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### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 70 year old male. I just moved to a new area and found a new ophthalmologist, and he said my optic disc was smaller than normal, and he recommended a visual field test, to get a baseline, should it be needed for the future. I called my ophthalmologist for the previous two decades, and he said he never bothered to look at my optic disc. From what I can find on the internet, a field vision test is used to check the progression of glaucoma, among other things, but not to diagnose it. My new ophthalmologist gave a diagnosis of low tension glaucoma, stage unspecified. He did not start treating me for it. When I questioned the diagnosis, he explained that the visual field test is the only way to diagnose it. I hate testing for the sake of testing. I am finding some articles on the internet that support the idea that a field vision test can be overused and a waste of time for a variety of reasons, including the management of glaucoma. My peripheral vision, as best I can tell is fine. I can certainly look straight ahead, cover one eye and see an object at 90 degrees. The doctor did no vision testing in his office. He only saw what he thought was a smaller than normal optic disc. He admitted this could be perfectly normal for me. My manual and online computer tests show no loss of peripheral vision. Do I really need this test? ### Response: Hello, Welcome to Chat Doctor forum. The spectrum of the disc and the cup size is hugely variable in people. The size of the optic disc is not the only determining factor. The size of the cup, average rim size and pattern, nerve fiber pattern, and intraocular pressure, are together taken into consideration before conclusively making a diagnosis of glaucoma.

Hello doctor,I am a 70 year old male. I just moved to a new area and found a new ophthalmologist, and he said my optic disc was smaller than normal, and he recommended a visual field test, to get a baseline, should it be needed for the future. I called my ophthalmologist for the previous two decades, and he said he never bothered to look at my optic disc. From what I can find on the internet, a field vision test is used to check the progression of glaucoma, among other things, but not to diagnose it. My new ophthalmologist gave a diagnosis of low tension glaucoma, stage unspecified. He did not start treating me for it. When I questioned the diagnosis, he explained that the visual field test is the only way to diagnose it. I hate testing for the sake of testing. I am finding some articles on the internet that support the idea that a field vision test can be overused and a waste of time for a variety of reasons, including the management of glaucoma. My peripheral vision, as best I can tell is fine. I can certainly look straight ahead, cover one eye and see an object at 90 degrees. The doctor did no vision testing in his office. He only saw what he thought was a smaller than normal optic disc. He admitted this could be perfectly normal for me. My manual and online computer tests show no loss of peripheral vision. Do I really need this test?

Hello, Welcome to Chat Doctor forum. The spectrum of the disc and the cup size is hugely variable in people. The size of the optic disc is not the only determining factor. The size of the cup, average rim size and pattern, nerve fiber pattern, and intraocular pressure, are together taken into consideration before conclusively making a diagnosis of glaucoma.

### Instruction: Answer this question truthfully ###Input: Hello doctor, I am 18 years old. Today I finally got the courage to talk to my doctor about the stress obsessive thoughts, and the physical harm it does to me. I got an appointment with a psychologist. She diagnosed me with anxiety, panic disorder, and being severe hyperemotional. The doctor did not want me to go to a psychiatrist because he might give me medication that would be addictive, and affect my learning skills. I have exams very soon, so they try to help me in some other ways, but I tried these before without any good. What should I do? I cannot deal with the obsessive feelings, crying, trembling all the time, digestive problems, and everything that comes with these disorders every day. ### Response: Hello, Welcome to ChatDoctor. First of all, I am so sorry to hear about your problem. I can imagine how hard it is for you, especially when you have so much to deal with. Although therapy is essential in treating anxiety, medications are a must to control the physical symptoms. You have not mentioned when your exams are, what you can do is mention this to your doctor so they will give you non-sedative medicines. So you will not feel very sleepy, but these medications will definitely help you perform better, and help you to cope up. About therapy, I would recommend you should continue, and if you do not find the local therapist effective, we can start it online via video consultation. Lastly, please always remember, nothing is more important than your health. Do not ever judge your worth based on your exam scores, you already have so much going on, just do as much you can and do not burnout yourself. On your own, try box breathing, progressive muscle relaxation and start maintaining a journal. It will help you out. Take care.

Hello doctor, I am 18 years old. Today I finally got the courage to talk to my doctor about the stress obsessive thoughts, and the physical harm it does to me. I got an appointment with a psychologist. She diagnosed me with anxiety, panic disorder, and being severe hyperemotional. The doctor did not want me to go to a psychiatrist because he might give me medication that would be addictive, and affect my learning skills. I have exams very soon, so they try to help me in some other ways, but I tried these before without any good. What should I do? I cannot deal with the obsessive feelings, crying, trembling all the time, digestive problems, and everything that comes with these disorders every day.

Hello, Welcome to ChatDoctor. First of all, I am so sorry to hear about your problem. I can imagine how hard it is for you, especially when you have so much to deal with. Although therapy is essential in treating anxiety, medications are a must to control the physical symptoms. You have not mentioned when your exams are, what you can do is mention this to your doctor so they will give you non-sedative medicines. So you will not feel very sleepy, but these medications will definitely help you perform better, and help you to cope up. About therapy, I would recommend you should continue, and if you do not find the local therapist effective, we can start it online via video consultation. Lastly, please always remember, nothing is more important than your health. Do not ever judge your worth based on your exam scores, you already have so much going on, just do as much you can and do not burnout yourself. On your own, try box breathing, progressive muscle relaxation and start maintaining a journal. It will help you out. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have episodes of bad sinuses every year. Last year, I had hay fever with an extreme blocked nose. I went to my GP, and he gave me sinus injection. I got better after treating it. The doctor prescribed Allerway 5, and Spersallerg eye drops for me. This year, my condition seems to be poor. My sinus has become bad. I use endless nasal sprays and allergy tablets. But there is no relief. I went to GP again, and he gave me an injection. This time, injection has not helped me.I have ear pain, head pain, clogged nose, with itchy eyes and itchy throat. When I lie down to sleep, the pain gets worse, and I have throbbing pain in the head. I have nonstop sneezing for 30 minutes in the mornings. I have also taken two courses of antibiotics. But there is no relief. In the mornings, when I sneeze, the mucous seems to be yellow with some blood present in it. Later, the mucus becomes clear again. I cannot sleep at night because of the throbbing head pain. I will try to change directions, and I will add more pillows to sleep. But nothing has helped me. ### Response: Hi. You are suffering from an acute attack of bacterial infection along with allergic rhinitis. You can take the following medications. Use Avamyse nasal spray (Fluticasone furoate nasal spray) once daily for a month. Take Claritin (Loratadine) tablet once daily during the winter season. Take tablet Targo 750 (Levofloxacin) once daily for ten days. Try to do self-nasal saline or water wash. The last treatment for allergic rhinitis is immunotherapy. You can redo CT scan for the nose and sinus after finishing Avamsye.

Hi doctor,I have episodes of bad sinuses every year. Last year, I had hay fever with an extreme blocked nose. I went to my GP, and he gave me sinus injection. I got better after treating it. The doctor prescribed Allerway 5, and Spersallerg eye drops for me. This year, my condition seems to be poor. My sinus has become bad. I use endless nasal sprays and allergy tablets. But there is no relief. I went to GP again, and he gave me an injection. This time, injection has not helped me.I have ear pain, head pain, clogged nose, with itchy eyes and itchy throat. When I lie down to sleep, the pain gets worse, and I have throbbing pain in the head. I have nonstop sneezing for 30 minutes in the mornings. I have also taken two courses of antibiotics. But there is no relief. In the mornings, when I sneeze, the mucous seems to be yellow with some blood present in it. Later, the mucus becomes clear again. I cannot sleep at night because of the throbbing head pain. I will try to change directions, and I will add more pillows to sleep. But nothing has helped me.

Hi. You are suffering from an acute attack of bacterial infection along with allergic rhinitis. You can take the following medications. Use Avamyse nasal spray (Fluticasone furoate nasal spray) once daily for a month. Take Claritin (Loratadine) tablet once daily during the winter season. Take tablet Targo 750 (Levofloxacin) once daily for ten days. Try to do self-nasal saline or water wash. The last treatment for allergic rhinitis is immunotherapy. You can redo CT scan for the nose and sinus after finishing Avamsye.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have been to four urologists and none of them know what is wrong with me. Hopefully, you will have some information I do not already possess.I have a lot of discomfort with the penile shaft. It feels like there as knots and stiffness in the shaft muscle. When running or any kind of exercise, it gets stiff and it is very uncomfortable. I am not sure if there is not enough circulation. The testicles are also red and the skin gets stiff as well. I have done blood tests, ultrasound, and the only diagnosis has been internal shaft bruising, from a urologist taking a guess. Years ago, I tried enhancement pills. That might have triggered the side effects. That is why he said nothing can be done. One urologist ruled out an infection. He said, however, these side effects are very strange and seem uncommon. One also laughed at me and said I do not know how to help you. I cannot wear gym clothes. This has made me very depressed over time. I need to find a solution to fix this issue. Please, please help me. If you are unsure please consult a colleague. ### Response: Hello, Welcome to Chat Doctor forum. I agree that your symptoms are very vague. As per your history, I can conclude either This can be possible due to one of the side effects of enhancement pills. In some cases like in yours, enhancement pills are known to cause changes in the penis like skin stiffness. Anyhow, you also need to rule out Peyronie\\s disease with an ultrasound penis. If not Peyronie\\s then it is due to side effects of enhancement pills. Oral ChatDoctor. But after confirmation of diagnosis, I will prefer a physical form of therapy like massage or traction. For more information consult a urologist online

Hello doctor,I have been to four urologists and none of them know what is wrong with me. Hopefully, you will have some information I do not already possess.I have a lot of discomfort with the penile shaft. It feels like there as knots and stiffness in the shaft muscle. When running or any kind of exercise, it gets stiff and it is very uncomfortable. I am not sure if there is not enough circulation. The testicles are also red and the skin gets stiff as well. I have done blood tests, ultrasound, and the only diagnosis has been internal shaft bruising, from a urologist taking a guess. Years ago, I tried enhancement pills. That might have triggered the side effects. That is why he said nothing can be done. One urologist ruled out an infection. He said, however, these side effects are very strange and seem uncommon. One also laughed at me and said I do not know how to help you. I cannot wear gym clothes. This has made me very depressed over time. I need to find a solution to fix this issue. Please, please help me. If you are unsure please consult a colleague.

Hello, Welcome to Chat Doctor forum. I agree that your symptoms are very vague. As per your history, I can conclude either This can be possible due to one of the side effects of enhancement pills. In some cases like in yours, enhancement pills are known to cause changes in the penis like skin stiffness. Anyhow, you also need to rule out Peyronie\\s disease with an ultrasound penis. If not Peyronie\\s then it is due to side effects of enhancement pills. Oral ChatDoctor. But after confirmation of diagnosis, I will prefer a physical form of therapy like massage or traction. For more information consult a urologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My wife is 47 years old. Suddenly in sleep, she felt palpitations two to three days back and we went to the hospital and found ECG normal. Echo test is normal, Trop I test is normal but TMT is positive. The doctor advised to go for angiography but another doctor says that before angiography we should go for stress echo test. Please advise what has to be done first. ### Response: Hello. Firstly, let me know if she has any risk factors like hypertension, diabetes, deranged lipid profile or family history of heart disease. Usually, what we do, since angiography is an invasive test, we make sure that the patient needs it or not. So initially, subjects the patients to minor tests like TMT (treadmill test) or stress echo or stress thallium. If either of the tests is abnormal then it is better to subject to the patient to angiography. Now, in our case, since her TMT is positive, it is better to subject her for angiography. There is no harm in having stress echo, but suppose it is positive then certainly she will need angiography. But if it is negative then we can again land up in a dilemma of which test to be relied upon. Then she will need some more tests like stress or CT coronary angiography to prove TMT was negative. So it is better to get an angiography done and clear all our doubts. There is sufficient evidence of abnormalities and angiography is a gold standard test. Also, discuss how strongly was TMT positive. If it is strongly positive then nothing to think and go ahead with angiography and if it is mild positive then you may think of stress echo. So overall, it is better to undergo angiography and no harm in stress echo if your doctor insists. For more information consult a cardiologist online Take care.

Hello doctor,My wife is 47 years old. Suddenly in sleep, she felt palpitations two to three days back and we went to the hospital and found ECG normal. Echo test is normal, Trop I test is normal but TMT is positive. The doctor advised to go for angiography but another doctor says that before angiography we should go for stress echo test. Please advise what has to be done first.

Hello. Firstly, let me know if she has any risk factors like hypertension, diabetes, deranged lipid profile or family history of heart disease. Usually, what we do, since angiography is an invasive test, we make sure that the patient needs it or not. So initially, subjects the patients to minor tests like TMT (treadmill test) or stress echo or stress thallium. If either of the tests is abnormal then it is better to subject to the patient to angiography. Now, in our case, since her TMT is positive, it is better to subject her for angiography. There is no harm in having stress echo, but suppose it is positive then certainly she will need angiography. But if it is negative then we can again land up in a dilemma of which test to be relied upon. Then she will need some more tests like stress or CT coronary angiography to prove TMT was negative. So it is better to get an angiography done and clear all our doubts. There is sufficient evidence of abnormalities and angiography is a gold standard test. Also, discuss how strongly was TMT positive. If it is strongly positive then nothing to think and go ahead with angiography and if it is mild positive then you may think of stress echo. So overall, it is better to undergo angiography and no harm in stress echo if your doctor insists. For more information consult a cardiologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,Last night I started experiencing some tightness in my upper left chest area, just below my armpit. This extended up my left side through my throat, cheek and up to the top of my head. This was persistent throughout the night. This morning I woke up and it was a little better but my face and throat area feel numb and the inside of my cheek and tongue feel swollen. This tightness is starting up again today though not as bad as last night and it is mostly in my throat. I also have tinnitus and when this tightness comes my tinnitus gets much worse. My left arm also goes numb and cold from time to time, particularly my pinkie and ring fingers.I have had a history of neck pain and I have had pain in my upper left chest and back area and my left arm numbness has been around for many years. It started after a weightlifting injury. I am wondering what this might be and if I should go to the hospital. ### Response: Hello, Welcome to Chat Doctor forum. This is most likely due to cervical pain, due to compression of nerves between spine. You should get X-ray cervical spine AP (anteroposterior or lateral view) and further may need MRI. You need to visit physiotherapist after X-ray and also an orthopedician. Till the time he can have tablet Neurobion Forte (Riboflavin, Pyridoxine, etc.) once a day which is a nerve vitamin. If this is not helpful, then you need to have tablet Pregabalin 75 mg bedtime, which is a nerve stabilizer. However, it is better to visit a hospital and get EKG done in order to rule out cardiac cause although appears to be less likely. You can also upload EKG here if you can get it done somewhere. For more information consult a cardiologist online

Hi doctor,Last night I started experiencing some tightness in my upper left chest area, just below my armpit. This extended up my left side through my throat, cheek and up to the top of my head. This was persistent throughout the night. This morning I woke up and it was a little better but my face and throat area feel numb and the inside of my cheek and tongue feel swollen. This tightness is starting up again today though not as bad as last night and it is mostly in my throat. I also have tinnitus and when this tightness comes my tinnitus gets much worse. My left arm also goes numb and cold from time to time, particularly my pinkie and ring fingers.I have had a history of neck pain and I have had pain in my upper left chest and back area and my left arm numbness has been around for many years. It started after a weightlifting injury. I am wondering what this might be and if I should go to the hospital.

Hello, Welcome to Chat Doctor forum. This is most likely due to cervical pain, due to compression of nerves between spine. You should get X-ray cervical spine AP (anteroposterior or lateral view) and further may need MRI. You need to visit physiotherapist after X-ray and also an orthopedician. Till the time he can have tablet Neurobion Forte (Riboflavin, Pyridoxine, etc.) once a day which is a nerve vitamin. If this is not helpful, then you need to have tablet Pregabalin 75 mg bedtime, which is a nerve stabilizer. However, it is better to visit a hospital and get EKG done in order to rule out cardiac cause although appears to be less likely. You can also upload EKG here if you can get it done somewhere. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 29-years-old male. I am 173 cm in height and weighs about 68 kg. I would like to know about testosterone injection if I took it in a small dosage weekly will that help my appearance to be more manly? Even that my appearance is manly but in general my physical built is small compared to other men, my face, hands, legs are small also my voice is feminine.My testosterone level is good. My body is too hairy and I did a testosterone test everything was normal. I know there is a lot of studies that say that testosterone can lead to depression but actually at the age of 21 I was suffering from depression and I took testosterone for a month (to gain muscles), my mood was very good and it actually helped my depression. Also, my sexual life and erection are very good, I do masturbate once or twice every two days and I get an erection easily.Kindly help me with these questions ### Response: Hi, Welcome to Chat Doctor forum. I have read and understood your problem. Testosterone injections have beneficial effects if only blood testosterone level is low. Otherwise, it may harm you in several ways. For a more manly look, the best solution is to do exercise. I have answered your question in the same order. Testosterone injections will not help to be manly unless your blood testosterone level is low. If the blood testosterone level is low, even then injections of HCG (human chorionic gonadotrophin) or oral Clomifene is a better choice. Mostly, testosterone injections are synthetic. It will not affect your personality if the blood level is normal. If the blood testosterone level is low then you may need longer treatment, but the effect is temporary. You may loose what you gained if you stop injections.

Hello doctor,I am 29-years-old male. I am 173 cm in height and weighs about 68 kg. I would like to know about testosterone injection if I took it in a small dosage weekly will that help my appearance to be more manly? Even that my appearance is manly but in general my physical built is small compared to other men, my face, hands, legs are small also my voice is feminine.My testosterone level is good. My body is too hairy and I did a testosterone test everything was normal. I know there is a lot of studies that say that testosterone can lead to depression but actually at the age of 21 I was suffering from depression and I took testosterone for a month (to gain muscles), my mood was very good and it actually helped my depression. Also, my sexual life and erection are very good, I do masturbate once or twice every two days and I get an erection easily.Kindly help me with these questions

Hi, Welcome to Chat Doctor forum. I have read and understood your problem. Testosterone injections have beneficial effects if only blood testosterone level is low. Otherwise, it may harm you in several ways. For a more manly look, the best solution is to do exercise. I have answered your question in the same order. Testosterone injections will not help to be manly unless your blood testosterone level is low. If the blood testosterone level is low, even then injections of HCG (human chorionic gonadotrophin) or oral Clomifene is a better choice. Mostly, testosterone injections are synthetic. It will not affect your personality if the blood level is normal. If the blood testosterone level is low then you may need longer treatment, but the effect is temporary. You may loose what you gained if you stop injections.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Earlier this year approximately five months ago, I was diagnosed with ulnar nerve entrapment at the right elbow. Sadly, I declined rapidly and lost all my hypotheaner and some of my lumbericals in a matter of six weeks. I was operated on exactly 14 weeks ago where I had a decompression of the ulnar nerve and an anterior interosseous nerve transfer to the motor component of the ulnar nerve so that the nerve axons would reach my hand quicker. I still have no improvement and I wanted to ask if it is possible to transfer muscle to fill in the hand? And will this protect my nerves in the hand? Would it be too soon to be considering this operation? ### Response: Hi, Welcome to Chat Doctor forum. Your query is genuine and I am extremely sorry to learn about your problems. To answer, let me explain to you how a nerve grows. It takes one month of latency and later nerve grows at 1 mm per day. Even though the nerve might reach your muscle, for bulk to improve, it takes another few months. For one to determine if the nerve signals have improved, you can get an electromyography to see for any improvement. Decompression will improve sensation very fast and then power. But for muscle bulk, it usually takes a while for muscle transfer to be suitable. In case, you have any form of weakness and never to fill up a cosmetic defect such as hypothenar flatness, for that one can consider fat grafting. If the bulk does not improve after six months. I would advise you to wait as it usually takes longer than 14 weeks. If you want to see and have proof of progress go for EMG. No muscle transfer as per my advise for now if you are not having any weakness. For more information consult a plastic surgeon online

Hello doctor,Earlier this year approximately five months ago, I was diagnosed with ulnar nerve entrapment at the right elbow. Sadly, I declined rapidly and lost all my hypotheaner and some of my lumbericals in a matter of six weeks. I was operated on exactly 14 weeks ago where I had a decompression of the ulnar nerve and an anterior interosseous nerve transfer to the motor component of the ulnar nerve so that the nerve axons would reach my hand quicker. I still have no improvement and I wanted to ask if it is possible to transfer muscle to fill in the hand? And will this protect my nerves in the hand? Would it be too soon to be considering this operation?

Hi, Welcome to Chat Doctor forum. Your query is genuine and I am extremely sorry to learn about your problems. To answer, let me explain to you how a nerve grows. It takes one month of latency and later nerve grows at 1 mm per day. Even though the nerve might reach your muscle, for bulk to improve, it takes another few months. For one to determine if the nerve signals have improved, you can get an electromyography to see for any improvement. Decompression will improve sensation very fast and then power. But for muscle bulk, it usually takes a while for muscle transfer to be suitable. In case, you have any form of weakness and never to fill up a cosmetic defect such as hypothenar flatness, for that one can consider fat grafting. If the bulk does not improve after six months. I would advise you to wait as it usually takes longer than 14 weeks. If you want to see and have proof of progress go for EMG. No muscle transfer as per my advise for now if you are not having any weakness. For more information consult a plastic surgeon online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I got married six months ago. My husband behaves weirdly in the bedroom. And he is using psychiatric medicine. Those are Limbitrol, Flutop 60, Prolol TR 40, Ventab plus from three months and Sildenafil too, but it is not effective.He keeps locking himself, avoids me, washing things repeatedly, repeats things and is scared when I am beside him. He is saying he does not feel like having sex with me. He says he is not getting erections. I asked him to take a semen test as well. The sperm count is 18 million and actively motile 5 % and asthenospermia. Could you please suggest whether he is marriage material or not. My in-laws blame me for not conceiving. ### Response: Hello, Welcome to Chat Doctor forum. Your husband is suffering from some psychiatric illness most probably an affective disorder. Semen analysis report (attachment removed to protect patient identity) is suggestive of asthenospermia, that is, low sperm motility. But all these problems including erectile dysfunction if present can be treated and several treatment options are available. First of all make sure he is taking treatment from a psychiatrist and not from a non-specialist, that is, a general practitioner. Support him and say you are with him and motivate him to share his problems with you. Open communication is the key for a healthy relationship. Not having a baby is not necessarily your fault, asthenospermia is one reason, and also to have a baby proper sexual relationship should be there. To conclude, I would say that every problem has a solution. You just need to try solving it. Help is just a step away. Feel free to ask if you have any further queries. For more information consult a psychiatrist online

Hello doctor,I got married six months ago. My husband behaves weirdly in the bedroom. And he is using psychiatric medicine. Those are Limbitrol, Flutop 60, Prolol TR 40, Ventab plus from three months and Sildenafil too, but it is not effective.He keeps locking himself, avoids me, washing things repeatedly, repeats things and is scared when I am beside him. He is saying he does not feel like having sex with me. He says he is not getting erections. I asked him to take a semen test as well. The sperm count is 18 million and actively motile 5 % and asthenospermia. Could you please suggest whether he is marriage material or not. My in-laws blame me for not conceiving.

Hello, Welcome to Chat Doctor forum. Your husband is suffering from some psychiatric illness most probably an affective disorder. Semen analysis report (attachment removed to protect patient identity) is suggestive of asthenospermia, that is, low sperm motility. But all these problems including erectile dysfunction if present can be treated and several treatment options are available. First of all make sure he is taking treatment from a psychiatrist and not from a non-specialist, that is, a general practitioner. Support him and say you are with him and motivate him to share his problems with you. Open communication is the key for a healthy relationship. Not having a baby is not necessarily your fault, asthenospermia is one reason, and also to have a baby proper sexual relationship should be there. To conclude, I would say that every problem has a solution. You just need to try solving it. Help is just a step away. Feel free to ask if you have any further queries. For more information consult a psychiatrist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My father is out of coma and on regular physiotherapy. However, we have a major concern now with frequent drop in his sodium level. Every five to six days his sodium level drops to 110-120. When that happens, his consciousness level goes down and stops body movement or response. He is given injection Sodium chloride 3% isotonic solution with Fludrocortisone one tablet per day. It takes about five to six days for his sodium level to improve around 130. When he starts responding, he opens his eyes and moves body parts. We have seen this three to four times since last one and a half months. Eight days back, his sodium level went down to 109 and currently it is 121, but he has not shown much of body movement yet. Normally, he recovers within five to six days. Please suggest what has to be done for faster recovery? What has to be done to prevent this happening again and again? I have listed the medicines he is taking currently. Initially Tolvaptan is given for 10 days (currently stopped). Fludrocortisone 10 g extra salt per day with liquid food, tablet Ofloxacin 200 mg, capsule or tablet Phenytoin sodium 100 mg, tablet vitamin B complex, tablet Losartan potassium 50 mg, tablet Metoprolol 50 mg and tablet Pantoprazole 40 mg. ### Response: Hi, Welcome to Chat Doctor forum. I am sorry to note that he is having problems with sodium levels. I suggest the following. 1. Serum specific gravity.2. Urine specific gravity.3. Serum and urine osmolality. Revert back after the investigations to a general medicine physician online.-

Hello doctor,My father is out of coma and on regular physiotherapy. However, we have a major concern now with frequent drop in his sodium level. Every five to six days his sodium level drops to 110-120. When that happens, his consciousness level goes down and stops body movement or response. He is given injection Sodium chloride 3% isotonic solution with Fludrocortisone one tablet per day. It takes about five to six days for his sodium level to improve around 130. When he starts responding, he opens his eyes and moves body parts. We have seen this three to four times since last one and a half months. Eight days back, his sodium level went down to 109 and currently it is 121, but he has not shown much of body movement yet. Normally, he recovers within five to six days. Please suggest what has to be done for faster recovery? What has to be done to prevent this happening again and again? I have listed the medicines he is taking currently. Initially Tolvaptan is given for 10 days (currently stopped). Fludrocortisone 10 g extra salt per day with liquid food, tablet Ofloxacin 200 mg, capsule or tablet Phenytoin sodium 100 mg, tablet vitamin B complex, tablet Losartan potassium 50 mg, tablet Metoprolol 50 mg and tablet Pantoprazole 40 mg.

Hi, Welcome to Chat Doctor forum. I am sorry to note that he is having problems with sodium levels. I suggest the following. 1. Serum specific gravity.2. Urine specific gravity.3. Serum and urine osmolality. Revert back after the investigations to a general medicine physician online.-

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am experiencing lower back pain, and it hurts whenever I stand up. I am also suffering from abdominal pain. I do not know if my period is the one that caused it. ### Response: Hello, Welcome to Chat Doctor forum. Sometimes these symptoms can be due to periods in young females, so your gynecologist should be able to give you an insight into this. As far as lower back pain is concerned, if it has been present for a long time even in the absence of your periods time, then it could be due to a spinal issue. If you have localized back pain with no other symptoms like radiating leg pain, neurological symptoms like numbness, weakness, paresthesias, etc., then you can start with following recommendations for an initial period of two to three weeks. 1. To maintain a proper posture of your back while working and sleeping. 2. If pain is more, then you can take a short course of anti-inflammatory medication like tab Ibuprofen or Paracetamol or one which suits you. 3. Physical therapy initially under the supervision of a trained physiotherapist and then to continue at home. 4. Adequate calcium and vitamin d intake if levels are low in the body. 5. Ice packs can be applied if your pain is acute, then hot fomentation can be done at home. 6. Analgesic spray for a local application can be used and is readily available. 7. Avoid lifting heavyweight and acute forward bending in mornings etc. We will observe you for the next two to three weeks how you respond to this conservative management protocol. If you are not feeling better, then we will have to get some investigations like, dynamic x-rays of lower back and few blood tests for evaluation. Do not hesitate to contact me if you need any further assistance.

Hello doctor,I am experiencing lower back pain, and it hurts whenever I stand up. I am also suffering from abdominal pain. I do not know if my period is the one that caused it.

Hello, Welcome to Chat Doctor forum. Sometimes these symptoms can be due to periods in young females, so your gynecologist should be able to give you an insight into this. As far as lower back pain is concerned, if it has been present for a long time even in the absence of your periods time, then it could be due to a spinal issue. If you have localized back pain with no other symptoms like radiating leg pain, neurological symptoms like numbness, weakness, paresthesias, etc., then you can start with following recommendations for an initial period of two to three weeks. 1. To maintain a proper posture of your back while working and sleeping. 2. If pain is more, then you can take a short course of anti-inflammatory medication like tab Ibuprofen or Paracetamol or one which suits you. 3. Physical therapy initially under the supervision of a trained physiotherapist and then to continue at home. 4. Adequate calcium and vitamin d intake if levels are low in the body. 5. Ice packs can be applied if your pain is acute, then hot fomentation can be done at home. 6. Analgesic spray for a local application can be used and is readily available. 7. Avoid lifting heavyweight and acute forward bending in mornings etc. We will observe you for the next two to three weeks how you respond to this conservative management protocol. If you are not feeling better, then we will have to get some investigations like, dynamic x-rays of lower back and few blood tests for evaluation. Do not hesitate to contact me if you need any further assistance.

### Instruction: Answer this question truthfully ###Input: Hi doctor,What is Rhesus? My wife is pregnant and started clinic today. ### Response: Hi, Welcome to Chat Doctor forum. At first visit, the pregnant lady\\s blood group needs to be checked. There are many blood groups like A, B, O, AB and another thing which we need to know is rhesus positive or rhesus negative. So on the basis of rhesus, it is A+, A-, B+, B-, O+, O-, AB+, AB -. So, every blood group have rhesus classification like rhesus positive and rhesus negative. A positive and a negative. Rhesus has to be known as there is one issue of rhesus incompatibility. If both mother and father of the child are rhesus positive or both rhesus negative, then no issue. But, if mother is rhesus negative and father is rhesus positive and developing baby is rhesus positive, then mother can develop antibodies against fetal blood that can cause lysis of blood cells most likely in next pregnancy which can lead to anemic baby. Rh negative mothers with Rh positive husbands need anti-D injections. They need to have twice at 28 and 32 weeks of gestation without any cause but in case of bleeding during pregnancy also need injection, after birth also. Check your blood group as well if wife is rhesus negative. She should have regular antenatal visits and in case of bleeding or pain report to gynecology emergency. If wife is Rh negative, have blood grouping of husband. Regular antenatal check-ups in maternal medicine unit if Rh negative and some other complications are related to it. Anti-D injections at 28 and 32 weeks. Balanced diet, weight, and BMI, folic acid. Regular antenatal check-ups. Report in case of any bleeding.

Hi doctor,What is Rhesus? My wife is pregnant and started clinic today.

Hi, Welcome to Chat Doctor forum. At first visit, the pregnant lady\\s blood group needs to be checked. There are many blood groups like A, B, O, AB and another thing which we need to know is rhesus positive or rhesus negative. So on the basis of rhesus, it is A+, A-, B+, B-, O+, O-, AB+, AB -. So, every blood group have rhesus classification like rhesus positive and rhesus negative. A positive and a negative. Rhesus has to be known as there is one issue of rhesus incompatibility. If both mother and father of the child are rhesus positive or both rhesus negative, then no issue. But, if mother is rhesus negative and father is rhesus positive and developing baby is rhesus positive, then mother can develop antibodies against fetal blood that can cause lysis of blood cells most likely in next pregnancy which can lead to anemic baby. Rh negative mothers with Rh positive husbands need anti-D injections. They need to have twice at 28 and 32 weeks of gestation without any cause but in case of bleeding during pregnancy also need injection, after birth also. Check your blood group as well if wife is rhesus negative. She should have regular antenatal visits and in case of bleeding or pain report to gynecology emergency. If wife is Rh negative, have blood grouping of husband. Regular antenatal check-ups in maternal medicine unit if Rh negative and some other complications are related to it. Anti-D injections at 28 and 32 weeks. Balanced diet, weight, and BMI, folic acid. Regular antenatal check-ups. Report in case of any bleeding.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have been suffering from anxiety for the last 10 years. I was able to live a normal life and working happily. I was on Nexitoplus (do not know if I had depression). Two months back because of family problems (father health issue), financial stress, work pressure, and continuous thoughts. The panic attack was on Nexito 20 and Etizola but with no greater relief. After that, our family doctor changed to Nexito forte. Now I am feeling physically well. Looking for motivation to get on with life and go to the job. Prior to use of Nexito forte, I was not able to concentrate. I was feeling less interested. Can you suggest how long should these medications be used? Also, how can I be mentally strong? ### Response: Hi, Welcome to Chat Doctor forum. It is quite common for anxiety to get elevated when faced with stressful situations in life. The good thing is with appropriate support your anxiety will come down eventually and you can function normally. Nexito (Escitalopram) is a good medication for your condition. It is positive that you are feeling better now. I see that you are prescribed Nexito Forte (which contains Clonazepam in addition to Escitalopram). I will recommend discussing with your family doctor and switch from Nexito Forte to Nexito (Clonazepam is not recommended for long-term use). Nexito 10 mg once daily can be continued at least for a year after your anxiety comes down and you are feeling better. Then it can be gradually cut down. I will recommend having some psychological therapy or counseling to deal with factors contributing to your anxiety and help manage family problems and stress at work. Exercise regularly, try yoga or meditation whichever you find comfortable. Cut down on ChatDoctor.

