said that it may be the symptoms of menopause. I just wanted to enquire about my health, whether if this is really a menopause and the further steps to be taken. Please advise.

Hi. Yes, it is right. You can have these symptoms if you are going through a menopause. As both your ovaries are removed, you are going to end up in menopause. This is called surgical menopause. To decrease the symptoms of menopause your doctor prescribed you Microgynon (combination of Ethinylestradiol and Levonorgestrel). This is called hormone replacement therapy. Because of the absence of both the ovaries, the hormones are not produced in your body. Hence, it is replaced from outside in the form of tablets. Since you are not taking it on time, you are experiencing these symptoms. Thyroid problem and cholesterol levels are the other correlated problems that can be associated, so your doctor has asked you to do these tests. So remove your confusion. If both the ovaries are removed, then you cannot be pregnant.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Two months back I met a girl and we ended up back in my room. Long story short, she performed oral on me for about 30 seconds and I performed oral on her for maybe about the same, less than a minute, no intercourse. About two weeks after my friend came down with a cold and so did my brother, that Sunday I felt a little weird too but had gone to the beach. At the beach, I ended up swallowing a lot of seawater accidentally. That entire week I had headaches, stomach felt weird every time I ate and a little sore throat. So my mind went back to the day I met that girl and started freaking out. Three weeks after my oral exposure, I did an HIV RNA test with a fourth generation duo combo test and came back negative. My headaches continued for a little over two weeks on and off. After 25 days of the exposure, she did RNA and fourth generation which also came back negative. During the fourth week, I did another fourth-generation myself and also negative again. On week five, I went to a clinic, did a rapid blood drawn test and a NAAT test, and all came back negative. Week six (42 days) did another fourth generation and was negative. 52 days little over seven weeks I went and did an HIV 2 RNA test, and today at 53 days did an HIV RNA test and fourth generation duo. After all, these tests, am I in the clear? If I had HIV symptoms for a few weeks already would I test positive by now? Does it matter if I got her tested to give me reassurance? ### Response: Hello. As you had enough sea water inside, it would have caused a sore throat. In all the tests you are found negative especially fourth generation which is very authentic and correct. So, no HIV infection is there. You have done a very good job to test the girl which is also negative. So, no HIV is possible. So, you are free from HIV. For more information consult an HIV AIDS specialist online

Hello doctor,Two months back I met a girl and we ended up back in my room. Long story short, she performed oral on me for about 30 seconds and I performed oral on her for maybe about the same, less than a minute, no intercourse. About two weeks after my friend came down with a cold and so did my brother, that Sunday I felt a little weird too but had gone to the beach. At the beach, I ended up swallowing a lot of seawater accidentally. That entire week I had headaches, stomach felt weird every time I ate and a little sore throat. So my mind went back to the day I met that girl and started freaking out. Three weeks after my oral exposure, I did an HIV RNA test with a fourth generation duo combo test and came back negative. My headaches continued for a little over two weeks on and off. After 25 days of the exposure, she did RNA and fourth generation which also came back negative. During the fourth week, I did another fourth-generation myself and also negative again. On week five, I went to a clinic, did a rapid blood drawn test and a NAAT test, and all came back negative. Week six (42 days) did another fourth generation and was negative. 52 days little over seven weeks I went and did an HIV 2 RNA test, and today at 53 days did an HIV RNA test and fourth generation duo. After all, these tests, am I in the clear? If I had HIV symptoms for a few weeks already would I test positive by now? Does it matter if I got her tested to give me reassurance?

Hello. As you had enough sea water inside, it would have caused a sore throat. In all the tests you are found negative especially fourth generation which is very authentic and correct. So, no HIV infection is there. You have done a very good job to test the girl which is also negative. So, no HIV is possible. So, you are free from HIV. For more information consult an HIV AIDS specialist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My mom is a glaucoma patient for the last 10 years. She has been on medications like eye drops including Azopt, Ganfort, Alphagan, Vigamox, and prior to them Cosopt (which did not suit her). She has gone through retina eye laser and also has been injected in both her eyes almost 22 times for retinal leakage as well, has also gone through cataract eye surgery 16 years ago. At the moment her eye pressure remains between 21 to 24. The doctor says implants are necessary as she can see very less now. Given her eye condition is sensitive, a doctor has suggested that it is best to operate her with Ahmed valve implant, however, it has its own risks. I wanted to know if it is better to try the latest option, called MIGS (minimally invasive glaucoma surgery) like Xen Gel Stent and InnFocus Microshunt as it has near to no complications. I want to get an opinion about this before thinking about Ahmed valve. ### Response: Hello. I am very sorry to hear about your mother\\s eyes. I suspect that she must have undergone the retina laser and the injections for a condition called as diabetic retinopathy. I feel that most likely it is a complication of diabetic retinopathy that might have caused a high pressure in her eyes. Xen gel stent is currently FDA approved for refractory glaucoma not caused by diabetic neovascularization and Inn focus micro shunt is currently being tested for long term side effects and usefulness in such situations. I must be clear in letting you know that neovascular glaucoma is a very adamant disease to treat and the treatment may not be straightforward and may require multiple procedures and reviews with the treating doctor, yet the most often agreed upon surgery, across most hospitals in the world is currently Ahmed glaucoma valve, along with of course the laser and injections. In case you need further clarification or if your mother is not a diabetic, please send a scanned copy of all her doctors records and prescriptions. I will do my best in helping you understand the situation. Take care.

Hello doctor,My mom is a glaucoma patient for the last 10 years. She has been on medications like eye drops including Azopt, Ganfort, Alphagan, Vigamox, and prior to them Cosopt (which did not suit her). She has gone through retina eye laser and also has been injected in both her eyes almost 22 times for retinal leakage as well, has also gone through cataract eye surgery 16 years ago. At the moment her eye pressure remains between 21 to 24. The doctor says implants are necessary as she can see very less now. Given her eye condition is sensitive, a doctor has suggested that it is best to operate her with Ahmed valve implant, however, it has its own risks. I wanted to know if it is better to try the latest option, called MIGS (minimally invasive glaucoma surgery) like Xen Gel Stent and InnFocus Microshunt as it has near to no complications. I want to get an opinion about this before thinking about Ahmed valve.

Hello. I am very sorry to hear about your mother\\s eyes. I suspect that she must have undergone the retina laser and the injections for a condition called as diabetic retinopathy. I feel that most likely it is a complication of diabetic retinopathy that might have caused a high pressure in her eyes. Xen gel stent is currently FDA approved for refractory glaucoma not caused by diabetic neovascularization and Inn focus micro shunt is currently being tested for long term side effects and usefulness in such situations. I must be clear in letting you know that neovascular glaucoma is a very adamant disease to treat and the treatment may not be straightforward and may require multiple procedures and reviews with the treating doctor, yet the most often agreed upon surgery, across most hospitals in the world is currently Ahmed glaucoma valve, along with of course the laser and injections. In case you need further clarification or if your mother is not a diabetic, please send a scanned copy of all her doctors records and prescriptions. I will do my best in helping you understand the situation. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor, For ten years, my husband has been successfully using an extended wear bandage contact lens (monthly wear) to control the pain of aphakic bullous keratopathy in one eye. About seven months ago, he had an episode of foreign body pain in the eye which the contact lens could not control. His optometrist changed the type of lens after remarking that the lens appeared tight. Although the painful sensations have decreased, they are still present with more of a sore feeling now. His ophthalmologist suggested that he discontinue the Azopt drops he had been using in case the preservative was causing some corneal toxicity. His eye pressure without the drops has read at 18 and 20 on separate occasions, but he does have corneal edema which may affect the measurement. He has had high pressure in that eye previously, but it was mostly lowered by Cyclodiode treatment some eight years ago. The consultant said he had left him on the Azopt drops just as a precaution. My query is that if the bandage lens has worked so well for pain management for 10 years is it possible that it can continue to work? And if the Azopt drops and their preservative had caused some toxic reaction seven months ago, could that still be causing him to feel the discomfort? His consultant suggested out that he could have the eye removed to control the pain, but as he has what he feels is some slight, useful vision in that eye, he does not want to take such a drastic and life-changing step. In fact, he wants to pursue the least invasive course of action to relieve the pain he is getting. I would appreciate any advice you could give as he is in quite a bit of pain. ### Response: Hello. I reviewed your history. Bandage contact lenses are a proven and effective treatment option for pain relief in case of aphakic bullous keratopathy. Hence he can continue the same and I do not think these are responsible for the sore feeling of the eyes. For symptomatic relief, he can use artificial tears eye ChatDoctor. Take care.

Hello doctor, For ten years, my husband has been successfully using an extended wear bandage contact lens (monthly wear) to control the pain of aphakic bullous keratopathy in one eye. About seven months ago, he had an episode of foreign body pain in the eye which the contact lens could not control. His optometrist changed the type of lens after remarking that the lens appeared tight. Although the painful sensations have decreased, they are still present with more of a sore feeling now. His ophthalmologist suggested that he discontinue the Azopt drops he had been using in case the preservative was causing some corneal toxicity. His eye pressure without the drops has read at 18 and 20 on separate occasions, but he does have corneal edema which may affect the measurement. He has had high pressure in that eye previously, but it was mostly lowered by Cyclodiode treatment some eight years ago. The consultant said he had left him on the Azopt drops just as a precaution. My query is that if the bandage lens has worked so well for pain management for 10 years is it possible that it can continue to work? And if the Azopt drops and their preservative had caused some toxic reaction seven months ago, could that still be causing him to feel the discomfort? His consultant suggested out that he could have the eye removed to control the pain, but as he has what he feels is some slight, useful vision in that eye, he does not want to take such a drastic and life-changing step. In fact, he wants to pursue the least invasive course of action to relieve the pain he is getting. I would appreciate any advice you could give as he is in quite a bit of pain.

Hello. I reviewed your history. Bandage contact lenses are a proven and effective treatment option for pain relief in case of aphakic bullous keratopathy. Hence he can continue the same and I do not think these are responsible for the sore feeling of the eyes. For symptomatic relief, he can use artificial tears eye ChatDoctor. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor, Please help. I am a man and had an anal sex with a negative HIV, hepatitis A,B,C and non-reactive syphilis but the condom broke but thankfully the lab test result which was made in different lab a week before the intercourse and the day after the intercourse showed normal. What risks may I face? I am panicking. If she is negative with HIV, virus A, B and C and syphlis and all salmonella and typhoids and no mucus and blood in her anus. Am I still at risk of the diseases mentioned above? If not since her results are clean, am I at risk of catching other STDs like herpes, chlamydia, gonorrhea, syphilis, mycoplasma genitalium, trichomoniasis, human papilloma virus (HPV), HIV/AIDS, crabs or pubic lice, bacterial vaginosis, molluscum-contagiosum, mucopurulent-cervicitis, lymphogranuloma-venereum. Please tell me if there is any medication to take in order to prevent all this from happening. ### Response: Hello, Welcome to Chat Doctor forum. I understand your concern. But the risk of acquiring a STD is not there if your partner does not have any one of the diseases you mentioned clinically or sub-clinically. There are STDs like herpes in which subclinical shedding can lead to herpes, but that is more common in vaginal sex. I do not think you need to worry too much at this point if she is negative for tests. Some STDs take time to become positive in blood. So just to be careful please repeat HIV, HBsAg, HCV, V ChatDoctor. Molluscum, HPV, pubic lice usually spread if there is active lesions, which I suppose were not there, so no need to worry. Just repeat the tests I suggested after three months and there is no such medication to be taken when all the tests of the partner are also negative. Prophylactic medications can be given if the status of the partner is not known sometimes. Take care.

Hi doctor, Please help. I am a man and had an anal sex with a negative HIV, hepatitis A,B,C and non-reactive syphilis but the condom broke but thankfully the lab test result which was made in different lab a week before the intercourse and the day after the intercourse showed normal. What risks may I face? I am panicking. If she is negative with HIV, virus A, B and C and syphlis and all salmonella and typhoids and no mucus and blood in her anus. Am I still at risk of the diseases mentioned above? If not since her results are clean, am I at risk of catching other STDs like herpes, chlamydia, gonorrhea, syphilis, mycoplasma genitalium, trichomoniasis, human papilloma virus (HPV), HIV/AIDS, crabs or pubic lice, bacterial vaginosis, molluscum-contagiosum, mucopurulent-cervicitis, lymphogranuloma-venereum. Please tell me if there is any medication to take in order to prevent all this from happening.

Hello, Welcome to Chat Doctor forum. I understand your concern. But the risk of acquiring a STD is not there if your partner does not have any one of the diseases you mentioned clinically or sub-clinically. There are STDs like herpes in which subclinical shedding can lead to herpes, but that is more common in vaginal sex. I do not think you need to worry too much at this point if she is negative for tests. Some STDs take time to become positive in blood. So just to be careful please repeat HIV, HBsAg, HCV, V ChatDoctor. Molluscum, HPV, pubic lice usually spread if there is active lesions, which I suppose were not there, so no need to worry. Just repeat the tests I suggested after three months and there is no such medication to be taken when all the tests of the partner are also negative. Prophylactic medications can be given if the status of the partner is not known sometimes. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I want to quit smoking but I cannot smoke. So suggest me some medicine so that I can quit smoking. ### Response: Hi. I hope you are doing well. I read your query and I am very proud that you have decided to take this great step. First of all, you need to understand that there is no medicine available which will make you quit smoking, it is only you who can make it happen. Its not 1 week or even 1 month process, it takes lot of time and courage. I usually recommend following steps to my patient who wants to quit smoking. 1. Set a date. Setting a date has a psychological effect and you can choose any memorable date, your birthday, your anniversary, etc. 2. Tell your family, your friends and your colleagues. Discuss with them. They are the one who will help you late on with the process. 3. Prepare yourself for the upcoming problems. You will face Nicotine with ChatDoctor. It will be cough, constipation, etc. These are not serious but if you do not anticipate these, such problems will discourage you from quitting and start smoking again. Try to find a friend or partner who also wants to quit. 2 people make it easier for each other. 4. Remove smoking related products (Cigerrates, ashtray) from your house, car, workplace. 5. Now in final step, here comes a little role of doctor. Now you need to understand you have 2 types of addictions, physical i.e. of nicotine and psychological i.e of act of smoking. For physical addiction I would recommend nicotine patches and bubblegum, whatever suits you better. For psychological addiction you have to control yourself, if you think that initially you cannot tolerate that, you can use electronic cigerratte for a month or so and it will help you. This is a workplan I can share with you which will help you in quitting smoking. I would love to see you again and help you step by step in the process wherever you need me.