Hello doctor,I have been suffering from anxiety for the last 10 years. I was able to live a normal life and working happily. I was on Nexitoplus (do not know if I had depression). Two months back because of family problems (father health issue), financial stress, work pressure, and continuous thoughts. The panic attack was on Nexito 20 and Etizola but with no greater relief. After that, our family doctor changed to Nexito forte. Now I am feeling physically well. Looking for motivation to get on with life and go to the job. Prior to use of Nexito forte, I was not able to concentrate. I was feeling less interested. Can you suggest how long should these medications be used? Also, how can I be mentally strong?

Hi, Welcome to Chat Doctor forum. It is quite common for anxiety to get elevated when faced with stressful situations in life. The good thing is with appropriate support your anxiety will come down eventually and you can function normally. Nexito (Escitalopram) is a good medication for your condition. It is positive that you are feeling better now. I see that you are prescribed Nexito Forte (which contains Clonazepam in addition to Escitalopram). I will recommend discussing with your family doctor and switch from Nexito Forte to Nexito (Clonazepam is not recommended for long-term use). Nexito 10 mg once daily can be continued at least for a year after your anxiety comes down and you are feeling better. Then it can be gradually cut down. I will recommend having some psychological therapy or counseling to deal with factors contributing to your anxiety and help manage family problems and stress at work. Exercise regularly, try yoga or meditation whichever you find comfortable. Cut down on ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,After two weeks of LMP, I had mild cramps and non-stop light vaginal bleeding, it lasted for three days. I experienced non-stop light vaginal bleeding, once again after this month periods. This morning, I started to have light bleeding again. Given my concerns, I had bloodwork this week; my blood counts are normal; my thyroid, hormones and pituitary gland levels are all normal; and I am not on birth control. However, my urinalysis revealed that my erythrocyte is 25, my leukocyte esterase is 0.3 mg/L, and my eGFR is 88. Plus, my ferritin is 10.Initially, my doctor believed my abnormal bleeding between my periods was due to a hormone imbalance but we now know that it is obviously not the case. Can this be due to gynecological cancers? I am only 32, I am healthy, I am not on birth control, I am not pregnant, I am not on hormones, and the possibility of having cancer makes no sense to me. I would appreciate talking to someone because I am terrified. ### Response: Hi, Welcome to Chat Doctor forum. Overall looks like normal. There is no ultrasound scan which is required if you having irregular bleeding. Secondly there are 100s of hormones producing and out of which we can do tests of few only. So cannot say by 100 % that it is not hormonal issue. Irregular menses can be due to other reasons also like starvation, environmental factors, stress, eating habit. There are some food nutrients which may have effects like hormones or may acts against hormones. Do one ultrasound scan. And may require dilatation and curattage and send endometrium to rule out endometrial cancer. Do ChatDoctor.

Hello doctor,After two weeks of LMP, I had mild cramps and non-stop light vaginal bleeding, it lasted for three days. I experienced non-stop light vaginal bleeding, once again after this month periods. This morning, I started to have light bleeding again. Given my concerns, I had bloodwork this week; my blood counts are normal; my thyroid, hormones and pituitary gland levels are all normal; and I am not on birth control. However, my urinalysis revealed that my erythrocyte is 25, my leukocyte esterase is 0.3 mg/L, and my eGFR is 88. Plus, my ferritin is 10.Initially, my doctor believed my abnormal bleeding between my periods was due to a hormone imbalance but we now know that it is obviously not the case. Can this be due to gynecological cancers? I am only 32, I am healthy, I am not on birth control, I am not pregnant, I am not on hormones, and the possibility of having cancer makes no sense to me. I would appreciate talking to someone because I am terrified.

Hi, Welcome to Chat Doctor forum. Overall looks like normal. There is no ultrasound scan which is required if you having irregular bleeding. Secondly there are 100s of hormones producing and out of which we can do tests of few only. So cannot say by 100 % that it is not hormonal issue. Irregular menses can be due to other reasons also like starvation, environmental factors, stress, eating habit. There are some food nutrients which may have effects like hormones or may acts against hormones. Do one ultrasound scan. And may require dilatation and curattage and send endometrium to rule out endometrial cancer. Do ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,We are planning for parenthood. My wife is 30 years old and was recently asked by the gynecologist to undergo rubella quantitative IgG antibodies test. The test report shows value as out of range having value as 14.60 IU/mL, and RDW as 15.2 %. What does these report signifies especially the rubella quantitative IgG antibodies, and does it impacts the pregnancy cycle? ### Response: Hi, Welcome to Chat Doctor forum. How are you doing? To understand better let me give you few facts about the test. Rubella is a virus, which can affect anybody and the usual clinical presentation may be just a cold or maybe slightly higher respiratory infections with or without rashes. Everyone is exposed to this throughout life, as it might have been the last common cold you got last time. Also the MMR (measles, mumps, and rubella) vaccine everyone gets in childhood. Rubella infects only once in life. Next, if anyone gets any infection due to any bacteria or virus, etc, they immediately develop IgM (immunoglobulin M), which is body\\s immediate response. Then after few days, this replaced by IgG, which only means that sometime in past you had the infection. So her result of IgG high means she had rubella sometime in the past 30 years, not recently. If you are still worried about the levels, just postpone pregnancy for next 2 to 3 months. Even if her IgM was high, she is advised to avoid pregnancy for next 2 to 3 months. By then her IgM values come down. So my advice would be to just forget about these unnecessary test, just go ahead and have a great pregnancy. For more information consult an obstetrician and gynaecologist online

Hello doctor,We are planning for parenthood. My wife is 30 years old and was recently asked by the gynecologist to undergo rubella quantitative IgG antibodies test. The test report shows value as out of range having value as 14.60 IU/mL, and RDW as 15.2 %. What does these report signifies especially the rubella quantitative IgG antibodies, and does it impacts the pregnancy cycle?

Hi, Welcome to Chat Doctor forum. How are you doing? To understand better let me give you few facts about the test. Rubella is a virus, which can affect anybody and the usual clinical presentation may be just a cold or maybe slightly higher respiratory infections with or without rashes. Everyone is exposed to this throughout life, as it might have been the last common cold you got last time. Also the MMR (measles, mumps, and rubella) vaccine everyone gets in childhood. Rubella infects only once in life. Next, if anyone gets any infection due to any bacteria or virus, etc, they immediately develop IgM (immunoglobulin M), which is body\\s immediate response. Then after few days, this replaced by IgG, which only means that sometime in past you had the infection. So her result of IgG high means she had rubella sometime in the past 30 years, not recently. If you are still worried about the levels, just postpone pregnancy for next 2 to 3 months. Even if her IgM was high, she is advised to avoid pregnancy for next 2 to 3 months. By then her IgM values come down. So my advice would be to just forget about these unnecessary test, just go ahead and have a great pregnancy. For more information consult an obstetrician and gynaecologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I want an explanation about my EEG report. I will try to explain my problems. After taking antibiotics, I had neurological reactions to them. They are memory loss, brain fog, and had concentration problems. Later on, we discovered that I have sensitivities to a lot of medications and chemical sensitivity. So I would like to explain the EEG report which was done during my reactions to antibiotics and brain problem. Can antibiotics slower the brain activity?My EEG report showed these results. My essential activity was appropriate. I had a relaxing and intermittent alpha rhythm with a frequency of 9 to 10 Hz and an amplitude of 30 V. There was alpha activity occurring intermittently from my parietal region to the temporal and central areas. The diffuser was the interpolated low-amplitude beta rhythm. My reaction to closing and opening the eyes was appropriate. A central and temporal had an intermittent rhythmic theta activity with a frequency of 6 Hz. Temporal and frontotemporal are rare theta waves or a tiny group of theta waves. During my deep breathing, I had no response to waves. The phenomenon of tracing was reflected during IFS. ### Response: Hi, Welcome to Chat Doctor forum. I have gone through the report (attachment removed to protect patient identity). There is a critical finding seen. You have a slow activity (theta waves) in the temporal and frontotemporal lobe. It correlates with the memory problems, and for the confusion you had. Coming to the point, I would recommend repeating the EEG (electroencephalography) after some weeks after taking the antibiotics. It may be a temporary brain dysfunction due to a possible allergic reaction or a metabolic disorder. We cannot say that taking antibiotics slows the brain activity, but it causes a temporary malfunction of the brain, probably due to cell swelling or cell dysfunction (electrolyte imbalance).

Hi doctor,I want an explanation about my EEG report. I will try to explain my problems. After taking antibiotics, I had neurological reactions to them. They are memory loss, brain fog, and had concentration problems. Later on, we discovered that I have sensitivities to a lot of medications and chemical sensitivity. So I would like to explain the EEG report which was done during my reactions to antibiotics and brain problem. Can antibiotics slower the brain activity?My EEG report showed these results. My essential activity was appropriate. I had a relaxing and intermittent alpha rhythm with a frequency of 9 to 10 Hz and an amplitude of 30 V. There was alpha activity occurring intermittently from my parietal region to the temporal and central areas. The diffuser was the interpolated low-amplitude beta rhythm. My reaction to closing and opening the eyes was appropriate. A central and temporal had an intermittent rhythmic theta activity with a frequency of 6 Hz. Temporal and frontotemporal are rare theta waves or a tiny group of theta waves. During my deep breathing, I had no response to waves. The phenomenon of tracing was reflected during IFS.

Hi, Welcome to Chat Doctor forum. I have gone through the report (attachment removed to protect patient identity). There is a critical finding seen. You have a slow activity (theta waves) in the temporal and frontotemporal lobe. It correlates with the memory problems, and for the confusion you had. Coming to the point, I would recommend repeating the EEG (electroencephalography) after some weeks after taking the antibiotics. It may be a temporary brain dysfunction due to a possible allergic reaction or a metabolic disorder. We cannot say that taking antibiotics slows the brain activity, but it causes a temporary malfunction of the brain, probably due to cell swelling or cell dysfunction (electrolyte imbalance).

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have undergone cystectomy in my left ovary to remove a chocolate cyst of 9 cm. It was done before two years. After that, I got conceived, and my baby boy is five months old now. I got my first period after three months of delivery, and I experienced mild pain in my left lower abdomen.I am experiencing mild constant lower abdomen pain. I have done an ultrasound and found the existence of the cyst with a size of 3 cm. As I was feeding my baby, I was told to wait for the baby to reach six months. I am worried about the cyst growth. I am looking for solutions to stop them growing. Please help. ### Response: Hi. Ovarian cysts are commonly known as PCOD. A cyst is a form of an immature ovum. It occurs due to hormonal imbalance, and it causes irregular menstruation. In this concern, some ayurvedic medicines taken along with yoga practices are beneficial. You need to have a regular check-up of your thyroid profile and USG abdomen. You can take the following medicines to prevent the further growth of cyst and to regulate the periods. Take Hyponid charak two tablets twice a day with warm water after meals. Take Kanchanara Guggulu (Kanchanara with Varuna) two tablets twice a day with warm water after meals. You can consume M2 tone syrup (Ashoka with Ashwagandha) 10 ml twice a day after meals. You can take Arogyavardhini Vati (Shuddha Guggulu with Shilajit) one tablet twice a day with warm water after meals. Do regular yoga like kapalbhati, Mandukasana and Ardhamatsyen ChatDoctor. These are very effective. Avoid eating spicy and fried junk foods.

Hi doctor,I have undergone cystectomy in my left ovary to remove a chocolate cyst of 9 cm. It was done before two years. After that, I got conceived, and my baby boy is five months old now. I got my first period after three months of delivery, and I experienced mild pain in my left lower abdomen.I am experiencing mild constant lower abdomen pain. I have done an ultrasound and found the existence of the cyst with a size of 3 cm. As I was feeding my baby, I was told to wait for the baby to reach six months. I am worried about the cyst growth. I am looking for solutions to stop them growing. Please help.

Hi. Ovarian cysts are commonly known as PCOD. A cyst is a form of an immature ovum. It occurs due to hormonal imbalance, and it causes irregular menstruation. In this concern, some ayurvedic medicines taken along with yoga practices are beneficial. You need to have a regular check-up of your thyroid profile and USG abdomen. You can take the following medicines to prevent the further growth of cyst and to regulate the periods. Take Hyponid charak two tablets twice a day with warm water after meals. Take Kanchanara Guggulu (Kanchanara with Varuna) two tablets twice a day with warm water after meals. You can consume M2 tone syrup (Ashoka with Ashwagandha) 10 ml twice a day after meals. You can take Arogyavardhini Vati (Shuddha Guggulu with Shilajit) one tablet twice a day with warm water after meals. Do regular yoga like kapalbhati, Mandukasana and Ardhamatsyen ChatDoctor. These are very effective. Avoid eating spicy and fried junk foods.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have read several studies on the effect of autophagy on aterial fibrilation. I cannot understand most of the conclusions and need some help with this. I basically follow a regime where I eat every other day and fast at least 24 to 30 hours at a time. As I believe, autophagy is activated and can have a positive or negative effect on the heart, in particular, the atrium and remoddeling of electrics.Can you please tell me if you think what I am doing could possible cause afib or remoddeling of my heart? I have no current issues, low cholesterol and BP, no family history and have a structually normal heart. However due to my years of excess I have this fear of getting afib. I am male, 35 years old, mixed ethnicity. ### Response: Hello, Welcome to Chat Doctor forum. Firstly, there is no good evidence for or against this rigorous fasting. Studies atleast have shown no significant increase in atrial fibrillation with such fasting. Practically, we do not have good evidence for it. Now if we consider theoretically, then yes fasting may stimulate autophagy and may have a beneficial effects on heart/ atrial fibrillation. It does improve your lipid profile and risk of myocardial ischemia which is a risk factor for atrial fibrillation. It may also reduce obesity/ bodily inflammation, which is again a risk factor for atrial fibrillation. So, there is no evidence to suggest that it induces afib or remodeling, but such rigorous fasting is not recommended based on current evidence. We are also not sure whether you are meeting the daily requirement of essential nutrients. Dehy ChatDoctor. You can share some studies with me so that I can clarify on them. So, fasting for few days say for 1-5 days a month is acceptable.

Hello doctor,I have read several studies on the effect of autophagy on aterial fibrilation. I cannot understand most of the conclusions and need some help with this. I basically follow a regime where I eat every other day and fast at least 24 to 30 hours at a time. As I believe, autophagy is activated and can have a positive or negative effect on the heart, in particular, the atrium and remoddeling of electrics.Can you please tell me if you think what I am doing could possible cause afib or remoddeling of my heart? I have no current issues, low cholesterol and BP, no family history and have a structually normal heart. However due to my years of excess I have this fear of getting afib. I am male, 35 years old, mixed ethnicity.

Hello, Welcome to Chat Doctor forum. Firstly, there is no good evidence for or against this rigorous fasting. Studies atleast have shown no significant increase in atrial fibrillation with such fasting. Practically, we do not have good evidence for it. Now if we consider theoretically, then yes fasting may stimulate autophagy and may have a beneficial effects on heart/ atrial fibrillation. It does improve your lipid profile and risk of myocardial ischemia which is a risk factor for atrial fibrillation. It may also reduce obesity/ bodily inflammation, which is again a risk factor for atrial fibrillation. So, there is no evidence to suggest that it induces afib or remodeling, but such rigorous fasting is not recommended based on current evidence. We are also not sure whether you are meeting the daily requirement of essential nutrients. Dehy ChatDoctor. You can share some studies with me so that I can clarify on them. So, fasting for few days say for 1-5 days a month is acceptable.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I had intercourse (he did not ejaculate) and took an i-pill the next day. I am suffering from PCOD and by doctor\\s prescription, I took Meprate for seven days twice daily. But still no sign of periods. What can be the causes? Also, after taking the i-pill there is no withdrawal bleeding.My last period was before two months and it is causing stress and I am overthinking. Please help. ### Response: Hi, Welcome to Chat Doctor forum. Do not worry, you have nothing to worry about. As you have PCOD (polycystic ovarian disease) your ovulation will not be on time. As you mentioned that he did not ejaculate and you took i-pill within 24 hours, chances of pregnancy are very low. Meprate is a hormone pill that increases the inner lining of the uterus and when you suddenly stop, it cause with ChatDoctor. Usually, you can wait up to 10 days after stopping. Because you had I-pill and Meprate your period would have got postponed. So I would advise you to wait for periods till 10 days after the last day of Meprate. If still no periods, just for confirmation get urine pregnancy tested. I bet it will be negative. Then take any of the oral contraceptive pills like Novelone, or Ovrel G, or Dear 21 or Diane 35 or Intimacy plus 3 twice a day for 10 days, throw that extra last tab. You will surely get periods within the next 10 days. If you get periods in between just stop the pills. In PCOD the inner lining of the uterus may not be thick enough, so your periods will be light sometimes with pink discharge only, so no with

Hi doctor,I had intercourse (he did not ejaculate) and took an i-pill the next day. I am suffering from PCOD and by doctor\\s prescription, I took Meprate for seven days twice daily. But still no sign of periods. What can be the causes? Also, after taking the i-pill there is no withdrawal bleeding.My last period was before two months and it is causing stress and I am overthinking. Please help.

Hi, Welcome to Chat Doctor forum. Do not worry, you have nothing to worry about. As you have PCOD (polycystic ovarian disease) your ovulation will not be on time. As you mentioned that he did not ejaculate and you took i-pill within 24 hours, chances of pregnancy are very low. Meprate is a hormone pill that increases the inner lining of the uterus and when you suddenly stop, it cause with ChatDoctor. Usually, you can wait up to 10 days after stopping. Because you had I-pill and Meprate your period would have got postponed. So I would advise you to wait for periods till 10 days after the last day of Meprate. If still no periods, just for confirmation get urine pregnancy tested. I bet it will be negative. Then take any of the oral contraceptive pills like Novelone, or Ovrel G, or Dear 21 or Diane 35 or Intimacy plus 3 twice a day for 10 days, throw that extra last tab. You will surely get periods within the next 10 days. If you get periods in between just stop the pills. In PCOD the inner lining of the uterus may not be thick enough, so your periods will be light sometimes with pink discharge only, so no with

### Instruction: Answer this question truthfully ###Input: Hi doctor,My mother is suffering from chronic kidney disease, and her creatinine level is 9.8 mg/dL. She has a history of diabetes for the past 25 years. She is taking Insulin from the beginning. She has hypertension for the past 35 years. Her hemoglobin is about 11.0 gm/dL. Her eyesight has been damaged before four years now. Her urine output is seven to eight times (volume is 1 to 1.5 liters within 24 hours). Can she avoid dialysis and reduced creatinine level? Please help. ### Response: Hello, Welcome to Chat Doctor forum. I have reviewed your query. There are specific indications for dialysis in patients with chronic kidney disease. They include low creatinine clearance, high potassium, patient becoming acidotic, symptoms of uremia (increased urea in the blood), loss of appetite, uremic heart problems and accumulation of fluid in body parts like feet causing edema and lungs causing shortness of breath. Even if your mother is not experiencing any of the above symptoms, depending on her history of chronic diabetes and levels of creatinine clearance, (I could not calculate exact creatinine clearance for your mother as you have not mentioned her weight, but taking an average female weight of 60 kilograms, your mother\\s creatinine clearance is very low), she might be considered for dialysis, which can be confirmed by a few other tests and examination done by your physician. Postponing the dialysis when she needs, it will make her worse. Though she is producing a decent amount of urine per day, she might still be at risk of various uremic complications based on her creatinine values. Get checked with your physician, and it is better to go on for dialysis if your physician advice to do it. For more information consult an internal medicine physician online

Hi doctor,My mother is suffering from chronic kidney disease, and her creatinine level is 9.8 mg/dL. She has a history of diabetes for the past 25 years. She is taking Insulin from the beginning. She has hypertension for the past 35 years. Her hemoglobin is about 11.0 gm/dL. Her eyesight has been damaged before four years now. Her urine output is seven to eight times (volume is 1 to 1.5 liters within 24 hours). Can she avoid dialysis and reduced creatinine level? Please help.

Hello, Welcome to Chat Doctor forum. I have reviewed your query. There are specific indications for dialysis in patients with chronic kidney disease. They include low creatinine clearance, high potassium, patient becoming acidotic, symptoms of uremia (increased urea in the blood), loss of appetite, uremic heart problems and accumulation of fluid in body parts like feet causing edema and lungs causing shortness of breath. Even if your mother is not experiencing any of the above symptoms, depending on her history of chronic diabetes and levels of creatinine clearance, (I could not calculate exact creatinine clearance for your mother as you have not mentioned her weight, but taking an average female weight of 60 kilograms, your mother\\s creatinine clearance is very low), she might be considered for dialysis, which can be confirmed by a few other tests and examination done by your physician. Postponing the dialysis when she needs, it will make her worse. Though she is producing a decent amount of urine per day, she might still be at risk of various uremic complications based on her creatinine values. Get checked with your physician, and it is better to go on for dialysis if your physician advice to do it. For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was wondering if an anesthesiologist would mind getting interviewed. I am writing a research paper and could not contact any anesthesiologist around me. Thank you for the help. Below are the questions I need an answer.1. How many years have you been a part of this profession? 2.\\tAbout how many times a month do you administer anesthesia to a pregnant mother in labor? 3.\\tRegarding the previous question, what kind of anesthetic is used? (GA, LA, or RA) 4.\\tHave you heard of transmitting the anesthetic agent through the placenta, from mother to child? 5.\\tIs there any information you could provide for the above? 6. About how many times a month do you administer anesthesia to infants for surgery related procedures? 7.\\tRegarding the previous question, what kind of anesthetic is used? (GA, LA, or RA) 8.\\tWhat kind of chemical compound is used in the hospital's anesthetic? 9.\\tDoes this hospital use an anesthetic \\x80\\x9cCocktail\\x80\\x9d (mixing drugs with anesthesia)? 10.\\tWhat information can you provide about the issue of neurological degeneration in infants who have been exposed to anesthesia either during surgery or birthing? 11.\\tWhat kind of introductory do you give your patients about the anesthesia they are about to receive? 12.\\tHave you ever had a follow up with any infant patients later in life? (adolescent age) 13.\\tIs there any more information that you believe could help me better understand this topic? ### Response: Hi, Welcome to Chat Doctor forum. I am glad to answer your queries. Responses are by the question numbers

Hello doctor,I was wondering if an anesthesiologist would mind getting interviewed. I am writing a research paper and could not contact any anesthesiologist around me. Thank you for the help. Below are the questions I need an answer.1. How many years have you been a part of this profession? 2.\\tAbout how many times a month do you administer anesthesia to a pregnant mother in labor? 3.\\tRegarding the previous question, what kind of anesthetic is used? (GA, LA, or RA) 4.\\tHave you heard of transmitting the anesthetic agent through the placenta, from mother to child? 5.\\tIs there any information you could provide for the above? 6. About how many times a month do you administer anesthesia to infants for surgery related procedures? 7.\\tRegarding the previous question, what kind of anesthetic is used? (GA, LA, or RA) 8.\\tWhat kind of chemical compound is used in the hospital's anesthetic? 9.\\tDoes this hospital use an anesthetic \\x80\\x9cCocktail\\x80\\x9d (mixing drugs with anesthesia)? 10.\\tWhat information can you provide about the issue of neurological degeneration in infants who have been exposed to anesthesia either during surgery or birthing? 11.\\tWhat kind of introductory do you give your patients about the anesthesia they are about to receive? 12.\\tHave you ever had a follow up with any infant patients later in life? (adolescent age) 13.\\tIs there any more information that you believe could help me better understand this topic?

Hi, Welcome to Chat Doctor forum. I am glad to answer your queries. Responses are by the question numbers

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am an athlete and my period is such a hassle. I just wish I could get rid of it. It is irregular and lasts for seven to eight days. I do not want to go on the pill, because emotionally my hormones have balanced out. I am worried that if I take any form of birth control, then it will mess that up. I have started considering a hysterectomy just to get rid of it, but I cannot really take time off from my training. I just do not know what to do. I am currently on Lexapro, Wellbutrin, Midodrine, Mestinon and Trazodone. ### Response: Hi, Welcome to Chat Doctor forum. Hysterectomy is a kind of an extreme option considering it is permanent. I understand that you may be hassled by your periods, but removing your uterus before you have completed your family or without any pathology is not the way to go. You can take the oral contraceptive pills, which will both regularize your periods as well as decrease the duration of flow, the pain and the discomfort as well. If you have an event and you need to be not bleeding, then you can manage to postpone the periods with minimal disruption to your hormones. You can take a milder form of contraception, which will not give you the side effects like bloating or migraines. I would suggest Yasmin or Yaz. It is mild and will keep your hormones in order. When you do wish to conceive you just need to stop the oral contraceptive pill. You can take it for six months on a cyclical basis as per the instructions on the back of the pack and give a break of a couple of months and then restart again with the consent of your specialist doctor. Please do not be frustrated. There are more conservative options than major surgery.

Hi doctor,I am an athlete and my period is such a hassle. I just wish I could get rid of it. It is irregular and lasts for seven to eight days. I do not want to go on the pill, because emotionally my hormones have balanced out. I am worried that if I take any form of birth control, then it will mess that up. I have started considering a hysterectomy just to get rid of it, but I cannot really take time off from my training. I just do not know what to do. I am currently on Lexapro, Wellbutrin, Midodrine, Mestinon and Trazodone.

Hi, Welcome to Chat Doctor forum. Hysterectomy is a kind of an extreme option considering it is permanent. I understand that you may be hassled by your periods, but removing your uterus before you have completed your family or without any pathology is not the way to go. You can take the oral contraceptive pills, which will both regularize your periods as well as decrease the duration of flow, the pain and the discomfort as well. If you have an event and you need to be not bleeding, then you can manage to postpone the periods with minimal disruption to your hormones. You can take a milder form of contraception, which will not give you the side effects like bloating or migraines. I would suggest Yasmin or Yaz. It is mild and will keep your hormones in order. When you do wish to conceive you just need to stop the oral contraceptive pill. You can take it for six months on a cyclical basis as per the instructions on the back of the pack and give a break of a couple of months and then restart again with the consent of your specialist doctor. Please do not be frustrated. There are more conservative options than major surgery.

### Instruction: Answer this question truthfully ###Input: Hello doctor, I would like to discuss about one of my family members. He is a teenager and he is 14 years old. I want to discuss his up and down moods. Is it just because he is a teen? His mood is very strange I think so when he is really happy or high I call it, he does stuff like he has enough energy to last forever and he has these ambitious plans and ideas he wants to do. When he is like, I say he is losing touch of reality cause he says he sees stuff that are not there and sometimes he feels like a religious person like \"God\". And sometimes there are voices in his head to tell him to jump off the bridge for fun or something like that and I know off these episodes only last about a day or two or even a week, but I know he has depression. But anyways when he is depressed he tends to have no energy at all to do anything at all and he is always tired and he becomes suicidal. What in your opinion he has? Please tell me the cause. I know he is depressed but why does he tend to be high? ### Response: Hi, Welcome to Chat Doctor forum. As per your history, I find that the patient sometimes is high and sometimes depressed. Though some more details about the symptoms are required, however, I may say that the patient is suffering from bipolar affective disorder. As the name suggests it has two poles. The first pole is depression which is very common where the patient feels sad, has decreased energy and pleasure and can have suicidal ideas. The second pole being mania where the patient appears high, they talk continuously, talk high things about themselves, highly energetic. Sometimes they have psychosis associated when they hear some unusual voices in their ears called hallucinations. This condition requires urgent psychiatric intervention.

Hello doctor, I would like to discuss about one of my family members. He is a teenager and he is 14 years old. I want to discuss his up and down moods. Is it just because he is a teen? His mood is very strange I think so when he is really happy or high I call it, he does stuff like he has enough energy to last forever and he has these ambitious plans and ideas he wants to do. When he is like, I say he is losing touch of reality cause he says he sees stuff that are not there and sometimes he feels like a religious person like \"God\". And sometimes there are voices in his head to tell him to jump off the bridge for fun or something like that and I know off these episodes only last about a day or two or even a week, but I know he has depression. But anyways when he is depressed he tends to have no energy at all to do anything at all and he is always tired and he becomes suicidal. What in your opinion he has? Please tell me the cause. I know he is depressed but why does he tend to be high?

Hi, Welcome to Chat Doctor forum. As per your history, I find that the patient sometimes is high and sometimes depressed. Though some more details about the symptoms are required, however, I may say that the patient is suffering from bipolar affective disorder. As the name suggests it has two poles. The first pole is depression which is very common where the patient feels sad, has decreased energy and pleasure and can have suicidal ideas. The second pole being mania where the patient appears high, they talk continuously, talk high things about themselves, highly energetic. Sometimes they have psychosis associated when they hear some unusual voices in their ears called hallucinations. This condition requires urgent psychiatric intervention.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Please go through and advise. \\Acute on chronic subdural hemorrhage in bilateral cerebral convexities measuring 2 cm in the right side and 1.3 cm in the left side. The mass effect is noted in the form of effacement of adjacent sulcal spaces and compression of ventricles. Thin rim of subdural hematoma is seen along the lateral convexity of the left cerebellar hemisphere with maximal thickness measuring about 4 mm. The C.P. Angeles and posterior fossa contents are normal. The basal cisterns and Sylvian fissures are normal. The sella, parasellar and suprasellar regions are normal.\\Immediate surgery was recommended by the doctors. The cause suspected is the use of Ecosprin 150 for the last three months. It was prescribed when last admitted for high sugar level which caused stroke symptoms. But, the brain CT was normal at that time. The patient has been diabetic for the last 35 years on insulin. Please advise if surgery is needed or it can be cured with medications. How critical is this condition and is it risky to delay? Is this a major or minor surgery? How will it be done? ### Response: Hello, Welcome to Chat Doctor forum. Surgery is absolutely indicated in this case. This hematoma cannot be cured with medications. Surgery should not be delayed as there is a possibility of permanent brain damage if the mass effect is not relieved. This is usually a minor surgery. Burr holes and ChatDoctor. In some cases, when there are membranes in the hematoma, craniotomy may be required to prevent recurrence.In addition to the surgery, Ecosprin (Aspirin) should be stopped immediately. It can be restarted at a later date depending upon its need. For more information consult a neuro surgeon online

Hello doctor,Please go through and advise. \\Acute on chronic subdural hemorrhage in bilateral cerebral convexities measuring 2 cm in the right side and 1.3 cm in the left side. The mass effect is noted in the form of effacement of adjacent sulcal spaces and compression of ventricles. Thin rim of subdural hematoma is seen along the lateral convexity of the left cerebellar hemisphere with maximal thickness measuring about 4 mm. The C.P. Angeles and posterior fossa contents are normal. The basal cisterns and Sylvian fissures are normal. The sella, parasellar and suprasellar regions are normal.\\Immediate surgery was recommended by the doctors. The cause suspected is the use of Ecosprin 150 for the last three months. It was prescribed when last admitted for high sugar level which caused stroke symptoms. But, the brain CT was normal at that time. The patient has been diabetic for the last 35 years on insulin. Please advise if surgery is needed or it can be cured with medications. How critical is this condition and is it risky to delay? Is this a major or minor surgery? How will it be done?

Hello, Welcome to Chat Doctor forum. Surgery is absolutely indicated in this case. This hematoma cannot be cured with medications. Surgery should not be delayed as there is a possibility of permanent brain damage if the mass effect is not relieved. This is usually a minor surgery. Burr holes and ChatDoctor. In some cases, when there are membranes in the hematoma, craniotomy may be required to prevent recurrence.In addition to the surgery, Ecosprin (Aspirin) should be stopped immediately. It can be restarted at a later date depending upon its need. For more information consult a neuro surgeon online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was at the dentist yesterday and had a gum cleaning and now today there are 2 bumps in the back of my mouth on top and my gums right there also look red and there more looking like balls per say. ### Response: Hello, Welcome to Chat Doctor forum. I have been through your query and I can understand your concern. The feeling of strange, weird and sometimes loose tooth are major complaints that a patient generally comes with, after having the cleaning (scaling and root planing) done. This is because of the removal of the debris. Earlier what would have become normal for the patient is now removed (debris) and the patient interprets it somewhat as loose tooth and strange feeling. The redness you are referring to is the erythmatous tissue that generally occurs post cleaning because the gums while cleaning gets separated from the tooth structure (like an injury). However, the healing capacity of gums is very fast and it would be go in 3-4 days. Referring to the picture (attachment removed to protect patient identity), the bumps you are saying, you do not need to worry about. As also you are saying that there is no pain means they are not infected. They might have occured due to the injury of hard palate during cleaning. I would suggest you to not worry as they are generally seen after cleaning is done. They would be gone after some days (generally 3-4 days). However, if the bumps persists beyond one week, I would advise you to have a visit to your nearest dentist for proper and overall examination. Moreover, I would suggest you to keep maintaining good oral hygiene by brushing twice daily and floss regularly. Also rinse your mouth with oral rinses for 4 days a week and 3 weeks a month. I hope I have satisfied you with my answer.

Hello doctor,I was at the dentist yesterday and had a gum cleaning and now today there are 2 bumps in the back of my mouth on top and my gums right there also look red and there more looking like balls per say.

Hello, Welcome to Chat Doctor forum. I have been through your query and I can understand your concern. The feeling of strange, weird and sometimes loose tooth are major complaints that a patient generally comes with, after having the cleaning (scaling and root planing) done. This is because of the removal of the debris. Earlier what would have become normal for the patient is now removed (debris) and the patient interprets it somewhat as loose tooth and strange feeling. The redness you are referring to is the erythmatous tissue that generally occurs post cleaning because the gums while cleaning gets separated from the tooth structure (like an injury). However, the healing capacity of gums is very fast and it would be go in 3-4 days. Referring to the picture (attachment removed to protect patient identity), the bumps you are saying, you do not need to worry about. As also you are saying that there is no pain means they are not infected. They might have occured due to the injury of hard palate during cleaning. I would suggest you to not worry as they are generally seen after cleaning is done. They would be gone after some days (generally 3-4 days). However, if the bumps persists beyond one week, I would advise you to have a visit to your nearest dentist for proper and overall examination. Moreover, I would suggest you to keep maintaining good oral hygiene by brushing twice daily and floss regularly. Also rinse your mouth with oral rinses for 4 days a week and 3 weeks a month. I hope I have satisfied you with my answer.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My baby is 2 months old. He is on pumped milk and once a day formula milk (Enfamil). He is gassy and cries mostly from evening till midnight. Spits up even after burping for 30 minutes. I give exercise, and tummy time, but there is no change. He gets reflux which makes him uncomfortable.His spits are watery. My pediatrician suggested Colicaid and Yamoo which I am using four times a day. Still, he gets gas and spits up. And now he did not poop for the past two days and trying very hard and cries in between feeds by trying to poop. Is this an effect of enzymes? Please help. ### Response: Hello. Please note the following, 1. The clinical picture that you are giving is most suggestive of reflux. It is advisable first to get a reflux study done to find the grade of reflux. 2. The initial medications to be given in reflux are Zantac (Ranitidine) and Perinorm (Metoclopramide). In most cases, this works. The next step beyond this is Gaviscon (antacid) and feed thickening. 3. Also very important is to keep the child in a slightly upright position (30 degrees to ground) after feeding (and most of the time) to reduce the amount of discomfort the child may be facing due to reflux. This one method goes a long way in helping chil ChatDoctor. As the child grows bigger, the need for this reduces eventually. 4. As regards to the crying episodes during stools, if the stools are hard or if there is gas the child may cry. Both are less likely due to the enzymes. They are mostly physiological considering the clinical scenario of the child. Take care.

Hello doctor,My baby is 2 months old. He is on pumped milk and once a day formula milk (Enfamil). He is gassy and cries mostly from evening till midnight. Spits up even after burping for 30 minutes. I give exercise, and tummy time, but there is no change. He gets reflux which makes him uncomfortable.His spits are watery. My pediatrician suggested Colicaid and Yamoo which I am using four times a day. Still, he gets gas and spits up. And now he did not poop for the past two days and trying very hard and cries in between feeds by trying to poop. Is this an effect of enzymes? Please help.

Hello. Please note the following, 1. The clinical picture that you are giving is most suggestive of reflux. It is advisable first to get a reflux study done to find the grade of reflux. 2. The initial medications to be given in reflux are Zantac (Ranitidine) and Perinorm (Metoclopramide). In most cases, this works. The next step beyond this is Gaviscon (antacid) and feed thickening. 3. Also very important is to keep the child in a slightly upright position (30 degrees to ground) after feeding (and most of the time) to reduce the amount of discomfort the child may be facing due to reflux. This one method goes a long way in helping chil ChatDoctor. As the child grows bigger, the need for this reduces eventually. 4. As regards to the crying episodes during stools, if the stools are hard or if there is gas the child may cry. Both are less likely due to the enzymes. They are mostly physiological considering the clinical scenario of the child. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor, I have Pericoronitis (swelling and pain behind the wisdom tooth). I went to the dentist yesterday and he cleaned my mouth and gave me antibiotics (Penicillin V) and Ibuprofen 600. I have been taking the antibiotics for two days now and I do not feel an improvement. Is this normal? How long does it normally take until it starts getting better? Should I go back to my dentist tomorrow? I take Ibuprofen but it only lasts for two to three hours. I am also using Chlorhexamed forte. ### Response: Hello, Welcome to ChatDoctor. I understand your concern. The loosely attached swollen gums over the wisdom tooth is called as pericoronitis. The age of eruption of wisdom teeth is from 17 to 21 years. Beyond that, if the wisdom tooth has not erupted or half erupted gives out pain or swelling, it is highly likely to be locked inside the jaw. Since they are the last ones to erupt, most of them do not get enough space to erupt and tries anyways and this causes jaw pain, swelling and sometimes the surrounding structures like same side temple, ear and throat also gives out pain. This wisdom tooth is called an impacted tooth. During the first visit, antibiotics and painkillers will be prescribed. The swelling will come down eventually but if that is impacted, it may not come down. Please visit your dentist and get an x-ray of your wisdom tooth to check whether there is enough space for it to erupt and to check whether it is erupting in the right direction. Taking painkillers and antibiotics will help to control pain and swelling but if the tooth is impacted, this will not be a permanent solution. You may require wisdom tooth removal. I hope this helps.

Hi doctor, I have Pericoronitis (swelling and pain behind the wisdom tooth). I went to the dentist yesterday and he cleaned my mouth and gave me antibiotics (Penicillin V) and Ibuprofen 600. I have been taking the antibiotics for two days now and I do not feel an improvement. Is this normal? How long does it normally take until it starts getting better? Should I go back to my dentist tomorrow? I take Ibuprofen but it only lasts for two to three hours. I am also using Chlorhexamed forte.

Hello, Welcome to ChatDoctor. I understand your concern. The loosely attached swollen gums over the wisdom tooth is called as pericoronitis. The age of eruption of wisdom teeth is from 17 to 21 years. Beyond that, if the wisdom tooth has not erupted or half erupted gives out pain or swelling, it is highly likely to be locked inside the jaw. Since they are the last ones to erupt, most of them do not get enough space to erupt and tries anyways and this causes jaw pain, swelling and sometimes the surrounding structures like same side temple, ear and throat also gives out pain. This wisdom tooth is called an impacted tooth. During the first visit, antibiotics and painkillers will be prescribed. The swelling will come down eventually but if that is impacted, it may not come down. Please visit your dentist and get an x-ray of your wisdom tooth to check whether there is enough space for it to erupt and to check whether it is erupting in the right direction. Taking painkillers and antibiotics will help to control pain and swelling but if the tooth is impacted, this will not be a permanent solution. You may require wisdom tooth removal. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,All my reports are normal for high BP. Presently, I am taking Tezlocbeta 50 since last six months. After that, I am suffering from so many problems like acidity. Presently, I feel anxiety for the past one month. Before one month, my doctor prescribed me Esopam 10 mg. After taking one tablet, I feel bad. After this, I am suffering from anxiety. Right now, I am taking Etizolam 0.25 mg, please suggest me what do. In starting time my blood pressure was 135/95 to 140/105. My doctor prescribed me Olmetrac AM, after a few months my blood pressure came 110/70. Again he changed Tezloc beta 50, before taking Esopam 10 mg. I have a gastric problem. ### Response: Hi, Welcome to Chat Doctor forum. I have read your health related query. Glad all your blood reports are normal. I understand your concern. Right now what is important is to manage your blood pressure, once the blood pressure is maintained with medication your symptoms may start to reduce gradually. You must continue the treatment as advised by your doctor. Meanwhile continue treatment for anxiety too. Apart from anxiety treatment, try some relaxation techniques like meditation, aromatherapy massage. Avoid stress or stressful situations. Avoid too much coffee and tea and sugars. Try to go out for small mild walks. Try to ChatDoctor. Try to be around people who care for you, spending time with family and friends. Try to take a break from work if that is leading to anxiety or any situation that can be a potential cause for anxiety. Visit your doctor regularly to follow up with blood pressure management.

Hello doctor,All my reports are normal for high BP. Presently, I am taking Tezlocbeta 50 since last six months. After that, I am suffering from so many problems like acidity. Presently, I feel anxiety for the past one month. Before one month, my doctor prescribed me Esopam 10 mg. After taking one tablet, I feel bad. After this, I am suffering from anxiety. Right now, I am taking Etizolam 0.25 mg, please suggest me what do. In starting time my blood pressure was 135/95 to 140/105. My doctor prescribed me Olmetrac AM, after a few months my blood pressure came 110/70. Again he changed Tezloc beta 50, before taking Esopam 10 mg. I have a gastric problem.

Hi, Welcome to Chat Doctor forum. I have read your health related query. Glad all your blood reports are normal. I understand your concern. Right now what is important is to manage your blood pressure, once the blood pressure is maintained with medication your symptoms may start to reduce gradually. You must continue the treatment as advised by your doctor. Meanwhile continue treatment for anxiety too. Apart from anxiety treatment, try some relaxation techniques like meditation, aromatherapy massage. Avoid stress or stressful situations. Avoid too much coffee and tea and sugars. Try to go out for small mild walks. Try to ChatDoctor. Try to be around people who care for you, spending time with family and friends. Try to take a break from work if that is leading to anxiety or any situation that can be a potential cause for anxiety. Visit your doctor regularly to follow up with blood pressure management.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 30 year old female. I fractured my pelvis in a car accident on the 7th. I was on crutches for six weeks and am now walking the past few weeks without. The fracture was a tiny hairline fracture of the sacrum and another two hairline fractures on the side towards the hip. No fractures were in the joints and I was able to heal with no surgery. The problem is that I am still getting a lot of pain which alternates from the front round to the lower back, with the back pain being the worst as it is so stiff I am finding it very hard to walk. I also get numbness and tingling in my right lower leg and foot specifically at night which sometimes stops me sleeping. I am very worried this pain and stiffness are going to stay with me now specifically the back pain and stiffness. I was told I would make a full recovery although I do remember one of the many doctors briefly saying I could get lasting back pain in the sacrum even though it was so fine it could not be seen on the X-ray. I have been taking up swimming twice a week. I am not back at work yet. ### Response: Hello. The pain what you have could be due to SI (sacroiliac) joint which in turn may inhibit butt muscles and develop spasm. I suggest you do a lot of icing on the sacrum and on the butt muscles frequently, for 15 minutes every two hours once possibly. Since there is a fracture, I am not recommending any massage or stretches for now. Do not worry. Everything will be alright as the tingling sensation and pain is due to spasm compressing the neural structures running below the muscle and will get settled down. Hope this is helpful for you. For more information consult a physiotherapist online

Hi doctor,I am a 30 year old female. I fractured my pelvis in a car accident on the 7th. I was on crutches for six weeks and am now walking the past few weeks without. The fracture was a tiny hairline fracture of the sacrum and another two hairline fractures on the side towards the hip. No fractures were in the joints and I was able to heal with no surgery. The problem is that I am still getting a lot of pain which alternates from the front round to the lower back, with the back pain being the worst as it is so stiff I am finding it very hard to walk. I also get numbness and tingling in my right lower leg and foot specifically at night which sometimes stops me sleeping. I am very worried this pain and stiffness are going to stay with me now specifically the back pain and stiffness. I was told I would make a full recovery although I do remember one of the many doctors briefly saying I could get lasting back pain in the sacrum even though it was so fine it could not be seen on the X-ray. I have been taking up swimming twice a week. I am not back at work yet.

Hello. The pain what you have could be due to SI (sacroiliac) joint which in turn may inhibit butt muscles and develop spasm. I suggest you do a lot of icing on the sacrum and on the butt muscles frequently, for 15 minutes every two hours once possibly. Since there is a fracture, I am not recommending any massage or stretches for now. Do not worry. Everything will be alright as the tingling sensation and pain is due to spasm compressing the neural structures running below the muscle and will get settled down. Hope this is helpful for you. For more information consult a physiotherapist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My husband uses Diclofenac solution (topical) for his neck pain. I am 28 weeks pregnant. He also uses a neck pillow after applying it. Will it affect my unborn baby? How long will it take for the solution to be fully absorbed in his body? I am scared that the Diclofenac solution will be absorbed in my body and will hurt the baby. Also if we have sex and he touches that hand in my vagina, will the Diclofenac solution spread into my body? Should I be worried? Please give me some advice as I am scared. ### Response: Hi, Welcome to Chat Doctor forum. You are in the last trimester (7-9 month) of pregnancy. Most of the organs in the fetus might have developed and now it is growing. Thus, care should be taken in food and lifestyle. The rate of absorption of Diclofenac solution into blood from skin is very very less. Even if you apply the solution on your own body skin for long hours, the absorption will be less. If it is absorbed, it stays in the blood for 2 hours. At the end of 2 hours, 50 % of the ChatDoctor. Remaining 25 % will get excreted in fourth hour. Remaining 12.5 % gets excreted in sixth hour. It means, if the solution reaches blood at 8 AM, it gets completely excreted at 4 PM. Note the point that the external solution does not get absorbed through skin into blood. Thus, need not to worry. Be careful with your vagina or oral. Because the vagina or oral is made by mucus membrane containing rich minute blood vessels. Vagina is different from skin. In vaigna, the absorption rate is higher and the Diclofenac

Hello doctor,My husband uses Diclofenac solution (topical) for his neck pain. I am 28 weeks pregnant. He also uses a neck pillow after applying it. Will it affect my unborn baby? How long will it take for the solution to be fully absorbed in his body? I am scared that the Diclofenac solution will be absorbed in my body and will hurt the baby. Also if we have sex and he touches that hand in my vagina, will the Diclofenac solution spread into my body? Should I be worried? Please give me some advice as I am scared.

Hi, Welcome to Chat Doctor forum. You are in the last trimester (7-9 month) of pregnancy. Most of the organs in the fetus might have developed and now it is growing. Thus, care should be taken in food and lifestyle. The rate of absorption of Diclofenac solution into blood from skin is very very less. Even if you apply the solution on your own body skin for long hours, the absorption will be less. If it is absorbed, it stays in the blood for 2 hours. At the end of 2 hours, 50 % of the ChatDoctor. Remaining 25 % will get excreted in fourth hour. Remaining 12.5 % gets excreted in sixth hour. It means, if the solution reaches blood at 8 AM, it gets completely excreted at 4 PM. Note the point that the external solution does not get absorbed through skin into blood. Thus, need not to worry. Be careful with your vagina or oral. Because the vagina or oral is made by mucus membrane containing rich minute blood vessels. Vagina is different from skin. In vaigna, the absorption rate is higher and the Diclofenac

### Instruction: Answer this question truthfully ###Input: Hello doctor, My main problem is alopecia. I had it from 2015 with several patches on the head and now they are gone, but the problem is my eyelashes are gone and never grew back. I used castor oil, garlic, and now Revitalash and other things. Two years ago a rheumatologist prescribed me Dolquine and I did not have patches but my eyelashes still fell. I have lots of problems like hypothyroidism and Hashimoto and currently on Euthyrox 100. My doctor told me it has nothing to do with alopecia because it is normal now (good T3, T4, and TSH, etc.). I newley knew that I have PCO (normal result in echo but my glucose is lowered after 1 hour of glucose 75 mg intake and my insulin was 60, plus androstenedione 3.5). And I have hyper prolactinemia for six years on its own did an IRM and no tumor and currently taking Dostinex. With all these problems I smoke water pipe (shisha, nargile) three times a day. ### Response: Hi. Your concern is genuine and you are so brave and facing all challenges very bravely. You did not mention your prolactin and thyroid hormone levels. Loss of hair can be autoimmune as you were treated for it as well and due to Hashimoto as well. If there is no skin issue involved in the loss of hair (you should consult a dermatologist for it) it may be due to your autoimmune disease. Hashimoto is autoimmune as well. What you can do is that you decrease the TSH (thyroid-stimulating hormone) target to a lower level with increasing Levothyroxine and then see if it has a better effect. I hope this helps.

Hello doctor, My main problem is alopecia. I had it from 2015 with several patches on the head and now they are gone, but the problem is my eyelashes are gone and never grew back. I used castor oil, garlic, and now Revitalash and other things. Two years ago a rheumatologist prescribed me Dolquine and I did not have patches but my eyelashes still fell. I have lots of problems like hypothyroidism and Hashimoto and currently on Euthyrox 100. My doctor told me it has nothing to do with alopecia because it is normal now (good T3, T4, and TSH, etc.). I newley knew that I have PCO (normal result in echo but my glucose is lowered after 1 hour of glucose 75 mg intake and my insulin was 60, plus androstenedione 3.5). And I have hyper prolactinemia for six years on its own did an IRM and no tumor and currently taking Dostinex. With all these problems I smoke water pipe (shisha, nargile) three times a day.

Hi. Your concern is genuine and you are so brave and facing all challenges very bravely. You did not mention your prolactin and thyroid hormone levels. Loss of hair can be autoimmune as you were treated for it as well and due to Hashimoto as well. If there is no skin issue involved in the loss of hair (you should consult a dermatologist for it) it may be due to your autoimmune disease. Hashimoto is autoimmune as well. What you can do is that you decrease the TSH (thyroid-stimulating hormone) target to a lower level with increasing Levothyroxine and then see if it has a better effect. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 42-year-old female. I am facing unexpected suddenly bleeding from yesterday. My periods are expected on 20th and it is always too regular, date to date.I want to point out my periods discharge is always thick, clotty, and very painful for four to five days. This is the first time, it is seven days earlier with no indication, no pain, and no clots too, but feeling heavy in the lower side and painful urine infection. I am also facing itching in that area. Today I consulted a gynecologist in my area. She suggested Pause 500 if needed and also suggested Codex CZ for 15 days. She said not to worry, it may be regular periods. If bleeding continues for more than seven days then go for USG.Please give your advice. Also, I am hypothyroid for the past 16-17 years and taking Eltroxin 100 mg. ### Response: Hi. The medicine your doctor has prescribed is good. Take tablet Pause 500 mg (Tranexamic acid and Mefenamic acid) thrice a day for five days. I hope your doctor also did a vaginal examination and had a look at your cervix to see for any lesion. Though mostly hormonal it may sometimes be due to cervical disease or cancer. If she has not done a vaginal examination I suggest you go to it. Also, recheck your thyroid levels to see if any dose change is needed. Go for an ultrasound seven days prior to your next expected period. It is called a premenstrual ultrasound pelvis. Test for FSH (follicle-stimulating hormone) and LH (Lutenizing hormone) too on day two of your next periods. Consult again with reports.

Hello doctor,I am a 42-year-old female. I am facing unexpected suddenly bleeding from yesterday. My periods are expected on 20th and it is always too regular, date to date.I want to point out my periods discharge is always thick, clotty, and very painful for four to five days. This is the first time, it is seven days earlier with no indication, no pain, and no clots too, but feeling heavy in the lower side and painful urine infection. I am also facing itching in that area. Today I consulted a gynecologist in my area. She suggested Pause 500 if needed and also suggested Codex CZ for 15 days. She said not to worry, it may be regular periods. If bleeding continues for more than seven days then go for USG.Please give your advice. Also, I am hypothyroid for the past 16-17 years and taking Eltroxin 100 mg.

Hi. The medicine your doctor has prescribed is good. Take tablet Pause 500 mg (Tranexamic acid and Mefenamic acid) thrice a day for five days. I hope your doctor also did a vaginal examination and had a look at your cervix to see for any lesion. Though mostly hormonal it may sometimes be due to cervical disease or cancer. If she has not done a vaginal examination I suggest you go to it. Also, recheck your thyroid levels to see if any dose change is needed. Go for an ultrasound seven days prior to your next expected period. It is called a premenstrual ultrasound pelvis. Test for FSH (follicle-stimulating hormone) and LH (Lutenizing hormone) too on day two of your next periods. Consult again with reports.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 25 year old female. Two years back I had noticed a very thin black straight line on my nail in the right hand finger. This line is growing along as my nail grows. Though the line was thin initially, now it has increased in its width and thickness. When I searched in the net about the straight black line on my right hand forefinger, it is showing up as something related to skin cancer or melanoma. I am worried. Should I be concerned about this? I am not very dark, nor very fair. I have wheatish skin. Please advice me. I am attaching a snap of my finger with dark line for your reference.Also, I used to have three moles on my left hand which had been there since my childhood, but to my surprise two years back they went off easily. I got another very small new mole at a different place on the same hand and that too went away when I scratched it off. Is this something normal? ### Response: Hi, Welcome to Chat Doctor forum. I can understand your concern. I have gone through the attached picture (attachment removed to protect patient identity). Presence of linear pigmented lines on the nails can be due to multiple causes. In white people they are considered abnormal and require thorough assessment including biopsy. In dark skinned people it is a common variant. The most common cause of these lines is racial factors. Others being ChatDoctor. You do not have to worry too much, but do keep a watch on the pigmentation. If you notice any variation within the pigmented line or pigmentation on the adjacent nail fold or finger pulp, then consult a dermatologist in person and get yourself evaluated. Regarding moles at other sites, it is sometimes possible that they can disappear. So you do not have to worry about that.

Hello doctor,I am a 25 year old female. Two years back I had noticed a very thin black straight line on my nail in the right hand finger. This line is growing along as my nail grows. Though the line was thin initially, now it has increased in its width and thickness. When I searched in the net about the straight black line on my right hand forefinger, it is showing up as something related to skin cancer or melanoma. I am worried. Should I be concerned about this? I am not very dark, nor very fair. I have wheatish skin. Please advice me. I am attaching a snap of my finger with dark line for your reference.Also, I used to have three moles on my left hand which had been there since my childhood, but to my surprise two years back they went off easily. I got another very small new mole at a different place on the same hand and that too went away when I scratched it off. Is this something normal?

Hi, Welcome to Chat Doctor forum. I can understand your concern. I have gone through the attached picture (attachment removed to protect patient identity). Presence of linear pigmented lines on the nails can be due to multiple causes. In white people they are considered abnormal and require thorough assessment including biopsy. In dark skinned people it is a common variant. The most common cause of these lines is racial factors. Others being ChatDoctor. You do not have to worry too much, but do keep a watch on the pigmentation. If you notice any variation within the pigmented line or pigmentation on the adjacent nail fold or finger pulp, then consult a dermatologist in person and get yourself evaluated. Regarding moles at other sites, it is sometimes possible that they can disappear. So you do not have to worry about that.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Yesterday I took a mouthful of soup which is extremely hot and I realized it only after swallowing it. It is so hot that I felt like it had been in the microwave for too long. I felt the heat going down my throat, burning from the esophagus into the stomach. I rushed in and drank water, but it felt like the damage was done. Today I am struggling with eating and drinking. The pain down the center of my body is excruciating when I swallow something. I am having constant pain in the middle of my chest and back, sort of under my ribs, and the back of my throat feels like I have the worse sore throat ever. I feel sick all the time. I have two questions. Can I take some Codine to numb the pain, or will this make my stomach worse? What medicine can I take to help my insides heal? ### Response: Hello, Welcome to Chat Doctor forum. I understand your concern. When you consume hot ChatDoctor. There may be small burns, as you know, that happens to our tongue when we have something very hot. There is nothing to worry about. I will advise you to stick to a bland diet for the next three to four days. Any spicy food will make it worse. Have more of cold milk, cereals, and curd. These being cold will soothe the lining while passing through the tract. You can take Paracetamol, for your pain, but only after the food. Also, take Sucralfate two tablespoons twice daily, after food for the next three to five days based on your symptoms. This syrup will form a protective coat around the area that has the lesion and help in healing. You should be feeling better in a couple of days. There is nothing to worry about. I hope this helps.

Hello doctor,Yesterday I took a mouthful of soup which is extremely hot and I realized it only after swallowing it. It is so hot that I felt like it had been in the microwave for too long. I felt the heat going down my throat, burning from the esophagus into the stomach. I rushed in and drank water, but it felt like the damage was done. Today I am struggling with eating and drinking. The pain down the center of my body is excruciating when I swallow something. I am having constant pain in the middle of my chest and back, sort of under my ribs, and the back of my throat feels like I have the worse sore throat ever. I feel sick all the time. I have two questions. Can I take some Codine to numb the pain, or will this make my stomach worse? What medicine can I take to help my insides heal?

Hello, Welcome to Chat Doctor forum. I understand your concern. When you consume hot ChatDoctor. There may be small burns, as you know, that happens to our tongue when we have something very hot. There is nothing to worry about. I will advise you to stick to a bland diet for the next three to four days. Any spicy food will make it worse. Have more of cold milk, cereals, and curd. These being cold will soothe the lining while passing through the tract. You can take Paracetamol, for your pain, but only after the food. Also, take Sucralfate two tablespoons twice daily, after food for the next three to five days based on your symptoms. This syrup will form a protective coat around the area that has the lesion and help in healing. You should be feeling better in a couple of days. There is nothing to worry about. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My 9-year-old daughter has recently been diagnosed with a mild high frequency hearing loss in both ears. Her hearing levels are only very slightly below normal and it is not impacting her day to day in a noticeable way so, for the moment, the audiology team are just monitoring it. My worry is that I accidentally caused it when she was a baby. There was one time when she was a young baby (maybe 2 months old) and she was in a rear facing car seat in the front of my car, i.e her ears were near the speakers at the front of the car. I turned the engine on and the radio blasted out really loud, I think it was probably on volume 12 or 13. I turned it down straight away and she did not cry but now I feel awful that I may have damaged her hearing. Please could you tell me how likely it is a one-off incident like this would have caused it? ### Response: Hello, Welcome to ChatDoctor. I understand your worry. I would say it is possible to develop such a hearing loss due to what we call acoustic trauma, noise-induced. However, we can never be sure whether the loss is due to that incident or due to some other or if the loss was congenitally present. What you can do to prevent further deterioration is prevent her from listening to loud music, keep her away from loud sounds, try and use noise isolation buds when there is excessive noise outside, eat a healthy diet and meditate. Rather than worrying about what could have caused the loss, I think it will be prudent to prevent any further damage to the ear and guide your daughter on the right path to achieve what she wants to. I hope this helps. Take care.

Hello doctor,My 9-year-old daughter has recently been diagnosed with a mild high frequency hearing loss in both ears. Her hearing levels are only very slightly below normal and it is not impacting her day to day in a noticeable way so, for the moment, the audiology team are just monitoring it. My worry is that I accidentally caused it when she was a baby. There was one time when she was a young baby (maybe 2 months old) and she was in a rear facing car seat in the front of my car, i.e her ears were near the speakers at the front of the car. I turned the engine on and the radio blasted out really loud, I think it was probably on volume 12 or 13. I turned it down straight away and she did not cry but now I feel awful that I may have damaged her hearing. Please could you tell me how likely it is a one-off incident like this would have caused it?

Hello, Welcome to ChatDoctor. I understand your worry. I would say it is possible to develop such a hearing loss due to what we call acoustic trauma, noise-induced. However, we can never be sure whether the loss is due to that incident or due to some other or if the loss was congenitally present. What you can do to prevent further deterioration is prevent her from listening to loud music, keep her away from loud sounds, try and use noise isolation buds when there is excessive noise outside, eat a healthy diet and meditate. Rather than worrying about what could have caused the loss, I think it will be prudent to prevent any further damage to the ear and guide your daughter on the right path to achieve what she wants to. I hope this helps. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,People called me stupid and annoying it is not that I do not understand. It is that I cannot focus, I have a tough time focusing, and I would not deny I am annoying. I never sit still I am wandering around the house all the time I told my dad I would not sit still even if I was glued to the sit and he said I believe that. People complain about the fact I talk a lot, and I talk fast. I climbed a broken fence I love climbing fences when I was 12 I let my friend push me across the road in a shopping cart, and I let my friend push me around in a shopping cart on a bumpy ground I do not think before I act. I get very mad when people talk badly about me I get easily frustrated I get crazy if I cannot find something or if mess up on something I will pretty much get mad over anything I have a low tolerance when it comes to anger. ADHD runs in my family. ### Response: Hello, Welcome to Chat Doctor forum. You are reporting symptoms which are suggestive of ADHD (attention-deficit hyperactive disorder). How are you managing at school? Further assessment, including developmental history from parents, corroborative information from school will help to clarify the severity of your symptoms and also to rule out other conditions mimicking ADHD. Effective management of the underlying condition will help you to function better. I will advise discussing with your parents and consult your doctor locally who can refer you for further specialist assessment as needed. Depending on the evaluation, medication or behavioral support may be recommended.Meanwhile, you can try some strategies to improve your functioning. Exercise regularly, make a reminder list for essential weekly activities to avoid missing deadlines, minimize distractions by avoiding TV, mobile during your work hours, etc. I hope this helps.

Hello doctor,People called me stupid and annoying it is not that I do not understand. It is that I cannot focus, I have a tough time focusing, and I would not deny I am annoying. I never sit still I am wandering around the house all the time I told my dad I would not sit still even if I was glued to the sit and he said I believe that. People complain about the fact I talk a lot, and I talk fast. I climbed a broken fence I love climbing fences when I was 12 I let my friend push me across the road in a shopping cart, and I let my friend push me around in a shopping cart on a bumpy ground I do not think before I act. I get very mad when people talk badly about me I get easily frustrated I get crazy if I cannot find something or if mess up on something I will pretty much get mad over anything I have a low tolerance when it comes to anger. ADHD runs in my family.

Hello, Welcome to Chat Doctor forum. You are reporting symptoms which are suggestive of ADHD (attention-deficit hyperactive disorder). How are you managing at school? Further assessment, including developmental history from parents, corroborative information from school will help to clarify the severity of your symptoms and also to rule out other conditions mimicking ADHD. Effective management of the underlying condition will help you to function better. I will advise discussing with your parents and consult your doctor locally who can refer you for further specialist assessment as needed. Depending on the evaluation, medication or behavioral support may be recommended.Meanwhile, you can try some strategies to improve your functioning. Exercise regularly, make a reminder list for essential weekly activities to avoid missing deadlines, minimize distractions by avoiding TV, mobile during your work hours, etc. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Age - 33 years Height - 164 cms Weight - 67 KgI am suffering from sore throat so I took Augmentin 625 before 12-13 days back but found no improvement but I started suffering from Stomach pain and excessive gases. Now I am taking below medicines as per prescribed by ENT specialist that are 1.Allegra M tablet 2.Rinifol capsule 3.Esoz D 40 capsule 4.Acinil O surup for ten days.Two days remaning to finish course.Stomach pain and blown stomach due to gas is still there. ### Response: Hello, Welcome to Chat Doctor forum. I welcome you to ChatDoctor. Well it is not uncommon to have Gastric upsets after a course of antibiotic. And antibiotic like augmentin are notorious to cause this. This occur secondary to effect of augmentin on decreasing the amount of lactobacillus microorganism which are normally present in the human gut and help digest the food. You should take yougurt, Kefir (fermented yougurt), Kefir. and there are certain diets with probiotic activity you can start taking it. Plus take Tab Ecotec twice daily for 4 weeks, and Tab Levosulpiride 75 mg once daily half hour before meals.for 2 weeks. You can continue with acinil O syp. while rest of your current medication can be stopped. I hope this will correct your microbiota and will bring the same healthiness as before. good day Antibiotic induced dysbiosis Small intestinal bacterial overgrowth Antibiotic induced dysbiosis Let me know in one week time how you respond to above regimen, if persistent of symptoms I would consider testing and giving some safe antibiotic therapy for 2 weeks.

Age - 33 years Height - 164 cms Weight - 67 KgI am suffering from sore throat so I took Augmentin 625 before 12-13 days back but found no improvement but I started suffering from Stomach pain and excessive gases. Now I am taking below medicines as per prescribed by ENT specialist that are 1.Allegra M tablet 2.Rinifol capsule 3.Esoz D 40 capsule 4.Acinil O surup for ten days.Two days remaning to finish course.Stomach pain and blown stomach due to gas is still there.

Hello, Welcome to Chat Doctor forum. I welcome you to ChatDoctor. Well it is not uncommon to have Gastric upsets after a course of antibiotic. And antibiotic like augmentin are notorious to cause this. This occur secondary to effect of augmentin on decreasing the amount of lactobacillus microorganism which are normally present in the human gut and help digest the food. You should take yougurt, Kefir (fermented yougurt), Kefir. and there are certain diets with probiotic activity you can start taking it. Plus take Tab Ecotec twice daily for 4 weeks, and Tab Levosulpiride 75 mg once daily half hour before meals.for 2 weeks. You can continue with acinil O syp. while rest of your current medication can be stopped. I hope this will correct your microbiota and will bring the same healthiness as before. good day Antibiotic induced dysbiosis Small intestinal bacterial overgrowth Antibiotic induced dysbiosis Let me know in one week time how you respond to above regimen, if persistent of symptoms I would consider testing and giving some safe antibiotic therapy for 2 weeks.