Hello doctor,I want to quit smoking but I cannot smoke. So suggest me some medicine so that I can quit smoking.

Hi. I hope you are doing well. I read your query and I am very proud that you have decided to take this great step. First of all, you need to understand that there is no medicine available which will make you quit smoking, it is only you who can make it happen. Its not 1 week or even 1 month process, it takes lot of time and courage. I usually recommend following steps to my patient who wants to quit smoking. 1. Set a date. Setting a date has a psychological effect and you can choose any memorable date, your birthday, your anniversary, etc. 2. Tell your family, your friends and your colleagues. Discuss with them. They are the one who will help you late on with the process. 3. Prepare yourself for the upcoming problems. You will face Nicotine with ChatDoctor. It will be cough, constipation, etc. These are not serious but if you do not anticipate these, such problems will discourage you from quitting and start smoking again. Try to find a friend or partner who also wants to quit. 2 people make it easier for each other. 4. Remove smoking related products (Cigerrates, ashtray) from your house, car, workplace. 5. Now in final step, here comes a little role of doctor. Now you need to understand you have 2 types of addictions, physical i.e. of nicotine and psychological i.e of act of smoking. For physical addiction I would recommend nicotine patches and bubblegum, whatever suits you better. For psychological addiction you have to control yourself, if you think that initially you cannot tolerate that, you can use electronic cigerratte for a month or so and it will help you. This is a workplan I can share with you which will help you in quitting smoking. I would love to see you again and help you step by step in the process wherever you need me.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 21 year old female student with great interest in human growth. More specifically, growth in height, as in getting taller. As learned from textbooks, teenagers stop growing around 18 to 21 years old. Well, I have always been optimistic about everything, and I refuse to believe that our growth is limited to a certain age. There are some recent articles that highlighted growth after 21 or 22 years, and this really gives hope to people with height issue, including me. I know that genetic plays more than 80 % of our growth. I am 5 feet tall, and I had my period when I was 10 years old. I gained only 1 to 1.5 cm a year since 12 years old. Based on health record, I gained only about 5 cm. My dad is 5.5 feet and my mom is 5.4 feet tall.Can I still gain some height? I assumed yes because we now know there are other bigger suns outside of our galaxy and the astronaut did not stop searching when they landed on te moon decades ago. How can I maximize my growth? What are the causes of my lack of growth? What are the factors that stop human growth? Can you give me any other information? I am about to conduct a personal experiment (with precautions) on myself to see if I can gain 2 inches in three years. I am hoping that with proper rest, nutrition, and physical activities will maximize my growth. There will be no height enhancement pills involved so, I really need to study from you guys. If you are still reading, then I thank you very much for spending your time to read my little obsession. I know there is an attitude in my writing, so please do not mind me, I am born bold. ### Response: Hello. I just read your detailed information and would like to answer your query one by one. Hope you find my advice of some benefit. Good luck. For more information consult an endocrinologist online

Hello doctor,I am a 21 year old female student with great interest in human growth. More specifically, growth in height, as in getting taller. As learned from textbooks, teenagers stop growing around 18 to 21 years old. Well, I have always been optimistic about everything, and I refuse to believe that our growth is limited to a certain age. There are some recent articles that highlighted growth after 21 or 22 years, and this really gives hope to people with height issue, including me. I know that genetic plays more than 80 % of our growth. I am 5 feet tall, and I had my period when I was 10 years old. I gained only 1 to 1.5 cm a year since 12 years old. Based on health record, I gained only about 5 cm. My dad is 5.5 feet and my mom is 5.4 feet tall.Can I still gain some height? I assumed yes because we now know there are other bigger suns outside of our galaxy and the astronaut did not stop searching when they landed on te moon decades ago. How can I maximize my growth? What are the causes of my lack of growth? What are the factors that stop human growth? Can you give me any other information? I am about to conduct a personal experiment (with precautions) on myself to see if I can gain 2 inches in three years. I am hoping that with proper rest, nutrition, and physical activities will maximize my growth. There will be no height enhancement pills involved so, I really need to study from you guys. If you are still reading, then I thank you very much for spending your time to read my little obsession. I know there is an attitude in my writing, so please do not mind me, I am born bold.

Hello. I just read your detailed information and would like to answer your query one by one. Hope you find my advice of some benefit. Good luck. For more information consult an endocrinologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,Recently, I have done some cardiac tests like ECG, 2D echo, TMT and serum electrolytes at my regular consultant. Four months ago, I got blood pressure 140/100. So, my regular consultant suggested I use Telvas CT 40 tablet (only half tablet at morning) daily. Recently, I got gastric problem. So, I went to my regular consultant and he suggested I use Pantop IT 40 mg and I went after 10 days for review and I have done the cardiac tests as mentioned earlier.My actual problem is when the ECG was done, the diagnosis report mentioned flattened T wave (I, V4, V6). Previously, I have done ECG last year but the diagnosis shows normal ECG. Now, it changed. Because of this, my doctor suggested me to do other tests like 2D echo, serum electrolytes, and TMT. Finally, he told me that all the reports are normal. There is nothing to worry but still, I am worried about my reports. Can you please check the reports and suggest me? I smoke one cigarette every day and drink 180 ml of brandy every week. ### Response: Hello, Welcome to Chat Doctor forum. Yes, there are changes in the ECG (attachment removed to protect patient identity). But, your evaluation is normal including echo and treadmill test. Now, the changes in the ECG are likely due to high BP and not any blockages. I guess you do not have any symptoms like chest pain or chest heaviness on exertion or during the treadmill test. So I do not think there is anything to worry about now. Is your blood pressure well controlled? You have to check your BP frequently, thrice a day at least for a week so as to know the pattern of BP. Have a low salt diet. It is important that gradually you quit smoking because smoking is much harmful than alcohol and alcohol occasionally is acceptable but not smoking. Hope this helps you and get back if you have any doubts. For more information consult a cardiologist online

Hello doctor,Recently, I have done some cardiac tests like ECG, 2D echo, TMT and serum electrolytes at my regular consultant. Four months ago, I got blood pressure 140/100. So, my regular consultant suggested I use Telvas CT 40 tablet (only half tablet at morning) daily. Recently, I got gastric problem. So, I went to my regular consultant and he suggested I use Pantop IT 40 mg and I went after 10 days for review and I have done the cardiac tests as mentioned earlier.My actual problem is when the ECG was done, the diagnosis report mentioned flattened T wave (I, V4, V6). Previously, I have done ECG last year but the diagnosis shows normal ECG. Now, it changed. Because of this, my doctor suggested me to do other tests like 2D echo, serum electrolytes, and TMT. Finally, he told me that all the reports are normal. There is nothing to worry but still, I am worried about my reports. Can you please check the reports and suggest me? I smoke one cigarette every day and drink 180 ml of brandy every week.

Hello, Welcome to Chat Doctor forum. Yes, there are changes in the ECG (attachment removed to protect patient identity). But, your evaluation is normal including echo and treadmill test. Now, the changes in the ECG are likely due to high BP and not any blockages. I guess you do not have any symptoms like chest pain or chest heaviness on exertion or during the treadmill test. So I do not think there is anything to worry about now. Is your blood pressure well controlled? You have to check your BP frequently, thrice a day at least for a week so as to know the pattern of BP. Have a low salt diet. It is important that gradually you quit smoking because smoking is much harmful than alcohol and alcohol occasionally is acceptable but not smoking. 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: Hi doctor,My wife is pregnant for the first time and it is her 12th week. We did a blood grouping and urine culture testing last week. It is found that the blood group is \\O\\ but the Rh was given as \\weak D positive\\. We did a second opinion testing in a different lab and the result was the same. Doctors are confused and they say that we need to check what is the blood group of the baby. We are a little bit worried and following are our queries.What type of blood group does she belong to (O+ or O-)?Does that affect my wife and baby for the first pregnancy?Do we need to take any preventive measures to make sure everything is normal or post pregnancy?Please help us. ### Response: Hello, Welcome to Chat Doctor forum. Weak D in itself is a specific category of blood group. Weak D expression primarily results from single point mutations in RhD which encode amino acid changes predicted to be intracellular or in the transmembrane regions of RhD. Molecular RhD blood group typing is very efficient for managing donors and patients carrying any of the various molecular types of weak D and partial D. Weak D people belonging to weak type 1, 2, 3, 4.0, 4.1, and 5 can be treated as Rh-positive and be transfused by Rh-positive red blood cells, while subjects with weak type 4.2\\x80\\x9311 and 15 should be treated as Rh-negative and transfused with Rh-negative red blood cells. Ideally, it is important to know the status of the blood group of the mother if she is Rh negative so that anti D injections can be given to prevent complications in subsequent pregnancies if the baby is Rh positive. A weak D positive is generally considered as Rh positive and usually, the anti D injections are not required in such patients. It should not affect either your wife or baby during her first pregnancy and subsequent pregnancies as well. Thank you. For more information consult a hematologist online

Hi doctor,My wife is pregnant for the first time and it is her 12th week. We did a blood grouping and urine culture testing last week. It is found that the blood group is \\O\\ but the Rh was given as \\weak D positive\\. We did a second opinion testing in a different lab and the result was the same. Doctors are confused and they say that we need to check what is the blood group of the baby. We are a little bit worried and following are our queries.What type of blood group does she belong to (O+ or O-)?Does that affect my wife and baby for the first pregnancy?Do we need to take any preventive measures to make sure everything is normal or post pregnancy?Please help us.

Hello, Welcome to Chat Doctor forum. Weak D in itself is a specific category of blood group. Weak D expression primarily results from single point mutations in RhD which encode amino acid changes predicted to be intracellular or in the transmembrane regions of RhD. Molecular RhD blood group typing is very efficient for managing donors and patients carrying any of the various molecular types of weak D and partial D. Weak D people belonging to weak type 1, 2, 3, 4.0, 4.1, and 5 can be treated as Rh-positive and be transfused by Rh-positive red blood cells, while subjects with weak type 4.2\\x80\\x9311 and 15 should be treated as Rh-negative and transfused with Rh-negative red blood cells. Ideally, it is important to know the status of the blood group of the mother if she is Rh negative so that anti D injections can be given to prevent complications in subsequent pregnancies if the baby is Rh positive. A weak D positive is generally considered as Rh positive and usually, the anti D injections are not required in such patients. It should not affect either your wife or baby during her first pregnancy and subsequent pregnancies as well. Thank you. For more information consult a hematologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a young woman and I recently discovered that I am HIV positive after I turned 21. When I told my mother about it, she confessed that she had known since I was 16 and that my father died of AIDS whilst she has been on ART for almost a decade now. They realized my status after I got tested since I was having frequent abscess wounds or boils, almost on a monthly basis but they never told me about it.I am a health student and interact with a lot of health professionals hence my hesitation to seek help to start treatment just in case I meet up with someone I know. However, my major concern is that I have recently been having drowsiness spells and frequent, almost consistent headaches though they are very light. An FBC test done a month ago showed that my Hb and HCT, as well as my neutrophil count, were slightly below normal, and I was advised to go on a month of Saferon tablets which I followed religiously. Recent full blood tests showed that my RBC, Hb, HCT, MCV, and MCH values were all now slightly below normal whilst all my WBC were within the normal range. The Hb and HCT went lower than the initial test.Therefore, my questions are, might this be related to my HIV positive status and how so? Also if it is, why is it that my white blood cells are not affected? I am mostly curious about whether such an instance as mine is quite common where a patient is born with HIV and lives an otherwise normal livelihood though with more frequent infections that go away after some time?I really do hope to hear from you. I am now 22 and have accepted my condition and forgiven my parents. I am trying to, however, get as much information and understanding about my condition hence contacting you. I sincerely thank you for your time. ### Response: Hi. This could be related to HIV. WBC (white blood cells) count is not generally affected, it is lymphocyte count which gradually depletes. For more information consult a HIV AIDS specialist online

Hello doctor,I am a young woman and I recently discovered that I am HIV positive after I turned 21. When I told my mother about it, she confessed that she had known since I was 16 and that my father died of AIDS whilst she has been on ART for almost a decade now. They realized my status after I got tested since I was having frequent abscess wounds or boils, almost on a monthly basis but they never told me about it.I am a health student and interact with a lot of health professionals hence my hesitation to seek help to start treatment just in case I meet up with someone I know. However, my major concern is that I have recently been having drowsiness spells and frequent, almost consistent headaches though they are very light. An FBC test done a month ago showed that my Hb and HCT, as well as my neutrophil count, were slightly below normal, and I was advised to go on a month of Saferon tablets which I followed religiously. Recent full blood tests showed that my RBC, Hb, HCT, MCV, and MCH values were all now slightly below normal whilst all my WBC were within the normal range. The Hb and HCT went lower than the initial test.Therefore, my questions are, might this be related to my HIV positive status and how so? Also if it is, why is it that my white blood cells are not affected? I am mostly curious about whether such an instance as mine is quite common where a patient is born with HIV and lives an otherwise normal livelihood though with more frequent infections that go away after some time?I really do hope to hear from you. I am now 22 and have accepted my condition and forgiven my parents. I am trying to, however, get as much information and understanding about my condition hence contacting you. I sincerely thank you for your time.

Hi. This could be related to HIV. WBC (white blood cells) count is not generally affected, it is lymphocyte count which gradually depletes. For more information consult a HIV AIDS specialist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,What is the conclusive timeline for hepatitis B and C testing? I have done the following tests.1. Normal ALT and AST at 12 weeks post possible infection.2. HBsAg at 15 weeks post possible infection.3. HBsAg, HBcAb and HBsAb at 22 weeks post possible infection.4. Hepatitis C antibody at 22 weeks post possible infection.5. Normal ALT, AST, ALP, LD, and albumin. I had slightly raised bilirubin (27 umol/L in a ref range of 8 to 24).6. HBsAg, HBcAb at 29 weeks post possible infection.7. Hepatitis C antibody at 29 weeks post possible infection.Does the test at 29 weeks (202 days) determine that my results are 100% conclusive and no further testing is needed? Why would there be elevated bilirubin? If I were infected, why the detectable elevations in bilirubin did not follow a positive hepatitis test, and why it is stuck in the middle of two negative tests (week 22 and week 29 negative tests)? ### Response: Hello. Normal bilirubin, as well as, normal ALT (alanine aminotransferase), and AST (aspartate aminotransferase), do not warranty that a person cannot have hepatitis B and C infection. A person infected with hepatitis B and C can have normal liver function tests. In a normal course, HbsAg (surface antigen) comes positive within four weeks of infection and Anti HCV (hepatitis C virus) antibody may take up to six weeks to three months to show its positivity. In general, if a person is found negative after months of exposure we consider it conclusive. In cases where there is a high risk or the diagnosis has to be early we need to get the PCR (polymerase chain reaction) test done for both hepatitis B and C. For hepatitis B we do HBV DNA and for Hepatitis C we do HCV RNA analysis. I hope this helps.