### Instruction: Answer this question truthfully ###Input: Respected doctor,My baby was born on 5th at the 36th week of pregnancy. Then he was admitted to NICU as signs of jaundice were seen and discharged on 8th. Then again on 11th, he was again admitted to NICU because of jaundice. Then on 12th (8th day) the doctor did a test of TSH, T3, and T4 (report is attached) where TSH was found 10.87 uIu/ml (report attached) and low T3. Thereafter, the doctor recommended a dosage of Eltroxin of 25 mcg for three years of life due to suspected hypothyroidism and advised us to repeat TSH level after three years and hence we have started giving the 25 mcg dosage to the baby since 12th. Meanwhile, we again tested for TSH, T3, and T4 (report is attached) on 28th. The TSH came out less than 0.05 ulu/ml. Kindly advise whether we stop the dosage of Eltroxin (25 mcg) or lower the dosage. ### Response: Hello, Welcome to Chat Doctor forum. I suppose there is some miscommunication or misunderstanding. We never recommend a continuous dosage of Levothyroxine for three years without checking the levels periodically. So, what is usually done is that we repeat thyroid profile three monthly and adjust the dosage. However, the current scenario warrants stopping the ChatDoctor. Once the level falls within the normal range we keep on monitoring the levels. If they increase, we start Levothyroxine again and adjust the dosage three-monthly based on TSH levels. I hope it helps you. For more information consult an internal medicine physician online

Respected doctor,My baby was born on 5th at the 36th week of pregnancy. Then he was admitted to NICU as signs of jaundice were seen and discharged on 8th. Then again on 11th, he was again admitted to NICU because of jaundice. Then on 12th (8th day) the doctor did a test of TSH, T3, and T4 (report is attached) where TSH was found 10.87 uIu/ml (report attached) and low T3. Thereafter, the doctor recommended a dosage of Eltroxin of 25 mcg for three years of life due to suspected hypothyroidism and advised us to repeat TSH level after three years and hence we have started giving the 25 mcg dosage to the baby since 12th. Meanwhile, we again tested for TSH, T3, and T4 (report is attached) on 28th. The TSH came out less than 0.05 ulu/ml. Kindly advise whether we stop the dosage of Eltroxin (25 mcg) or lower the dosage.

Hello, Welcome to Chat Doctor forum. I suppose there is some miscommunication or misunderstanding. We never recommend a continuous dosage of Levothyroxine for three years without checking the levels periodically. So, what is usually done is that we repeat thyroid profile three monthly and adjust the dosage. However, the current scenario warrants stopping the ChatDoctor. Once the level falls within the normal range we keep on monitoring the levels. If they increase, we start Levothyroxine again and adjust the dosage three-monthly based on TSH levels. I hope it helps you. For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have had issues with my left ear for the past two months. I normally clean my ears with peroxide. After I added drops of peroxide back last month, I noticed that when people spoke to me loudly I would hear wind sound in my ears. Also, my ears felt plugged and I heard thumping (heartbeat sound) in my ear.Two days ago, I attempted to clean my ear with a home irrigation system. I was able to dislodge a large piece of dried, white wax. My ear felt the best in a long time. I was hearing clearly and the sounds in my ear went away.Yesterday, my ear felt plugged again. So I irrigated my ear and nothing came out. But the plugged feeling and sound went away. This morning my ear felt plugged again, and I irrigated my ear and nothing came out. But my ear felt clear and the plugged feeling and sound went away. What is causing this issue? Why does it keep coming back? ### Response: Hi. It looks like your having a eustachian tube catarrh. This tube essentially ventilates both the ear and nose and in an event where this tube has got blocked, you might develop fullness and ringing sensation in the same ear. Self-cleaning your ear is the most dangerous thing you can ever do. Never introduce peroxide or any thing under doctor\\s advice as it can be disastrous considering the ear and it is related structures to be one the most sensitive regions in the body. Another possibility is that there could be some remnant wax in your ear which can be the reason for you developing this ringing sensation on a regular basis. You can consider using Soliwax ear ChatDoctor. Other than this, take tablet Sinarest (Acetaminophen, Chlorpheniramine, and pseudoephe

Hello doctor,I have had issues with my left ear for the past two months. I normally clean my ears with peroxide. After I added drops of peroxide back last month, I noticed that when people spoke to me loudly I would hear wind sound in my ears. Also, my ears felt plugged and I heard thumping (heartbeat sound) in my ear.Two days ago, I attempted to clean my ear with a home irrigation system. I was able to dislodge a large piece of dried, white wax. My ear felt the best in a long time. I was hearing clearly and the sounds in my ear went away.Yesterday, my ear felt plugged again. So I irrigated my ear and nothing came out. But the plugged feeling and sound went away. This morning my ear felt plugged again, and I irrigated my ear and nothing came out. But my ear felt clear and the plugged feeling and sound went away. What is causing this issue? Why does it keep coming back?

Hi. It looks like your having a eustachian tube catarrh. This tube essentially ventilates both the ear and nose and in an event where this tube has got blocked, you might develop fullness and ringing sensation in the same ear. Self-cleaning your ear is the most dangerous thing you can ever do. Never introduce peroxide or any thing under doctor\\s advice as it can be disastrous considering the ear and it is related structures to be one the most sensitive regions in the body. Another possibility is that there could be some remnant wax in your ear which can be the reason for you developing this ringing sensation on a regular basis. You can consider using Soliwax ear ChatDoctor. Other than this, take tablet Sinarest (Acetaminophen, Chlorpheniramine, and pseudoephe

### Instruction: Answer this question truthfully ###Input: Hello doctor,I took a pill of 200 mcg yesterday night and two pills of 200 mcg of Mifegest kit today morning and I am having lower back pain and abdominal cramps.So, when will bleeding start? And is it risky that I cannot handle it by myself at home? ### Response: Hello, Welcome to Chat Doctor forum. How are you doing? The first pill dislodges the embryo from the uterine lining and you may have some vomiting tendency, but no bleeding. Then the second pills make the uterus to contract and open the cervical canal and the dislodged embryo falls out. The ideal way of taking the pill is to have the first pill and then have the second group of pills after 48 hours of the first pills. Thereby, you give enough time for the embryo to separate from the uterus. The bleeding usually starts within a day or two of the second pill. It is the second pill, which is making the uterus to contract and the cervical canal to open, that is causing the cramps. You can have any of the painkillers like tablet Meftal spas or Cyclopam or Spasmo Proxyvon two to three times a day. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. The bleeding depends on the duration of pregnancy. If early, like less than six to seven weeks, the bleeding will be like periods. If later than that, it will have few clots and the bleeding will be more than normal but can be handled at home. You will need the doctor\\s help only if there is no bleeding or too much bleeding. Usually, it will resolve in two to three days. Hope I have clarified your query, Do write back if you have any more queries. All the best.

Hello doctor,I took a pill of 200 mcg yesterday night and two pills of 200 mcg of Mifegest kit today morning and I am having lower back pain and abdominal cramps.So, when will bleeding start? And is it risky that I cannot handle it by myself at home?

Hello, Welcome to Chat Doctor forum. How are you doing? The first pill dislodges the embryo from the uterine lining and you may have some vomiting tendency, but no bleeding. Then the second pills make the uterus to contract and open the cervical canal and the dislodged embryo falls out. The ideal way of taking the pill is to have the first pill and then have the second group of pills after 48 hours of the first pills. Thereby, you give enough time for the embryo to separate from the uterus. The bleeding usually starts within a day or two of the second pill. It is the second pill, which is making the uterus to contract and the cervical canal to open, that is causing the cramps. You can have any of the painkillers like tablet Meftal spas or Cyclopam or Spasmo Proxyvon two to three times a day. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. The bleeding depends on the duration of pregnancy. If early, like less than six to seven weeks, the bleeding will be like periods. If later than that, it will have few clots and the bleeding will be more than normal but can be handled at home. You will need the doctor\\s help only if there is no bleeding or too much bleeding. Usually, it will resolve in two to three days. Hope I have clarified your query, Do write back if you have any more queries. All the best.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Prostate biopsy was prompted by rising PSA over several years (20%-25% per year) reaching over 4 this past year (spiked at 7.3 which I think really is why they wanted the biopsy but I expect it to come down since then). 12 core came back benign, but I do not understand the implications for some of the additional descriptive language and why I need continued six months follow-up.DRE had nodules and TRUS shows calcification and volume of 27cc. Path description says reactive and atrophic acini and focally reactive. Does that mean BPH or prostatitis, or is that a precursor to PCa? I have no symptoms of BPH or prostatitis, other than getting up between 3 AM and 4 AM every morning. I think it is just an age factor. I am not interested in the DREs and TRUS procedures if it is not going to tell anything new, and I can have bloodwork done without the time and expense of a doctor\\s visit. ### Response: Hi, Welcome to Chat Doctor forum. I have studied your reports and consulted with my pathologist. (attachment removed to protect patient identity). As per her advice and mine too, your reports are normal, the biopsy changes are age related. In the biopsy no carcinoma is identified. Doing ChatDoctor. And results are negative for cancer and BPH (benign prostatic hyperplasia). Biopsy was done because in benign prostatic hypertrophy and prostate cancer calcification occurs in 10% of cases. And your biopsy is normal. Biopsy is the choice of diagnosis. And your biopsy is normal. Your doctor has asked for the followup to see the changes in prostate calcification. Yes, TRUS and

Hello doctor,Prostate biopsy was prompted by rising PSA over several years (20%-25% per year) reaching over 4 this past year (spiked at 7.3 which I think really is why they wanted the biopsy but I expect it to come down since then). 12 core came back benign, but I do not understand the implications for some of the additional descriptive language and why I need continued six months follow-up.DRE had nodules and TRUS shows calcification and volume of 27cc. Path description says reactive and atrophic acini and focally reactive. Does that mean BPH or prostatitis, or is that a precursor to PCa? I have no symptoms of BPH or prostatitis, other than getting up between 3 AM and 4 AM every morning. I think it is just an age factor. I am not interested in the DREs and TRUS procedures if it is not going to tell anything new, and I can have bloodwork done without the time and expense of a doctor\\s visit.

Hi, Welcome to Chat Doctor forum. I have studied your reports and consulted with my pathologist. (attachment removed to protect patient identity). As per her advice and mine too, your reports are normal, the biopsy changes are age related. In the biopsy no carcinoma is identified. Doing ChatDoctor. And results are negative for cancer and BPH (benign prostatic hyperplasia). Biopsy was done because in benign prostatic hypertrophy and prostate cancer calcification occurs in 10% of cases. And your biopsy is normal. Biopsy is the choice of diagnosis. And your biopsy is normal. Your doctor has asked for the followup to see the changes in prostate calcification. Yes, TRUS and

### Instruction: Answer this question truthfully ###Input: Hi doctor,The dentist thought my tooth had a fracture, so he put on a temporary crown. That worsened the pain and throbbing exponentially, so he sent me to an endodontist that said my tissue was extremely inflamed and needed a root canal ASAP. After the root canal, the regular dentist put on the permanent crown. I felt the throbbing again after he put the permanent crown on. I got a second opinion and the dentist #2 did an X-ray and noticed the crown did not cover my tooth fully. I went back to Dentist #1 who had to restart. He took the permanent crown off and put a temporary crown on again. But, he had thrown my original imprint away and waited to take a new imprint until after he removed my permanent crown. The temporary crown is on now and is tiny compared to my other teeth. It looks like a kernel of corn. Should he have taken the impression first before taking the permanent crown off? I worry my new permanent crown that comes in will be tiny. ### Response: Hello, Welcome to Chat Doctor forum. Did you have any pain after completion of root canal procedure before permanent crown placement? How is the pain? Is it the same pain which you experienced before root canal? If the pain did not stop after completion of root canal and before crown placement, then it should be from the tooth. You should get back to your endodontist in this case. Generally, a couple of days will be left as healing period before placement of crown. If the crown is placed immediately without allowing a period of healing, it hurts. If the pain started after placement of permanent crown, then you should visit your general dentist to check the status and fit of the crown. In this case, the crown needs some fine adjustments for a perfect fit and bite.

Hi doctor,The dentist thought my tooth had a fracture, so he put on a temporary crown. That worsened the pain and throbbing exponentially, so he sent me to an endodontist that said my tissue was extremely inflamed and needed a root canal ASAP. After the root canal, the regular dentist put on the permanent crown. I felt the throbbing again after he put the permanent crown on. I got a second opinion and the dentist #2 did an X-ray and noticed the crown did not cover my tooth fully. I went back to Dentist #1 who had to restart. He took the permanent crown off and put a temporary crown on again. But, he had thrown my original imprint away and waited to take a new imprint until after he removed my permanent crown. The temporary crown is on now and is tiny compared to my other teeth. It looks like a kernel of corn. Should he have taken the impression first before taking the permanent crown off? I worry my new permanent crown that comes in will be tiny.

Hello, Welcome to Chat Doctor forum. Did you have any pain after completion of root canal procedure before permanent crown placement? How is the pain? Is it the same pain which you experienced before root canal? If the pain did not stop after completion of root canal and before crown placement, then it should be from the tooth. You should get back to your endodontist in this case. Generally, a couple of days will be left as healing period before placement of crown. If the crown is placed immediately without allowing a period of healing, it hurts. If the pain started after placement of permanent crown, then you should visit your general dentist to check the status and fit of the crown. In this case, the crown needs some fine adjustments for a perfect fit and bite.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have been detected with a dentigerous cyst and compound odontoma inside my lower gums. I have been advised for removal of the cyst and to have a biopsy of the cyst for odontoma. I do not have pain and swelling. I visited a dentist before few months where I took an X-ray. We found a small dark area in the X-ray. It was an odontoma with an unerupted canine. It was confirmed again in a CBCT scan. The results came with a dentigerous cyst and odontoma. I am scared of the surgery done under GA. Is it necessary to remove the cyst?Surgeons suggest me different opinions. One oral surgeon is implying for removal of the cyst, odontoma and placing a plate on the canine. Another surgeon is recommending for the removal of the cyst and odontoma. Another dentist says me to wait and watch as it is asymptomatic. I am attaching my reports. Please suggest. ### Response: Hi. If the cysts are small, they can be left untreated. But the problem is that the cysts can create an infection later. They can also cause more issues like tooth mobility, bone loss or any other transformation. So it is better to remove it. Odontomas are developmental. They also create problems when they are left untreated. But again, there are chances of cyst formation and expansion later. So, if the oral surgeon suggests for removal of the cyst, try to go for it. I have gone through the reports (attachment removed to protect patient identity). It is better to remove the cyst. Currently, you do not have problems. If it is left untreated, it can form ameloblastoma in the future. You do not worry. These cysts are found in any person due to the impacted tooth.

Hi doctor,I have been detected with a dentigerous cyst and compound odontoma inside my lower gums. I have been advised for removal of the cyst and to have a biopsy of the cyst for odontoma. I do not have pain and swelling. I visited a dentist before few months where I took an X-ray. We found a small dark area in the X-ray. It was an odontoma with an unerupted canine. It was confirmed again in a CBCT scan. The results came with a dentigerous cyst and odontoma. I am scared of the surgery done under GA. Is it necessary to remove the cyst?Surgeons suggest me different opinions. One oral surgeon is implying for removal of the cyst, odontoma and placing a plate on the canine. Another surgeon is recommending for the removal of the cyst and odontoma. Another dentist says me to wait and watch as it is asymptomatic. I am attaching my reports. Please suggest.

Hi. If the cysts are small, they can be left untreated. But the problem is that the cysts can create an infection later. They can also cause more issues like tooth mobility, bone loss or any other transformation. So it is better to remove it. Odontomas are developmental. They also create problems when they are left untreated. But again, there are chances of cyst formation and expansion later. So, if the oral surgeon suggests for removal of the cyst, try to go for it. I have gone through the reports (attachment removed to protect patient identity). It is better to remove the cyst. Currently, you do not have problems. If it is left untreated, it can form ameloblastoma in the future. You do not worry. These cysts are found in any person due to the impacted tooth.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 34 year old male working as an engineer. Regarding my mental state, I feel lethargic and sleepy all day. I do not have the interest to do anything in life. Even if I start something, I am easily bored. I am always in a hurry. I have rapid mood swings. I cannot concentrate while reading as my mind is restless. I constantly have negative thoughts. Most of the time, I am sad. I am short tempered and my pulse rate increases rapidly. I often want to smash things or throw things at people. I ponder about doing crazy things and anticipate the outcomes of doing silly things. I have repetitive thoughts like a maniac. I do not feel like doing anything. I have lost interest even in my favorite activities. I consulted a psychiatrist and he diagnosed it as major depressive disorder with OCD traits and hypertension. But, I do not want to take medicines unless I know for sure it is really going to cure me. Please help. ### Response: Hello. The kind of thoughts that you describe and the fact that they keep coming repetitively is diagnostic of obsessive compulsive disorder (OCD). Your complaints of weakness, mood swings, anger, and a loss of interest in doing things is typical of depression. So, your doctor\\s diagnosis is correct. I would suggest tablet Fluvoxamine as the first choice of medicine. For OCD and depression, the best and easiest treatment which will give early results is medication. Other therapies like psychotherapy, etc. are not effective when you suffer from a severe type of OCD and depression. So, I believe that they will prolong your suffering. The earlier you start the treatment, the better it will get. If you have any doubts or negative ideas about medicines, clear them with your doctor or with me.

Hello doctor,I am a 34 year old male working as an engineer. Regarding my mental state, I feel lethargic and sleepy all day. I do not have the interest to do anything in life. Even if I start something, I am easily bored. I am always in a hurry. I have rapid mood swings. I cannot concentrate while reading as my mind is restless. I constantly have negative thoughts. Most of the time, I am sad. I am short tempered and my pulse rate increases rapidly. I often want to smash things or throw things at people. I ponder about doing crazy things and anticipate the outcomes of doing silly things. I have repetitive thoughts like a maniac. I do not feel like doing anything. I have lost interest even in my favorite activities. I consulted a psychiatrist and he diagnosed it as major depressive disorder with OCD traits and hypertension. But, I do not want to take medicines unless I know for sure it is really going to cure me. Please help.

Hello. The kind of thoughts that you describe and the fact that they keep coming repetitively is diagnostic of obsessive compulsive disorder (OCD). Your complaints of weakness, mood swings, anger, and a loss of interest in doing things is typical of depression. So, your doctor\\s diagnosis is correct. I would suggest tablet Fluvoxamine as the first choice of medicine. For OCD and depression, the best and easiest treatment which will give early results is medication. Other therapies like psychotherapy, etc. are not effective when you suffer from a severe type of OCD and depression. So, I believe that they will prolong your suffering. The earlier you start the treatment, the better it will get. If you have any doubts or negative ideas about medicines, clear them with your doctor or with me.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 31-year-old male with a height of 180 cm and I weigh 83 kg. I am a father of three children. My problem is premature ejaculation. When I am having sexual intercourse, always the first round is very fast. It is just one to one and a half minutes and sometimes less than that. The second round of intercourse is slightly better than the first time may be two to five minutes. But, sometimes I feel there is an erectile dysfunction due to depression and I am not able to continue for the second round.I have tried Viagra for only three times just to experiment and the result for the first round of sex was the same as usual. But, the second round of intercourse was a bit longer say around 30 minutes. I had this problem since teenage. I thought it would go away but it has worsened. I have tried Lidocaine spray in the past to decrease the sensitivity but there was no big difference. Please advice. ### Response: Hello, Welcome to Chat Doctor forum. Viagra (Sildenafil) is not the medicine to be used for premature ejaculation. You need to get a physical examination with a urologist to rule out any genital infection causing an early discharge. If not, practice following exercises on daily basis for three to six months for a permanent cure. You can visit the Internet and know how to do them. Until then, I suggest you take tablet Dapoxetine 30 mg 90 minutes before sex. Consult your specialist doctor, discuss with him or her and with their consent take the medicine. For better results, combine this with Lignocaine (Lidocaine) spray only to the frenulum of the penis. For more information consult a sexologist online

Hello doctor,I am a 31-year-old male with a height of 180 cm and I weigh 83 kg. I am a father of three children. My problem is premature ejaculation. When I am having sexual intercourse, always the first round is very fast. It is just one to one and a half minutes and sometimes less than that. The second round of intercourse is slightly better than the first time may be two to five minutes. But, sometimes I feel there is an erectile dysfunction due to depression and I am not able to continue for the second round.I have tried Viagra for only three times just to experiment and the result for the first round of sex was the same as usual. But, the second round of intercourse was a bit longer say around 30 minutes. I had this problem since teenage. I thought it would go away but it has worsened. I have tried Lidocaine spray in the past to decrease the sensitivity but there was no big difference. Please advice.

Hello, Welcome to Chat Doctor forum. Viagra (Sildenafil) is not the medicine to be used for premature ejaculation. You need to get a physical examination with a urologist to rule out any genital infection causing an early discharge. If not, practice following exercises on daily basis for three to six months for a permanent cure. You can visit the Internet and know how to do them. Until then, I suggest you take tablet Dapoxetine 30 mg 90 minutes before sex. Consult your specialist doctor, discuss with him or her and with their consent take the medicine. For better results, combine this with Lignocaine (Lidocaine) spray only to the frenulum of the penis. For more information consult a sexologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I think I have social anxiety, but I am not sure if it is affecting my life enough to do anything about it. I do not want to tell my mom, but I am sure therapy would help as I am very insecure, have a negative mindset, and generally I am very paranoid of what others think.I do not know how I will hold a job as I hate others observing me and hate confrontation and I am worried about interacting with customers, etc. Is social anxiety an essential one to get treated? How to tell my mom without making her worry. ### Response: Hello, Welcome to Chat Doctor forum. I understand you are quite worried and frightened about your problems. Social anxiety is common, and it is all about what it does that affects the people more. Your worries about your inability to hold on to a job and avoiding social situations are valid. It is very important to treat social anxiety because if left untreated it will gradually keep increasing and you may end up feeling frustrated and depressed as well. Regarding explaining this to your mother, you can read and find it easy to understand articles regarding social anxiety and ask your mother to go through that. First of all, you need to make her understand that it is an illness like diabetes or hypertension. If it is an illness, it has some symptoms and a proper course and treatment as well. If you had diabetes, would your mother pity you? No, she would ask you to consult a doctor. Similarly, in this case, you will need medicines as well as therapy to overcome your symptoms and gain some control of your life. No one needs to pity you for anything. Once you start viewing this from a rational point of view, you will be able to explain it better to your family. I hope this helps. Take care.

Hello doctor,I think I have social anxiety, but I am not sure if it is affecting my life enough to do anything about it. I do not want to tell my mom, but I am sure therapy would help as I am very insecure, have a negative mindset, and generally I am very paranoid of what others think.I do not know how I will hold a job as I hate others observing me and hate confrontation and I am worried about interacting with customers, etc. Is social anxiety an essential one to get treated? How to tell my mom without making her worry.

Hello, Welcome to Chat Doctor forum. I understand you are quite worried and frightened about your problems. Social anxiety is common, and it is all about what it does that affects the people more. Your worries about your inability to hold on to a job and avoiding social situations are valid. It is very important to treat social anxiety because if left untreated it will gradually keep increasing and you may end up feeling frustrated and depressed as well. Regarding explaining this to your mother, you can read and find it easy to understand articles regarding social anxiety and ask your mother to go through that. First of all, you need to make her understand that it is an illness like diabetes or hypertension. If it is an illness, it has some symptoms and a proper course and treatment as well. If you had diabetes, would your mother pity you? No, she would ask you to consult a doctor. Similarly, in this case, you will need medicines as well as therapy to overcome your symptoms and gain some control of your life. No one needs to pity you for anything. Once you start viewing this from a rational point of view, you will be able to explain it better to your family. I hope this helps. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,The dermatologist has said that I have urticaria (hives) and prescribed Deflazacort 6 mg and Hydroxyzine HCl, but I am 28 weeks pregnant. Can I take those medicines? Suspecting it is chickenpox. The itching started 10 days ago, rashes started five days ago. Appears to be small red bumps on thighs and hands. Then appearing as water blisters and healing now. ### Response: Hi, Welcome to Chat Doctor forum. Deflazacort is corticosteroids and can be used as per need but can interact with diabetic medications and will act as an anti-inflammatory and can give side effects like weight gain, mood variations, vomitings, etc. Hy ChatDoctor. Suspecting chicken pox at 28 weeks, you need to report urgently to treating obstetrician. If you tell within 24 hours of the appearance of the lesion, you can have medications like Acyclovir. If severe symptoms, it can be given orally as well. Chicken pox first needs to check as urgent before treatment for IgG and IgM as well ( IgM recent infection and IgG already immunized petient). In pregnancy, the vaccine could not be given as it is a live attenuated vaccine but after 20 weeks if patient reports within 24 hours of having confirmed leisions of chicken pox could have medical treatment. Take it seriously and just report to your treating obstetrician to have proper examination and treatment accordingly. But it seems you have spent most of the infectious and symptomatic period already but better to have a check up immediately and do have electronic fetal monitoring to check fetal well-being. Continue Iron and Calcium supplements. A healthy balanced diet with less salt, sugar, oil and spice. Have isolation, try to avoid chil

Hi doctor,The dermatologist has said that I have urticaria (hives) and prescribed Deflazacort 6 mg and Hydroxyzine HCl, but I am 28 weeks pregnant. Can I take those medicines? Suspecting it is chickenpox. The itching started 10 days ago, rashes started five days ago. Appears to be small red bumps on thighs and hands. Then appearing as water blisters and healing now.

Hi, Welcome to Chat Doctor forum. Deflazacort is corticosteroids and can be used as per need but can interact with diabetic medications and will act as an anti-inflammatory and can give side effects like weight gain, mood variations, vomitings, etc. Hy ChatDoctor. Suspecting chicken pox at 28 weeks, you need to report urgently to treating obstetrician. If you tell within 24 hours of the appearance of the lesion, you can have medications like Acyclovir. If severe symptoms, it can be given orally as well. Chicken pox first needs to check as urgent before treatment for IgG and IgM as well ( IgM recent infection and IgG already immunized petient). In pregnancy, the vaccine could not be given as it is a live attenuated vaccine but after 20 weeks if patient reports within 24 hours of having confirmed leisions of chicken pox could have medical treatment. Take it seriously and just report to your treating obstetrician to have proper examination and treatment accordingly. But it seems you have spent most of the infectious and symptomatic period already but better to have a check up immediately and do have electronic fetal monitoring to check fetal well-being. Continue Iron and Calcium supplements. A healthy balanced diet with less salt, sugar, oil and spice. Have isolation, try to avoid chil

### Instruction: Answer this question truthfully ###Input: Hi doctor,The patient is a 59-year-old male with whose weight is 52.3 kg and height is 166 cm. His PSA was 247.5. He had a TRUS guided biopsy, and the report is as follows.1. Moderately differentiated adenocarcinoma.2. Gleason grade 4+4.3. Perineural invasion present.What does the biopsy report say? What will be the next step? What medicine should the patient take at the initial stage before any surgery? The patient is on Tamdura for the prostate issue and Diamicron MR 30 for diabetes. ### Response: Hi. I am sorry to know about the problem. The biopsy report says that prostate has a cancer disease. Since PSA is very high, it means that there is a chance that it has spread outside the prostate. The next step will be PSMA PET scan to find out the areas in the body affected by prostate cancer. If this scan is not available, you can get an MRI scan of the abdomen to check local involvement or lymph node involvement along with bone scan to find out bone metastasis. The treatment depends on the stage of disease. If it has spread to bones, then bilateral orchidectomy (removal of testes) is the standard treatment. If the patient does not want orchidectomy, then can get regular injections (once in 3 months) to suppress the testicular function. The patient should also take injection Zole ChatDoctor. Other than these, there is a need for calcium supplements and iron supplements. Please consult the Urologist for regular follow up, since the treatment needs to be modified according to the response of PSA and clinical factors. PSMA PET scan or MRI abdomen with bone scan. Metastatic carcinoma prostate.

Hi doctor,The patient is a 59-year-old male with whose weight is 52.3 kg and height is 166 cm. His PSA was 247.5. He had a TRUS guided biopsy, and the report is as follows.1. Moderately differentiated adenocarcinoma.2. Gleason grade 4+4.3. Perineural invasion present.What does the biopsy report say? What will be the next step? What medicine should the patient take at the initial stage before any surgery? The patient is on Tamdura for the prostate issue and Diamicron MR 30 for diabetes.

Hi. I am sorry to know about the problem. The biopsy report says that prostate has a cancer disease. Since PSA is very high, it means that there is a chance that it has spread outside the prostate. The next step will be PSMA PET scan to find out the areas in the body affected by prostate cancer. If this scan is not available, you can get an MRI scan of the abdomen to check local involvement or lymph node involvement along with bone scan to find out bone metastasis. The treatment depends on the stage of disease. If it has spread to bones, then bilateral orchidectomy (removal of testes) is the standard treatment. If the patient does not want orchidectomy, then can get regular injections (once in 3 months) to suppress the testicular function. The patient should also take injection Zole ChatDoctor. Other than these, there is a need for calcium supplements and iron supplements. Please consult the Urologist for regular follow up, since the treatment needs to be modified according to the response of PSA and clinical factors. PSMA PET scan or MRI abdomen with bone scan. Metastatic carcinoma prostate.

### Instruction: Answer this question truthfully ###Input: Dear doctor,This is about a tumor in the kidney case as follows.On the night of 14th, the patient found blood stain in the urine. No pain, no other symptoms.On 15th morning, after drinking two glasses of water, he developed pain in lower abdomen and back. Got an ultrasound done. Ultrasound showed a tumor in the left kidney (report attached).On 16th, we got a CT scan done and it showed a big mass arising from the lower pole of the left kidney of size 8.8(AP)*6.9(TR)*7.4(SI) cm and doctor suggested surgery which involves removal of the kidney to save from spreading.Let me know if kidney can be saved and disease eradicated and controlled from spreading further. ### Response: Hello. It looks a large tumor in the left kidney. The reports (attachment removed to protect patient identity) show that the disease is localized and not spread to other parts. The only curative treatment for this tumor is surgery (removal of affected kidney along with the whole tumor). It is difficult to save the kidney because of the large tumor size, but the surgeon will review the CT scan films with the radiologist to decide finally regarding any chance of saving the kidney. After surgery (removal of the tumor), the pathological report will be available which will show the type of tumor and pathological stage. That will guide us whether further treatment is needed or not. You have not attached kidney RFT/LFT, serum chemistry, LDH, alkaline phosphate blood test reports. So that I can tell you whether further tests are needed or not like isotope bone scan, etc. After surgery usually prognosis is good depending on the pathological report. For more information consult a medical oncologist online Take care.

Dear doctor,This is about a tumor in the kidney case as follows.On the night of 14th, the patient found blood stain in the urine. No pain, no other symptoms.On 15th morning, after drinking two glasses of water, he developed pain in lower abdomen and back. Got an ultrasound done. Ultrasound showed a tumor in the left kidney (report attached).On 16th, we got a CT scan done and it showed a big mass arising from the lower pole of the left kidney of size 8.8(AP)*6.9(TR)*7.4(SI) cm and doctor suggested surgery which involves removal of the kidney to save from spreading.Let me know if kidney can be saved and disease eradicated and controlled from spreading further.

Hello. It looks a large tumor in the left kidney. The reports (attachment removed to protect patient identity) show that the disease is localized and not spread to other parts. The only curative treatment for this tumor is surgery (removal of affected kidney along with the whole tumor). It is difficult to save the kidney because of the large tumor size, but the surgeon will review the CT scan films with the radiologist to decide finally regarding any chance of saving the kidney. After surgery (removal of the tumor), the pathological report will be available which will show the type of tumor and pathological stage. That will guide us whether further treatment is needed or not. You have not attached kidney RFT/LFT, serum chemistry, LDH, alkaline phosphate blood test reports. So that I can tell you whether further tests are needed or not like isotope bone scan, etc. After surgery usually prognosis is good depending on the pathological report. For more information consult a medical oncologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 61 years old, male, 80 kg weight 165 cm height and I am a diabetic for the past 18 years and now I am on low carbo high fate diet (Keto). I am taking now januvia 100 mg tablet 1-0-1. I had a priking pain in the heart side of chest two days back and went to a hospital they have taken ECG, echo and blood test and found normal and hence they asked me to go for CT coronary angiogram. Find attached the CT-angio report. Please advice me what medicine I should take now to avoid heart atack in future. ### Response: Hello. It shows minor disease only. So, need to focus on healthy lifestyle which I guess you must be having, which includes healthy diet like avoiding oily fatty and high calorie diet. Regular exercises like walking or brisk walking according to your capacity. Such pricking pain are usually related to gastritis and reflux disease rather than cardiac. However, you may experience some exertional pain due to myocardial bridging which is usually benign. These 20-30 percent blockages would not cause any pain. In my opinion, you should be on Antiplatelet Statin combination like Ecosprin av 75/10 mg bedtime for long term, for preventive purpose. So, should discuss this with your treating doctor. If you get any pain on exertion which relieves with rest, then it may be due to myocardial bridging, then you may require beta blockers like Metoprolol. In the future, you should also undergo echo and TMT testing every 2-3 yearly to keep check on the blockages. Hope this helps you and get back if you have any doubts. Take care.

Hello doctor,I am 61 years old, male, 80 kg weight 165 cm height and I am a diabetic for the past 18 years and now I am on low carbo high fate diet (Keto). I am taking now januvia 100 mg tablet 1-0-1. I had a priking pain in the heart side of chest two days back and went to a hospital they have taken ECG, echo and blood test and found normal and hence they asked me to go for CT coronary angiogram. Find attached the CT-angio report. Please advice me what medicine I should take now to avoid heart atack in future.

Hello. It shows minor disease only. So, need to focus on healthy lifestyle which I guess you must be having, which includes healthy diet like avoiding oily fatty and high calorie diet. Regular exercises like walking or brisk walking according to your capacity. Such pricking pain are usually related to gastritis and reflux disease rather than cardiac. However, you may experience some exertional pain due to myocardial bridging which is usually benign. These 20-30 percent blockages would not cause any pain. In my opinion, you should be on Antiplatelet Statin combination like Ecosprin av 75/10 mg bedtime for long term, for preventive purpose. So, should discuss this with your treating doctor. If you get any pain on exertion which relieves with rest, then it may be due to myocardial bridging, then you may require beta blockers like Metoprolol. In the future, you should also undergo echo and TMT testing every 2-3 yearly to keep check on the blockages. Hope this helps you and get back if you have any doubts. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am an occupational therapist, and my client\\s mother would not let me talk to her neurologist even though I need to script some equipment. So I wanted to ask general questions, the client is 12 years old and has hydrocephalus and had many many surgeries as her shunts keep becoming blocked. She now has the most significant possible VP shunt in her brain, and recently (a couple of weeks ago) had a bleed after surgery, but that has been treated now, and she is going well.The client also has uncontrollable absence seizures, a chromosomal disorder, intellectual disability, connective tissue issues, hand deformity, and recently diagnosed tuberous sclerosis (skin and possibly in the brain). The client\\s mother would like me to complete a funding application for them to get a hospital bed at home, as the daughter (client) is currently sleeping upright with pillows.She said sleeping upright helps the shunt drain. I have not been able to find any research around this, and have also read about something that says over drainage can be an issue. Did you have any thoughts about this issue? Or if it is really client specific and I do need to contact her neurologist or neurosurgeon. ### Response: Hello. I read your question carefully and would explain the upright position (head of the bed 45 degrees) can help reduce the intracranial pressure. So, I agree with the patient that she feels better in this position. Regarding the medication, I would recommend Diamox and Furosemide to help reduce intracranial pressure. An anti-epilepsy ChatDoctor. I would suggest Valproate or Levetiracetam. I hope you will find this answer helpful. I remain at your disposal for any further questions whenever you need. Take care.

Hello doctor,I am an occupational therapist, and my client\\s mother would not let me talk to her neurologist even though I need to script some equipment. So I wanted to ask general questions, the client is 12 years old and has hydrocephalus and had many many surgeries as her shunts keep becoming blocked. She now has the most significant possible VP shunt in her brain, and recently (a couple of weeks ago) had a bleed after surgery, but that has been treated now, and she is going well.The client also has uncontrollable absence seizures, a chromosomal disorder, intellectual disability, connective tissue issues, hand deformity, and recently diagnosed tuberous sclerosis (skin and possibly in the brain). The client\\s mother would like me to complete a funding application for them to get a hospital bed at home, as the daughter (client) is currently sleeping upright with pillows.She said sleeping upright helps the shunt drain. I have not been able to find any research around this, and have also read about something that says over drainage can be an issue. Did you have any thoughts about this issue? Or if it is really client specific and I do need to contact her neurologist or neurosurgeon.

Hello. I read your question carefully and would explain the upright position (head of the bed 45 degrees) can help reduce the intracranial pressure. So, I agree with the patient that she feels better in this position. Regarding the medication, I would recommend Diamox and Furosemide to help reduce intracranial pressure. An anti-epilepsy ChatDoctor. I would suggest Valproate or Levetiracetam. I hope you will find this answer helpful. I remain at your disposal for any further questions whenever you need. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,What to do now? I was in love with a girl for five years when I was doing my college and then I told my parents and they did not agree. She also loved me back. In her home also they will not accept. Now both of us are not talking for the past one and half years. I am working now and she is studying now. I used to meet and send her texts when I got leave and miss her. Now she does not want to talk to me. This time I asked her if she is free to meet me. She told she is busy. Now, is she really over me or just protecting me? What should I do to get over her? Sometimes, I feel like everything is over between me and her but then suddenly I miss her a lot. Is this how it is going to be always? ### Response: Hi, Welcome to Chat Doctor forum. The best answer is to ask yourself whether you wish to and looking forward to marrying her or not? If not, you need to move on. A girl, unlike man, cannot call and text you just for the sake of pleasing you. Girls are always under the radar of their family and society. They need 110 percent assurance from you. They just cannot be your time pass. In your case, it is difficult for you to persuade your and her family but not impossible. If you really love each other you may have a fighting chance. During the last one and a half year of non-communication, she has probably decided to move on with her life as she got no real assurance from you. So call her, and try to meet her if you really are interested in marrying her. Or else, let her be a part of your good memories and move on.

Hello doctor,What to do now? I was in love with a girl for five years when I was doing my college and then I told my parents and they did not agree. She also loved me back. In her home also they will not accept. Now both of us are not talking for the past one and half years. I am working now and she is studying now. I used to meet and send her texts when I got leave and miss her. Now she does not want to talk to me. This time I asked her if she is free to meet me. She told she is busy. Now, is she really over me or just protecting me? What should I do to get over her? Sometimes, I feel like everything is over between me and her but then suddenly I miss her a lot. Is this how it is going to be always?

Hi, Welcome to Chat Doctor forum. The best answer is to ask yourself whether you wish to and looking forward to marrying her or not? If not, you need to move on. A girl, unlike man, cannot call and text you just for the sake of pleasing you. Girls are always under the radar of their family and society. They need 110 percent assurance from you. They just cannot be your time pass. In your case, it is difficult for you to persuade your and her family but not impossible. If you really love each other you may have a fighting chance. During the last one and a half year of non-communication, she has probably decided to move on with her life as she got no real assurance from you. So call her, and try to meet her if you really are interested in marrying her. Or else, let her be a part of your good memories and move on.

### Instruction: Answer this question truthfully ###Input: Hi doctor,Five years ago my mother was diagnosed with fibromyalgia. I think she also has rheumatoid arthritis. For the past five years, she was managing the pain with anti-inflammatory medicine, Lyrica, Mythycobal, Voltaren injections, herbal creams, etc. You can see the veins in her hands popping out. I also realized that the pain has got worse now.For about 12 months the doctor put her only on Prednisolone 5 mg/day and painkiller when necessary. She was fine till last month but the pain increased in her hands now. In the daytime she is fine and the pain starts mildly in the evening. When she lies down in the bed she gets electrical tingling in her legs by which her sleep gets disturbed. She has undergone several tests last week and I attached them for your reference. She did not consult a rheumatologist yet. What medication can I give to reduce the inflammation and cure her? Her ESR, CPR, and ANA are quite high. The pain in her hands and the tingling in her legs at night are agonizing her life. Kindly provide your expert advice. ### Response: Hi, Welcome to Chat Doctor forum. First of all your mother does not have rheumatoid arthritis or fibromyalgia. From her reports (attachment removed to protect patient identity) I found that she has connective tissue disorder and the most possible diagnosis would be systemic lupus erythematosus (SLE). The joint pain, high ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), positive ANA (antinuclear antibody) and response to Prednisolone favors the diagnosis of connective tissue disorder. She definitely does not have functional pain which occurs in fibromyalgia. Her pain and suffering are very true.Now to help you better I need some more details

Hi doctor,Five years ago my mother was diagnosed with fibromyalgia. I think she also has rheumatoid arthritis. For the past five years, she was managing the pain with anti-inflammatory medicine, Lyrica, Mythycobal, Voltaren injections, herbal creams, etc. You can see the veins in her hands popping out. I also realized that the pain has got worse now.For about 12 months the doctor put her only on Prednisolone 5 mg/day and painkiller when necessary. She was fine till last month but the pain increased in her hands now. In the daytime she is fine and the pain starts mildly in the evening. When she lies down in the bed she gets electrical tingling in her legs by which her sleep gets disturbed. She has undergone several tests last week and I attached them for your reference. She did not consult a rheumatologist yet. What medication can I give to reduce the inflammation and cure her? Her ESR, CPR, and ANA are quite high. The pain in her hands and the tingling in her legs at night are agonizing her life. Kindly provide your expert advice.

Hi, Welcome to Chat Doctor forum. First of all your mother does not have rheumatoid arthritis or fibromyalgia. From her reports (attachment removed to protect patient identity) I found that she has connective tissue disorder and the most possible diagnosis would be systemic lupus erythematosus (SLE). The joint pain, high ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), positive ANA (antinuclear antibody) and response to Prednisolone favors the diagnosis of connective tissue disorder. She definitely does not have functional pain which occurs in fibromyalgia. Her pain and suffering are very true.Now to help you better I need some more details

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have had many years of health problems including severe joint pain, inability to lose weight, chronic fatigue, transient pains, and abdominal pains that seem to come and go in cycles sometimes lasting for days or even months. I have a medical phobia, so have not been to the doctor unless it was an emergency. But over 20 years ago I ended up going to the ER and had several tests. I was told I had lupus, osteoarthritis, PCOS, and thyroid issues. I have tried to treat myself and pain naturally over the years with a healthy lifestyle and natural aids, but the pain finally became so bad over the last couple of years that I have gone to some appointments.I was referred to a rhuematologist that did blood work and said I was fine except low vitamin D. I told the new doctor about the early diagnosis and she said it was probably wrong but she would run blood test anyway. When the test results came back, she said I did not have an autoimmune problem and I was fine except that I had low Vitamin D. I have a copy of the test results that look like there are some problems to me and based on her reviews and my personal experience with my health, I would very much like a second opinion. I am taking Xanax when needed. Some tests are attached. I have also had an MRI that showed osteitis pubis, fatty liver, and mild bladder inflammation. ### Response: Hello, Welcome to Chat Doctor forum. I have gone through your history and blood reports. (attachment removed to protect patient identity). I found a few abnormalities which I would like to ask a few more details on and also some more questions pertaining to your problem which would help us reach a conclusive diagnosis. Do you experience any ChatDoctor.

Hello doctor,I have had many years of health problems including severe joint pain, inability to lose weight, chronic fatigue, transient pains, and abdominal pains that seem to come and go in cycles sometimes lasting for days or even months. I have a medical phobia, so have not been to the doctor unless it was an emergency. But over 20 years ago I ended up going to the ER and had several tests. I was told I had lupus, osteoarthritis, PCOS, and thyroid issues. I have tried to treat myself and pain naturally over the years with a healthy lifestyle and natural aids, but the pain finally became so bad over the last couple of years that I have gone to some appointments.I was referred to a rhuematologist that did blood work and said I was fine except low vitamin D. I told the new doctor about the early diagnosis and she said it was probably wrong but she would run blood test anyway. When the test results came back, she said I did not have an autoimmune problem and I was fine except that I had low Vitamin D. I have a copy of the test results that look like there are some problems to me and based on her reviews and my personal experience with my health, I would very much like a second opinion. I am taking Xanax when needed. Some tests are attached. I have also had an MRI that showed osteitis pubis, fatty liver, and mild bladder inflammation.

Hello, Welcome to Chat Doctor forum. I have gone through your history and blood reports. (attachment removed to protect patient identity). I found a few abnormalities which I would like to ask a few more details on and also some more questions pertaining to your problem which would help us reach a conclusive diagnosis. Do you experience any ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I just want to start off by saying that I am a 24-year-old male. I have been diagnosed with IBS in the past, and for about a good seven months I have had stomach issues on and off. Nothing serious, no weight loss or any large amounts of blood in the stool. I had one CT scan the first time six months ago and my abdomen was fine. I did one about a month ago, and they found numerous pericecal enlarged lymph nodes measuring up to 12 mm that may represent mesenteric adenitis. I am afraid that this is stage 4 colon cancer. All my GI doctors think it is not necessary to do a colonoscopy, and that I am too young to have anything wrong with me and it is probably nothing. I did just find out that I had a grandfather who had a blockage in colon a very long time ago but received no cancer treatment for it. Should I consult a GI doctor? Are this grounds for concern? ### Response: Hi, Welcome to Chat Doctor forum. See as such mesenteric lymphadenitis does not directly represent colon cancer. It is very commonly seen post infection. So what we do is that we give antibiotics for seven days and later repeat an ultrasound abdomen after one month to check for the size of lymph nodes. If size are decreasing in size we simply wait and watch. Actually, these lymph nodes if once increased in size may take weeks to months to come down to normal size. Even you do not have any symptoms of colon cancer. However, your suspected family history should make us little concern. So I would recommend you to take a Gastroenterologist consultation and simply get a stool for occult blood done. If this test comes out to be positive then you would need a colonoscopy.

Hello doctor,I just want to start off by saying that I am a 24-year-old male. I have been diagnosed with IBS in the past, and for about a good seven months I have had stomach issues on and off. Nothing serious, no weight loss or any large amounts of blood in the stool. I had one CT scan the first time six months ago and my abdomen was fine. I did one about a month ago, and they found numerous pericecal enlarged lymph nodes measuring up to 12 mm that may represent mesenteric adenitis. I am afraid that this is stage 4 colon cancer. All my GI doctors think it is not necessary to do a colonoscopy, and that I am too young to have anything wrong with me and it is probably nothing. I did just find out that I had a grandfather who had a blockage in colon a very long time ago but received no cancer treatment for it. Should I consult a GI doctor? Are this grounds for concern?

Hi, Welcome to Chat Doctor forum. See as such mesenteric lymphadenitis does not directly represent colon cancer. It is very commonly seen post infection. So what we do is that we give antibiotics for seven days and later repeat an ultrasound abdomen after one month to check for the size of lymph nodes. If size are decreasing in size we simply wait and watch. Actually, these lymph nodes if once increased in size may take weeks to months to come down to normal size. Even you do not have any symptoms of colon cancer. However, your suspected family history should make us little concern. So I would recommend you to take a Gastroenterologist consultation and simply get a stool for occult blood done. If this test comes out to be positive then you would need a colonoscopy.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have been experiencing flare-ups for weeks now. I do not know if this has something to do with the change of weather. I have been having trouble sleeping lately since I am very uncomfortable right now. I am using Cetaphil gentle wash and shampoo because my scalp gets itchy as well. I am using Elica ointment and somehow it helps me with some of the areas that are not really that worse, however, the uncomfortable feeling is still there. Sometimes I take antihistamines, however, I do not think that it helps me feel relieved with my atopic dermatitis.I am 28 years old and a project manager. My clients are in the US and I need to follow their timezone, my shift starts at 10 PM to 7 AM. I weigh around 190 lbs and I am 5\\1\". I also have an irregular menstrual cycle, and I usually get my period every quarter. I have asthma and I am currently taking Seretide inhaler as prescribed by my doctor. Please help. ### Response: Hi. Atopic dermatitis is relatively more sort of relapsing with seasonal aggravation. It has a genetic and familial component as well. If you have severe symptoms which is hampering your daily activities you need to start with systemic immunosuppressants like Prednisolone and or Azathioprine. Elica ointment i.e. Mometasone is good enough for skin lesions. But I would rather add on Tacrolimus gel 0.1% over the inflamed lesions. But you need to use moisturizers very frequently than previous. You need to take antihistamine on a daily basis. Reduce your stress. Avoid wool and strong soaps. Practice wet wrap therapy. I hope this helps.

Hi doctor,I have been experiencing flare-ups for weeks now. I do not know if this has something to do with the change of weather. I have been having trouble sleeping lately since I am very uncomfortable right now. I am using Cetaphil gentle wash and shampoo because my scalp gets itchy as well. I am using Elica ointment and somehow it helps me with some of the areas that are not really that worse, however, the uncomfortable feeling is still there. Sometimes I take antihistamines, however, I do not think that it helps me feel relieved with my atopic dermatitis.I am 28 years old and a project manager. My clients are in the US and I need to follow their timezone, my shift starts at 10 PM to 7 AM. I weigh around 190 lbs and I am 5\\1\". I also have an irregular menstrual cycle, and I usually get my period every quarter. I have asthma and I am currently taking Seretide inhaler as prescribed by my doctor. Please help.

Hi. Atopic dermatitis is relatively more sort of relapsing with seasonal aggravation. It has a genetic and familial component as well. If you have severe symptoms which is hampering your daily activities you need to start with systemic immunosuppressants like Prednisolone and or Azathioprine. Elica ointment i.e. Mometasone is good enough for skin lesions. But I would rather add on Tacrolimus gel 0.1% over the inflamed lesions. But you need to use moisturizers very frequently than previous. You need to take antihistamine on a daily basis. Reduce your stress. Avoid wool and strong soaps. Practice wet wrap therapy. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 32-year-old female. And I have got throat pain on 22nd and met a doctor on 26th for the same. He gave me Azee 250 mg and one multivitamin for five days and I have taken it till 30th. From that day I am doing basic gargling and taking milk with pepper and haldi in the night. But yesterday I got the message that whoever visited one mall from the date 10th -17th and having any symptoms of Covid-19 should seek medical support. I visited that mall on 12th and after that, I got throat pain but it is already 22 days since I visited that mall and almost 10 days I have this throat pain. Should I consider this throat pain as a symptom? I do not have any temperature or any other problem. I called the helpline and told them that I visited the mall on 12th March but not that particular shop and told me about my current situation and the person told me to take the Azee tablet for two more days if I still have mild throat pain. I want to know since it is already 22 days I visited the mall and also my throat pain is already there for almost 10 days, do I need to worry about anything? I am very scared and panicked after seeing that news. Please help me with your suggestion. ### Response: Hi. Is there any cough or breathing difficulty or wheezing? Does anyone else in your family have similar symptoms? Is there any nasal congestion or discharge or block? Can you please take a picture of the back of the throat with open mouth showing details of the affected area and send it to me?

Hello doctor,I am a 32-year-old female. And I have got throat pain on 22nd and met a doctor on 26th for the same. He gave me Azee 250 mg and one multivitamin for five days and I have taken it till 30th. From that day I am doing basic gargling and taking milk with pepper and haldi in the night. But yesterday I got the message that whoever visited one mall from the date 10th -17th and having any symptoms of Covid-19 should seek medical support. I visited that mall on 12th and after that, I got throat pain but it is already 22 days since I visited that mall and almost 10 days I have this throat pain. Should I consider this throat pain as a symptom? I do not have any temperature or any other problem. I called the helpline and told them that I visited the mall on 12th March but not that particular shop and told me about my current situation and the person told me to take the Azee tablet for two more days if I still have mild throat pain. I want to know since it is already 22 days I visited the mall and also my throat pain is already there for almost 10 days, do I need to worry about anything? I am very scared and panicked after seeing that news. Please help me with your suggestion.

Hi. Is there any cough or breathing difficulty or wheezing? Does anyone else in your family have similar symptoms? Is there any nasal congestion or discharge or block? Can you please take a picture of the back of the throat with open mouth showing details of the affected area and send it to me?

### Instruction: Answer this question truthfully ###Input: Hi doctor,Before a month, someone who has labial herpes kissed me on my cheek. After that, my lips were burning, but I did not apply any lotion on the lips till now. I am a little bit hypochondriac. Before two days I met my boyfriend and I kissed him on the cheeks. The next day, I feel pain on my chin and after that I had something like acne there and then I had two aphthous ulcers at an interval of two to three days. One under my tongue and another inside the cheek or lip. Now, my boyfriend has headache and throat pain. He thinks it is the beginning of an upper respiratory tract infection. Could it be his primary infection? Did I pass herpes to him? Can we do a viral culture of his throat to know whether HSV-1 is present or not? Is am I HSV positive? Please help. ### Response: Hi. As I understand you are conscious about you and your friend\\s health. But, no need to worry. First, I would like to tell you that herpes infection are transmitted by direct contact like kissing and manifest with multiple painful vesicle, which may develop to ulceration associated with pharyngitis or ulcer over oral mucosa. So, if you had a kiss by a confirm case of Herpes labialis, you may get such infection. But, it is not always an infection to convert into a disease as body\\s immune system protects us from such kind of pathogen. I do not think to go for viral culture as it will not help in deciding treatment plan. Viral infection usually gets cured itself within 10 to 14 days. We need to do symptomatic treatment and maintain good nutrition and hy ChatDoctor. You may be having a herpes infection, but do not worry.

Hi doctor,Before a month, someone who has labial herpes kissed me on my cheek. After that, my lips were burning, but I did not apply any lotion on the lips till now. I am a little bit hypochondriac. Before two days I met my boyfriend and I kissed him on the cheeks. The next day, I feel pain on my chin and after that I had something like acne there and then I had two aphthous ulcers at an interval of two to three days. One under my tongue and another inside the cheek or lip. Now, my boyfriend has headache and throat pain. He thinks it is the beginning of an upper respiratory tract infection. Could it be his primary infection? Did I pass herpes to him? Can we do a viral culture of his throat to know whether HSV-1 is present or not? Is am I HSV positive? Please help.

Hi. As I understand you are conscious about you and your friend\\s health. But, no need to worry. First, I would like to tell you that herpes infection are transmitted by direct contact like kissing and manifest with multiple painful vesicle, which may develop to ulceration associated with pharyngitis or ulcer over oral mucosa. So, if you had a kiss by a confirm case of Herpes labialis, you may get such infection. But, it is not always an infection to convert into a disease as body\\s immune system protects us from such kind of pathogen. I do not think to go for viral culture as it will not help in deciding treatment plan. Viral infection usually gets cured itself within 10 to 14 days. We need to do symptomatic treatment and maintain good nutrition and hy ChatDoctor. You may be having a herpes infection, but do not worry.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My mom had cough and cold which continued for a week. We conducted X-ray which indicated too much cough congestion in the chest and TLC count was 18K. One day, due to too much cough she vomited, and she was injected with a medicine to stop it and it worked. Next day, we went abroad for a week and as soon as we came back, we reconducted the X-ray which still indicates congestion is there and TLC count is now 15K. But she is getting fever since two days reaching up to 103. Crocin is not reducing it. I am really worried. Is it a viral fever? Or is it because of congestion. I am attaching the prescription/ medicines which she is taking as well as the latest blood report. ### Response: Hello. It is not a viral infection but a bacterial infection as her TLC has increased. Also, diabetic patients are prone to such infection. Treatment is antibiotics, which she has been started by her physician. In most patients, this resolves with a week. Continue other medicines as prescribed. We should see a response in 24 to 48 hours. If there is no improvement in fever, cough, or increase in her symptoms like increased shortness of breath, visit a hospital as her antibiotics will need to be escalated and she may need higher IV antibiotics. If you have electronic BP apparatus, then monitor BP twice a day. Excessive fall in BP or decreased frequency of urination are some of the warning signs. Repeat TLC, urea and creatinine test to see antibiotics response. So overall, a majority of the patients recover well but some amount of risk is always there in such infections. Hope this helps you and get back if you have any doubts. Take care.

Hello doctor,My mom had cough and cold which continued for a week. We conducted X-ray which indicated too much cough congestion in the chest and TLC count was 18K. One day, due to too much cough she vomited, and she was injected with a medicine to stop it and it worked. Next day, we went abroad for a week and as soon as we came back, we reconducted the X-ray which still indicates congestion is there and TLC count is now 15K. But she is getting fever since two days reaching up to 103. Crocin is not reducing it. I am really worried. Is it a viral fever? Or is it because of congestion. I am attaching the prescription/ medicines which she is taking as well as the latest blood report.

Hello. It is not a viral infection but a bacterial infection as her TLC has increased. Also, diabetic patients are prone to such infection. Treatment is antibiotics, which she has been started by her physician. In most patients, this resolves with a week. Continue other medicines as prescribed. We should see a response in 24 to 48 hours. If there is no improvement in fever, cough, or increase in her symptoms like increased shortness of breath, visit a hospital as her antibiotics will need to be escalated and she may need higher IV antibiotics. If you have electronic BP apparatus, then monitor BP twice a day. Excessive fall in BP or decreased frequency of urination are some of the warning signs. Repeat TLC, urea and creatinine test to see antibiotics response. So overall, a majority of the patients recover well but some amount of risk is always there in such infections. Hope this helps you and get back if you have any doubts. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 25 year old guy. I am working in a private company although my dream is to work in government sector. I have that caliber which I know and I believe I can, but the problem with me is nowadays, I take everything for granted. I lost my father three years back. Till then, everything was fine as my bonding with him was like a friend. I used to discuss a lot of things with him just like a friend. After him, I have to take care of the responsibility of my family which was not like that actually. I have spent a big amount of his savings. Now even I know the financial stage of my family. If I do not get a government job, it will not be possible to live the life the way I want to. I am not happy at all with my private sector job. A year back, I had a breakup with my longtime girlfriend.The problem now is although I know the outcome of everything, I am not working towards my goal .instead, I am a regular drinker. I really want to stop drinking. I keep myself motivated that I will not drink today but somehow I do end up drinking. It all started after my father\\s death. I do not want to make it an excuse for my drinking habit but still, I do not know how to leave this habit. I am losing so much due to these things. I feel like I am behaving like a numb person even after knowing everything. I live alone as well. What should I do? ### Response: Hello. I have gone through your problem and understand your concern. It is clear that after the death of your father, you were not able to handle the pressure of responsibility and started ChatDoctor. As you are regularly

Hello doctor,I am a 25 year old guy. I am working in a private company although my dream is to work in government sector. I have that caliber which I know and I believe I can, but the problem with me is nowadays, I take everything for granted. I lost my father three years back. Till then, everything was fine as my bonding with him was like a friend. I used to discuss a lot of things with him just like a friend. After him, I have to take care of the responsibility of my family which was not like that actually. I have spent a big amount of his savings. Now even I know the financial stage of my family. If I do not get a government job, it will not be possible to live the life the way I want to. I am not happy at all with my private sector job. A year back, I had a breakup with my longtime girlfriend.The problem now is although I know the outcome of everything, I am not working towards my goal .instead, I am a regular drinker. I really want to stop drinking. I keep myself motivated that I will not drink today but somehow I do end up drinking. It all started after my father\\s death. I do not want to make it an excuse for my drinking habit but still, I do not know how to leave this habit. I am losing so much due to these things. I feel like I am behaving like a numb person even after knowing everything. I live alone as well. What should I do?

Hello. I have gone through your problem and understand your concern. It is clear that after the death of your father, you were not able to handle the pressure of responsibility and started ChatDoctor. As you are regularly

### Instruction: Answer this question truthfully ###Input: Hello doctor,I feel like I may be pregnant. I have been constipated, bad back pains, been very fatigued, nauseous, and often feeling of having to pee. I have not fully missed a period but had a very light period a little over a week ago, it was way darker than normal also very light and lasted for maybe two days. Which is odd because I have been taking birth control for almost three years now so my period has become very regular and the same consistency each time. Also another weird thing, since I am curious if I am with child or not, I have stopped taking my birth control, and as you should know, when you stop taking it the next day you bleed. Which is what normally happens to me if I miss one. But, I have not had any blood at all and it has been four days now. A week back, I took two pregnancy tests which both came out negative. Is it possible that I have taken the tests too early? I am going to a clinic today but not sure if I should. ### Response: Hello, Welcome to Chat Doctor forum. Learning that you have been taking your birth control since last three years regularly, the bleeding that you had a week before in form of scanty menses was a breakthrough bleed and can happen in cases with prolonged oral contraceptive pill uses. The pregnancy test is negative, which it should be. The menses should generally occur after 5 to 7 days post stoppage pill pack. So, if no menses in a week, post-pill stoppage then a serum beta hCG test may be done to rule out any pregnancy conclusively first and if negative then you should wait for the menses to occur (the symptoms experienced are then premenstrual symptoms and not for pregnancy).

Hello doctor,I feel like I may be pregnant. I have been constipated, bad back pains, been very fatigued, nauseous, and often feeling of having to pee. I have not fully missed a period but had a very light period a little over a week ago, it was way darker than normal also very light and lasted for maybe two days. Which is odd because I have been taking birth control for almost three years now so my period has become very regular and the same consistency each time. Also another weird thing, since I am curious if I am with child or not, I have stopped taking my birth control, and as you should know, when you stop taking it the next day you bleed. Which is what normally happens to me if I miss one. But, I have not had any blood at all and it has been four days now. A week back, I took two pregnancy tests which both came out negative. Is it possible that I have taken the tests too early? I am going to a clinic today but not sure if I should.

Hello, Welcome to Chat Doctor forum. Learning that you have been taking your birth control since last three years regularly, the bleeding that you had a week before in form of scanty menses was a breakthrough bleed and can happen in cases with prolonged oral contraceptive pill uses. The pregnancy test is negative, which it should be. The menses should generally occur after 5 to 7 days post stoppage pill pack. So, if no menses in a week, post-pill stoppage then a serum beta hCG test may be done to rule out any pregnancy conclusively first and if negative then you should wait for the menses to occur (the symptoms experienced are then premenstrual symptoms and not for pregnancy).

### Instruction: Answer this question truthfully ###Input: Hello doctor,My nephew is 6-year-old, and weight is 20 kg, had been detected with ADHD from three years. We had started his medication and behavior therapy around 40 days back under the consultation of pediatrics and psychologist. After 10 days, we consulted a neuro-psychiatrist who recommended us EEG brain (sleep). The report of EEG was abnormal, whereby non-epileptic discharges were captured. The doctor prescribed liquid Valprol in some dosage.Since the finding was abnormal, we thought of getting a second opinion from a neurologist with video EEG this time. The video EEG (awake and asleep) under consultation with senior neurologist gave absolute normal findings. We showed this video EEG report to the previous doctor and asked him why is the difference in his (abnormal) and elsewhere video EEG (normal) report. The former doctor said that once the patient has been detected with abnormal findings, then subsequent normal findings cannot contradict the fact that the patient has the issue of non-epileptic discharge. We are confused about whether we should give him the syrup Valprol or not. ### Response: Hello, Welcome to Chat Doctor forum. I have read your concern and seen the reports (attachment removed to protect patient identity). It seems like there is a discrepancy. It would be wise taking to account both results are true positives. It is warranted to that you go to your child neurologist to confirm if these are seizures. Most of the time, a video EEG (electroencephalography) confirms the presence of seizures. If it was not caught on video EEG, a thorough history and physical exam are warranted for your nephew. You can continue the valprol for now and let your neurologist discontinue it on the proper time.

Hello doctor,My nephew is 6-year-old, and weight is 20 kg, had been detected with ADHD from three years. We had started his medication and behavior therapy around 40 days back under the consultation of pediatrics and psychologist. After 10 days, we consulted a neuro-psychiatrist who recommended us EEG brain (sleep). The report of EEG was abnormal, whereby non-epileptic discharges were captured. The doctor prescribed liquid Valprol in some dosage.Since the finding was abnormal, we thought of getting a second opinion from a neurologist with video EEG this time. The video EEG (awake and asleep) under consultation with senior neurologist gave absolute normal findings. We showed this video EEG report to the previous doctor and asked him why is the difference in his (abnormal) and elsewhere video EEG (normal) report. The former doctor said that once the patient has been detected with abnormal findings, then subsequent normal findings cannot contradict the fact that the patient has the issue of non-epileptic discharge. We are confused about whether we should give him the syrup Valprol or not.