Hello doctor,What is the conclusive timeline for hepatitis B and C testing? I have done the following tests.1. Normal ALT and AST at 12 weeks post possible infection.2. HBsAg at 15 weeks post possible infection.3. HBsAg, HBcAb and HBsAb at 22 weeks post possible infection.4. Hepatitis C antibody at 22 weeks post possible infection.5. Normal ALT, AST, ALP, LD, and albumin. I had slightly raised bilirubin (27 umol/L in a ref range of 8 to 24).6. HBsAg, HBcAb at 29 weeks post possible infection.7. Hepatitis C antibody at 29 weeks post possible infection.Does the test at 29 weeks (202 days) determine that my results are 100% conclusive and no further testing is needed? Why would there be elevated bilirubin? If I were infected, why the detectable elevations in bilirubin did not follow a positive hepatitis test, and why it is stuck in the middle of two negative tests (week 22 and week 29 negative tests)?

Hello. Normal bilirubin, as well as, normal ALT (alanine aminotransferase), and AST (aspartate aminotransferase), do not warranty that a person cannot have hepatitis B and C infection. A person infected with hepatitis B and C can have normal liver function tests. In a normal course, HbsAg (surface antigen) comes positive within four weeks of infection and Anti HCV (hepatitis C virus) antibody may take up to six weeks to three months to show its positivity. In general, if a person is found negative after months of exposure we consider it conclusive. In cases where there is a high risk or the diagnosis has to be early we need to get the PCR (polymerase chain reaction) test done for both hepatitis B and C. For hepatitis B we do HBV DNA and for Hepatitis C we do HCV RNA analysis. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am pretty sure that I have retrograde ejaculation because when I ejaculate it does not come out at the same moment of ejaculation, but it does come out seconds later and when I urinate there is some sperm. I also have male Incontinence and bedwetting problem since I was young and I am now 24 years old and a couple of times this year I found it hard to urinate, I felt like my bladder was numbed or something. So I went to a urologist and I had my testicles tested because I had pain there and thought it was the reason for all this. He gave me antibiotics I also did an ultrasound on my testicles and to check my kidney stones but everything was fine and after the antibiotics nothing change but the testicular pain.My urologist said he wants to do a TURP (transurethral resection of the prostate) but I do not know anything about the operation and he told me I will feel pain and I am scared of that but I also do not know why he wants to do this operation. I searched online and it says mercury retrograde might be from multiple sclerosis, week bladder muscle, problem with the nerves, a previous operation (does not apply to me) or medication side effect (does not apply to me).So I am not sure what to do? I want to check for multiple sclerosis and also look at my bladder muscles? Could it be a problem in the prostate? And is TURP necessary? I want a urologist who really wants to find out what is with me instead of just doing a test and not listening to what I am saying and then tell me to come back a month later. I have more than one problem and I want to know what is causing all this? ### Response: Hello. I think that there is an obstruction in your prostate gland. Prostate gland store semen. That is why he wants to do this procedure. TURP stands for transurethral resection of the prostate. You must go for it. If you have further questions, do follow-up.

Hello doctor,I am pretty sure that I have retrograde ejaculation because when I ejaculate it does not come out at the same moment of ejaculation, but it does come out seconds later and when I urinate there is some sperm. I also have male Incontinence and bedwetting problem since I was young and I am now 24 years old and a couple of times this year I found it hard to urinate, I felt like my bladder was numbed or something. So I went to a urologist and I had my testicles tested because I had pain there and thought it was the reason for all this. He gave me antibiotics I also did an ultrasound on my testicles and to check my kidney stones but everything was fine and after the antibiotics nothing change but the testicular pain.My urologist said he wants to do a TURP (transurethral resection of the prostate) but I do not know anything about the operation and he told me I will feel pain and I am scared of that but I also do not know why he wants to do this operation. I searched online and it says mercury retrograde might be from multiple sclerosis, week bladder muscle, problem with the nerves, a previous operation (does not apply to me) or medication side effect (does not apply to me).So I am not sure what to do? I want to check for multiple sclerosis and also look at my bladder muscles? Could it be a problem in the prostate? And is TURP necessary? I want a urologist who really wants to find out what is with me instead of just doing a test and not listening to what I am saying and then tell me to come back a month later. I have more than one problem and I want to know what is causing all this?

Hello. I think that there is an obstruction in your prostate gland. Prostate gland store semen. That is why he wants to do this procedure. TURP stands for transurethral resection of the prostate. You must go for it. If you have further questions, do follow-up.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 36 year old male. I am suffering with OCD and I stammer for past 15 years along with laziness and tiredness all the time. My appetite is not good and so my weight is approximately 53 to 55 kg only. I have changed many psychiatrists in last 15 years. I had Nexito 20 mg, Ciplar 40 mg and Lonazep 25 mg twice a day and a capsule Performax for libido under doctor supervision. Few days back I went to a physician and I told him about my issues. He prescribed me Fluoxetine 20 mg to take in the morning and Nexito 10 mg at night that is 2 SSRIs together. After which my libido was totally reduced. I am single now.So, what should I tell to my partner about my issues? First of all, should I tell or not? Because medications can be life-long and I do not like either my partner or in-laws questioning me for that after marriage. My parents and friends advised me not to tell anything now. Second thing, as I told you, in the past I was having good libido but now it become less. Earlier I used to masturbate regularly but now once in two weeks. Should I get this issue solved before marriage? I had an affair in the past. After break up, sometimes I feel like does not want to mingle with anyone. I faced a lot of negativity in my life and still not able to prepare myself completely for marriage. Please give a genuine marriage. ### Response: Hi, Welcome to Chat Doctor forum. I have read the query, and I can understand your concern. You have OCD (obsessive-compulsive disorder) and co-morbid anxiety. The combination of Fluoxetine 20 mg and 10 mg Escitalopram (Nexito) was totally irrational. It is not advisable to take two SSRIs (Selective serotonin reuptake inhibitor) at the same time. Both ChatDoctor.

Hi doctor,I am a 36 year old male. I am suffering with OCD and I stammer for past 15 years along with laziness and tiredness all the time. My appetite is not good and so my weight is approximately 53 to 55 kg only. I have changed many psychiatrists in last 15 years. I had Nexito 20 mg, Ciplar 40 mg and Lonazep 25 mg twice a day and a capsule Performax for libido under doctor supervision. Few days back I went to a physician and I told him about my issues. He prescribed me Fluoxetine 20 mg to take in the morning and Nexito 10 mg at night that is 2 SSRIs together. After which my libido was totally reduced. I am single now.So, what should I tell to my partner about my issues? First of all, should I tell or not? Because medications can be life-long and I do not like either my partner or in-laws questioning me for that after marriage. My parents and friends advised me not to tell anything now. Second thing, as I told you, in the past I was having good libido but now it become less. Earlier I used to masturbate regularly but now once in two weeks. Should I get this issue solved before marriage? I had an affair in the past. After break up, sometimes I feel like does not want to mingle with anyone. I faced a lot of negativity in my life and still not able to prepare myself completely for marriage. Please give a genuine marriage.

Hi, Welcome to Chat Doctor forum. I have read the query, and I can understand your concern. You have OCD (obsessive-compulsive disorder) and co-morbid anxiety. The combination of Fluoxetine 20 mg and 10 mg Escitalopram (Nexito) was totally irrational. It is not advisable to take two SSRIs (Selective serotonin reuptake inhibitor) at the same time. Both ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 66-year-old male with a weight of 90 kg and a height of 175 cms. For the last four months, I am continuously facing the following problems.Moderate sore throat, feeling like a lump in my deep throat, gastric reflux, poor digestion, a feeling of air blocked in both the ears and popping sound on swallowing.After treatment, these symptoms subside for some time. But now I have deviated septum. Presently I have sticky mucus discharge from the nose in postnasal mode. Sometimes I also feel stress in the jaws.Due to continuous popping in ears (mostly left ear) and lump feeling in the throat, I am unable to sleep properly. This is having an adverse effect on my health.I am on medication for almost three months on and off, including Levocetirizine one tablet twice daily and Fluticasone spray. I also take Rabeprazole DSR for the reflux issue, steam inhalation, and saline gargles. But symptoms sometimes abate and again come up. I regularly take Bisoprolol and Metformin and glimperamide for few years.Due to soreness in the throat, popping in the ears, and continuous cough, I am unable to sleep. The sticky mucus is viscous and salty in taste and discharges in the throat. RTF test showed partial dysfunction of the left eustachian tube. What could be the likely causes and line of treatment to get rid of this? Could it be due to air pollution or some other allergy source? Due to continuous coughing, my abdominal muscles are paining, and there is a split voice in my throat. It appears like there is an overproduction of mucus all over the respiratory tract. I have started taking antibiotic Augmentin eight hours once for the last four days, but no relief. Please advise. ### Response: Hello. Can you take a picture of the back of the throat, showing details of the affected area and send it to us? Which area do you live in? Do you ChatDoctor.

Hello doctor,I am a 66-year-old male with a weight of 90 kg and a height of 175 cms. For the last four months, I am continuously facing the following problems.Moderate sore throat, feeling like a lump in my deep throat, gastric reflux, poor digestion, a feeling of air blocked in both the ears and popping sound on swallowing.After treatment, these symptoms subside for some time. But now I have deviated septum. Presently I have sticky mucus discharge from the nose in postnasal mode. Sometimes I also feel stress in the jaws.Due to continuous popping in ears (mostly left ear) and lump feeling in the throat, I am unable to sleep properly. This is having an adverse effect on my health.I am on medication for almost three months on and off, including Levocetirizine one tablet twice daily and Fluticasone spray. I also take Rabeprazole DSR for the reflux issue, steam inhalation, and saline gargles. But symptoms sometimes abate and again come up. I regularly take Bisoprolol and Metformin and glimperamide for few years.Due to soreness in the throat, popping in the ears, and continuous cough, I am unable to sleep. The sticky mucus is viscous and salty in taste and discharges in the throat. RTF test showed partial dysfunction of the left eustachian tube. What could be the likely causes and line of treatment to get rid of this? Could it be due to air pollution or some other allergy source? Due to continuous coughing, my abdominal muscles are paining, and there is a split voice in my throat. It appears like there is an overproduction of mucus all over the respiratory tract. I have started taking antibiotic Augmentin eight hours once for the last four days, but no relief. Please advise.

Hello. Can you take a picture of the back of the throat, showing details of the affected area and send it to us? Which area do you live in? Do you ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am currently taking only daily Vitamin with a fish oil omega 3 supplement. I am 5\\6, 120 lbs, and 42 years old female. About a year ago I started having problems with my neck. After MRI, it was determined I had a degenerative disc at my C4 to C7. I opted for no surgery and decided to go the pain management route. Being on Hydrocodone and getting steroid injections for about a year, I decided to stop cold turkey. I went through withdrawal symptoms and a month back I went to the emergency room because of heart palpitations and chest pains and shortness of breath. (Earlier that day, I went for a 4-mile walk). The EKG and X-ray which came back normal. But the laboratory work showed an elevation of TSH at 6.455. All other lab work was fine but I was a little low in potassium (3.4). Blood pressure was normal as well. The doctor on call suggested that I might have hypothyroidism. My question is could the high levels of TSH be a result of withdrawal from Hydrocodone and if so how long will it take to clear up on its own or do I have a thyroid issue that needs to be taken care of? ### Response: Hello, Welcome to Chat Doctor forum. I just read your query and from what you have mentioned it appears that you have subclinical hypothyroidism. You do not need any treatment for that currently but you need to repeat your thyroid function tests after six weeks again just to be on the safe side. Yes, you are right. This sub-clinical hypothyroidism could be due to many reasons, such as your neck trauma followed by steroids treatment and sudden discontinuation of that steroid and then suffering from hypoa ChatDoctor. So, ultimately you just have to give your body time to heal itself. It could take anything from six months to a year to get back to normal, which is usually what has been observed. For more information consult an endocrinologist online

Hello doctor,I am currently taking only daily Vitamin with a fish oil omega 3 supplement. I am 5\\6, 120 lbs, and 42 years old female. About a year ago I started having problems with my neck. After MRI, it was determined I had a degenerative disc at my C4 to C7. I opted for no surgery and decided to go the pain management route. Being on Hydrocodone and getting steroid injections for about a year, I decided to stop cold turkey. I went through withdrawal symptoms and a month back I went to the emergency room because of heart palpitations and chest pains and shortness of breath. (Earlier that day, I went for a 4-mile walk). The EKG and X-ray which came back normal. But the laboratory work showed an elevation of TSH at 6.455. All other lab work was fine but I was a little low in potassium (3.4). Blood pressure was normal as well. The doctor on call suggested that I might have hypothyroidism. My question is could the high levels of TSH be a result of withdrawal from Hydrocodone and if so how long will it take to clear up on its own or do I have a thyroid issue that needs to be taken care of?