Hello, Welcome to Chat Doctor forum. I have read your concern and seen the reports (attachment removed to protect patient identity). It seems like there is a discrepancy. It would be wise taking to account both results are true positives. It is warranted to that you go to your child neurologist to confirm if these are seizures. Most of the time, a video EEG (electroencephalography) confirms the presence of seizures. If it was not caught on video EEG, a thorough history and physical exam are warranted for your nephew. You can continue the valprol for now and let your neurologist discontinue it on the proper time.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had a CT scan today and two punctate stones were found in the mid-lower portion of my right kidney. I was advised they measured 1 to 2 mm. I currently have urologic issues of possible stricture near the tip of the penis. In addition, I have a lifelong urine flow issue where the flow is not strong. I have not spoken to my urologist yet but given my history of possible stricture and weak flow, I am concerned about my ability to pass these on my own. I would like your opinion on my options. Is lithotripsy an option? Can these stones get bigger? Does the location of the stones have any significance? I did have calcium oxalate stones seven years ago. At the moment, I do not have bad pain. A recent urine culture found no infection. If these are calcium oxalate too, anything I can do to may help dissolve them given they are small? ### Response: Hello. Relax and do not worry. 1 to 2 mm stones in lower pole are very, very small in size. As far as treatment is concerned, they do not require any treatment like lithotripsy because they are very very small. Regarding precautions, you should take precautions to prevent their increase in size. You need to ChatDoctor. 5 liters per day. You need to take food containing low in oxalates. There are so many foods having oxalates. A complete list you can get from the internet. So, avoid these foods. You can follow up with the ultrasound every six months to check for an increase in size. Regarding stricture, you require may be a cystoscopy and optical urethrotomy as adviced by your urologist. For more information consult a urologist online

Hello doctor,I had a CT scan today and two punctate stones were found in the mid-lower portion of my right kidney. I was advised they measured 1 to 2 mm. I currently have urologic issues of possible stricture near the tip of the penis. In addition, I have a lifelong urine flow issue where the flow is not strong. I have not spoken to my urologist yet but given my history of possible stricture and weak flow, I am concerned about my ability to pass these on my own. I would like your opinion on my options. Is lithotripsy an option? Can these stones get bigger? Does the location of the stones have any significance? I did have calcium oxalate stones seven years ago. At the moment, I do not have bad pain. A recent urine culture found no infection. If these are calcium oxalate too, anything I can do to may help dissolve them given they are small?

Hello. Relax and do not worry. 1 to 2 mm stones in lower pole are very, very small in size. As far as treatment is concerned, they do not require any treatment like lithotripsy because they are very very small. Regarding precautions, you should take precautions to prevent their increase in size. You need to ChatDoctor. 5 liters per day. You need to take food containing low in oxalates. There are so many foods having oxalates. A complete list you can get from the internet. So, avoid these foods. You can follow up with the ultrasound every six months to check for an increase in size. Regarding stricture, you require may be a cystoscopy and optical urethrotomy as adviced by your urologist. For more information consult a urologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am suffering from health anxiety, and I am scared of ALS. I started getting muscle twitches all over my body about six months ago. It started after I stopped taking Valium 10 mg daily for seven months (in suppository form). However, they still occur. I have discontinued Benzodiazepines (Valium and Xanax) for about seven months. I am very focused on my every movement. I have done two neurology exams (one by a psychiatrist and one by a neurologist). Both were normal. I also did two EMG on the same day. The psychiatrist did an EMG, a paraspinal EMG and tested 28 muscles altogether. His impression was healthy except for isolated fasciculation potentials in the right medial gastrocnemius. However, the above muscle was silent at rest with standard motor unit configuration and usual recruitment pattern. He said the study was healthy and did not suggest any motor neuron disease. The neurologist tested again because I made him do it. He did the nerve study and EMG directly on my right hand and arm where I am complaining as well as left hand, left arm, and left leg. He did not find any fasciculations and said it is all normal. The doctor told I do not have ALS. Both the doctors said there is no need to repeat the test. My questions are ### Response: Hi. Your symptoms could be related to benign fasciculation syn ChatDoctor. Of course, anxiety can trigger this clinical situation. As your EMG (electromyography) was normal, we can exclude any possible ALS (amyotrophic lateral sclerosis). ALS patients also have an abnormal physical exam (neurological signs). So, I do not think that you suffer from ALS. I would just recommend performing further tests

Hi doctor,I am suffering from health anxiety, and I am scared of ALS. I started getting muscle twitches all over my body about six months ago. It started after I stopped taking Valium 10 mg daily for seven months (in suppository form). However, they still occur. I have discontinued Benzodiazepines (Valium and Xanax) for about seven months. I am very focused on my every movement. I have done two neurology exams (one by a psychiatrist and one by a neurologist). Both were normal. I also did two EMG on the same day. The psychiatrist did an EMG, a paraspinal EMG and tested 28 muscles altogether. His impression was healthy except for isolated fasciculation potentials in the right medial gastrocnemius. However, the above muscle was silent at rest with standard motor unit configuration and usual recruitment pattern. He said the study was healthy and did not suggest any motor neuron disease. The neurologist tested again because I made him do it. He did the nerve study and EMG directly on my right hand and arm where I am complaining as well as left hand, left arm, and left leg. He did not find any fasciculations and said it is all normal. The doctor told I do not have ALS. Both the doctors said there is no need to repeat the test. My questions are

Hi. Your symptoms could be related to benign fasciculation syn ChatDoctor. Of course, anxiety can trigger this clinical situation. As your EMG (electromyography) was normal, we can exclude any possible ALS (amyotrophic lateral sclerosis). ALS patients also have an abnormal physical exam (neurological signs). So, I do not think that you suffer from ALS. I would just recommend performing further tests

### Instruction: Answer this question truthfully ###Input: Hello doctor,I injured my back at work after lifting, pushing, and pulling boxes. The boxes weighed up to 75 lbs. I was diagnosed with sprain or strain of the lower lumbar spine. The pain varies from time to time. It happened a month ago, and I have had physical therapy for three weeks. The pain goes from the lower spine to the right lower part of the back, the abdomen, the groin, and leg. At first, the pain shot halfway between the hip and the knee. It got to the point of the knee, and then tonight I felt it go down to my ankle. At first, neither standing nor sitting helped, now sitting helps better. I have had three muscle relaxer injections and two steroid injections since this happened. I was on Ibuprofen 800 mg, thrice for three weeks. I was on Tramadol and Cyclobenzaprine for a week. I was also prescribed Metaxalone 800 mg, for three times a day. For a week, I was prescribed to take it two times a day. I have been prescribed to take extra-strength Tylenol and Gabapentin. I have been using ice and heat as directed since this happened and placed on lifting no more than 30 lbs, push or pull no more than 60 lbs and sitting 50 %. The pain is still present today, so I took my first dose of Gabapentin and Prednisolone. I need a second opinion. ### Response: Hello, Welcome to Chat Doctor forum. I have reviewed your question. I am sorry you are experiencing low back pain. In fact, nearly 80 % people experience back pain at some point in their life. For more information consult a chiropractor online

Hello doctor,I injured my back at work after lifting, pushing, and pulling boxes. The boxes weighed up to 75 lbs. I was diagnosed with sprain or strain of the lower lumbar spine. The pain varies from time to time. It happened a month ago, and I have had physical therapy for three weeks. The pain goes from the lower spine to the right lower part of the back, the abdomen, the groin, and leg. At first, the pain shot halfway between the hip and the knee. It got to the point of the knee, and then tonight I felt it go down to my ankle. At first, neither standing nor sitting helped, now sitting helps better. I have had three muscle relaxer injections and two steroid injections since this happened. I was on Ibuprofen 800 mg, thrice for three weeks. I was on Tramadol and Cyclobenzaprine for a week. I was also prescribed Metaxalone 800 mg, for three times a day. For a week, I was prescribed to take it two times a day. I have been prescribed to take extra-strength Tylenol and Gabapentin. I have been using ice and heat as directed since this happened and placed on lifting no more than 30 lbs, push or pull no more than 60 lbs and sitting 50 %. The pain is still present today, so I took my first dose of Gabapentin and Prednisolone. I need a second opinion.

Hello, Welcome to Chat Doctor forum. I have reviewed your question. I am sorry you are experiencing low back pain. In fact, nearly 80 % people experience back pain at some point in their life. For more information consult a chiropractor online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My father is 59 years old and suffering from diabetes for the last 15 years within control limit of sugar. Recently, he got attach with a brain hemorrhage on the right side, and he stopped to talk and his right side hand and leg become inactive. Slowly with medication and physiotherapy exercise, he recovered somewhat and able to speak. He can walk with rod support and his hand is still inactive. His creatine level in blood keeps on the higher side from 5.0 to up to 8.0.In the last few days, he started vomiting and unable to digest any foods. Doctor advised for immediate dialysis and is undergoing the procedure. Within a week\\s time, this is the second time he is going with the procedure. The first time it lasts for one and a half hours, and for the second time it lasts for three hours. While discussing with the fellow patient taking the procedure, they said this is a regular procedure and may require on a daily basis also.My query regarding dialysis is if once we opted is it a regular procedure? Please clarify the doubt. ### Response: Hi. I have thoroughly gone through your case and can well understand your genuine health concerns. No, this is not a permanent procedure for every patient. It depends on the status of kidney functions and roughly we can predict from creatinine levels (just to make it clear to you). If he gets creatinine levels of 0.2-1.2 mg/dL and the kidneys will be doing normal functions, then we can stop doing dialysis as kidneys are now doing their job by themselves. Dialysis is alternative kidneys actually. The job which kidneys do normally, dialysis does the same for the time being until the patient gets normal kidney functions back. I hope this helps.

Hello doctor,My father is 59 years old and suffering from diabetes for the last 15 years within control limit of sugar. Recently, he got attach with a brain hemorrhage on the right side, and he stopped to talk and his right side hand and leg become inactive. Slowly with medication and physiotherapy exercise, he recovered somewhat and able to speak. He can walk with rod support and his hand is still inactive. His creatine level in blood keeps on the higher side from 5.0 to up to 8.0.In the last few days, he started vomiting and unable to digest any foods. Doctor advised for immediate dialysis and is undergoing the procedure. Within a week\\s time, this is the second time he is going with the procedure. The first time it lasts for one and a half hours, and for the second time it lasts for three hours. While discussing with the fellow patient taking the procedure, they said this is a regular procedure and may require on a daily basis also.My query regarding dialysis is if once we opted is it a regular procedure? Please clarify the doubt.

Hi. I have thoroughly gone through your case and can well understand your genuine health concerns. No, this is not a permanent procedure for every patient. It depends on the status of kidney functions and roughly we can predict from creatinine levels (just to make it clear to you). If he gets creatinine levels of 0.2-1.2 mg/dL and the kidneys will be doing normal functions, then we can stop doing dialysis as kidneys are now doing their job by themselves. Dialysis is alternative kidneys actually. The job which kidneys do normally, dialysis does the same for the time being until the patient gets normal kidney functions back. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My daughter is 5 years 9 months old. She had a heavy cold and cough last week due to which she got a temperature of 99.8. So I gave her Calpol 250 next day morning similar range so I again continued the medicine and visited the doctor. He said continue fever doses irrespective of whether there is or not for three days post which the same day and next day she had no fever but again suddenly she got 99.5 and till night it went to 102.8 and did not reduce at all till we visited the doctor next day. He asked us to take blood urine reports are prescribed antibiotic Augmentin and continued to Calpol and SOS Meftal syrup as he sighted bacterial infection. Now she is taking antibiotic four doses plus Paracetomol but fever keeps coming back. So, by yesterday night gave her Meftal post which her fever came down. Should I continue Meftal syrup irrespective of fever level along with Calpol and antibiotic as to control the fever levels? I am worried why the fever keeps coming back the same level even though now four doses of antibiotic are completed. ### Response: Hi, Welcome to Chat Doctor forum. The symptoms seem secondary to upper respiratory tract infection. Fever sometimes takes time to settle and may take up to a week. If cough and fever continue beyond 10 days then get a chest X-ray done to rule out pneumonia. Meftal (Mefenamic acid) needs to be given only if fever is not controlled with Paracetamol. If there is no fever or mild fever no need to give Meftal. I would suggest waiting for one day and then getting a chest X-ray done. For more information consult an internal medicine physician online

Hello doctor,My daughter is 5 years 9 months old. She had a heavy cold and cough last week due to which she got a temperature of 99.8. So I gave her Calpol 250 next day morning similar range so I again continued the medicine and visited the doctor. He said continue fever doses irrespective of whether there is or not for three days post which the same day and next day she had no fever but again suddenly she got 99.5 and till night it went to 102.8 and did not reduce at all till we visited the doctor next day. He asked us to take blood urine reports are prescribed antibiotic Augmentin and continued to Calpol and SOS Meftal syrup as he sighted bacterial infection. Now she is taking antibiotic four doses plus Paracetomol but fever keeps coming back. So, by yesterday night gave her Meftal post which her fever came down. Should I continue Meftal syrup irrespective of fever level along with Calpol and antibiotic as to control the fever levels? I am worried why the fever keeps coming back the same level even though now four doses of antibiotic are completed.

Hi, Welcome to Chat Doctor forum. The symptoms seem secondary to upper respiratory tract infection. Fever sometimes takes time to settle and may take up to a week. If cough and fever continue beyond 10 days then get a chest X-ray done to rule out pneumonia. Meftal (Mefenamic acid) needs to be given only if fever is not controlled with Paracetamol. If there is no fever or mild fever no need to give Meftal. I would suggest waiting for one day and then getting a chest X-ray done. For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have intrusive thoughts, blasphemous thoughts that keeps returning to my head. In the past I had porn addiction, and the day I forced myself to stop, I began having those thoughts. I already had OCD symptoms when younger but more subtle. I suspect I have some low serotonine so I am taking St John's Wort and some Magnesium which are helping in my porn withdrawal and thoughts. I had these thoughts for around 2 to 3 years and sometimes I do compulsions especially digital compulsions. My work is mainly on the computer, so even deleting or renaming files create some thoughts in my head. I hear about exposure prevention therapy and I was reading that we can record the thoughts and listen to them till they reduce the anxiety, but I cannot in record the thoughts which are blasphemous.What do you think is the best therapy in my case? As I already have anxiety issues which led me to go to the emergency room (because of panic attacks, probably because of my past addiction post acute withdrawal symptoms), do you think those thoughts would go away along with the anxiety itself? Or should I treat them separately? ### Response: Hi, Welcome to Chat Doctor forum. I have gone through your query with interest. As you had OCD in childhood and anxiety disorder and taking St John\\s wort, Omega 3 , Magnesium and Vitamins (attachment removed to protect patient identity). You need to start SSRI group of ChatDoctor. SSRI will take care of OCD and panic attacks and anxiety disorder. The therapy for OCD or blasphemous thoughts are exposure and response prevention and / or cognitive therapy. You need to visit your therapist to do these therapy as you alone might not be able to do these. You need not to take different

Hello doctor,I have intrusive thoughts, blasphemous thoughts that keeps returning to my head. In the past I had porn addiction, and the day I forced myself to stop, I began having those thoughts. I already had OCD symptoms when younger but more subtle. I suspect I have some low serotonine so I am taking St John's Wort and some Magnesium which are helping in my porn withdrawal and thoughts. I had these thoughts for around 2 to 3 years and sometimes I do compulsions especially digital compulsions. My work is mainly on the computer, so even deleting or renaming files create some thoughts in my head. I hear about exposure prevention therapy and I was reading that we can record the thoughts and listen to them till they reduce the anxiety, but I cannot in record the thoughts which are blasphemous.What do you think is the best therapy in my case? As I already have anxiety issues which led me to go to the emergency room (because of panic attacks, probably because of my past addiction post acute withdrawal symptoms), do you think those thoughts would go away along with the anxiety itself? Or should I treat them separately?

Hi, Welcome to Chat Doctor forum. I have gone through your query with interest. As you had OCD in childhood and anxiety disorder and taking St John\\s wort, Omega 3 , Magnesium and Vitamins (attachment removed to protect patient identity). You need to start SSRI group of ChatDoctor. SSRI will take care of OCD and panic attacks and anxiety disorder. The therapy for OCD or blasphemous thoughts are exposure and response prevention and / or cognitive therapy. You need to visit your therapist to do these therapy as you alone might not be able to do these. You need not to take different

### Instruction: Answer this question truthfully ###Input: Hello doctor,My father is suffering from chest pain for the last six months which is during for about 30 seconds to 1 minute and he says he is feeling like his heart is vibrating, poking during the pain. He has consulted a cardiologist four months ago and has taken ECG, echocardiogram, treadmill stress test but the report is normal except on comments it was mentioned as mildly hypokinetic mid and apical anterior septum and conducted treadmill stress test for possible ischemic but the result came as negative. And when asked about any prescription, the doctor has denied prescription suggesting it is gastric problem, nothing to worry about but again the pain has started and he is even afraid to sleep (keeping alarms once in two hours). Can anyone please suggest is this something serious? ### Response: Hello, Welcome to Chat Doctor forum. It does not appear to be a serious problem. Cardiac pain is unlikely to occur for this short time. It typically occurs on exertion and relieves with rest, and persists for 5 to 10 minutes. Such rest occurs usually due to gastritis and reflux disease. He should avoid fatty, oily and spicy diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Avoid smoking and alcohol if any. He should have tablet Pan DSR (Pantoprazole, Domperidone) 40 mg or Esomeprazole, Domperidone combination before breakfast once a day for two weeks. If not adequately relieved, then you should add syrup Sucral O (Oxetacaine, Sucralfate) or Gelusil two teaspoons three times a day for a week. For more information consult a cardiologist online

Hello doctor,My father is suffering from chest pain for the last six months which is during for about 30 seconds to 1 minute and he says he is feeling like his heart is vibrating, poking during the pain. He has consulted a cardiologist four months ago and has taken ECG, echocardiogram, treadmill stress test but the report is normal except on comments it was mentioned as mildly hypokinetic mid and apical anterior septum and conducted treadmill stress test for possible ischemic but the result came as negative. And when asked about any prescription, the doctor has denied prescription suggesting it is gastric problem, nothing to worry about but again the pain has started and he is even afraid to sleep (keeping alarms once in two hours). Can anyone please suggest is this something serious?

Hello, Welcome to Chat Doctor forum. It does not appear to be a serious problem. Cardiac pain is unlikely to occur for this short time. It typically occurs on exertion and relieves with rest, and persists for 5 to 10 minutes. Such rest occurs usually due to gastritis and reflux disease. He should avoid fatty, oily and spicy diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Avoid smoking and alcohol if any. He should have tablet Pan DSR (Pantoprazole, Domperidone) 40 mg or Esomeprazole, Domperidone combination before breakfast once a day for two weeks. If not adequately relieved, then you should add syrup Sucral O (Oxetacaine, Sucralfate) or Gelusil two teaspoons three times a day for a week. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,The radiologist stated scattered white matter lesions but does not tell the location, or size. They state as unsure etiology or clinical significance. The ordering physician suspects MS due to symptoms like disorientation, incontinence, and body pain.If the radiologist suspected MS would not they state the size and location? And diagnoses suspected disease or kind of lesion? Was this a poor report? Or was he basically not sure of what is going on? I leave it up to the ordering doctor. I have done blood for lupus, arthritis, Lyme disease, and complete blood test. ### Response: Hi, Welcome to Chat Doctor forum. The few scattered white matter lesions could mean that there are areas in the white matter of brain which are seen as small pinhead size on T2 and flair sequence. This is commonly from small vessel ischemic changes and is seen usually in older age and slightly uncommon in the young population. The cause is sometimes unknown. Suspicion of MS (multiple sclerosis) is by diagnostic criteria and matching it with clinical examination. There is McDonalds criteria for imaging in MS and if the radiologist did not mention any findings which are under these criteria then it is unlikely to be MS from this scan. The criteria specify that the patient might require a subsequent MRI scan and the new scan is compared with the old one to make a probable diagnosis of MS in you. It is clear that the findings are less likely to be from MS on this scan. Talking about radiologists, every person has their comfortable style of reporting and I feel mentioning the location of the larger white matter lesions would have been good for your ordering doctor. I will not say this is a poor report but surely it can be improved by providing the size and location of the larger white matter lesions. I hope this helps.

Hello doctor,The radiologist stated scattered white matter lesions but does not tell the location, or size. They state as unsure etiology or clinical significance. The ordering physician suspects MS due to symptoms like disorientation, incontinence, and body pain.If the radiologist suspected MS would not they state the size and location? And diagnoses suspected disease or kind of lesion? Was this a poor report? Or was he basically not sure of what is going on? I leave it up to the ordering doctor. I have done blood for lupus, arthritis, Lyme disease, and complete blood test.

Hi, Welcome to Chat Doctor forum. The few scattered white matter lesions could mean that there are areas in the white matter of brain which are seen as small pinhead size on T2 and flair sequence. This is commonly from small vessel ischemic changes and is seen usually in older age and slightly uncommon in the young population. The cause is sometimes unknown. Suspicion of MS (multiple sclerosis) is by diagnostic criteria and matching it with clinical examination. There is McDonalds criteria for imaging in MS and if the radiologist did not mention any findings which are under these criteria then it is unlikely to be MS from this scan. The criteria specify that the patient might require a subsequent MRI scan and the new scan is compared with the old one to make a probable diagnosis of MS in you. It is clear that the findings are less likely to be from MS on this scan. Talking about radiologists, every person has their comfortable style of reporting and I feel mentioning the location of the larger white matter lesions would have been good for your ordering doctor. I will not say this is a poor report but surely it can be improved by providing the size and location of the larger white matter lesions. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I think I have an inner ear infection. I went to the doctor last year and he asked me about my symptoms. I told him and he said I had a viral thing in which he gave me antibiotics to take which I did not take. When I got my summary it is said that I had sinusitis. Now until this day my sinuses have been bothering me. The doctor said I had fluid in my left ear. I think the fluid in my left ear is causing me to feel bad. Last weekend I was laying on the couch on my right side and turned to my left fast over and saw the pictures on the wall go by when I turned fast. I tried in the night to lean back in the recliner part on the couch and had the same feeling almost, but I sat back up. I also have that feeling when I bend down but not a lot. I am worried and want to get relief for my left ear. What I just described to you is it a certain type of vertigo? ### Response: Hello, Welcome to Chat Doctor forum. As I understand you have three issues. Sinusitis, for this, take steam inhalation daily for one month. Also, do send me pictures of CT (computed tomography) scan for sinuses. So that I can further suggest what is the treatment or surgery. Fluid in the ear, if it is significantly there, then this needs to be removed and a ventilation tube needs to be inserted. It is a small procedure. Vertigo, can be due to fluid in the ear or an independent episode too. Do take good rest. Avoid much neck movement. Take tablet Betahistine 16 mg three times a day and consult a local ENT doctor, or take a video consultation with me with reports.

Hello doctor,I think I have an inner ear infection. I went to the doctor last year and he asked me about my symptoms. I told him and he said I had a viral thing in which he gave me antibiotics to take which I did not take. When I got my summary it is said that I had sinusitis. Now until this day my sinuses have been bothering me. The doctor said I had fluid in my left ear. I think the fluid in my left ear is causing me to feel bad. Last weekend I was laying on the couch on my right side and turned to my left fast over and saw the pictures on the wall go by when I turned fast. I tried in the night to lean back in the recliner part on the couch and had the same feeling almost, but I sat back up. I also have that feeling when I bend down but not a lot. I am worried and want to get relief for my left ear. What I just described to you is it a certain type of vertigo?

Hello, Welcome to Chat Doctor forum. As I understand you have three issues. Sinusitis, for this, take steam inhalation daily for one month. Also, do send me pictures of CT (computed tomography) scan for sinuses. So that I can further suggest what is the treatment or surgery. Fluid in the ear, if it is significantly there, then this needs to be removed and a ventilation tube needs to be inserted. It is a small procedure. Vertigo, can be due to fluid in the ear or an independent episode too. Do take good rest. Avoid much neck movement. Take tablet Betahistine 16 mg three times a day and consult a local ENT doctor, or take a video consultation with me with reports.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 23 years old female. Can you please explain to me the clinical presentation of decompensated phoria? I have had diplopia for over two years now, binocular, horizontal, worse on distant gaze. I have had an MRI as well, but no lesions found in my brain stem or other areas. Only a few white spots, punctate, in both hemispheres. They say, it is not cranial nerve palsy, so I wondered if it could be some kind of muscle-misalignment caused by decompensated phoria. I also have astigmatism, myopia (left eye -3.75 and right eye -4.25). I am very anxious about this diplopia being a sign of MS. (I have severe health-anxiety). I have no other symptoms, no headache, and taking no medicines. ### Response: Hi, Welcome to Chat Doctor forum. Diplopia for distance vision is more common in neurological conditions. If you do not have any neurological problems (ruled out by MRI), other problems can be considered. In your case, as you have high myopia, it can be due to decompensated tropia (phoria). In myopia, there is a loss of accommodation since childhood. This will lead to loss or decrease of fusion (focus on an object). This may lead to intermittent diplopia. This can be improved to some extent by fusion exercises like holding a pen in hand and looking at the tip of the pen, bring it slowly near to your nose. Repeat this exercise daily 5 to 10 minutes morning and evening. You can send pictures of your eyes for better evaluation and treatment. You can also call for any queries. For more information consult an eye care ophthalmologist online

Hello doctor,I am 23 years old female. Can you please explain to me the clinical presentation of decompensated phoria? I have had diplopia for over two years now, binocular, horizontal, worse on distant gaze. I have had an MRI as well, but no lesions found in my brain stem or other areas. Only a few white spots, punctate, in both hemispheres. They say, it is not cranial nerve palsy, so I wondered if it could be some kind of muscle-misalignment caused by decompensated phoria. I also have astigmatism, myopia (left eye -3.75 and right eye -4.25). I am very anxious about this diplopia being a sign of MS. (I have severe health-anxiety). I have no other symptoms, no headache, and taking no medicines.

Hi, Welcome to Chat Doctor forum. Diplopia for distance vision is more common in neurological conditions. If you do not have any neurological problems (ruled out by MRI), other problems can be considered. In your case, as you have high myopia, it can be due to decompensated tropia (phoria). In myopia, there is a loss of accommodation since childhood. This will lead to loss or decrease of fusion (focus on an object). This may lead to intermittent diplopia. This can be improved to some extent by fusion exercises like holding a pen in hand and looking at the tip of the pen, bring it slowly near to your nose. Repeat this exercise daily 5 to 10 minutes morning and evening. You can send pictures of your eyes for better evaluation and treatment. You can also call for any queries. For more information consult an eye care ophthalmologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 62 year old male. I am suffering from multiple neurofibroma of spinal cord and acoustic neurofibroma. I had bypass surgery four years ago and since then I am under medication, which is given below. My present problem is related to stomach. Since the operation, I started having sudden bouts of loose motion. Earlier, the interval between the bouts was about 15 to 20 days which gradually reduced now to about three days. I have consulted numerous doctors including gastro specialist. Sonography reveals all organs to be normal except grade one fatty liver. No blood, pus cells in stool. My hemoglobin is 16.1. I have undergone deworming course by taking Rcifax 400 bd for five days, Noworm 400 and Nortryptomer od for three days, but there has been no effect. The consulted doctors have different opinions, some say that it is due to neurofibroma and some say it is due to reaction of medicines which I am taking. But no remedy has been suggested yet. If the loose motions become uncontrolled, I am forced to take Norflox TZ, which gives temporary relief. These loose motions are sudden, often soil clothes and have imprisoned me in the house. My current medication includes Nikoran 5 bd, Cardivas 3.125 bd, Cardace 2.5 od, Flavedon MR od, Lasix 40 half tablet od, Becosule od, Clopivas 150 od and Rosuvas 10 od. Please help me. ### Response: Hi, Welcome to Chat Doctor forum. Such diarrhea is seen in Irritable bowel syn ChatDoctor. IBS is of three types

Hi doctor,I am a 62 year old male. I am suffering from multiple neurofibroma of spinal cord and acoustic neurofibroma. I had bypass surgery four years ago and since then I am under medication, which is given below. My present problem is related to stomach. Since the operation, I started having sudden bouts of loose motion. Earlier, the interval between the bouts was about 15 to 20 days which gradually reduced now to about three days. I have consulted numerous doctors including gastro specialist. Sonography reveals all organs to be normal except grade one fatty liver. No blood, pus cells in stool. My hemoglobin is 16.1. I have undergone deworming course by taking Rcifax 400 bd for five days, Noworm 400 and Nortryptomer od for three days, but there has been no effect. The consulted doctors have different opinions, some say that it is due to neurofibroma and some say it is due to reaction of medicines which I am taking. But no remedy has been suggested yet. If the loose motions become uncontrolled, I am forced to take Norflox TZ, which gives temporary relief. These loose motions are sudden, often soil clothes and have imprisoned me in the house. My current medication includes Nikoran 5 bd, Cardivas 3.125 bd, Cardace 2.5 od, Flavedon MR od, Lasix 40 half tablet od, Becosule od, Clopivas 150 od and Rosuvas 10 od. Please help me.

Hi, Welcome to Chat Doctor forum. Such diarrhea is seen in Irritable bowel syn ChatDoctor. IBS is of three types

### Instruction: Answer this question truthfully ###Input: Hi doctor,I was on a business trip and my friend and I went to a high-end brothel. My friend hired two girls and brought them back to the hotel. He had to take a phone call and while the girls were waiting for him they performed oral sex on me for a few minutes without a condom. They had no symptoms in their lips and facial region. I am worried, I contracted herpes. I got tested for chlamydia, syphilis, gonorrhea, hepatitis, and HIV and they came up negative. It has been four weeks since the incindent and I have no herpes symtomps. What are my chances of having herpes? I know people might not show symptoms. I am married and I felt very guilty for what I had done and told my wife. We are planing to have kids. What are the chances of her getting herpes and passing on to our baby? I appreciate all your help with my concerns. ### Response: Hi, Welcome to Chat Doctor forum. I can understand your concern. There are very fewer chances of you having herpes since four weeks have passed and you have not developed any symptoms. But yes, herpes can even occur as sub clinical infection without presenting with any signs and symptoms. I would recommend you go for an ELISA (enzyme-linked immunosorbent assay) test for herpesvirus that is HSV 1 IgG and HSV 2 IgG and HSV 1 IgM and HSV 2 IgM. These tests are confirmatory in herpesvirus infection. These will tell your herpes status. If positive there are chances of passing the infection to your wife but not very high since you are asymptomatic. I would recommend you to first get the tests done and find your status. Then we can discuss further possibilities. I hope this helps.

Hi doctor,I was on a business trip and my friend and I went to a high-end brothel. My friend hired two girls and brought them back to the hotel. He had to take a phone call and while the girls were waiting for him they performed oral sex on me for a few minutes without a condom. They had no symptoms in their lips and facial region. I am worried, I contracted herpes. I got tested for chlamydia, syphilis, gonorrhea, hepatitis, and HIV and they came up negative. It has been four weeks since the incindent and I have no herpes symtomps. What are my chances of having herpes? I know people might not show symptoms. I am married and I felt very guilty for what I had done and told my wife. We are planing to have kids. What are the chances of her getting herpes and passing on to our baby? I appreciate all your help with my concerns.

Hi, Welcome to Chat Doctor forum. I can understand your concern. There are very fewer chances of you having herpes since four weeks have passed and you have not developed any symptoms. But yes, herpes can even occur as sub clinical infection without presenting with any signs and symptoms. I would recommend you go for an ELISA (enzyme-linked immunosorbent assay) test for herpesvirus that is HSV 1 IgG and HSV 2 IgG and HSV 1 IgM and HSV 2 IgM. These tests are confirmatory in herpesvirus infection. These will tell your herpes status. If positive there are chances of passing the infection to your wife but not very high since you are asymptomatic. I would recommend you to first get the tests done and find your status. Then we can discuss further possibilities. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My son is 1.7 years. He had rickets sometimes back and was put on supplements for six months. Upon taking him for review, alkaline phosphatase was extremely high but calcium level was okay and was referred to an endocrinologist. Upon doing several laboratory tests, TSH was okay, PTH was low, vitamin D levels were fine and wrist X-ray was normal. The boy cannot walk and does not look as if he will soon. When standing, he bends his legs at knee point and also clenches his fists when grasping. From the looks, he seems okay. Please help. ### Response: Hello, Welcome to ChatDoctor. Rickets can be due to vitamin D deficiency or hypophosphatemia. You did not tell me the phosphate level in blood of your child. The hypophosphatemic form of rickets is resistant to vitamin D supplement. As X-ray is normal, this is a remote possibility in your child. Alkaline phosphatase is very commonly found to be high in growing child. But it is also high in rickets. With treatment, ALP comes to within reference range. I suggest you continue with the Vitamin D and Calcium supplementation and get a phosphate level in your child\\s blood. Do not worry if minor deformities are present. Because these deformities will disappear as the child grows. But if the child cannot walk properly despite having a normal X-ray, and normal phosphate level, then consult with an orthopedic consultant. He will help your child by suggesting some good orthoses. I suggest you do a repeat PTH test and to do a serum phosphate level. Also, continue the Calcium and Vitamin D supplementation. Inadequate treatment. PTH, serum phosphate. Vitamin D resistant rickets, hypophosphatemic rickets.

Hello doctor,My son is 1.7 years. He had rickets sometimes back and was put on supplements for six months. Upon taking him for review, alkaline phosphatase was extremely high but calcium level was okay and was referred to an endocrinologist. Upon doing several laboratory tests, TSH was okay, PTH was low, vitamin D levels were fine and wrist X-ray was normal. The boy cannot walk and does not look as if he will soon. When standing, he bends his legs at knee point and also clenches his fists when grasping. From the looks, he seems okay. Please help.