Hello, Welcome to Chat Doctor forum. I just read your query and from what you have mentioned it appears that you have subclinical hypothyroidism. You do not need any treatment for that currently but you need to repeat your thyroid function tests after six weeks again just to be on the safe side. Yes, you are right. This sub-clinical hypothyroidism could be due to many reasons, such as your neck trauma followed by steroids treatment and sudden discontinuation of that steroid and then suffering from hypoa ChatDoctor. So, ultimately you just have to give your body time to heal itself. It could take anything from six months to a year to get back to normal, which is usually what has been observed. For more information consult an endocrinologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have a lower wisdom tooth that has been infected chronically for well over a year. I also have an upper molar that is broken decayed and has been like this for years. The wisdom tooth oozes green pus if you apply pressure with a cotton swab. The decayed tooth is mildly painful. I saw my dentist a few days ago, who did not seem overly concerned. She slightly cleaned the gums around the wisdom tooth and prescribed me Cephalexin and sent me on my way. I have been taking Cephalexin for a few days, and yet the tooth is still oozing. My throat is red and irritated, the gums inflamed and there is no swelling in the mouth. Also, my nostril on that side is tender and painful. I am severely worried about the infection spreading to either my heart or my brain. In fact, I read an article a few days ago about a 26 year old who died from a tooth infection spreading.I do not have a fever. I have mild nausea. It is tender on that side of my jaw. The dentist had said the next thing she could give me was Clindamycin, but I have a fear of the side effects of that medicine. I already have heart problems and mild stomach issues. I have read that Clindamycin can cause severe gastrointestinal problems and arrhythmias. She also suggested Zithromax, but I have had heart palpitations while on that medication as well. I am having the teeth removed by an oral surgeon in two weeks, but am afraid of dying from infection before then. What are my options? What is the best course of action? Are there other antibiotics for this? Am I dying from the infection already? Any of your advice or help is appreciated. My other possibly relevant health history is as follows ### Response: Hi, Welcome to Chat Doctor forum. I have read your complaint and the relevant details. Please do not panic relating this to death. Maintain good oral hygiene for this two weeks. Revert after a week of extraction to a dentist online.-

Hi doctor,I have a lower wisdom tooth that has been infected chronically for well over a year. I also have an upper molar that is broken decayed and has been like this for years. The wisdom tooth oozes green pus if you apply pressure with a cotton swab. The decayed tooth is mildly painful. I saw my dentist a few days ago, who did not seem overly concerned. She slightly cleaned the gums around the wisdom tooth and prescribed me Cephalexin and sent me on my way. I have been taking Cephalexin for a few days, and yet the tooth is still oozing. My throat is red and irritated, the gums inflamed and there is no swelling in the mouth. Also, my nostril on that side is tender and painful. I am severely worried about the infection spreading to either my heart or my brain. In fact, I read an article a few days ago about a 26 year old who died from a tooth infection spreading.I do not have a fever. I have mild nausea. It is tender on that side of my jaw. The dentist had said the next thing she could give me was Clindamycin, but I have a fear of the side effects of that medicine. I already have heart problems and mild stomach issues. I have read that Clindamycin can cause severe gastrointestinal problems and arrhythmias. She also suggested Zithromax, but I have had heart palpitations while on that medication as well. I am having the teeth removed by an oral surgeon in two weeks, but am afraid of dying from infection before then. What are my options? What is the best course of action? Are there other antibiotics for this? Am I dying from the infection already? Any of your advice or help is appreciated. My other possibly relevant health history is as follows

Hi, Welcome to Chat Doctor forum. I have read your complaint and the relevant details. Please do not panic relating this to death. Maintain good oral hygiene for this two weeks. Revert after a week of extraction to a dentist online.-

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 20 years old. Two to three months ago, I started to have pain on my left testicle whenever I go out as I am usually at home. I speculate that I have varicocele as upon doing a self-examination, I found that the veins were bigger than the other testicle. There were no lumps found, but the left testicle feels bigger than the right one.I would say it is around 5 mm bigger in diameter. I do not have urinary problems like burning sensation. Although when it pains, my left lower abdomen and the pelvic area also hurt sometimes which could be due to lack of exercise as I am on my computer most of the time.The pain or ache on my left testicle usually appears when I am wearing tight pants. But I did not have this problem three months ago. I consulted a general practitioner, and he did a physical check and said it was likely due to congestion of the blood at the testicle. Do you think it could be an infection like epididymitis? I only had sex once in my life with my partner, but I do not have any other symptoms of STD. And do you think that there is something serious? Or is it probably due to congestion or tight pants? ### Response: Hello. Testicular pain with no obvious pathology on physical examination is common in young boys. As the testes descend through the lower abdominal wall, they carry spiral muscle which keeps them suspended in a dynamic position. Contraction of these muscles gives rise to pain. Tight pants press on the inguinal canal and may hinder venous return causing congestion. Wearing Langot (cotton strip worn by wrestlers to support testicles in India) will prevent their hanging, so there will be no muscle contraction. Get a USG scrotum (ultrasound). Wear scrotal support (langot). Kindly consult your doctor to discuss the suggestion and take the treatment with concern. Tablet Pregabalin 75 mg with Mecobalamin (Methylcobalamin) at bedtime for 10 days.

Hello doctor,I am 20 years old. Two to three months ago, I started to have pain on my left testicle whenever I go out as I am usually at home. I speculate that I have varicocele as upon doing a self-examination, I found that the veins were bigger than the other testicle. There were no lumps found, but the left testicle feels bigger than the right one.I would say it is around 5 mm bigger in diameter. I do not have urinary problems like burning sensation. Although when it pains, my left lower abdomen and the pelvic area also hurt sometimes which could be due to lack of exercise as I am on my computer most of the time.The pain or ache on my left testicle usually appears when I am wearing tight pants. But I did not have this problem three months ago. I consulted a general practitioner, and he did a physical check and said it was likely due to congestion of the blood at the testicle. Do you think it could be an infection like epididymitis? I only had sex once in my life with my partner, but I do not have any other symptoms of STD. And do you think that there is something serious? Or is it probably due to congestion or tight pants?

Hello. Testicular pain with no obvious pathology on physical examination is common in young boys. As the testes descend through the lower abdominal wall, they carry spiral muscle which keeps them suspended in a dynamic position. Contraction of these muscles gives rise to pain. Tight pants press on the inguinal canal and may hinder venous return causing congestion. Wearing Langot (cotton strip worn by wrestlers to support testicles in India) will prevent their hanging, so there will be no muscle contraction. Get a USG scrotum (ultrasound). Wear scrotal support (langot). Kindly consult your doctor to discuss the suggestion and take the treatment with concern. Tablet Pregabalin 75 mg with Mecobalamin (Methylcobalamin) at bedtime for 10 days.

### Instruction: Answer this question truthfully ###Input: Hello doctor, I have been dealing with some health issues for three years. I had an ultrasound before showing my spleen was mildly enlarged to 12.8 cm. Since then I have had on and off spleen enlargements. Last week I had an ultrasound with again a mild spleen enlargement at 12.8 cm. Sometimes the spleen returns to a normal size of 11.8cm. I have also noticed in my ultrasound that my liver was enlarged to 16.8 cm when my liver was previously normal at 15.5 cm. I have also done a bunch of blood work and my bilirubin levels went to 27 when they should be below 20 and my conjugated bilirubin was 9 when it should be below 7. I have had my ALT and AST testing and all is fine there. I have had my CBC and differential and all is good with this too. I am very concerned about what this could be and what is happening to my body. My doctor is sending me to a hematologist, please help me to understand what is happening. If this is cancer or something serious. Please help. ### Response: Hi. I hope you are safe. I reviewed your doctor\\s report. (attachment removed to protect patient identity). While I can understand your concern, but as of there is no one pick and choose a reason for your case. To be frank, I am not bothered by your spleen size or liver size. Yes, they are close to the above normal range. I do not know if you have some component of fatty liver, your USG (ultrasound) may tell you that. If you ChatDoctor. Examples are OCPs (oral contraceptive pills), birth pills. There are many more. Just get your medicine list reviewed by your PCP. Easy bruisability over the skin, do you have gum bleeds as well? But your platelet count is well above the normal range as well. Do you have any family history of bleeding and do you have excessive menstrual bleeding?

Hello doctor, I have been dealing with some health issues for three years. I had an ultrasound before showing my spleen was mildly enlarged to 12.8 cm. Since then I have had on and off spleen enlargements. Last week I had an ultrasound with again a mild spleen enlargement at 12.8 cm. Sometimes the spleen returns to a normal size of 11.8cm. I have also noticed in my ultrasound that my liver was enlarged to 16.8 cm when my liver was previously normal at 15.5 cm. I have also done a bunch of blood work and my bilirubin levels went to 27 when they should be below 20 and my conjugated bilirubin was 9 when it should be below 7. I have had my ALT and AST testing and all is fine there. I have had my CBC and differential and all is good with this too. I am very concerned about what this could be and what is happening to my body. My doctor is sending me to a hematologist, please help me to understand what is happening. If this is cancer or something serious. Please help.

Hi. I hope you are safe. I reviewed your doctor\\s report. (attachment removed to protect patient identity). While I can understand your concern, but as of there is no one pick and choose a reason for your case. To be frank, I am not bothered by your spleen size or liver size. Yes, they are close to the above normal range. I do not know if you have some component of fatty liver, your USG (ultrasound) may tell you that. If you ChatDoctor. Examples are OCPs (oral contraceptive pills), birth pills. There are many more. Just get your medicine list reviewed by your PCP. Easy bruisability over the skin, do you have gum bleeds as well? But your platelet count is well above the normal range as well. Do you have any family history of bleeding and do you have excessive menstrual bleeding?

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have an anal fissure, internal hemorrhoid, SRUS, and constipation. One year ago, I was suffering from a hard stool that was difficult to pass. I went to a gastroenterologist, who did a colonoscopy and found that I had an anal fissure and internal hemorrhoid. He prescribed Sitcom Forte, Eldicet, Velgut, and Pankreoflat. He also gave me Sucralcoat Ano cream. However, every night I was in too much pain. So, early this year, I decided to consult an Ayurveda doctor who gave me some Kashayams and tablets. However, my pain did not subside. I used to evacuate the stools using my fingers. That eliminated the stools, but there was so much mucus released and extreme pain after motion. Two months ago, I went to a GP who gave me some antibiotics and painkillers for five days. During this time, I was always sleepy. I took leave from work and was always tired and fatigued. Earlier this month, I went to another GI specialist who did a sigmoidoscopy and said that it is SRUS. He said that I should not finger evacuate the stools and gave me liquid paraffin and LoX cream. Now, my current situation is that it has been three days and I am very constipated and fatigued. The pain has subsided a little. However, I am not passing stools as I used to before. After I drink water or eat something, I get a vomiting sensation. I get anxiety and panic attacks as I am scared about my condition and do not know which doctor I should consult and what I should do. Is this condition serious and life-long? Will I ever be cured? Please advise on the correct medications (allopathy or ayurveda), lifestyle changes and other things to take care. ### Response: Hello. I have gone through the files uploaded by you. (attachment removed to protect patient identity). Hope your queries have been cleared. Good luck. For more information consult a medical gastroenterologist online Take care.

Hello doctor,I have an anal fissure, internal hemorrhoid, SRUS, and constipation. One year ago, I was suffering from a hard stool that was difficult to pass. I went to a gastroenterologist, who did a colonoscopy and found that I had an anal fissure and internal hemorrhoid. He prescribed Sitcom Forte, Eldicet, Velgut, and Pankreoflat. He also gave me Sucralcoat Ano cream. However, every night I was in too much pain. So, early this year, I decided to consult an Ayurveda doctor who gave me some Kashayams and tablets. However, my pain did not subside. I used to evacuate the stools using my fingers. That eliminated the stools, but there was so much mucus released and extreme pain after motion. Two months ago, I went to a GP who gave me some antibiotics and painkillers for five days. During this time, I was always sleepy. I took leave from work and was always tired and fatigued. Earlier this month, I went to another GI specialist who did a sigmoidoscopy and said that it is SRUS. He said that I should not finger evacuate the stools and gave me liquid paraffin and LoX cream. Now, my current situation is that it has been three days and I am very constipated and fatigued. The pain has subsided a little. However, I am not passing stools as I used to before. After I drink water or eat something, I get a vomiting sensation. I get anxiety and panic attacks as I am scared about my condition and do not know which doctor I should consult and what I should do. Is this condition serious and life-long? Will I ever be cured? Please advise on the correct medications (allopathy or ayurveda), lifestyle changes and other things to take care.

Hello. I have gone through the files uploaded by you. (attachment removed to protect patient identity). Hope your queries have been cleared. Good luck. For more information consult a medical gastroenterologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,This query is for my dad who is 75 years old. He has been seeing the same doctor who has recommended the same tests to be done for each follow-up since the past five years. Initially, he saw him once a year, recently it has become quarterly. I have uploaded a copy of the blood test reports and ECG was done for the follow-up on eighth of this month. Yesterday too he had to do a confirmatory blood test (Troponin) as well as ECG which confirmed he had a silent heart attack 10 days back. The admitting doctor after being informed of the test results recommended to stop Eliquis 2.5 mg 1-0-1 and take Ecosprin 150 mg 0-1-0 and tablet Plavix 75 mg 0-1-0. Also injection Clexane 80 mg SC twice a day for five days. He strongly advised getting admitted for a couple of days at least. My query is ### Response: Hello, Welcome to Chat Doctor forum. So he did not have any symptoms, and this was detected on routine blood testing, right? His troponin is elevated here (attachment removed to protect patient identity), so it suggests he had a heart attack. So such patients are admitted for observation and administration of medications. We usually recommend admission immediately after a heart attack for 5 to 7 days, but since this time has already passed, admission is not absolutely necessary, but better to get admitted for observation, injectionClexane, and angiography. He should undergo echo and angiography, and for angiography, he has to be admitted. After angiography, he may need angioplasty or bypass. Also, if any warning signs like low bp or shortness of breath are there then he should be admitted. Also, Clexane is blood thinner which helps in the dissolution of an already formed clot which is the reason for heart attack. So it should be given after heart attack. For more information consult a cardiologist online

Hello doctor,This query is for my dad who is 75 years old. He has been seeing the same doctor who has recommended the same tests to be done for each follow-up since the past five years. Initially, he saw him once a year, recently it has become quarterly. I have uploaded a copy of the blood test reports and ECG was done for the follow-up on eighth of this month. Yesterday too he had to do a confirmatory blood test (Troponin) as well as ECG which confirmed he had a silent heart attack 10 days back. The admitting doctor after being informed of the test results recommended to stop Eliquis 2.5 mg 1-0-1 and take Ecosprin 150 mg 0-1-0 and tablet Plavix 75 mg 0-1-0. Also injection Clexane 80 mg SC twice a day for five days. He strongly advised getting admitted for a couple of days at least. My query is

Hello, Welcome to Chat Doctor forum. So he did not have any symptoms, and this was detected on routine blood testing, right? His troponin is elevated here (attachment removed to protect patient identity), so it suggests he had a heart attack. So such patients are admitted for observation and administration of medications. We usually recommend admission immediately after a heart attack for 5 to 7 days, but since this time has already passed, admission is not absolutely necessary, but better to get admitted for observation, injectionClexane, and angiography. He should undergo echo and angiography, and for angiography, he has to be admitted. After angiography, he may need angioplasty or bypass. Also, if any warning signs like low bp or shortness of breath are there then he should be admitted. Also, Clexane is blood thinner which helps in the dissolution of an already formed clot which is the reason for heart attack. So it should be given after heart attack. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am having two months old baby. Since two days I am observing that his diapers are not wet and heavy as they used to be. So I checked his urine output by laying him down without a diaper for five hours and fed him twice with two and a half hours gap between each feed. He peed thrice after the first feed with 20 minutes gap and he did not pee until he had his second feed. After the second feed, he peed thrice with 20 to 30 minutes gap.Recently, I have reduced his feeding amount on pediatrician advice as he was vomiting. I used to feed him up to 100 ml with 3 to 4 hours gap and now I am feeding him 60 to 70 ml with 2.5 hours gap. I am exclusively expressing milk and feeding through the bottle and sometimes on formula. He is having motion 3 to 4 times per day. Please advise me if this is normal since I feel that his urine has decreased compared to previously. His weight is 4.5 kg checked 20 days before. ### Response: Hello, Welcome to Chat Doctor forum. I understand your concern for your baby. Your baby should urinate 6 to 8 times per day. As you have told that the baby peed after feeds, this seems absolutely normal. You may just keep a track on total 24 hours urine. Should be 6 to 8 times in a day. Reducing feed amount is fine but feed every 2 to 3 hourly and on-demand feeding. Why are you not breastfeeding? Is there any problem? If it is there, it should be ad ChatDoctor. The bottle feeds increase the risk of infection. The stools 3 to 4 times is normal. Weight is 4.5 kg, it is a good weight but need to know the birth weight. Then only would be able to know whether adequate weight gain is there or not. And also the present weight, if you know.

Hi doctor,I am having two months old baby. Since two days I am observing that his diapers are not wet and heavy as they used to be. So I checked his urine output by laying him down without a diaper for five hours and fed him twice with two and a half hours gap between each feed. He peed thrice after the first feed with 20 minutes gap and he did not pee until he had his second feed. After the second feed, he peed thrice with 20 to 30 minutes gap.Recently, I have reduced his feeding amount on pediatrician advice as he was vomiting. I used to feed him up to 100 ml with 3 to 4 hours gap and now I am feeding him 60 to 70 ml with 2.5 hours gap. I am exclusively expressing milk and feeding through the bottle and sometimes on formula. He is having motion 3 to 4 times per day. Please advise me if this is normal since I feel that his urine has decreased compared to previously. His weight is 4.5 kg checked 20 days before.

Hello, Welcome to Chat Doctor forum. I understand your concern for your baby. Your baby should urinate 6 to 8 times per day. As you have told that the baby peed after feeds, this seems absolutely normal. You may just keep a track on total 24 hours urine. Should be 6 to 8 times in a day. Reducing feed amount is fine but feed every 2 to 3 hourly and on-demand feeding. Why are you not breastfeeding? Is there any problem? If it is there, it should be ad ChatDoctor. The bottle feeds increase the risk of infection. The stools 3 to 4 times is normal. Weight is 4.5 kg, it is a good weight but need to know the birth weight. Then only would be able to know whether adequate weight gain is there or not. And also the present weight, if you know.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am in my late 6th month pregnancy. Recently I went for a scan named targeted imaging for fetal anomalies (TIFFA). All the reports were normal except hypoplastic nasal bone and higher normal values of amniotic fluid. I am approaching you for second consultation now. My questions are, what if we go for genetic amniocentesis and results were positive for Down\\s syndrome? Can I terminate the pregnancy in my 28th week of pregnancy? How much safe it is to go for amniocentesis test? Is there any alternate test to get better results? I decided not to have a baby who is mentally retarded. Please suggest me your valuable advice. ### Response: Hi, Welcome to Chat Doctor forum. I have thoroughly gone through your case and can well understand your genuine health concerns. 1. We can better comment on the outcome after getting the results of the amniocentesis. Even if Down\\s syn ChatDoctor. 2. You may terminate anytime depending on where you opt in for this termination. I mean you need to have expert hands for that.3. Amniocentesis is very widely done test all over the world and as for every diagnostic invasive procedure it has its own safety profile.4. Risk of complications is always there as it is associated with invasive procedure. Again I want to add that if you opt in for the expert hands and a seasoned professional obstetricians and gynecologists and interventional radiologist then there is no to low risk for the baby and the mother.5. Amniocentesis and karyotyping to rule out for genetic disorders that involve chromosomal anomalies is the best test universally. No other choice, as this is what we need to know next and this is the specific test available which may guide us about that.6. It is your right to decide and it is solely you who can decide about your body as to what is better for you. Physician can only guide you about the procedures and the final decision is solely your own as to what should be done.

Hi doctor,I am in my late 6th month pregnancy. Recently I went for a scan named targeted imaging for fetal anomalies (TIFFA). All the reports were normal except hypoplastic nasal bone and higher normal values of amniotic fluid. I am approaching you for second consultation now. My questions are, what if we go for genetic amniocentesis and results were positive for Down\\s syndrome? Can I terminate the pregnancy in my 28th week of pregnancy? How much safe it is to go for amniocentesis test? Is there any alternate test to get better results? I decided not to have a baby who is mentally retarded. Please suggest me your valuable advice.

Hi, Welcome to Chat Doctor forum. I have thoroughly gone through your case and can well understand your genuine health concerns. 1. We can better comment on the outcome after getting the results of the amniocentesis. Even if Down\\s syn ChatDoctor. 2. You may terminate anytime depending on where you opt in for this termination. I mean you need to have expert hands for that.3. Amniocentesis is very widely done test all over the world and as for every diagnostic invasive procedure it has its own safety profile.4. Risk of complications is always there as it is associated with invasive procedure. Again I want to add that if you opt in for the expert hands and a seasoned professional obstetricians and gynecologists and interventional radiologist then there is no to low risk for the baby and the mother.5. Amniocentesis and karyotyping to rule out for genetic disorders that involve chromosomal anomalies is the best test universally. No other choice, as this is what we need to know next and this is the specific test available which may guide us about that.6. It is your right to decide and it is solely you who can decide about your body as to what is better for you. Physician can only guide you about the procedures and the final decision is solely your own as to what should be done.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Last summer, I sat in the sun for a few hours tanning. Nothing to drink and I used two oils on me. My face and chest have been red ever since. After then, I donated my blood and they sent a letter saying about some blood cells. I had my appointment with a rheumatologist and got blood work done and I guess it had come back stating I had lupus. Everything has cleared up on me with the redness except my so called bufferfly rash. What do I do? I am starting to get annoying also. This week I have also started to notice my hair has been thinning and I have a weird bald spot on top of my head which in fact I have not had my hair cut trimmed in over a year or two. So what would you think about that also? Last year, I had pain in my knuckles in the winter every morning I would wake up but not come back that is the confusing part. I am starting Prednisone tonight to see if that helps and I am on Topamax and Adipex right now those are it. ### Response: Hello, Welcome to ChatDoctor. I have gone through your history and images. (attachment removed to protect patient identity). Your rash seems still very florid and the alopecia is setting in. I am not sure about the medications you are taking as it does not show up on the phone app, but you need to increase your medicines. Oral steroids are needed in your case. It will stop the hair fall and improve the rash. Although they do come with side effects of weight gain and increased hair over the face, it will help to stop the disease process. I am sure you are already on Hy ChatDoctor. Topical steroids are not recommended for the face as they can cause scarring. Topical Tacrolimus creams are helpful. Lastly, I would like to know if there are any major organs involved in your case. From the history, it looks like minor organ lupus only, but remaining workup is essential to be sure.

Hello doctor,Last summer, I sat in the sun for a few hours tanning. Nothing to drink and I used two oils on me. My face and chest have been red ever since. After then, I donated my blood and they sent a letter saying about some blood cells. I had my appointment with a rheumatologist and got blood work done and I guess it had come back stating I had lupus. Everything has cleared up on me with the redness except my so called bufferfly rash. What do I do? I am starting to get annoying also. This week I have also started to notice my hair has been thinning and I have a weird bald spot on top of my head which in fact I have not had my hair cut trimmed in over a year or two. So what would you think about that also? Last year, I had pain in my knuckles in the winter every morning I would wake up but not come back that is the confusing part. I am starting Prednisone tonight to see if that helps and I am on Topamax and Adipex right now those are it.

Hello, Welcome to ChatDoctor. I have gone through your history and images. (attachment removed to protect patient identity). Your rash seems still very florid and the alopecia is setting in. I am not sure about the medications you are taking as it does not show up on the phone app, but you need to increase your medicines. Oral steroids are needed in your case. It will stop the hair fall and improve the rash. Although they do come with side effects of weight gain and increased hair over the face, it will help to stop the disease process. I am sure you are already on Hy ChatDoctor. Topical steroids are not recommended for the face as they can cause scarring. Topical Tacrolimus creams are helpful. Lastly, I would like to know if there are any major organs involved in your case. From the history, it looks like minor organ lupus only, but remaining workup is essential to be sure.

### Instruction: Answer this question truthfully ###Input: Hi doctor,My son is 22 years old and doing final year college. He used to be good at studies. During his first year college, he was in love with a girl and that was a one side affair. So, he became depressed. He was diagnosed with acute psychosis and treated with Divalproex sodium and Olanzapine. He was stabilized by then. He continued medication for three months and then stopped it. Again, before four months, he became hyperactive, sleepless, angry and began to feel invincible. He was being treated for acute mania with Lithium carb 900 mg and Olanz 15 mg. Now, he has to appear for his final examinations and he is too much worried and depressed. Sometimes, he cries. I took him to the same doctor and he gave some antidepressant, but no improvement in the last six days. Only we have five more days to exam. Kindly advice what to do. ### Response: Hello, Welcome to Chat Doctor forum. I can understand the situation that you and your son are in and you have my sympathies for the same. If worry and exam anxiety are the main issues currently, then he can be given tablet Trika SR (Alprazolam) 0.5 mg in the morning daily. This can be given till his exams are over. Alprazolam should help to certain extent by temporarily reducing worries and stress. Bipolar depression takes time to respond and I am sorry to say that there is no therapy, which will treat it instantaneously. Continue with the prescribed medication and things will hopefully improve with passing days. I would also like to recommend that you convince him not to burden himself with the pressure of exam unnecessarily. The priority must be on coming out of bipolar depression and remaining normal in the future with proper treatment. If he is not able to clear the exam this time, he can always do it at the next opportunity. You could also consider the option of not appearing for the exam if you feel that failing in the exam will hurt him emotionally more.

Hi doctor,My son is 22 years old and doing final year college. He used to be good at studies. During his first year college, he was in love with a girl and that was a one side affair. So, he became depressed. He was diagnosed with acute psychosis and treated with Divalproex sodium and Olanzapine. He was stabilized by then. He continued medication for three months and then stopped it. Again, before four months, he became hyperactive, sleepless, angry and began to feel invincible. He was being treated for acute mania with Lithium carb 900 mg and Olanz 15 mg. Now, he has to appear for his final examinations and he is too much worried and depressed. Sometimes, he cries. I took him to the same doctor and he gave some antidepressant, but no improvement in the last six days. Only we have five more days to exam. Kindly advice what to do.

Hello, Welcome to Chat Doctor forum. I can understand the situation that you and your son are in and you have my sympathies for the same. If worry and exam anxiety are the main issues currently, then he can be given tablet Trika SR (Alprazolam) 0.5 mg in the morning daily. This can be given till his exams are over. Alprazolam should help to certain extent by temporarily reducing worries and stress. Bipolar depression takes time to respond and I am sorry to say that there is no therapy, which will treat it instantaneously. Continue with the prescribed medication and things will hopefully improve with passing days. I would also like to recommend that you convince him not to burden himself with the pressure of exam unnecessarily. The priority must be on coming out of bipolar depression and remaining normal in the future with proper treatment. If he is not able to clear the exam this time, he can always do it at the next opportunity. You could also consider the option of not appearing for the exam if you feel that failing in the exam will hurt him emotionally more.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have few questions which I would like to ask a professional. As I am not able to find the answers by myself, I would love to hear from a practicing professional.How is the best Insulin treatment (syringe, pen, pump and pod) selected for a type 1 diabetes patient? Generally, how long the patients need to learn the injecting technique? Why does injecting Insulin into the same location cause a hard bump in that area? Is this reaction the reason ports are not used to deliver Insulin? How common is the use of the new inhaled Insulin? Does it have to be supplemented by another method of injection? When would an islet cell transplant be recommended? When would a patient be given an entire pancreas transplant operation rather than an islet cell transplant? In both situations, what keeps the beta cells from being tagged by autoantibodies and destroyed again? ### Response: Hi, Welcome to Chat Doctor forum. Rather than the best way, we consider more convenient and economical ways for the patient. The best is always an Insulin pump, but it is costly and requires continued patient education. Injecting Insulin into the same site will cause damage to the fat tissue which results in necrosis (cell death). Because of the fat damage, hard bump forms. New inhalation Insulin is not yet come into usage in full fledges. Also, I have not put any of my patients yet on inhaled Insulin, so cannot comment. But yes, initially it has to be supplemented with subcutaneous Insulin as dosing and efficacy is not completely established for Inhaled Insulin. Islet cell transplant is recommended for patients of type 1 diabetes who are difficult to control on Insulin (by any method). If the transplant is considered for only diabetes purpose then only islet cell transplant is sufficient. The pancreas has other functions like digestion. If the digestion system gets impaired in a patient who is requiring islet cell transplant, in such a patient\\sentire pancreas transplant would be helpful. Well, if no immunosuppressant is used post-transplant, these autoantibodies can destroy the newly transplanted pancreas also.

Hi doctor,I have few questions which I would like to ask a professional. As I am not able to find the answers by myself, I would love to hear from a practicing professional.How is the best Insulin treatment (syringe, pen, pump and pod) selected for a type 1 diabetes patient? Generally, how long the patients need to learn the injecting technique? Why does injecting Insulin into the same location cause a hard bump in that area? Is this reaction the reason ports are not used to deliver Insulin? How common is the use of the new inhaled Insulin? Does it have to be supplemented by another method of injection? When would an islet cell transplant be recommended? When would a patient be given an entire pancreas transplant operation rather than an islet cell transplant? In both situations, what keeps the beta cells from being tagged by autoantibodies and destroyed again?