Hello, Welcome to ChatDoctor. Rickets can be due to vitamin D deficiency or hypophosphatemia. You did not tell me the phosphate level in blood of your child. The hypophosphatemic form of rickets is resistant to vitamin D supplement. As X-ray is normal, this is a remote possibility in your child. Alkaline phosphatase is very commonly found to be high in growing child. But it is also high in rickets. With treatment, ALP comes to within reference range. I suggest you continue with the Vitamin D and Calcium supplementation and get a phosphate level in your child\\s blood. Do not worry if minor deformities are present. Because these deformities will disappear as the child grows. But if the child cannot walk properly despite having a normal X-ray, and normal phosphate level, then consult with an orthopedic consultant. He will help your child by suggesting some good orthoses. I suggest you do a repeat PTH test and to do a serum phosphate level. Also, continue the Calcium and Vitamin D supplementation. Inadequate treatment. PTH, serum phosphate. Vitamin D resistant rickets, hypophosphatemic rickets.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have a history of recurrent early miscarriage (before seven weeks). Investigations pointed to high autoimmune antibodies and high NK cells. With medication, I conceived naturally and had a successful pregnancy. I am now pregnant again (unplanned) and am 7 weeks + 3. I had some spotting and cramping three days ago. The spotting was light and stopped within a few hours. The cramping continued for another day. Blood hCG levels are rising very well and are currently over 83,000. A transvaginal scan yesterday showed the heartbeat and we were told all is well. Today, I had some light spotting (dark brown) and discomfort and passed a brown clot. My query is whether this may have been the cause of the spotting the other day, or maybe this was caused by irritation from the TV scan yesterday. I am concerned anyway and any advice would be greatly appreciated. Current medications ### Response: Hi, Welcome to Chat Doctor forum. How are you doing? I understand your concern. From your history, I do not see any reason for you to worry. This spotting could be from mild erosion on surface of the cervix, which may bleed spontaneously or during sex or due to scan probe. In your history as you have not mentioned pain, I can say for sure that there is no intrauterine blood. Scan also did not pick any hemorrhages (attachment removed to protect patient identity). The medications you are having is absolutely the perfect ones. Most of the miscarriages before 12 weeks are due to genetic problems. But in the present scan as baby\\s growth has been adequate, you do not need to worry. This clot could be an implantation bleed. This is normal and nothing needs to be done.

Hi doctor,I have a history of recurrent early miscarriage (before seven weeks). Investigations pointed to high autoimmune antibodies and high NK cells. With medication, I conceived naturally and had a successful pregnancy. I am now pregnant again (unplanned) and am 7 weeks + 3. I had some spotting and cramping three days ago. The spotting was light and stopped within a few hours. The cramping continued for another day. Blood hCG levels are rising very well and are currently over 83,000. A transvaginal scan yesterday showed the heartbeat and we were told all is well. Today, I had some light spotting (dark brown) and discomfort and passed a brown clot. My query is whether this may have been the cause of the spotting the other day, or maybe this was caused by irritation from the TV scan yesterday. I am concerned anyway and any advice would be greatly appreciated. Current medications

Hi, Welcome to Chat Doctor forum. How are you doing? I understand your concern. From your history, I do not see any reason for you to worry. This spotting could be from mild erosion on surface of the cervix, which may bleed spontaneously or during sex or due to scan probe. In your history as you have not mentioned pain, I can say for sure that there is no intrauterine blood. Scan also did not pick any hemorrhages (attachment removed to protect patient identity). The medications you are having is absolutely the perfect ones. Most of the miscarriages before 12 weeks are due to genetic problems. But in the present scan as baby\\s growth has been adequate, you do not need to worry. This clot could be an implantation bleed. This is normal and nothing needs to be done.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 18 years old male. There is not a single day when I sleep happily. And the reason is that I am not able to study. It is not that the syllabus is too tough for me. It is just that I do not sit too long and for that matter, I do not sit to study at all. I know the consequences. This semester is important for me. If I perform badly in this, my parents will kick me and throw me out of the house. I need to study well to get a good branch. Just the thought of not studying is making me lose my life. I am feeling completely frustrated and am with no hope. I also get suicidal thoughts. So, I thought of consulting someone. If I start studying, I will do miracles. But, I get deviated easily. I feel like I love buying troubles by not studying. Please guide me on how to be motivated to study regularly. Just one act of not studying is making me lose my happiness. And, I often get headaches too due to irregular sleeping habits, may be. Please help me. ### Response: Hello. First of all, I would like to mention that studying, though important, is just one of the many parts of life. Do not lose confidence or be so harsh on yourself. Study smart and not more. Study in small shifts of half an hour followed by a rest of five minutes. Set small feasible targets and try to achieve them. Praise yourself if they are achieved and if not, do not worry. Also, keep one hour daily for your hobbies to vent out daily stress.Remember every problem has a solution. You just need to try solving it and help is just a step away. For more information consult a psychiatrist online

Hello doctor,I am 18 years old male. There is not a single day when I sleep happily. And the reason is that I am not able to study. It is not that the syllabus is too tough for me. It is just that I do not sit too long and for that matter, I do not sit to study at all. I know the consequences. This semester is important for me. If I perform badly in this, my parents will kick me and throw me out of the house. I need to study well to get a good branch. Just the thought of not studying is making me lose my life. I am feeling completely frustrated and am with no hope. I also get suicidal thoughts. So, I thought of consulting someone. If I start studying, I will do miracles. But, I get deviated easily. I feel like I love buying troubles by not studying. Please guide me on how to be motivated to study regularly. Just one act of not studying is making me lose my happiness. And, I often get headaches too due to irregular sleeping habits, may be. Please help me.

Hello. First of all, I would like to mention that studying, though important, is just one of the many parts of life. Do not lose confidence or be so harsh on yourself. Study smart and not more. Study in small shifts of half an hour followed by a rest of five minutes. Set small feasible targets and try to achieve them. Praise yourself if they are achieved and if not, do not worry. Also, keep one hour daily for your hobbies to vent out daily stress.Remember every problem has a solution. You just need to try solving it and help is just a step away. For more information consult a psychiatrist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 31-year-old male and I was diagnosed with spondyloarthropathy seven years back. I am taking only Sulfasalazine tablets daily. Currently, I do not have any pain or stiffness. My HLA-B27 report is negative. Now, if I do the following MRIs, how much chances are there that any abnormality might be found in my body?DL Spine MRIHip Joint MRILumbosacral MRIPlease tell me only about these three MRI test as I need to show it to someone and I do not want to be caught with any disease.Last week, I did a blood test and chest X-ray (PA view). The X-ray report was normal. ESR was 20 mm. TC and DC were normal. Please help. I have attached the MRI report for your reference. ### Response: Hello, Welcome to Chat Doctor forum. I am unable to find the attachment. It is good to know that you are doing well on Sulfasalazine only. But if you are doing well and have no symptoms with normal blood tests, I will not recommend MRI (magnetic resonance imaging) to be repeated. The MRI is only needed for doubtful diagnosis initially and to look for inflammation in the joints if there is a doubt. For followup, we only do X-rays of the neck, mid spine and lower spine. That usually is good enough to see if there is any disease progression when we compare it to the previous ones. But if really you want to do an MRI and you have no symptoms, I am sure it will show improvement. A look at the MRI report would be helpful. Do let me know if you have more queries. For more information consult a rheumatologist online

Hello doctor,I am a 31-year-old male and I was diagnosed with spondyloarthropathy seven years back. I am taking only Sulfasalazine tablets daily. Currently, I do not have any pain or stiffness. My HLA-B27 report is negative. Now, if I do the following MRIs, how much chances are there that any abnormality might be found in my body?DL Spine MRIHip Joint MRILumbosacral MRIPlease tell me only about these three MRI test as I need to show it to someone and I do not want to be caught with any disease.Last week, I did a blood test and chest X-ray (PA view). The X-ray report was normal. ESR was 20 mm. TC and DC were normal. Please help. I have attached the MRI report for your reference.

Hello, Welcome to Chat Doctor forum. I am unable to find the attachment. It is good to know that you are doing well on Sulfasalazine only. But if you are doing well and have no symptoms with normal blood tests, I will not recommend MRI (magnetic resonance imaging) to be repeated. The MRI is only needed for doubtful diagnosis initially and to look for inflammation in the joints if there is a doubt. For followup, we only do X-rays of the neck, mid spine and lower spine. That usually is good enough to see if there is any disease progression when we compare it to the previous ones. But if really you want to do an MRI and you have no symptoms, I am sure it will show improvement. A look at the MRI report would be helpful. Do let me know if you have more queries. For more information consult a rheumatologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I had unprotected sex before 1.5 years. I was in deep mental stress after that with no proper food. After seven months, I got admitted to a hospital with skin rashes, headache and vomitings. Doctors tested and confirmed that I got meningitis TB and given treatment for 10 days. I was asked to use Forecox tablets for nine months. Now, that is more than a year after my high-risk exposure; I was tested for HIV 1 and 2 under enhanced Chemiluminescence, which was non-reactive. Please tell me whether my HIV results are conclusive despite all these parameters. Would my TB treatment and immune system alter the HIV results? Because my WBC count is low while testing HIV when compared to before. Please advice. ### Response: Hi, Welcome to Chat Doctor forum. Unprotected sexual exposure is a risk factor for multiple STDs (sexually transmitted disease), including HIV. However, the risk is quite low ranging from 0.02 to 0.04%. HIV infection has a window period of one to three months during which the test results can be false negative. According to WHO (World Health Organization), all results are considered conclusive at 12 weeks after the last high-risk exposure. Tuberculosis and HIV are known to have a higher coincidence rate together. But, as your test results are negative and well beyond the window period, you can be assured that you have not acquired the infection. Kindly upload the report to check the method used and the laboratory to confirm the same. 1. HBsAg, (hepatitis B surface antigen)2. Anti-HCV (hepatitis C virus)3. V ChatDoctor. Revert with the reports to a HIV AIDS specialist online.-

Hi doctor,I had unprotected sex before 1.5 years. I was in deep mental stress after that with no proper food. After seven months, I got admitted to a hospital with skin rashes, headache and vomitings. Doctors tested and confirmed that I got meningitis TB and given treatment for 10 days. I was asked to use Forecox tablets for nine months. Now, that is more than a year after my high-risk exposure; I was tested for HIV 1 and 2 under enhanced Chemiluminescence, which was non-reactive. Please tell me whether my HIV results are conclusive despite all these parameters. Would my TB treatment and immune system alter the HIV results? Because my WBC count is low while testing HIV when compared to before. Please advice.

Hi, Welcome to Chat Doctor forum. Unprotected sexual exposure is a risk factor for multiple STDs (sexually transmitted disease), including HIV. However, the risk is quite low ranging from 0.02 to 0.04%. HIV infection has a window period of one to three months during which the test results can be false negative. According to WHO (World Health Organization), all results are considered conclusive at 12 weeks after the last high-risk exposure. Tuberculosis and HIV are known to have a higher coincidence rate together. But, as your test results are negative and well beyond the window period, you can be assured that you have not acquired the infection. Kindly upload the report to check the method used and the laboratory to confirm the same. 1. HBsAg, (hepatitis B surface antigen)2. Anti-HCV (hepatitis C virus)3. V ChatDoctor. Revert with the reports to a HIV AIDS specialist online.-

### Instruction: Answer this question truthfully ###Input: Hello doctor,My daughter is 18 months of age. She was born at 38 weeks due to placenta failure and oxygen issues. She was 5 lbs 10 ounces at birth and was healthy (did not have to stay in the NICU). She hit all of her milestones in terms of rolling over, crawling and walking (walked at 14.5 months), but is a toe walker. Her left leg (to us) is weaker than her right and her left leg does not bend as much as her right leg. She began to speak around 10 months of age then her speech left. We came to find out she had chronic fluid and a month back she had tubes placed. I am hearing more vowel and consonants now but no true words yet. She makes fine eye contact. Her non-verbal communication is good. She responds to her name but not always. She is beginning to learn more of what we are saying, she plays with some toys, is not terribly social. We are thinking that she may be on the autism spectrum and we have an evaluation soon to determine that. But my question is, could this be cerebral palsy? ### Response: Hi, Welcome to Chat Doctor forum. I understand the situation you are facing with your child. As there is no history of perinatal insult and NICU stay at birth, cerebral palsy could be less likely at this early age to diagnose. The description you made is more of a like to be an autistic spectrum disorder. But this could be just a small delay in catching up all milestones. Some kids learn early and some little late. So, observe over a period and if no improvement is seen, then consult a pediatric neurologist and developmental specialist for further evaluation and management.

Hello doctor,My daughter is 18 months of age. She was born at 38 weeks due to placenta failure and oxygen issues. She was 5 lbs 10 ounces at birth and was healthy (did not have to stay in the NICU). She hit all of her milestones in terms of rolling over, crawling and walking (walked at 14.5 months), but is a toe walker. Her left leg (to us) is weaker than her right and her left leg does not bend as much as her right leg. She began to speak around 10 months of age then her speech left. We came to find out she had chronic fluid and a month back she had tubes placed. I am hearing more vowel and consonants now but no true words yet. She makes fine eye contact. Her non-verbal communication is good. She responds to her name but not always. She is beginning to learn more of what we are saying, she plays with some toys, is not terribly social. We are thinking that she may be on the autism spectrum and we have an evaluation soon to determine that. But my question is, could this be cerebral palsy?

Hi, Welcome to Chat Doctor forum. I understand the situation you are facing with your child. As there is no history of perinatal insult and NICU stay at birth, cerebral palsy could be less likely at this early age to diagnose. The description you made is more of a like to be an autistic spectrum disorder. But this could be just a small delay in catching up all milestones. Some kids learn early and some little late. So, observe over a period and if no improvement is seen, then consult a pediatric neurologist and developmental specialist for further evaluation and management.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I had high blood pressure, low heart rate. Is my ECG showing infarction? I have no chest pain. At the time of ECG, my blood pressure was 168/100 and heart beat 46. ### Response: Hello, Welcome to Chat Doctor forum. I have gone through your ECG (attachment removed to protect patient identity). The reports mentioned on ECG are machine generated and are frequently inaccurate. There is no clear-cut evidence of myocardial infarction on ECG. As you also do not have any history of chest pain, it is unlikely for you to have any heart attack. And yes, heart rate is low and it is sinus bradycardia. Do you have any symptoms of dizziness, syncope, etc? If not then it needs no action at the moment. However, you should undergo thyroid test to rule out hypothyroidism as a cause for low heart rate. Also, should undergo echo, which will additionally provide the assurance to rule out MI. Also, if echo is normal then should have TMT (treadmill test), which will help in ruling out minor blockages, subclinical ischemic heart disease and to look for maximum heart rate you achieve during exercise, which will help in determining the benign nature of sinus bradycardia if the adequate heart rate is achieved. Also, high bp can also cause low heart rate by a reflex mechanism. So you should have medicine for it. I guess you are not receiving any medicines like beta blockers which can reduce heart rate. You should have tablet Telma CTD (Telmisartan and Chlorthalidone) 40/12.5 mg once a day in the morning for hypertension so get it prescribed by a local doctor. For more information consult a cardiologist online

Hi doctor,I had high blood pressure, low heart rate. Is my ECG showing infarction? I have no chest pain. At the time of ECG, my blood pressure was 168/100 and heart beat 46.

Hello, Welcome to Chat Doctor forum. I have gone through your ECG (attachment removed to protect patient identity). The reports mentioned on ECG are machine generated and are frequently inaccurate. There is no clear-cut evidence of myocardial infarction on ECG. As you also do not have any history of chest pain, it is unlikely for you to have any heart attack. And yes, heart rate is low and it is sinus bradycardia. Do you have any symptoms of dizziness, syncope, etc? If not then it needs no action at the moment. However, you should undergo thyroid test to rule out hypothyroidism as a cause for low heart rate. Also, should undergo echo, which will additionally provide the assurance to rule out MI. Also, if echo is normal then should have TMT (treadmill test), which will help in ruling out minor blockages, subclinical ischemic heart disease and to look for maximum heart rate you achieve during exercise, which will help in determining the benign nature of sinus bradycardia if the adequate heart rate is achieved. Also, high bp can also cause low heart rate by a reflex mechanism. So you should have medicine for it. I guess you are not receiving any medicines like beta blockers which can reduce heart rate. You should have tablet Telma CTD (Telmisartan and Chlorthalidone) 40/12.5 mg once a day in the morning for hypertension so get it prescribed by a local doctor. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor, I am a 27-year-old male. I have never had an increase in moles, except for the past two weeks I have had over 50 show up on my chest. In the past two months, I moved from one country to another, and a month ago, I had a really bad sunburn in Indonesia. ### Response: Hi, Welcome to Chat Doctor forum. Moles are genetic collection of melanocytes which go through a cycle of emerging in childhood then become darker and fade by middle ages. In fair skin up to 50 are normal more than that increase the risk for skin cancer. And change in size, symmetry, color, symptoms also is a risk factor. Mole or nevi as called in medical term appearing in adult age like in you are always a risk factor. And in such an abrupt manner more so. They need to be followed up for any change in color, size, symmetry border, symptoms, and so. All your moles that I can see in the photo are harmless. (attachment removed to protect patient identity). Mole does increase after prolonged sun exposure as you give history. I hope you do not have any other medical problems. I advise you an initial in physically examination by a dermatologist, you can wait for lockdown, not an emergency, then you can do it yourself, all the mole for the changes described earlier, at least once a month and a complete work done by a dermatologist once every six months. Lifetime risk is very low but if you have fair skin, adult moles, more than fifty you need that follow-up to be on the safer side. I hope this helps. Sun exposure. Workup for changes. Seborrheic keratosis. Screening for changes. Every six months.

Hi doctor, I am a 27-year-old male. I have never had an increase in moles, except for the past two weeks I have had over 50 show up on my chest. In the past two months, I moved from one country to another, and a month ago, I had a really bad sunburn in Indonesia.

Hi, Welcome to Chat Doctor forum. Moles are genetic collection of melanocytes which go through a cycle of emerging in childhood then become darker and fade by middle ages. In fair skin up to 50 are normal more than that increase the risk for skin cancer. And change in size, symmetry, color, symptoms also is a risk factor. Mole or nevi as called in medical term appearing in adult age like in you are always a risk factor. And in such an abrupt manner more so. They need to be followed up for any change in color, size, symmetry border, symptoms, and so. All your moles that I can see in the photo are harmless. (attachment removed to protect patient identity). Mole does increase after prolonged sun exposure as you give history. I hope you do not have any other medical problems. I advise you an initial in physically examination by a dermatologist, you can wait for lockdown, not an emergency, then you can do it yourself, all the mole for the changes described earlier, at least once a month and a complete work done by a dermatologist once every six months. Lifetime risk is very low but if you have fair skin, adult moles, more than fifty you need that follow-up to be on the safer side. I hope this helps. Sun exposure. Workup for changes. Seborrheic keratosis. Screening for changes. Every six months.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 74-year-old male, weighing 142 lbs, height 5\\10\" and a non-smoker. I worked in an auto body shop for two years and painting cars for 18 to 19 years. Had minimal exposure to asbestos and quit grain farming at the age of 44 years. When I was 56 years old, I had a severe panic disorder and MVP. Around three months ago, I had a very small amount of blood in my phlegm when clearing my throat about six times. The doctor said that it was due to a blood vessel breakage, but ordered a pulmonary function test and chest CT to be sure. Pulmonary function test done two months back was normal. Chest CT findings showed no bronchiectasis or interstitial lung disease, no pneumothorax or pleural effusion. There is very minimal atelectasis in the left and right lower lobes. There is a 2 mm pleural based RT, lower lobe pulmonary nodule and no additional nodule or mass. My pulmonary doctor talked like nothing is seriously wrong.What is your opinion? Should I have follow-ups on the 2 mm nodule? What did minimal atelectasis mean and what caused it? I take no medicines except Ativan PRN. ### Response: Hi. See, solitary pulmonary nodule which is asymptomatic does not require any further investigations. However, any persisting fever, cough and cold warrants bronchoscopy and biopsy of the lesion to rule out any possible causes. Atelectasis is the collapse of alveoli of the lung. So, that needs an evaluation from my side. I would suggest bronchoscopy for you based on your current scenario. For more information consult a criticalcare physician online

Hello doctor,I am a 74-year-old male, weighing 142 lbs, height 5\\10\" and a non-smoker. I worked in an auto body shop for two years and painting cars for 18 to 19 years. Had minimal exposure to asbestos and quit grain farming at the age of 44 years. When I was 56 years old, I had a severe panic disorder and MVP. Around three months ago, I had a very small amount of blood in my phlegm when clearing my throat about six times. The doctor said that it was due to a blood vessel breakage, but ordered a pulmonary function test and chest CT to be sure. Pulmonary function test done two months back was normal. Chest CT findings showed no bronchiectasis or interstitial lung disease, no pneumothorax or pleural effusion. There is very minimal atelectasis in the left and right lower lobes. There is a 2 mm pleural based RT, lower lobe pulmonary nodule and no additional nodule or mass. My pulmonary doctor talked like nothing is seriously wrong.What is your opinion? Should I have follow-ups on the 2 mm nodule? What did minimal atelectasis mean and what caused it? I take no medicines except Ativan PRN.

Hi. See, solitary pulmonary nodule which is asymptomatic does not require any further investigations. However, any persisting fever, cough and cold warrants bronchoscopy and biopsy of the lesion to rule out any possible causes. Atelectasis is the collapse of alveoli of the lung. So, that needs an evaluation from my side. I would suggest bronchoscopy for you based on your current scenario. For more information consult a criticalcare physician online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I was just hit on the right side of my neck with a basketball. Part of the basketball hit my chin, so my neck cartilage did not take the entirety of the impact. The basketball was probably traveling around 20 mph, I do not know for sure. As a large object, it probably did not exert that much pressure per area. Regardless, it happened in a fraction of a second. I do not have any noticeable wheezing or any hoarseness right now. However, I have some mild shortness of breath. I do not know whether this is related. Because I also have asthma and silent reflux, I have a pulse oximeter and a peak flow meter, both values of which are normal presently.I have some mild neck pain too. My cough is normal (no blood), and I do not have any difficulty swallowing. Can I wait a couple of weeks to get an indirect nasal laryngoscopy from an ENT in my area, and then depending on the result, symptoms then, get a CT/MRI a week thereafter? Or should I go seek emergency medical care now? ### Response: Hello, Welcome to Chat Doctor forum. Normally larynx is well protected by protruding mandible. Most of the impact is received by the sturdy mandible. However, since the impact was on the side of the neck, the laryngeal framework might have received some impact. I would like you to palpate your neck for tenderness and if you can also feel for crepitus of the thyroid cartilage if any. Also, look for any swelling. If there is anything like that or if you develop any hoarseness or dyspnea you may pay a visit to ER. In the absence of these, you can wait and take some analgesics in the meanwhile.

Hi doctor,I was just hit on the right side of my neck with a basketball. Part of the basketball hit my chin, so my neck cartilage did not take the entirety of the impact. The basketball was probably traveling around 20 mph, I do not know for sure. As a large object, it probably did not exert that much pressure per area. Regardless, it happened in a fraction of a second. I do not have any noticeable wheezing or any hoarseness right now. However, I have some mild shortness of breath. I do not know whether this is related. Because I also have asthma and silent reflux, I have a pulse oximeter and a peak flow meter, both values of which are normal presently.I have some mild neck pain too. My cough is normal (no blood), and I do not have any difficulty swallowing. Can I wait a couple of weeks to get an indirect nasal laryngoscopy from an ENT in my area, and then depending on the result, symptoms then, get a CT/MRI a week thereafter? Or should I go seek emergency medical care now?

Hello, Welcome to Chat Doctor forum. Normally larynx is well protected by protruding mandible. Most of the impact is received by the sturdy mandible. However, since the impact was on the side of the neck, the laryngeal framework might have received some impact. I would like you to palpate your neck for tenderness and if you can also feel for crepitus of the thyroid cartilage if any. Also, look for any swelling. If there is anything like that or if you develop any hoarseness or dyspnea you may pay a visit to ER. In the absence of these, you can wait and take some analgesics in the meanwhile.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was on birth control (Aviane) for almost two years. I stopped taking the pills after my serious relationship ended before two months. My first period after my withdrawal bleed happened in the middle of last month. It lasted about two days, was somewhat heavy, but then I mostly spotted for two days. Since then, all of my periods have been the same. Somewhat heavy for two days, then light spotting for two or three days. My cervical mucus has not seemed fertile, and I have not felt any ovulation pains like before I was on birth control.Everything about my period seemed different, and I have been thinking that meant that I was not ovulating like before, but I know that might not be the case. I had unprotected sex on day 10 of my cycle. We used the pull-out method, but just to be safe, I took five orange pills (Aviane) about 12 hours later, then five more orange pills 12 hours after the first dose. Today, four days later, I am feeling mildly crampy, but I am experiencing a lot of white thick discharge.My question is, are my chances of pregnancy low considering everything? And also, if I experience a withdrawal bleed from the bc pills, when should I expect my real period again? ### Response: Hi. Since you have taken pills, there is no chance of pregnancy. These symptoms could be because of hormonal changes due to the pill you have taken. Your next period could be a bit erratic, because of the hormonal changes due to the pill you have taken. But from the third month, usually, it get back to normal. So relax and do not worry. However, if you have any doubt then get back to me.

Hello doctor,I was on birth control (Aviane) for almost two years. I stopped taking the pills after my serious relationship ended before two months. My first period after my withdrawal bleed happened in the middle of last month. It lasted about two days, was somewhat heavy, but then I mostly spotted for two days. Since then, all of my periods have been the same. Somewhat heavy for two days, then light spotting for two or three days. My cervical mucus has not seemed fertile, and I have not felt any ovulation pains like before I was on birth control.Everything about my period seemed different, and I have been thinking that meant that I was not ovulating like before, but I know that might not be the case. I had unprotected sex on day 10 of my cycle. We used the pull-out method, but just to be safe, I took five orange pills (Aviane) about 12 hours later, then five more orange pills 12 hours after the first dose. Today, four days later, I am feeling mildly crampy, but I am experiencing a lot of white thick discharge.My question is, are my chances of pregnancy low considering everything? And also, if I experience a withdrawal bleed from the bc pills, when should I expect my real period again?

Hi. Since you have taken pills, there is no chance of pregnancy. These symptoms could be because of hormonal changes due to the pill you have taken. Your next period could be a bit erratic, because of the hormonal changes due to the pill you have taken. But from the third month, usually, it get back to normal. So relax and do not worry. However, if you have any doubt then get back to me.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I need help. Two weeks ago, I was at a friend\\s gathering or party. And we filled a barrel with glass bottle drinks and a lot of ice and a lot of water. Everyone picked up their drinks from the barrel. I had a cut on my finger and constantly dipped my hand in the barrel for a drink. I later got to know some colleagues at the party are HIV positive. But I did not see the water in the barrel bloody or anything of that sort. And I cannot tell if someone had cuts on their hands as well. A week after the incident, I got this mild cold. And I am worried. Please, is it possible for HIV to have survived in the water? Should it be the case that anyone had a cut on his or her hand? Is it possible to have gotten infected just like that? Please help me. ### Response: Hi. I have read your query carefully. You are tensed about your exposure to HIV. Now I am explaining you everything. HIV infection is usually acquired through sexual intercourse, exposure to infected blood, or perinatal transmission. In your case, you are exposed to HIV by blood mixing fluid to ChatDoctor. You have to keep in mind that the HIV virus does not survive for a long time outside the body. You also keep in mind that exposure through oral route is extremely rare. So there is very very little chance to be infected by this mean. But if you are worried after that explanation, you can go for a test named ELISA for HIV. But it needs minimum 2 to 3 weeks to be positive in the fourth generation test. And 7 to 8 weeks in the first generation ELISA todetect the virus after exposure. So you should wait.

Hi doctor,I need help. Two weeks ago, I was at a friend\\s gathering or party. And we filled a barrel with glass bottle drinks and a lot of ice and a lot of water. Everyone picked up their drinks from the barrel. I had a cut on my finger and constantly dipped my hand in the barrel for a drink. I later got to know some colleagues at the party are HIV positive. But I did not see the water in the barrel bloody or anything of that sort. And I cannot tell if someone had cuts on their hands as well. A week after the incident, I got this mild cold. And I am worried. Please, is it possible for HIV to have survived in the water? Should it be the case that anyone had a cut on his or her hand? Is it possible to have gotten infected just like that? Please help me.

Hi. I have read your query carefully. You are tensed about your exposure to HIV. Now I am explaining you everything. HIV infection is usually acquired through sexual intercourse, exposure to infected blood, or perinatal transmission. In your case, you are exposed to HIV by blood mixing fluid to ChatDoctor. You have to keep in mind that the HIV virus does not survive for a long time outside the body. You also keep in mind that exposure through oral route is extremely rare. So there is very very little chance to be infected by this mean. But if you are worried after that explanation, you can go for a test named ELISA for HIV. But it needs minimum 2 to 3 weeks to be positive in the fourth generation test. And 7 to 8 weeks in the first generation ELISA todetect the virus after exposure. So you should wait.

### Instruction: Answer this question truthfully ###Input: Hi doctor,My father is having enlarged prostate and has to undergo prostatectomy surgery. But, it is getting delayed due to ITP (idiopathic thrombocytopenic purpura). Right now he is under urine catheter. From past 12 days he is using Silodal-D 8 mg. Doctor said that after 20 days the prostate gland will reduce. Through ultrasound test we came to know the size of prostate enlarged is 54.6 cc. My doubt is, if it is enlarged to 54, is it possible that it can reduce through tablets? Or is it a must to undergo surgery? Right now the platelet count is 40,000. Please suggest a solution for this. ### Response: Hi, Welcome to Chat Doctor forum. Your father was on medication and has history of urine retention in the past. Currently, he is on catheter. Chances of medical management will not be successful. He needs surgery of either TURP (transurethral resection of the prostate) or HoLEP (Holmium laser enucleation of the prostate) for prostate. Size is never a criteria for surgery. Enlarged prostate can shrink by 30% if Dutasteride is given. But, this does not guarantee that the patient will become catheter free. However, it reduces blood vessels in prostate and helps decrease blood loss in surgery. Dutas-T (Dutasteride and Tamsulosin) also contains similar medicines as Silodal D (combination of Dutasteride and Silodosin). His ITP needs to be tackled and with all due precautions and keeping platelet concentrates on standby. He can undergo endoscopic surgery with due risks. Laser surgery - HoLEP will be better for him if available.

Hi doctor,My father is having enlarged prostate and has to undergo prostatectomy surgery. But, it is getting delayed due to ITP (idiopathic thrombocytopenic purpura). Right now he is under urine catheter. From past 12 days he is using Silodal-D 8 mg. Doctor said that after 20 days the prostate gland will reduce. Through ultrasound test we came to know the size of prostate enlarged is 54.6 cc. My doubt is, if it is enlarged to 54, is it possible that it can reduce through tablets? Or is it a must to undergo surgery? Right now the platelet count is 40,000. Please suggest a solution for this.

Hi, Welcome to Chat Doctor forum. Your father was on medication and has history of urine retention in the past. Currently, he is on catheter. Chances of medical management will not be successful. He needs surgery of either TURP (transurethral resection of the prostate) or HoLEP (Holmium laser enucleation of the prostate) for prostate. Size is never a criteria for surgery. Enlarged prostate can shrink by 30% if Dutasteride is given. But, this does not guarantee that the patient will become catheter free. However, it reduces blood vessels in prostate and helps decrease blood loss in surgery. Dutas-T (Dutasteride and Tamsulosin) also contains similar medicines as Silodal D (combination of Dutasteride and Silodosin). His ITP needs to be tackled and with all due precautions and keeping platelet concentrates on standby. He can undergo endoscopic surgery with due risks. Laser surgery - HoLEP will be better for him if available.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I seem to be getting these dizzy rush sensations. They happen randomly throughout the day, but mostly when I am on the computer. It feels like an electrical pulse is surging up through the back of my head. I also feel dizzy turning side to side and when I get a headache, it feels like it is coming from deep within my left ear. It causes me to panic and get a lot of anxiety afterward. What could this electrical rush sensation be? Then, also, after I get it, I cannot look up too quickly because I feel very dizzy. It usually happens again, while typing on the computer or looking down at a smartphone. ### Response: Hello. I will try my level best to help you out. Your symptoms are mostly dizziness, which worsens with sudden eye movements or body movements, and are sometimes associated with headaches. Based on the symptoms, the most common cause in your age group is a vestibular migraine or benign paroxysmal positional vertigo (BPPV). I assume you do not have any other risk factors such as diabetes, hypertension, previous stroke or diagnosis of epilepsy. A simple neurological exam using Dix Hallpike Maneuver can help differentiate between BPPV and vestibular migraine. Also, further questions on the quality of headache, location and associated symptoms such as light sensitivity, loud noise sensitivity and nausea are other important questions, that can happen with vestibular migraine. Treatment for BPPV is physiotherapy with some specific exercises and medicines such as Topiramate or Valproic acid for vestibular migraine. If there are any red flags on neurological exam, then an MRI (magnetic resonance imaging) of the brain would be needed. Please do not hesitate to ask me any other questions. Take care. For more information consult a neurologist online

Hello doctor,I seem to be getting these dizzy rush sensations. They happen randomly throughout the day, but mostly when I am on the computer. It feels like an electrical pulse is surging up through the back of my head. I also feel dizzy turning side to side and when I get a headache, it feels like it is coming from deep within my left ear. It causes me to panic and get a lot of anxiety afterward. What could this electrical rush sensation be? Then, also, after I get it, I cannot look up too quickly because I feel very dizzy. It usually happens again, while typing on the computer or looking down at a smartphone.