Hi, Welcome to Chat Doctor forum. Rather than the best way, we consider more convenient and economical ways for the patient. The best is always an Insulin pump, but it is costly and requires continued patient education. Injecting Insulin into the same site will cause damage to the fat tissue which results in necrosis (cell death). Because of the fat damage, hard bump forms. New inhalation Insulin is not yet come into usage in full fledges. Also, I have not put any of my patients yet on inhaled Insulin, so cannot comment. But yes, initially it has to be supplemented with subcutaneous Insulin as dosing and efficacy is not completely established for Inhaled Insulin. Islet cell transplant is recommended for patients of type 1 diabetes who are difficult to control on Insulin (by any method). If the transplant is considered for only diabetes purpose then only islet cell transplant is sufficient. The pancreas has other functions like digestion. If the digestion system gets impaired in a patient who is requiring islet cell transplant, in such a patient\\sentire pancreas transplant would be helpful. Well, if no immunosuppressant is used post-transplant, these autoantibodies can destroy the newly transplanted pancreas also.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I recently visited the doctors as I was unable to catch my breath and was feeling strange. The doctor performed a breath test which came back fine. I had an ECG and the doctor said that my ECG showed possible left ventricle enlargement. He then asked me to perform different breathing while he checked me with a stethoscope. He said he could hear no blockages or other problems and that my blood pressure was slightly raised, usually, it is normal. He said that I was suffering from anxiety and had a panic attack. I have suffered from anxiety all my life. When I asked about the enlargement he said my ECG was borderline. I am now worrying excessively about this and whether to have another ECG just to be on the safe side. I am fit, eat a healthy diet and have not drunk since I was in my 20s. I work out regularly since the age of 25 and I am now 40. I had this ECG abroad as I was working away so I am wondering whether to have it checked back home. I sometimes feel like I cannot take deep breaths when I am stressed, but I do not feel this while exercising. I have a very tight left shoulder and my left rib is sore near the top of my left breast near the armpit, like a muscle aches that comes and goes. I am quite an anxious person, worrying about health issues particularly after losing my mother to breast cancer. ### Response: Hello, Welcome to Chat Doctor forum. Did you ever have chest pain or symptoms of excessive sweating with pain? If your ECG is fine, then there are very fewer chances of you having a cardiac pathology. Left ventricular hypertrophy develops after prolonged hypertension in individuals, but as you have said you have normal blood pressure so I do not think LVH should be there. To relieve your anxiety you can undergo a stress echo or TMT (treadmill test) to rule out inducible angina. Also, you said you do not develop symptoms during exercise so I do not think stress echo or TMT will come out positive.

Hi doctor,I recently visited the doctors as I was unable to catch my breath and was feeling strange. The doctor performed a breath test which came back fine. I had an ECG and the doctor said that my ECG showed possible left ventricle enlargement. He then asked me to perform different breathing while he checked me with a stethoscope. He said he could hear no blockages or other problems and that my blood pressure was slightly raised, usually, it is normal. He said that I was suffering from anxiety and had a panic attack. I have suffered from anxiety all my life. When I asked about the enlargement he said my ECG was borderline. I am now worrying excessively about this and whether to have another ECG just to be on the safe side. I am fit, eat a healthy diet and have not drunk since I was in my 20s. I work out regularly since the age of 25 and I am now 40. I had this ECG abroad as I was working away so I am wondering whether to have it checked back home. I sometimes feel like I cannot take deep breaths when I am stressed, but I do not feel this while exercising. I have a very tight left shoulder and my left rib is sore near the top of my left breast near the armpit, like a muscle aches that comes and goes. I am quite an anxious person, worrying about health issues particularly after losing my mother to breast cancer.

Hello, Welcome to Chat Doctor forum. Did you ever have chest pain or symptoms of excessive sweating with pain? If your ECG is fine, then there are very fewer chances of you having a cardiac pathology. Left ventricular hypertrophy develops after prolonged hypertension in individuals, but as you have said you have normal blood pressure so I do not think LVH should be there. To relieve your anxiety you can undergo a stress echo or TMT (treadmill test) to rule out inducible angina. Also, you said you do not develop symptoms during exercise so I do not think stress echo or TMT will come out positive.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My mother's age is 80+ and she had heart attack four times. Two attacks in quick succession a year back and two attacks quick in last one month. Her heart pumping capacity is about 35 % with kidney creatinine 3.4 mg/dl. But it is decreasing now. She never had diabetes. But always when admitted to hospital for heart attack treatment, her sugar level increased a bit and hospital always started giving her Insulin. Last one and half year her cardiologist never advised her to go under any aggressive treatment like doing angiogram and then further treatment like angioplasty and ect.If we go for angiogram followed by further treatment like angioplasty and ring fixing. Will it be safe for her? Will she be able to survive? Traditional angiogram or CT angiogram and then angioplasty or ring. ### Response: Hi. Although bypass or angioplasty can be done in old age, if the health of patient is promising, but if other health issues are present then it becomes a high risk case. As your mother\\s kidney function is poor, it becomes very risky to have an angiogram done because even non-ionic contrast medium is detrimental for the kidneys. One possibility is that have her 1 or 2 sessions of dialysis done first, then go for angiography and angioplasty and again have one or more sessions of dialysis in close liaison with good nephrologist. If this is done safely, then next risk is of bleeding. After angioplasty, blood thinning medicines are given for long time, this may cause bleeding problem in old age. Regarding bypass, it is a major surgery and needs general anesthesia, although not impossible in old age but, it depends upon overall health and organ functions of body. Cardiac anesthetist will fully evaluate her before bypass. Third option is to keep her on medicines only without going for any intervention. In my opinion, consult a nephrologist that is there any chance of recovery of kidney function, if no then periprocedural dialysis can be considered.

Hello doctor,My mother's age is 80+ and she had heart attack four times. Two attacks in quick succession a year back and two attacks quick in last one month. Her heart pumping capacity is about 35 % with kidney creatinine 3.4 mg/dl. But it is decreasing now. She never had diabetes. But always when admitted to hospital for heart attack treatment, her sugar level increased a bit and hospital always started giving her Insulin. Last one and half year her cardiologist never advised her to go under any aggressive treatment like doing angiogram and then further treatment like angioplasty and ect.If we go for angiogram followed by further treatment like angioplasty and ring fixing. Will it be safe for her? Will she be able to survive? Traditional angiogram or CT angiogram and then angioplasty or ring.

Hi. Although bypass or angioplasty can be done in old age, if the health of patient is promising, but if other health issues are present then it becomes a high risk case. As your mother\\s kidney function is poor, it becomes very risky to have an angiogram done because even non-ionic contrast medium is detrimental for the kidneys. One possibility is that have her 1 or 2 sessions of dialysis done first, then go for angiography and angioplasty and again have one or more sessions of dialysis in close liaison with good nephrologist. If this is done safely, then next risk is of bleeding. After angioplasty, blood thinning medicines are given for long time, this may cause bleeding problem in old age. Regarding bypass, it is a major surgery and needs general anesthesia, although not impossible in old age but, it depends upon overall health and organ functions of body. Cardiac anesthetist will fully evaluate her before bypass. Third option is to keep her on medicines only without going for any intervention. In my opinion, consult a nephrologist that is there any chance of recovery of kidney function, if no then periprocedural dialysis can be considered.

### Instruction: Answer this question truthfully ###Input: Hi doctor,A recent accident happened to my father which makes him unable to walk. A week ago, he suddenly fell on the ground while walking and his right leg was injured. He was transferred to hospital and X-ray indicted his leg is not broken but severely ricked, as a result, it is not moving and will need time to recover. However, the problem is not the injured right leg but the left leg. His left leg is fully functional (i.e., he can move his knee and toes without any pain and numbness) in laying down and sitting position but once he stands up, he can not even rise up his left leg from the ground. Therefore, he is now completely paralyzed and unable to walk. What could be the reason?Here are some details about his medical background. He is about 70 years old. He has been suffering from type 2 diabetes for over 20 years and three years ago was prescribed to use Insulin. Recently, his doctor told him that his blood sugar is under control. He experienced previous imbalance feeling and fell several times while walking in past. Basically, whenever he stood up, he would need an effort to gain his balance. His hands also have been shaking a bit. He had an open heart surgery 10 years ago. He had a back pain (even in laying down position) which went worse after the accident. He has lost a majority of his vision over the years due to glaucoma. His X-ray indicates no broken bone. ### Response: Hello, Welcome to ChatDoctor. I read carefully your question and would explain that this clinical situation could be caused by a stroke, which is probably the cause of falling. Another possible cause would be a nerve damage related to the trauma. For this reason, it is important performing a brain CT (computed tomography) scan or MRI (magnetic resonance imaging) to investigate for a possible stroke. If this test result is normal, I would recommend performing a nerve conduction study to examine his nerves. For more information consult a neurologist online

Hi doctor,A recent accident happened to my father which makes him unable to walk. A week ago, he suddenly fell on the ground while walking and his right leg was injured. He was transferred to hospital and X-ray indicted his leg is not broken but severely ricked, as a result, it is not moving and will need time to recover. However, the problem is not the injured right leg but the left leg. His left leg is fully functional (i.e., he can move his knee and toes without any pain and numbness) in laying down and sitting position but once he stands up, he can not even rise up his left leg from the ground. Therefore, he is now completely paralyzed and unable to walk. What could be the reason?Here are some details about his medical background. He is about 70 years old. He has been suffering from type 2 diabetes for over 20 years and three years ago was prescribed to use Insulin. Recently, his doctor told him that his blood sugar is under control. He experienced previous imbalance feeling and fell several times while walking in past. Basically, whenever he stood up, he would need an effort to gain his balance. His hands also have been shaking a bit. He had an open heart surgery 10 years ago. He had a back pain (even in laying down position) which went worse after the accident. He has lost a majority of his vision over the years due to glaucoma. His X-ray indicates no broken bone.

Hello, Welcome to ChatDoctor. I read carefully your question and would explain that this clinical situation could be caused by a stroke, which is probably the cause of falling. Another possible cause would be a nerve damage related to the trauma. For this reason, it is important performing a brain CT (computed tomography) scan or MRI (magnetic resonance imaging) to investigate for a possible stroke. If this test result is normal, I would recommend performing a nerve conduction study to examine his nerves. For more information consult a neurologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My 10-month-old baby had a viral infection with roseola infantum. It started fever 38.5 degrees and 39 degrees measured rectally on the second day treated with Ibuprofen 3.5 ml and Paracetamol (Panadol) 4 ml administrated after 6 hours (almost three days of treatment). The third day, the baby did not have fever at all and on the fourth day a rash appeared on his face, after his ears and on his back mainly, with mild signs on his tummy. Also, in the fourth day she had changes in his stool- kind of yellow with mucus and quite fluid with no fever.Five days later, the blood tests indicated severe neutropenia with 0 neutrophils on a test taken from her finger. As we got very scared, we repeated the test the next day and the result was 0.2 neutrophils so again a very low value.My question is that is it possible that this neutropenia is a consequence of the roseola infantum plus the administration of Paracetamol? The baby is fine now, she is very happy, playing, and eating normal. Also, would it be possible that these indicators can be so low due to the way of taking blood sample? We got it out of her finger, not through the veins. We were given Azithromicin just to be on the safe side, but I would not give her antibiotics if clinically she is well and shows no sign of being unwell. ### Response: Hi. The low count may be because of the disease process and less likely the Paracetamol or Ibuprofen. Another reason can also be the way the sample was collected (although I am not very sure about it). Do not worry about it if the child is currently fine. However, I would advise taking a fresh sample of blood from the veins and checking the counts again. If they persistently stay low on three consecutive occasions, I would advise a detailed workup to rule out any genetic disorders in the child.

Hello doctor,My 10-month-old baby had a viral infection with roseola infantum. It started fever 38.5 degrees and 39 degrees measured rectally on the second day treated with Ibuprofen 3.5 ml and Paracetamol (Panadol) 4 ml administrated after 6 hours (almost three days of treatment). The third day, the baby did not have fever at all and on the fourth day a rash appeared on his face, after his ears and on his back mainly, with mild signs on his tummy. Also, in the fourth day she had changes in his stool- kind of yellow with mucus and quite fluid with no fever.Five days later, the blood tests indicated severe neutropenia with 0 neutrophils on a test taken from her finger. As we got very scared, we repeated the test the next day and the result was 0.2 neutrophils so again a very low value.My question is that is it possible that this neutropenia is a consequence of the roseola infantum plus the administration of Paracetamol? The baby is fine now, she is very happy, playing, and eating normal. Also, would it be possible that these indicators can be so low due to the way of taking blood sample? We got it out of her finger, not through the veins. We were given Azithromicin just to be on the safe side, but I would not give her antibiotics if clinically she is well and shows no sign of being unwell.

Hi. The low count may be because of the disease process and less likely the Paracetamol or Ibuprofen. Another reason can also be the way the sample was collected (although I am not very sure about it). Do not worry about it if the child is currently fine. However, I would advise taking a fresh sample of blood from the veins and checking the counts again. If they persistently stay low on three consecutive occasions, I would advise a detailed workup to rule out any genetic disorders in the child.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I had unprotected sex on day 13 of my cycle and had an I-pill a day later. Again, I had sex in a gap of three days after the intake of tablet. I am really worried if I should take the pill again. This was a terrible mistake. Please help. ### Response: Hi, Welcome to Chat Doctor forum. I am assuming that you have regular monthly periods. In that case, it is the time where you are going to ovulate. So, it is an unsafe period to have sex. And, if you have once unprotected sex and have taken I-pill (emergency contraceptive pill) once, then why to make mistake for the second time. Because, I-pill in itself is not 100% effective even if taken once. There is no study about two times taken I-pill. It works with two mechanisms. First of all, it will delay ovulation and second, it brings bleeding. So, if pregnancy happens, it resists implantation. In your case, if I believe that ovulation is delayed while you have taken the tablet, then it is good. If you have taken the tablet for the second time, then the ovulation is more delayed and period will be somewhat late with more chance of avoiding pregnancy. The second thing is that with I-pill your period cycle can become irregular. The chance of that increases more if you have taken two times. Because, it is a chemical (hormone), which is produced in your body to maintain your regular cycle. And, when you take it from outside it can disturb your normal cycle. If you do not want pregnancy in the first place, then either use condom or other method as preferred by you both after discussing with your doctor. I-pill is an emergency contraceptive and not a regular contraceptive pill that you can take as and when required. It should be taken when fear of failure of normal contraception is more. So, make the thing clear about whether you want pregnancy or not and go for a solution which helps you in future.

Hi doctor,I had unprotected sex on day 13 of my cycle and had an I-pill a day later. Again, I had sex in a gap of three days after the intake of tablet. I am really worried if I should take the pill again. This was a terrible mistake. Please help.