Hello. I will try my level best to help you out. Your symptoms are mostly dizziness, which worsens with sudden eye movements or body movements, and are sometimes associated with headaches. Based on the symptoms, the most common cause in your age group is a vestibular migraine or benign paroxysmal positional vertigo (BPPV). I assume you do not have any other risk factors such as diabetes, hypertension, previous stroke or diagnosis of epilepsy. A simple neurological exam using Dix Hallpike Maneuver can help differentiate between BPPV and vestibular migraine. Also, further questions on the quality of headache, location and associated symptoms such as light sensitivity, loud noise sensitivity and nausea are other important questions, that can happen with vestibular migraine. Treatment for BPPV is physiotherapy with some specific exercises and medicines such as Topiramate or Valproic acid for vestibular migraine. If there are any red flags on neurological exam, then an MRI (magnetic resonance imaging) of the brain would be needed. Please do not hesitate to ask me any other questions. Take care. For more information consult a neurologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,My daughter has skin lesions that started last year. They are on one side of the body. Initially, she got eczema kind small red rashes for which we applied Corticosteroid and later we observed whitish patches developing on those spots. Initially, the GP thought it could be tinea versicolor and suspected it could also be vitiligo.He referred us to a skin specialist and initially, the skin specialist thought it could be hypopigmentation and after a month, in the next appointment, she thought it could be vitiligo and started with Tacrolimus and Corticosteroid cream.Even before we started applying this Tacrolimus, we saw some repigmentation in some areas but it was slow repigmentation. We were confused as is it vitiligo or not and also as we are applying strong creams for a 6-year-old girl. Any long-term issues?We want to have a second opinion. I live in a city where it is very difficult to get skin specialist appointments. They give for every three to six months. Could you please help us in diagnosing the skin patches and treatment? I can send in the photos. I uploaded the photos ### Response: Hi, Welcome to Chat Doctor forum. I have gone through your history and clinical photographs (attachment removed to protect patient identity). From the present situation, it looks to be vitiligo. Since it is on one side of the body, it can be called as segmental vitiligo also. Tacrolimus is the right medication. Wood\\s lamp examination helps to diagnose vitiligo. Yes, in some places, there is repigmentation which is a good sign. Did anyone in the family have vitiligo? Revert with more information to a cosmetologist online

Hi doctor,My daughter has skin lesions that started last year. They are on one side of the body. Initially, she got eczema kind small red rashes for which we applied Corticosteroid and later we observed whitish patches developing on those spots. Initially, the GP thought it could be tinea versicolor and suspected it could also be vitiligo.He referred us to a skin specialist and initially, the skin specialist thought it could be hypopigmentation and after a month, in the next appointment, she thought it could be vitiligo and started with Tacrolimus and Corticosteroid cream.Even before we started applying this Tacrolimus, we saw some repigmentation in some areas but it was slow repigmentation. We were confused as is it vitiligo or not and also as we are applying strong creams for a 6-year-old girl. Any long-term issues?We want to have a second opinion. I live in a city where it is very difficult to get skin specialist appointments. They give for every three to six months. Could you please help us in diagnosing the skin patches and treatment? I can send in the photos. I uploaded the photos

Hi, Welcome to Chat Doctor forum. I have gone through your history and clinical photographs (attachment removed to protect patient identity). From the present situation, it looks to be vitiligo. Since it is on one side of the body, it can be called as segmental vitiligo also. Tacrolimus is the right medication. Wood\\s lamp examination helps to diagnose vitiligo. Yes, in some places, there is repigmentation which is a good sign. Did anyone in the family have vitiligo? Revert with more information to a cosmetologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had a tooth extracted, and it resulted in the perforated sinus. I was on antibiotics Amoxicillin for seven days before and three days after the extraction. I took all the medicines on the sixth day I got a bad sinus infection. I went to my primary care doctor she put me on Amoxicillin once again. She told me to go back to the dentist if there is no improvement.I went back to the dentist, and she prescribed Augmentin and advised to go to an oral surgeon, and he confirmed the sinus perforation. He told me it was healing and told me to stay on antibiotics come back in two weeks for follow-up. After six days on Augmentin, I am still having bad headaches in the front by my eye and a lot of sinus pressure. I am taking the Augmentin, Sudafed, Off Brand Flonase, Tylenol, Ibuprofen 800, and Asprin alternating. Should I be taking another type of antibiotics, or do you feel the Augmentin is working? ### Response: Hello, Welcome to Chat Doctor forum. Did you get a CT scan done to see the size of the fistula? It\\s called an oro-antral fistula. If it is big then it may have to be corrected surgically. Additionally if the infection is not healing one can give a thorough antral wash and wash out the contents of the sinus in an operation theatre under anesthesia which will help in bringing down the load of infection and help the antibiotics act. Since you have taken amoxicillin/augmentin for quite some time, I also feel the antibiotic can be changed into a stronger one with a broader action, say like Levofloxacin and Metronidazole.

Hello doctor,I had a tooth extracted, and it resulted in the perforated sinus. I was on antibiotics Amoxicillin for seven days before and three days after the extraction. I took all the medicines on the sixth day I got a bad sinus infection. I went to my primary care doctor she put me on Amoxicillin once again. She told me to go back to the dentist if there is no improvement.I went back to the dentist, and she prescribed Augmentin and advised to go to an oral surgeon, and he confirmed the sinus perforation. He told me it was healing and told me to stay on antibiotics come back in two weeks for follow-up. After six days on Augmentin, I am still having bad headaches in the front by my eye and a lot of sinus pressure. I am taking the Augmentin, Sudafed, Off Brand Flonase, Tylenol, Ibuprofen 800, and Asprin alternating. Should I be taking another type of antibiotics, or do you feel the Augmentin is working?

Hello, Welcome to Chat Doctor forum. Did you get a CT scan done to see the size of the fistula? It\\s called an oro-antral fistula. If it is big then it may have to be corrected surgically. Additionally if the infection is not healing one can give a thorough antral wash and wash out the contents of the sinus in an operation theatre under anesthesia which will help in bringing down the load of infection and help the antibiotics act. Since you have taken amoxicillin/augmentin for quite some time, I also feel the antibiotic can be changed into a stronger one with a broader action, say like Levofloxacin and Metronidazole.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am going to undergo a laparoscopic fundoplication surgery after a week for severe GERD. For the past two months, I am taking Valium 5 mg for severe anxiety (mainly related to my health) three times daily. I am also taking Omeprazole 80 mg daily for several months.I recently came across a study that stated the AUC and half-life of Valium are increased by 130 % with a dose of 40 mg Omeprazole. As I am taking double the dose of Omeprazole, I am afraid that it has raised my plasma level. I am concerned about the concurrent use of other drugs (opioids) that can help me.I need to talk to an anesthesiologist before my surgery. Is this dangerous, or are there any other alternative sedatives to opiates that would interact less with my Valium dose? Is there any increased concentration in my body? This is my first major surgery, and I am terrified. I am taking Aspirin 81 mg and Crestor 10 mg. My past medications are Lorazepam, Citalopram, Escitalopram, Zoloft, Propranolol, Esomeprazole, and Ranitidine. ### Response: Hi, Welcome to Chat Doctor forum. Please convey your medical history to the anesthetist when you have a pre-anesthetic consultation. I am sure that they will be using Remifentanil infusion for the surgery. This ChatDoctor. I suggest you consult an anesthetist before surgery and stop taking Valium. There are better medications for controlling anxiety. I recommend a psychiatrist referral after the surgery. This will cure your stress and anxiety related gastritis.

Hi doctor,I am going to undergo a laparoscopic fundoplication surgery after a week for severe GERD. For the past two months, I am taking Valium 5 mg for severe anxiety (mainly related to my health) three times daily. I am also taking Omeprazole 80 mg daily for several months.I recently came across a study that stated the AUC and half-life of Valium are increased by 130 % with a dose of 40 mg Omeprazole. As I am taking double the dose of Omeprazole, I am afraid that it has raised my plasma level. I am concerned about the concurrent use of other drugs (opioids) that can help me.I need to talk to an anesthesiologist before my surgery. Is this dangerous, or are there any other alternative sedatives to opiates that would interact less with my Valium dose? Is there any increased concentration in my body? This is my first major surgery, and I am terrified. I am taking Aspirin 81 mg and Crestor 10 mg. My past medications are Lorazepam, Citalopram, Escitalopram, Zoloft, Propranolol, Esomeprazole, and Ranitidine.

Hi, Welcome to Chat Doctor forum. Please convey your medical history to the anesthetist when you have a pre-anesthetic consultation. I am sure that they will be using Remifentanil infusion for the surgery. This ChatDoctor. I suggest you consult an anesthetist before surgery and stop taking Valium. There are better medications for controlling anxiety. I recommend a psychiatrist referral after the surgery. This will cure your stress and anxiety related gastritis.

### Instruction: Answer this question truthfully ###Input: Results from an HSG procedure showed that I have a bicornuate uterus or a thick septum. Both Fallopian tubes are patent. But there is an abnormal position of the uterine body, possibly due to a cystic nodularity in the right adnexa, displacing the entire uterine body toward the left side of the pelvic cavity. Currently trying to conceive and I\\m pretty concerned about the complications with both fertility and pregnancy due to the potential above diagnosis. Further clinical evaluation is recommended. What can be done to fix this and/or make the changes for a healthy full-term pregnancy? Thanks! ### Response: HiThanks for your querywoman may never need treatment for a bicornuate uterus. If it is required, the surgery is known as a Strassman metroplasty.This surgery may be recommended if a woman has repeated miscarriages and bicornuate uterus is thought to be the cause.Performing this procedure, as a solution to infertility, is controversial, as the majority of research carried out suggests that having a bicornuate uterus will not affect a woman's chances of falling pregnant.Some evidence suggests that problems, such as miscarriage and early birth, are more likely in women with the condition, though it does not rule out a successful pregnancy and natural delivery.Women with a bicornuate uterus who do become pregnant should have additional monitoring and checkups throughout their pregnancy, to minimize risk and identify any problems early on.It's not necessary that all those with this condition will get problems with fertility or pregnancy but the chances are more especially if it's septate uterus where there's full septum diving uterus into two.Sometimes it can't be established on imaging and laparoscopic view may be necessary. Take care.

Results from an HSG procedure showed that I have a bicornuate uterus or a thick septum. Both Fallopian tubes are patent. But there is an abnormal position of the uterine body, possibly due to a cystic nodularity in the right adnexa, displacing the entire uterine body toward the left side of the pelvic cavity. Currently trying to conceive and I\\m pretty concerned about the complications with both fertility and pregnancy due to the potential above diagnosis. Further clinical evaluation is recommended. What can be done to fix this and/or make the changes for a healthy full-term pregnancy? Thanks!

HiThanks for your querywoman may never need treatment for a bicornuate uterus. If it is required, the surgery is known as a Strassman metroplasty.This surgery may be recommended if a woman has repeated miscarriages and bicornuate uterus is thought to be the cause.Performing this procedure, as a solution to infertility, is controversial, as the majority of research carried out suggests that having a bicornuate uterus will not affect a woman's chances of falling pregnant.Some evidence suggests that problems, such as miscarriage and early birth, are more likely in women with the condition, though it does not rule out a successful pregnancy and natural delivery.Women with a bicornuate uterus who do become pregnant should have additional monitoring and checkups throughout their pregnancy, to minimize risk and identify any problems early on.It's not necessary that all those with this condition will get problems with fertility or pregnancy but the chances are more especially if it's septate uterus where there's full septum diving uterus into two.Sometimes it can't be established on imaging and laparoscopic view may be necessary. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was diagnosed with epilepsy in late 2016, and have been taking Levetiracetam since then (500 mg twice a day). I have been concerned that it is affecting my mental health. I have been experiencing anxiety, depression, irritability, and anger which is very out of character for me. It has taken some time to pinpoint, but it seems like these behavioral changes may correlate with when I began taking the medication.Prior to starting Levetiracetam, I had two grand mal seizures about 12-15 months apart. I frequently had what were diagnoses as epilepsy-related auras. Since I have been taking Levetiracetam, I have not had any more seizures or auras. I am happy the medication is working, but I am interested in advice about other possible medications or non-prescription treatments. ### Response: Hi, Welcome to Chat Doctor forum. Your assumption is right, Levetiracetam causes behavioral disturbance as a side effect. There are two options now, 1. To taper off the Levetiracetam - if you have not experienced any seizure or aura in the last four years then we can go straight away with gradual tapering of the medicine, for that we need to know the last seizure/ aura episode, but with this, there is a risk of recurrence, you need to be cautious and under the watch of someone for few months. 2. Substitute Levetiracetam with Sodium valproate - in this risk of seizure is less, but still, it is there, on the fact the Sodium valproate is a mood stabilizer. Please do not do any of the above by self, you can consult a neurologist locally let him manage or get a telephonic consultation.

Hello doctor,I was diagnosed with epilepsy in late 2016, and have been taking Levetiracetam since then (500 mg twice a day). I have been concerned that it is affecting my mental health. I have been experiencing anxiety, depression, irritability, and anger which is very out of character for me. It has taken some time to pinpoint, but it seems like these behavioral changes may correlate with when I began taking the medication.Prior to starting Levetiracetam, I had two grand mal seizures about 12-15 months apart. I frequently had what were diagnoses as epilepsy-related auras. Since I have been taking Levetiracetam, I have not had any more seizures or auras. I am happy the medication is working, but I am interested in advice about other possible medications or non-prescription treatments.

Hi, Welcome to Chat Doctor forum. Your assumption is right, Levetiracetam causes behavioral disturbance as a side effect. There are two options now, 1. To taper off the Levetiracetam - if you have not experienced any seizure or aura in the last four years then we can go straight away with gradual tapering of the medicine, for that we need to know the last seizure/ aura episode, but with this, there is a risk of recurrence, you need to be cautious and under the watch of someone for few months. 2. Substitute Levetiracetam with Sodium valproate - in this risk of seizure is less, but still, it is there, on the fact the Sodium valproate is a mood stabilizer. Please do not do any of the above by self, you can consult a neurologist locally let him manage or get a telephonic consultation.

### Instruction: Answer this question truthfully ###Input: Hello doctor,A new mole on a toe that I have not noticed before, I know about it probably for a week, it is blackish and not round, about 3 to 4 mm wide and sort of even in color. I am 21 years old male and as far as I know we have no cancer history in my family. I can provide photos too. ### Response: Hi, Welcome to Chat Doctor forum. I went through your case history and the photos provided by you (attachment removed to protect patient identity). I can see a dark irregular lesion of about 5 mm in size over the tip of the toe. As it is to 3 days history the first thing I want to rule out is an history of injury or bruise.They do present like this and you may have forgotten the history of trauma. Secondly, moles also appear at this age and they also present like this if you have tendency of moles this may be a normal mole you can just observe it for few days. The other thing obviously is melanoma, acral lentiginous melanosis, this can be dangerous and has to be ruled by biopsy as soon as possible. But as you do not have any family history and if you do not have any other or very few moles over other parts of the body the chances again become very less. And again such a small history of the lesion the possibility is least. But to be sure you should monitor the lesion. Observe it for 5 days. If due to trauma, it will diminish and slowly go away. If persist and grow more immediately, go for a biopsy by a dermatologist for histopathogical examination. trauma, biopsy after 5 days. Intradermal hemorrhage, nevus nevus excision. none after 5 days.

Hello doctor,A new mole on a toe that I have not noticed before, I know about it probably for a week, it is blackish and not round, about 3 to 4 mm wide and sort of even in color. I am 21 years old male and as far as I know we have no cancer history in my family. I can provide photos too.

Hi, Welcome to Chat Doctor forum. I went through your case history and the photos provided by you (attachment removed to protect patient identity). I can see a dark irregular lesion of about 5 mm in size over the tip of the toe. As it is to 3 days history the first thing I want to rule out is an history of injury or bruise.They do present like this and you may have forgotten the history of trauma. Secondly, moles also appear at this age and they also present like this if you have tendency of moles this may be a normal mole you can just observe it for few days. The other thing obviously is melanoma, acral lentiginous melanosis, this can be dangerous and has to be ruled by biopsy as soon as possible. But as you do not have any family history and if you do not have any other or very few moles over other parts of the body the chances again become very less. And again such a small history of the lesion the possibility is least. But to be sure you should monitor the lesion. Observe it for 5 days. If due to trauma, it will diminish and slowly go away. If persist and grow more immediately, go for a biopsy by a dermatologist for histopathogical examination. trauma, biopsy after 5 days. Intradermal hemorrhage, nevus nevus excision. none after 5 days.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have been diagnosed with iron deficiency anemia before three months. On my latest check-up, I have seen that my iron level has reduced (5.74 g/dL to 5.72 g/dL) while my serum iron level has got higher (36 mcg/dL to 39 mcg/dL). My RBC level is normal. But my hemoglobin level got higher (11.3 g/dL) as my UBIC is still high. I made a urine test too, as I had white things in my urine for almost three months. My results say the leucocyte clusters are typical and there are 15 to 20 % epithelial cells seen. My doctor advised me to take Ciprofloxacin antibiotics. From yesterday, as I started using Iron tablets, I saw my stool in two colored like some of them are black (because of the iron), and few ones are light brown. When the stools are dropping, I have a feeling of something is hurting me. It quickly passes away, and after it has gone, my anus starts to burn. Is this a sign of bacterial infection? There was no blood in my stool. ### Response: Hi, Welcome to Chat Doctor forum. The black stool is because of iron intake. You can have a burning sensation while passing stool because of proctitis like inflammation or due to piles. For that local rectal and proctoscopy examination is needed. Anal water sitz bath is beneficial, and if piles is present, then Cremaffin syrup (Sodium Picosulfate with liquid Paraffin) can be taken. Your white color urine is due to the presence of pus cells and it can be suggestive of urinary tract infection. For more information consult a hematologist online

Hi doctor,I have been diagnosed with iron deficiency anemia before three months. On my latest check-up, I have seen that my iron level has reduced (5.74 g/dL to 5.72 g/dL) while my serum iron level has got higher (36 mcg/dL to 39 mcg/dL). My RBC level is normal. But my hemoglobin level got higher (11.3 g/dL) as my UBIC is still high. I made a urine test too, as I had white things in my urine for almost three months. My results say the leucocyte clusters are typical and there are 15 to 20 % epithelial cells seen. My doctor advised me to take Ciprofloxacin antibiotics. From yesterday, as I started using Iron tablets, I saw my stool in two colored like some of them are black (because of the iron), and few ones are light brown. When the stools are dropping, I have a feeling of something is hurting me. It quickly passes away, and after it has gone, my anus starts to burn. Is this a sign of bacterial infection? There was no blood in my stool.

Hi, Welcome to Chat Doctor forum. The black stool is because of iron intake. You can have a burning sensation while passing stool because of proctitis like inflammation or due to piles. For that local rectal and proctoscopy examination is needed. Anal water sitz bath is beneficial, and if piles is present, then Cremaffin syrup (Sodium Picosulfate with liquid Paraffin) can be taken. Your white color urine is due to the presence of pus cells and it can be suggestive of urinary tract infection. For more information consult a hematologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a female, 58, 5\\10\", 239lbs. I am having nausea every morning. It comes and goes during the day. I also have black stools, belly pain, and gas. I am on Lexapro 10 mg, Pramipexole 3 mg, Lamotrigine 25 mg twice daily and 200 mg once, Meloxicam 15 mg, Metformin 500 mg, Gabapentin 300 mg, and Atorvastatin 40 mg. ### Response: Hello, Welcome to Chat Doctor forum. Your symptoms are suggestive of upper gastrointestinal intestinal bleed. Please stop Meloxicam 15 mg tablet immediately. I suggest you take proton pump inhibitor medication like Omeprazole 40 mg tablet straightaway and take preferably cold water. Please check with an accident and emergency department for further care for intravenous proton pump inhibitor, antiemetic medications, and further lab investigations such as complete blood count, bleeding and clotting time, prothrombin time with platelets, APTT (activated partial thromboplastin time), INR (international normalized ratio), stool for occult blood, ultrasound abdomen, complete liver function tests to assess the extent of blood loss through stools. In case of evidence of ongoing bleed, you will require packed cells and urgent upper GI endoscopy for diagnosis and stapling of bleeding esophageal varices. Do not take Aspirin tablets or any other painkillers as they can worsen bleeding inside the gut. Stop alcohol, spicy diet, coffee, and tea. After emergency treatment, I suggest the long list of medications be reviewed to see whether it can be simplified. For more information consult a general practitioner online

Hello doctor,I am a female, 58, 5\\10\", 239lbs. I am having nausea every morning. It comes and goes during the day. I also have black stools, belly pain, and gas. I am on Lexapro 10 mg, Pramipexole 3 mg, Lamotrigine 25 mg twice daily and 200 mg once, Meloxicam 15 mg, Metformin 500 mg, Gabapentin 300 mg, and Atorvastatin 40 mg.

Hello, Welcome to Chat Doctor forum. Your symptoms are suggestive of upper gastrointestinal intestinal bleed. Please stop Meloxicam 15 mg tablet immediately. I suggest you take proton pump inhibitor medication like Omeprazole 40 mg tablet straightaway and take preferably cold water. Please check with an accident and emergency department for further care for intravenous proton pump inhibitor, antiemetic medications, and further lab investigations such as complete blood count, bleeding and clotting time, prothrombin time with platelets, APTT (activated partial thromboplastin time), INR (international normalized ratio), stool for occult blood, ultrasound abdomen, complete liver function tests to assess the extent of blood loss through stools. In case of evidence of ongoing bleed, you will require packed cells and urgent upper GI endoscopy for diagnosis and stapling of bleeding esophageal varices. Do not take Aspirin tablets or any other painkillers as they can worsen bleeding inside the gut. Stop alcohol, spicy diet, coffee, and tea. After emergency treatment, I suggest the long list of medications be reviewed to see whether it can be simplified. For more information consult a general practitioner online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had protected sex before two years. As I recall she was on the top and then later I was on top of her. During the act, my condom slipped, but there was no exposure to my bare penis. I could not achieve an erection, so she removed the condom and applied lotion on my penis. My question is,1. Can her vaginal fluids enter my exposed penis as she applied lotion, making me infective (unknown status)?2. I had two p24 tests done at four and nine weeks. Both came negative. Should I go to 12 weeks or is this conclusive? Is there any chance of turning negative to positive?3. I feel swollen lymph node in my neck which occurred close to 12 weeks now. Am I HIV infective? Please help with your reply, and I am getting stressed. ### Response: Hello. Answers to your queries are, 1)This is not a likely situation of entry of HIV through the vaginal fluid. Acquisition of HIV in this scenario is non-existent. Your fears are unwanted. 2) It is good that your p24 test is negative at four and nine weeks. Majority of the individuals (approximately 97 %) turned positive after an HIV exposure in two to eight weeks, and a very few take six months for the test to become positive. As per the recommendations and I also suggest you undertake a repeat HIV antibody test at three months and if negative then at six months. You need not repeat it in between. 3) Enlargements of lymph nodes can be in multiple conditions. Get it evaluated. Lymph node biopsy helps in establishing the diagnosis. I hope your queries are answered, but if you still have, feel free to ask.

Hello doctor,I had protected sex before two years. As I recall she was on the top and then later I was on top of her. During the act, my condom slipped, but there was no exposure to my bare penis. I could not achieve an erection, so she removed the condom and applied lotion on my penis. My question is,1. Can her vaginal fluids enter my exposed penis as she applied lotion, making me infective (unknown status)?2. I had two p24 tests done at four and nine weeks. Both came negative. Should I go to 12 weeks or is this conclusive? Is there any chance of turning negative to positive?3. I feel swollen lymph node in my neck which occurred close to 12 weeks now. Am I HIV infective? Please help with your reply, and I am getting stressed.

Hello. Answers to your queries are, 1)This is not a likely situation of entry of HIV through the vaginal fluid. Acquisition of HIV in this scenario is non-existent. Your fears are unwanted. 2) It is good that your p24 test is negative at four and nine weeks. Majority of the individuals (approximately 97 %) turned positive after an HIV exposure in two to eight weeks, and a very few take six months for the test to become positive. As per the recommendations and I also suggest you undertake a repeat HIV antibody test at three months and if negative then at six months. You need not repeat it in between. 3) Enlargements of lymph nodes can be in multiple conditions. Get it evaluated. Lymph node biopsy helps in establishing the diagnosis. I hope your queries are answered, but if you still have, feel free to ask.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 41 year old male with height 5 feet10 and weight 84 kg. I am having a health situation for the last two years where the top of my feet (the area covered under the shoe) gets very sensitive to touch. Even a touch of the cotton pajama feels irritating. My left hand (below where we tie the watch) occasionally burns and has the same \\sensitive to touch\\ feel as the feet. Sometimes, I have felt the same kind of sensitivity on my nose-tip and edges of the lips. Recently, I am noticing that the finger pads on both the hands have become too sensitive to pressure and the reddish and painful mark remains for a long time even after applying a bit of effort like turning a key in the lock. I am attaching my blood test report from the last month. Kindly help me as this is a very irritating situation and I am finding it difficult to concentrate on work because of this. ### Response: Hello. I have gone through your reports (attachment removed to protect patient identity). Your uric acid is slightly increased. So, avoid red meat and recheck uric acid after three months. Most of your symptoms point to a neuropathy. So, you need to get a nerve conduction study done. It is done by a neurologist on an OPD basis. Low calcium levels can cause some of these symptoms. So, I suggest starting tablet Shelcal 500 mg (Calcium and Vitamin D3) once a day for three months. Consult your specialist doctor, discuss with him or her and start taking the medicine with their consent. Also, check serum vitamin D levels if symptoms do not improve in the month\\s time. For more information consult an internal medicine physician online

Hello doctor,I am a 41 year old male with height 5 feet10 and weight 84 kg. I am having a health situation for the last two years where the top of my feet (the area covered under the shoe) gets very sensitive to touch. Even a touch of the cotton pajama feels irritating. My left hand (below where we tie the watch) occasionally burns and has the same \\sensitive to touch\\ feel as the feet. Sometimes, I have felt the same kind of sensitivity on my nose-tip and edges of the lips. Recently, I am noticing that the finger pads on both the hands have become too sensitive to pressure and the reddish and painful mark remains for a long time even after applying a bit of effort like turning a key in the lock. I am attaching my blood test report from the last month. Kindly help me as this is a very irritating situation and I am finding it difficult to concentrate on work because of this.

Hello. I have gone through your reports (attachment removed to protect patient identity). Your uric acid is slightly increased. So, avoid red meat and recheck uric acid after three months. Most of your symptoms point to a neuropathy. So, you need to get a nerve conduction study done. It is done by a neurologist on an OPD basis. Low calcium levels can cause some of these symptoms. So, I suggest starting tablet Shelcal 500 mg (Calcium and Vitamin D3) once a day for three months. Consult your specialist doctor, discuss with him or her and start taking the medicine with their consent. Also, check serum vitamin D levels if symptoms do not improve in the month\\s time. For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was wondering if anyone could tell me about my condition. I used to go to an eye doctor when I was little but I cannot remember when I last went. I was never pushed to go by my parents when I was younger, only when I needed a new pair of glasses.I was born with one eye small, the other normal. My vision is fine, I am very nearsighted but with glasses, I see quite well. My depth perception is normal too, I can see most things and when I tried to drive once, it went well. In my affected eye pupil is floating around. I cannot see much out of it, and it is not big enough.Other than that, no other health conditions. Could anyone tell me what this is? Is it something that progresses and will I go blind someday? ### Response: Hi, Welcome to Chat Doctor forum. You have unilateral microphthalmos i.e. your one eye which in your case is right eye is not fully developed and has developed a squint. Other eyes appear normal but I will advise you to get a fundus in the left eye also to rule out any retinal anomaly. The condition in the right will always remain like this and this condition will not affect the left eye. If it is normal just do not engage in activities that can lead do an injury in the left eye also. So please consult a vitreoretinal specialist to rule out any retinal lesions in the left eye and get yourself rechecked for glasses every six months. Though your left eye appears very normal from outside but since you are nearsighted I will advise you to get retinal examination in your normal eye too, so that if there is any treatable lesion we can fix it at an early stage.

Hello doctor,I was wondering if anyone could tell me about my condition. I used to go to an eye doctor when I was little but I cannot remember when I last went. I was never pushed to go by my parents when I was younger, only when I needed a new pair of glasses.I was born with one eye small, the other normal. My vision is fine, I am very nearsighted but with glasses, I see quite well. My depth perception is normal too, I can see most things and when I tried to drive once, it went well. In my affected eye pupil is floating around. I cannot see much out of it, and it is not big enough.Other than that, no other health conditions. Could anyone tell me what this is? Is it something that progresses and will I go blind someday?

Hi, Welcome to Chat Doctor forum. You have unilateral microphthalmos i.e. your one eye which in your case is right eye is not fully developed and has developed a squint. Other eyes appear normal but I will advise you to get a fundus in the left eye also to rule out any retinal anomaly. The condition in the right will always remain like this and this condition will not affect the left eye. If it is normal just do not engage in activities that can lead do an injury in the left eye also. So please consult a vitreoretinal specialist to rule out any retinal lesions in the left eye and get yourself rechecked for glasses every six months. Though your left eye appears very normal from outside but since you are nearsighted I will advise you to get retinal examination in your normal eye too, so that if there is any treatable lesion we can fix it at an early stage.

### Instruction: Answer this question truthfully ###Input: Hello doctor, I had sex with a lady and after three days my penis gets pain a lot in the night. I cannot sleep much in pain. After one week I checked with the hospital, they give me antibiotic medicine but there is no relief. I have done my HSV 1, HSV 2, VDRL, and HIV test. All test are negative. Now one year has gone, still, I have pain little inside the urine pipe when I go for urine and on the tip of my penis a red dot appears. On applying Candid cream the red dot goes away but when I stop applying the cream again that red dot appears. I am also taking AF-150. I am sending you my picture. Please help. ### Response: Hi, Welcome to Chat Doctor forum. I have gone through your history and reviewed the attached photograph. (attachment removed to protect patient identity). According to me, there are two possibilities, one is candidal balanoposthitis and the other is herpes genitalis. Since you have mentioned that your HSV 1 and 2 tests (herpes simplex virus) were negative then chances of candida infection is more. But I would recommend you to repeat HSV 1 and 2 tests again to rule out herpes infection. As far as treatment is concerned, wash the affected area with water only and keep it as ChatDoctor. Apply Sertaconazole cream on the affected area twice daily for at least two weeks and take tablet Fluconazole 200 mg twice weekly for two weeks. You can revert back to me after two weeks. Candida infection, Herpes infection. ELISA for HSV 1 and 2. Candidal balanoposthitis. As mentioned above. As mentioned above.

Hello doctor, I had sex with a lady and after three days my penis gets pain a lot in the night. I cannot sleep much in pain. After one week I checked with the hospital, they give me antibiotic medicine but there is no relief. I have done my HSV 1, HSV 2, VDRL, and HIV test. All test are negative. Now one year has gone, still, I have pain little inside the urine pipe when I go for urine and on the tip of my penis a red dot appears. On applying Candid cream the red dot goes away but when I stop applying the cream again that red dot appears. I am also taking AF-150. I am sending you my picture. Please help.

Hi, Welcome to Chat Doctor forum. I have gone through your history and reviewed the attached photograph. (attachment removed to protect patient identity). According to me, there are two possibilities, one is candidal balanoposthitis and the other is herpes genitalis. Since you have mentioned that your HSV 1 and 2 tests (herpes simplex virus) were negative then chances of candida infection is more. But I would recommend you to repeat HSV 1 and 2 tests again to rule out herpes infection. As far as treatment is concerned, wash the affected area with water only and keep it as ChatDoctor. Apply Sertaconazole cream on the affected area twice daily for at least two weeks and take tablet Fluconazole 200 mg twice weekly for two weeks. You can revert back to me after two weeks. Candida infection, Herpes infection. ELISA for HSV 1 and 2. Candidal balanoposthitis. As mentioned above. As mentioned above.