Hi, Welcome to Chat Doctor forum. I am assuming that you have regular monthly periods. In that case, it is the time where you are going to ovulate. So, it is an unsafe period to have sex. And, if you have once unprotected sex and have taken I-pill (emergency contraceptive pill) once, then why to make mistake for the second time. Because, I-pill in itself is not 100% effective even if taken once. There is no study about two times taken I-pill. It works with two mechanisms. First of all, it will delay ovulation and second, it brings bleeding. So, if pregnancy happens, it resists implantation. In your case, if I believe that ovulation is delayed while you have taken the tablet, then it is good. If you have taken the tablet for the second time, then the ovulation is more delayed and period will be somewhat late with more chance of avoiding pregnancy. The second thing is that with I-pill your period cycle can become irregular. The chance of that increases more if you have taken two times. Because, it is a chemical (hormone), which is produced in your body to maintain your regular cycle. And, when you take it from outside it can disturb your normal cycle. If you do not want pregnancy in the first place, then either use condom or other method as preferred by you both after discussing with your doctor. I-pill is an emergency contraceptive and not a regular contraceptive pill that you can take as and when required. It should be taken when fear of failure of normal contraception is more. So, make the thing clear about whether you want pregnancy or not and go for a solution which helps you in future.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 60 year old female, who is 5.4 feet, and I weighs 157 lbs. I am looking for a name for my condition. The only medication I take is Imipramine hydrochloride 40 mg tablets each day. I have been told that I have a neurological condition, but the symptoms do not follow any diagnosis.When I was 26 years old, I had an operation, a day later it was hard for me to move my right leg and arm. Within a few days, my speech was slurred, and it was more difficult to use my right arm and leg. I had to use crutches to walk. My doctor gave me high doses of Prednisone, and I did tests for MS, which were negative. My symptoms went into remission, and I had periodic symptoms during times of high stress.When I was 56 years old, I had a case of shingles on my face, left lip, and nose area. When the blistering and ooze was finally gone, the MS like symptoms returned. I had slurred speech, and my legs were weak and unable to stand or walk without assistance. My hands shook when I tried using them to eat, turning a page in a book, and handing something as small as an envelope to someone. When I hold out my arm to hand someone something, my arm slowly starts to drop.I recently had an MRI that showed no myelin scaring for MS. My neurologist said I have an unknown neurological condition. I would like more information than an unknown neurological condition that the doctors are giving me, but I do not know where or what kind of doctor that can give me more information. What can I do to have a better quality of life for myself and my family? ### Response: Hi. Sorry to hear about your prolonged symptoms, I can understand your frustration. A neurologist would be able to help you discuss or exclude some of the above. Kind regards. For more information consult an internal medicine physician online

Hello doctor,I am a 60 year old female, who is 5.4 feet, and I weighs 157 lbs. I am looking for a name for my condition. The only medication I take is Imipramine hydrochloride 40 mg tablets each day. I have been told that I have a neurological condition, but the symptoms do not follow any diagnosis.When I was 26 years old, I had an operation, a day later it was hard for me to move my right leg and arm. Within a few days, my speech was slurred, and it was more difficult to use my right arm and leg. I had to use crutches to walk. My doctor gave me high doses of Prednisone, and I did tests for MS, which were negative. My symptoms went into remission, and I had periodic symptoms during times of high stress.When I was 56 years old, I had a case of shingles on my face, left lip, and nose area. When the blistering and ooze was finally gone, the MS like symptoms returned. I had slurred speech, and my legs were weak and unable to stand or walk without assistance. My hands shook when I tried using them to eat, turning a page in a book, and handing something as small as an envelope to someone. When I hold out my arm to hand someone something, my arm slowly starts to drop.I recently had an MRI that showed no myelin scaring for MS. My neurologist said I have an unknown neurological condition. I would like more information than an unknown neurological condition that the doctors are giving me, but I do not know where or what kind of doctor that can give me more information. What can I do to have a better quality of life for myself and my family?

Hi. Sorry to hear about your prolonged symptoms, I can understand your frustration. A neurologist would be able to help you discuss or exclude some of the above. Kind regards. For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,Last week I had sex with a guy with expired condoms. I saw the packets only after sex and found that they are expired. Is this a problem? Could I be pregnant?Also, I am not sure if this is linked or not but three days ago, I had a really sore, stinging and itchy vagina. I have had thrush before and do not know if this is what it is? I got Canesten thrush combi internal and external cream packet and have been rubbing some cream on my vagina for the last few days. It does not feel as weird burn as much as the first day but still feels weird. About half an hour ago, I inserted the internal cream. My vagina has been feeling really weird, but it feels like a urine infection in a way but does not burn to urinate. I do not know if this is thrush or an infection like a sexual infection from an expired condom? I have not gone to the doctor. When I did put a finger inside the other day there were some white bits on my finger. My opening to the vagina hurts and is sore when I try to finger myself. Could I be pregnant? Or could I have got a sexual infection due to an expired condoms? The soreness started a few days after the sex with expired condom. I feel uncomfortable and do not know what to do? Is it true that once period comes it clears up? Please suggest. ### Response: Hello, Welcome to Chat Doctor forum. If the condom is expired it means it may break easily if it has not had breach then it is as safe as normal condoms. According to your information, three months have passed after this incident and during these three months did you had normal periods? Normal period means no pregnancy. The symptoms you are mentioning are suggestive of thrush and oral Fluconazole 150 mg one tablet daily will take care. The ideal thing would have been if you had uploaded an image so that one could see what is there. And yes, you have to avoid sex for a few days until soreness settles.

Hello doctor,Last week I had sex with a guy with expired condoms. I saw the packets only after sex and found that they are expired. Is this a problem? Could I be pregnant?Also, I am not sure if this is linked or not but three days ago, I had a really sore, stinging and itchy vagina. I have had thrush before and do not know if this is what it is? I got Canesten thrush combi internal and external cream packet and have been rubbing some cream on my vagina for the last few days. It does not feel as weird burn as much as the first day but still feels weird. About half an hour ago, I inserted the internal cream. My vagina has been feeling really weird, but it feels like a urine infection in a way but does not burn to urinate. I do not know if this is thrush or an infection like a sexual infection from an expired condom? I have not gone to the doctor. When I did put a finger inside the other day there were some white bits on my finger. My opening to the vagina hurts and is sore when I try to finger myself. Could I be pregnant? Or could I have got a sexual infection due to an expired condoms? The soreness started a few days after the sex with expired condom. I feel uncomfortable and do not know what to do? Is it true that once period comes it clears up? Please suggest.

Hello, Welcome to Chat Doctor forum. If the condom is expired it means it may break easily if it has not had breach then it is as safe as normal condoms. According to your information, three months have passed after this incident and during these three months did you had normal periods? Normal period means no pregnancy. The symptoms you are mentioning are suggestive of thrush and oral Fluconazole 150 mg one tablet daily will take care. The ideal thing would have been if you had uploaded an image so that one could see what is there. And yes, you have to avoid sex for a few days until soreness settles.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 41-year-old male. For a long time and I am afraid of death, aviation and diseases, and despite my only and I fear flying. I always found myself assailed by the fear of death while I pray because of that I am trying to finish my prayer soon to escape from there and heading towards the house. This case has happened for more than 20 times.Eight months ago I experienced a state of severe fear when I am in a barber shop. While I was getting shaved I started sweating and my heart accelerates. I left the shop before my shaving was over. I went to the hospital the next day and they told me that my BP was high and I need medication to lower it. Three days after I visited the hospital after a dizziness in my head and my BP was 160/110 mmHg and they prescribed me a medicine, and after the stability of the pressure to 130/84 mmHg anxiety started again and my previous drug was then substituted by Eisenberg 10 mg but I still have a permanent feeling of fear and anxiety, and currently troubled, because I started to forget some of the names and mention them after some minutes at most times. But rarely I have this a kind of confusion, on seeing somebody and due to fear of getting their names wrong I moved away from them.After this, I have done all blood tests to detect the problem and I decided to go to a psychiatrist and he told me that I have an anxiety disorder. He prescribed me Escitalopram 20 mg. But I did not take it. Please help me I am confused. ### Response: Hello. I read your query word by word and affirm that this is an anxiety disorder. As you are aware that anxiety disorder is characterized by excessive concern about one or another thing. Many of the patients with anxiety problems present with excessive sweating, palpitations or pounding heart and ChatDoctor. As your psychiatrist told you the antidepressant class of medicines are the

Hello doctor,I am a 41-year-old male. For a long time and I am afraid of death, aviation and diseases, and despite my only and I fear flying. I always found myself assailed by the fear of death while I pray because of that I am trying to finish my prayer soon to escape from there and heading towards the house. This case has happened for more than 20 times.Eight months ago I experienced a state of severe fear when I am in a barber shop. While I was getting shaved I started sweating and my heart accelerates. I left the shop before my shaving was over. I went to the hospital the next day and they told me that my BP was high and I need medication to lower it. Three days after I visited the hospital after a dizziness in my head and my BP was 160/110 mmHg and they prescribed me a medicine, and after the stability of the pressure to 130/84 mmHg anxiety started again and my previous drug was then substituted by Eisenberg 10 mg but I still have a permanent feeling of fear and anxiety, and currently troubled, because I started to forget some of the names and mention them after some minutes at most times. But rarely I have this a kind of confusion, on seeing somebody and due to fear of getting their names wrong I moved away from them.After this, I have done all blood tests to detect the problem and I decided to go to a psychiatrist and he told me that I have an anxiety disorder. He prescribed me Escitalopram 20 mg. But I did not take it. Please help me I am confused.

Hello. I read your query word by word and affirm that this is an anxiety disorder. As you are aware that anxiety disorder is characterized by excessive concern about one or another thing. Many of the patients with anxiety problems present with excessive sweating, palpitations or pounding heart and ChatDoctor. As your psychiatrist told you the antidepressant class of medicines are the

### Instruction: Answer this question truthfully ###Input: Hello doctor,The query is about sanded grout exposure. I am quite concerned about my girlfriend's exposure to silica dust. We were doing a home renovation. I left for about 1.5 hours while she was removing tile in a kitchen. When I had come back I saw she was removing grout with a grinder and no dust mask. The room was filled with dust in the air. The room is about 10x9 with 12\\x80\\x9d tiles. This makes for a total cut distance of 1100\\x80\\x9d with the grinder. Assuming a 1/8\\x80\\x9d cut with a depth of 3/8\\x80\\x9d and this works out to 51.56 cubic inches of dust released into the air. Assuming an average of 25 % silica content in the grout and weight of 38 g per cu inch for the dust, that is about 490 grams of silica dust releases into the air. The room was open to adjacent rooms so I estimated about 90 cubic meter space, wich would work out to 5.4 g/m^3. She was doing this for about an hour and a half so I estimate about 1 m^3 was inhaled. From what I have read this is really high-level exposure.Is my math wrong? Did I miss something? I am making her go to the doctor and we will monitor her health closely. I am really concerned this could lead to serious problems in the near future. ### Response: Hi. Looking at the history, it is quite a high-level exposure and it can cause some kind of pneumonitis feature called hypersensitivity pneumonitis or toxic dust syn ChatDoctor. If she develops symptoms of a cough, breathlessness, better to get a CT thorax to see her lungs and if possible lung function tests also. Kindly get back if you need more information.

Hello doctor,The query is about sanded grout exposure. I am quite concerned about my girlfriend's exposure to silica dust. We were doing a home renovation. I left for about 1.5 hours while she was removing tile in a kitchen. When I had come back I saw she was removing grout with a grinder and no dust mask. The room was filled with dust in the air. The room is about 10x9 with 12\\x80\\x9d tiles. This makes for a total cut distance of 1100\\x80\\x9d with the grinder. Assuming a 1/8\\x80\\x9d cut with a depth of 3/8\\x80\\x9d and this works out to 51.56 cubic inches of dust released into the air. Assuming an average of 25 % silica content in the grout and weight of 38 g per cu inch for the dust, that is about 490 grams of silica dust releases into the air. The room was open to adjacent rooms so I estimated about 90 cubic meter space, wich would work out to 5.4 g/m^3. She was doing this for about an hour and a half so I estimate about 1 m^3 was inhaled. From what I have read this is really high-level exposure.Is my math wrong? Did I miss something? I am making her go to the doctor and we will monitor her health closely. I am really concerned this could lead to serious problems in the near future.

Hi. Looking at the history, it is quite a high-level exposure and it can cause some kind of pneumonitis feature called hypersensitivity pneumonitis or toxic dust syn ChatDoctor. If she develops symptoms of a cough, breathlessness, better to get a CT thorax to see her lungs and if possible lung function tests also. Kindly get back if you need more information.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 25 years old. I am healthy, no medications, regular periods of 28 to 30 days. My partner and I have been together for seven years and we have been TTC for five years with no luck. I have given up hope for a long time. End last year, I started seeing a chiropractor because of lower back pain. Early this year, my period was a week late and I felt different. So, I decided to take a pregnancy test. I had two positive digital tests and another positive on the first response with two lines that appeared. I was definitely pregnant. I could not believe it! The only thing I had done differently was to see a chiropractor and it was instant that I conceived. Unfortunately, I had a very early miscarriage. Just two days after my positive tests, I began to bleed and confirmed with a doctor it had been miscarried. To this day, I still see a chiropractor and we keep on trying to get pregnant but it is not happening. I am back to feeling hopeless. I still cannot believe I saw three positive tests. I thought I would never see that for myself. I was so close. It gives me the slightest hope that maybe it will happen for me one day. Is there any information you can give me? Why is this happening to me? What might help me? ### Response: Hello. There are multiple factors which need to be evaluated in a secondary infertility case, the male and the female. Considering that you became pregnant, the male factor is healthy with motile and healthy sperms. It is now important to get your hormonal profile done along with an ultrasound pelvis to rule out PCOD (polycystic ovaries disease), hypothyroidism or hyperprolactinemia which can cause delayed follicular development or immature follicles which do not ovulate. You may be experiencing anovulatory cycles. Hence follicular monitoring should be done for a natural dummy cycle to check for follicular growth. For more information consult an infertility specialist online Take care.

Hello doctor,I am 25 years old. I am healthy, no medications, regular periods of 28 to 30 days. My partner and I have been together for seven years and we have been TTC for five years with no luck. I have given up hope for a long time. End last year, I started seeing a chiropractor because of lower back pain. Early this year, my period was a week late and I felt different. So, I decided to take a pregnancy test. I had two positive digital tests and another positive on the first response with two lines that appeared. I was definitely pregnant. I could not believe it! The only thing I had done differently was to see a chiropractor and it was instant that I conceived. Unfortunately, I had a very early miscarriage. Just two days after my positive tests, I began to bleed and confirmed with a doctor it had been miscarried. To this day, I still see a chiropractor and we keep on trying to get pregnant but it is not happening. I am back to feeling hopeless. I still cannot believe I saw three positive tests. I thought I would never see that for myself. I was so close. It gives me the slightest hope that maybe it will happen for me one day. Is there any information you can give me? Why is this happening to me? What might help me?

Hello. There are multiple factors which need to be evaluated in a secondary infertility case, the male and the female. Considering that you became pregnant, the male factor is healthy with motile and healthy sperms. It is now important to get your hormonal profile done along with an ultrasound pelvis to rule out PCOD (polycystic ovaries disease), hypothyroidism or hyperprolactinemia which can cause delayed follicular development or immature follicles which do not ovulate. You may be experiencing anovulatory cycles. Hence follicular monitoring should be done for a natural dummy cycle to check for follicular growth. For more information consult an infertility specialist online Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 49 year old male. Five years ago, I got two stents on the left. Actually, my heart was good only 30 % block. I take Vitoryn and Aspirin until now. I started having arrhythmia two years ago. AF comes out once every one and a half months for two to four hours. When AF attacks, I cannot stand up. I feel dizzy and like I am going to faint. I only took medicines for a month that time. THree and a half months back, I started taking Cordarone 200 mg. And Xarelto 15 mg. Until now, AF never came back. I already stopped Xarelto one month ago. Can I reduce Cordarone into half or take it every two days? Two weeks ago, suddenly my entire body felt itchy and swollen for two hours, then went away by itself. Please advice. ### Response: Hello, Welcome to Chat Doctor forum. I have reviewed your health query and can well understand you are worried about your heart health. I would not say to stop Xarelto (Rivaroxaban) and/or Cordarone (Amiodarone) as these are very important medications and you need them. For stent patients, Xarelto reduces the risk of strokes, pulmonary embolism, and deep venous thrombosis, and clots initiating from the stents area. It is a blood thinning agent and keeps the blood running in veins and arteries without excessive clotting. Cordarone, on the other hand, keeps you away from heart rhythm problems like AF (atrial fibrillation). With the fact that you are having no arrhythmias while taking this medication, I do not think there is an obvious need to change the dosage. If your cardiologist gets some indication to reduce the dosage after examining you physically, that would be a different story. My final suggestion is to consult your treating physician before changing medications. Hope this helps. For more infiormation consult a cardiologist online

Hi doctor,I am a 49 year old male. Five years ago, I got two stents on the left. Actually, my heart was good only 30 % block. I take Vitoryn and Aspirin until now. I started having arrhythmia two years ago. AF comes out once every one and a half months for two to four hours. When AF attacks, I cannot stand up. I feel dizzy and like I am going to faint. I only took medicines for a month that time. THree and a half months back, I started taking Cordarone 200 mg. And Xarelto 15 mg. Until now, AF never came back. I already stopped Xarelto one month ago. Can I reduce Cordarone into half or take it every two days? Two weeks ago, suddenly my entire body felt itchy and swollen for two hours, then went away by itself. Please advice.

Hello, Welcome to Chat Doctor forum. I have reviewed your health query and can well understand you are worried about your heart health. I would not say to stop Xarelto (Rivaroxaban) and/or Cordarone (Amiodarone) as these are very important medications and you need them. For stent patients, Xarelto reduces the risk of strokes, pulmonary embolism, and deep venous thrombosis, and clots initiating from the stents area. It is a blood thinning agent and keeps the blood running in veins and arteries without excessive clotting. Cordarone, on the other hand, keeps you away from heart rhythm problems like AF (atrial fibrillation). With the fact that you are having no arrhythmias while taking this medication, I do not think there is an obvious need to change the dosage. If your cardiologist gets some indication to reduce the dosage after examining you physically, that would be a different story. My final suggestion is to consult your treating physician before changing medications. Hope this helps. For more infiormation consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hi,I am approaching you since I am concerned about a situation regarding which I am very embarrassed. I am a 43 year old female. I am normally healthy. I am 178cm tall and I weigh 75kg. Around 9-12 months ago, I started to suffer from anal itching.It is rather intense at night, after passing stools and during/after having intercourse or anal masturbation.I also have few lumps on my anal ring that seem to grow outside of my anal opening as an extended piece of flesh.They are very sensitive but they are odd and it really troubles me.I fear that my problem started as a result of anal masturbation and anal sex.I feel very ashamed to say this. I was using anal toys and hand and I am afraid that during these years I myself have created problems to my health and I do not know how to fix it.I do not have constipation and my stool is normal.I pass motion once a day and I have no abdominal pain while passing stools.Sometimes when I have anal sex I start bleeding from my rectum for a few seconds and then it stops.It does not bleed when I pass stools or any other time.I have not attained menopause even though my period seems to be every 6-7 weeks these days.I would appreciate if you can help me understand how to treat this issue and what should I do (i.e, special diet, special creams, instructions on how to clean the area etc.)Help me please, I am looking for a very discreet way to handle my situation since I am too concerned about talking with my spouse. ### Response: Hi, Welcome to ChatDoctor. I read your entire history and have understood your concern. I also understand your hesitation in discussing your problems with anyone. Lastly, no good doctor will ever judge you for anything you do in your personal life. So do not feel ashamed in consulting one and getting the growths removed. Revert back with the reports to a Dermatologist online

Hi,I am approaching you since I am concerned about a situation regarding which I am very embarrassed. I am a 43 year old female. I am normally healthy. I am 178cm tall and I weigh 75kg. Around 9-12 months ago, I started to suffer from anal itching.It is rather intense at night, after passing stools and during/after having intercourse or anal masturbation.I also have few lumps on my anal ring that seem to grow outside of my anal opening as an extended piece of flesh.They are very sensitive but they are odd and it really troubles me.I fear that my problem started as a result of anal masturbation and anal sex.I feel very ashamed to say this. I was using anal toys and hand and I am afraid that during these years I myself have created problems to my health and I do not know how to fix it.I do not have constipation and my stool is normal.I pass motion once a day and I have no abdominal pain while passing stools.Sometimes when I have anal sex I start bleeding from my rectum for a few seconds and then it stops.It does not bleed when I pass stools or any other time.I have not attained menopause even though my period seems to be every 6-7 weeks these days.I would appreciate if you can help me understand how to treat this issue and what should I do (i.e, special diet, special creams, instructions on how to clean the area etc.)Help me please, I am looking for a very discreet way to handle my situation since I am too concerned about talking with my spouse.

Hi, Welcome to ChatDoctor. I read your entire history and have understood your concern. I also understand your hesitation in discussing your problems with anyone. Lastly, no good doctor will ever judge you for anything you do in your personal life. So do not feel ashamed in consulting one and getting the growths removed. Revert back with the reports to a Dermatologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,Should I think about going to a hematologist? The last few years of my CBC shows WBC 8.4, 9.6, 13.9, 11.3, 11.3, 10.5, 8.3, 12.3, lymph (abs) 3.2, 4.4, 3.9, 4.0, 3.8, 3.6, 3.9, platelets 331, 400, 380, 453, 428, 407, 459, 389, neutrophils (abs) 5.8, 8.5, 6.3, 6.4, 5.8, 3.9, 7.6, eosinophils (abs) have all been .1 or .2. I am an active 50-year-old female, 156 lbs, with hypothyroidism 175 (since past nine years, Levothyroxine MCG), Genetic high cholesterol (since I was 18 years old), cholesterol total 257, tri 273, HDL 80, LDL 135. Just started on Atorvastatin 20 mg. I am starting to get concerned that I am in the early stages of CLL. Should I request to be sent to a hematologist? ### Response: Hello. I do not find any significant abnormality in the report. At one stage your lymphocytes were high that is 4.4. But it fluctuates as per reports and not raised to more than 4.5 at any time (attachment removed to protect patient identity). If absolute lymphocytes remain persistent high greater than 4.5, then CLL can be ruled out by flow cytometry investigation. You can consult a hematologist for your detailed physical examination.

Hello doctor,Should I think about going to a hematologist? The last few years of my CBC shows WBC 8.4, 9.6, 13.9, 11.3, 11.3, 10.5, 8.3, 12.3, lymph (abs) 3.2, 4.4, 3.9, 4.0, 3.8, 3.6, 3.9, platelets 331, 400, 380, 453, 428, 407, 459, 389, neutrophils (abs) 5.8, 8.5, 6.3, 6.4, 5.8, 3.9, 7.6, eosinophils (abs) have all been .1 or .2. I am an active 50-year-old female, 156 lbs, with hypothyroidism 175 (since past nine years, Levothyroxine MCG), Genetic high cholesterol (since I was 18 years old), cholesterol total 257, tri 273, HDL 80, LDL 135. Just started on Atorvastatin 20 mg. I am starting to get concerned that I am in the early stages of CLL. Should I request to be sent to a hematologist?

Hello. I do not find any significant abnormality in the report. At one stage your lymphocytes were high that is 4.4. But it fluctuates as per reports and not raised to more than 4.5 at any time (attachment removed to protect patient identity). If absolute lymphocytes remain persistent high greater than 4.5, then CLL can be ruled out by flow cytometry investigation. You can consult a hematologist for your detailed physical examination.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I currently have pericoronitis and it has developed over these past two days. The main symptom I noticed was pain and discomfort in my lower right wisdom tooth. The tooth is half in and half out. I scheduled an appointment with my oral surgeon but would like some advice. I noticed yesterday that the lymph node almost behind my jaw on the side of the infected tooth was swollen and painful to touch. Then today, I noticed the lymph node under my chin was extremely large and painful to touch as well. It was not like that yesterday. Because of that, I went into an urgent care and he prescribed me Penicillin and painkillers. I have only taken one Penicillin pill over these past few hours. I started to do more research on the topic and came across multiple reputable websites stating that if you have swollen lymph nodes with pericoronitis to go to the hospital. I am wondering if I need to go this evening or if I can wait until the morning and discuss it with my oral surgeon. ### Response: Hi, Welcome to Chat Doctor forum. Pericoronitis itself is usually painful mainly because of food entrapment between the gums and the half-erupted tooth along with inflammation there. The swollen and painful lymph nodes are nothing but indications of persistent infection. It does not mean that you have to rush to the hospital in this case. Once the infected tooth is pulled out and the gums heal normally, the lymph nodes get back to normal. The only case when you should be much concerned is that big swelling of the cheek which is visible on the face. You had mentioned that you had tablet Penicillin and painkillers. This is alright, it helps the infection go down a little bit while you wait for your appointment. But ideally, active dental treatment along with antibiotic coverage would be most helpful. You could as well continue Penicillin for at least five days three times daily and painkillers whenever you have pain. You can absolutely wait until your appointment for the scheduled extraction. For more information consult a dentist online

Hi doctor,I currently have pericoronitis and it has developed over these past two days. The main symptom I noticed was pain and discomfort in my lower right wisdom tooth. The tooth is half in and half out. I scheduled an appointment with my oral surgeon but would like some advice. I noticed yesterday that the lymph node almost behind my jaw on the side of the infected tooth was swollen and painful to touch. Then today, I noticed the lymph node under my chin was extremely large and painful to touch as well. It was not like that yesterday. Because of that, I went into an urgent care and he prescribed me Penicillin and painkillers. I have only taken one Penicillin pill over these past few hours. I started to do more research on the topic and came across multiple reputable websites stating that if you have swollen lymph nodes with pericoronitis to go to the hospital. I am wondering if I need to go this evening or if I can wait until the morning and discuss it with my oral surgeon.

Hi, Welcome to Chat Doctor forum. Pericoronitis itself is usually painful mainly because of food entrapment between the gums and the half-erupted tooth along with inflammation there. The swollen and painful lymph nodes are nothing but indications of persistent infection. It does not mean that you have to rush to the hospital in this case. Once the infected tooth is pulled out and the gums heal normally, the lymph nodes get back to normal. The only case when you should be much concerned is that big swelling of the cheek which is visible on the face. You had mentioned that you had tablet Penicillin and painkillers. This is alright, it helps the infection go down a little bit while you wait for your appointment. But ideally, active dental treatment along with antibiotic coverage would be most helpful. You could as well continue Penicillin for at least five days three times daily and painkillers whenever you have pain. You can absolutely wait until your appointment for the scheduled extraction. For more information consult a dentist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I would like to know the results of my brain MRI. I do not know what this bright spot near the vestibular nerve is? Can it be vestibular schwannoma? Or something else in some cranial nerves or near the brain stem. In the second picture that is highlighted what can this white cluster shaped thing be?I have got a few symptoms. For the past three months, I have had tingling and needle sensation starting from the right eyebrow then radiating towards the left side and the entire forehead and right eyelid and sometimes even towards the tip of the nose. The sensation never stops no matter what I do. I feel dizzy all the time like if I am on a boat. When I tilt my head and move it gets even worse and starts spinning. I have a hard time looking at an object and cannot focus. My left eye is getting blood red whenever I look at a screen. My doctor prescribed Cortisone tablets that did not help. My left ear feels clogged and my hearing on that ear is reduced too.I also have tinnitus lately on the same ear. Doctors at first thought it was due to B12 or Iron deficiency but both are at normal range. My blood pressure is normal too. Lately, I have this numbness and tingling sensations om my feet and fingers too and whenever I visit the toilet when I check the stool is yellowish color and floats on the water and no solid shape. The full blood tests show absolutely normal for liver, pancreas and bile. Blood sugar levels are also normal. ### Response: Hi, Welcome to Chat Doctor forum. I have seen the reports. (attachment removed to protect patient identity). The white area in the circle is likely minimal fluid and mastoid effusion in the left mastoid temporal bone, in the inferior air cells area. It can be due to a mild left middle ear infection. Your symptoms of feeling dizzy and spinning and left ear problems can be explained by the finding. There are less changes of vestibular schwannoma in the area. There are no other lesions in the brain.

Hello doctor,I would like to know the results of my brain MRI. I do not know what this bright spot near the vestibular nerve is? Can it be vestibular schwannoma? Or something else in some cranial nerves or near the brain stem. In the second picture that is highlighted what can this white cluster shaped thing be?I have got a few symptoms. For the past three months, I have had tingling and needle sensation starting from the right eyebrow then radiating towards the left side and the entire forehead and right eyelid and sometimes even towards the tip of the nose. The sensation never stops no matter what I do. I feel dizzy all the time like if I am on a boat. When I tilt my head and move it gets even worse and starts spinning. I have a hard time looking at an object and cannot focus. My left eye is getting blood red whenever I look at a screen. My doctor prescribed Cortisone tablets that did not help. My left ear feels clogged and my hearing on that ear is reduced too.I also have tinnitus lately on the same ear. Doctors at first thought it was due to B12 or Iron deficiency but both are at normal range. My blood pressure is normal too. Lately, I have this numbness and tingling sensations om my feet and fingers too and whenever I visit the toilet when I check the stool is yellowish color and floats on the water and no solid shape. The full blood tests show absolutely normal for liver, pancreas and bile. Blood sugar levels are also normal.

Hi, Welcome to Chat Doctor forum. I have seen the reports. (attachment removed to protect patient identity). The white area in the circle is likely minimal fluid and mastoid effusion in the left mastoid temporal bone, in the inferior air cells area. It can be due to a mild left middle ear infection. Your symptoms of feeling dizzy and spinning and left ear problems can be explained by the finding. There are less changes of vestibular schwannoma in the area. There are no other lesions in the brain.