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### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 30 years old. I do not like being in public. I do not do anything fun. I have a thought that always people in my surroundings are looking at me. So I would rather be at home. I do not like using the phone. I am taking Klonopin 2 mg 3 times a day. But I am not taking it now as I am travelling with my husband state to state for his job.With regards to anxiety my symptoms are extreme worry, classic panic attacks sometimes 5-6 times a day, feel hard to breath, stomach sick. I do not get motivated to do anything like shower, changing clothes, cleaning house, keep a job. My husband will do most of the shopping including grocery. I forgot any type of social get together with friends and family. I do not even visit my in-laws. I feel tiredness in my whole body, a tense feel and headache. When I take Klonopin these symptoms will disappear. I have been on this medication since 13 years.Can anxiety be the cause for such issues or is it something else? I wish to spend some time outside with my family. Please explain what is wrong with me. ### Response: Hi, Welcome to Chat Doctor forum. You are suffering from panic attacks with agoraphobia (fear to go to public place). You are taking Benzodiazepine (Klonopin-Clonazepam) of very high dose. Continue it but should take it occasionally only, as high chance of dependence is there. You should start an antidepressant, which is useful in panic attacks, for maintenance. Take tablet Pari CR (Paroxetine) 12.5 mg for 5 days, then shift on Pari CR 25 m and continue it in the morning.You can take psychotherapy sessions (CBT - Cognitive behavioural therapy) by therapist or psychiatrist. Thyroid Function Test. Review after 21 days, to adjust dose of medication.Revert back after 21 days to a psychiatrist online.-

Hi doctor,I am 30 years old. I do not like being in public. I do not do anything fun. I have a thought that always people in my surroundings are looking at me. So I would rather be at home. I do not like using the phone. I am taking Klonopin 2 mg 3 times a day. But I am not taking it now as I am travelling with my husband state to state for his job.With regards to anxiety my symptoms are extreme worry, classic panic attacks sometimes 5-6 times a day, feel hard to breath, stomach sick. I do not get motivated to do anything like shower, changing clothes, cleaning house, keep a job. My husband will do most of the shopping including grocery. I forgot any type of social get together with friends and family. I do not even visit my in-laws. I feel tiredness in my whole body, a tense feel and headache. When I take Klonopin these symptoms will disappear. I have been on this medication since 13 years.Can anxiety be the cause for such issues or is it something else? I wish to spend some time outside with my family. Please explain what is wrong with me.

Hi, Welcome to Chat Doctor forum. You are suffering from panic attacks with agoraphobia (fear to go to public place). You are taking Benzodiazepine (Klonopin-Clonazepam) of very high dose. Continue it but should take it occasionally only, as high chance of dependence is there. You should start an antidepressant, which is useful in panic attacks, for maintenance. Take tablet Pari CR (Paroxetine) 12.5 mg for 5 days, then shift on Pari CR 25 m and continue it in the morning.You can take psychotherapy sessions (CBT - Cognitive behavioural therapy) by therapist or psychiatrist. Thyroid Function Test. Review after 21 days, to adjust dose of medication.Revert back after 21 days to a psychiatrist online.-

### Instruction: Answer this question truthfully ###Input: Hi doctor,My chief complaint is severe lower back pain and pain in upper thighs. My medical history is as follows. Carcinoma of the breast three years back, followed by surgery, chemotherapy, and radiotherapy. I am on Tamoxifen for past 3 years, and now I am taking Arimidex. I have been suffering from osteoporosis for over 7 years. Before six years, I had severe osteopenia with maximum bone loss of 21% on L3 and spine, ribs, trunk, and arms with more on the left side.I had undergone the following investigations. Before three years, I had FNAC which showed invasive ductal carcinoma, right breast ER+, PR+, Hercep score \"0.\" Last month, I had an x-ray and MRI, which showed focal altered marrow intensity lesions seen in B/L pelvic bone, sacrum, and left upper femoral shaft consistent with metastasis. I also had a PET scan which showed metabolically active ill-defined lytic destructive lesions in post cortex shaft of left femur, right inferior pubic ramus, B/L iliac bones, sacrum, D5, 7, 11 and L1, 4, sternum, right 3, 5, 7 post ribs with mid-right paravertebral soft tissue lesion at D7 level likely metastasis. ### Response: Hello, Welcome to Chat Doctor forum. I do not have full information regarding the case from your query. The conclusion I can make from the information which you have given is that the patient has bone metastasis only. The treatment for such a case is a change in hormone therapy. Your medication has already been changed from Tamoxifen to Arimidex. I do not know since how many days or months you are taking Arimidex. Has it made any difference in intensity of your back pain? You also need to take Zole ChatDoctor. This also helps in bone metastasis. You also need adequate pain medications, maybe Morphine preparation to control your pain.

Hi doctor,My chief complaint is severe lower back pain and pain in upper thighs. My medical history is as follows. Carcinoma of the breast three years back, followed by surgery, chemotherapy, and radiotherapy. I am on Tamoxifen for past 3 years, and now I am taking Arimidex. I have been suffering from osteoporosis for over 7 years. Before six years, I had severe osteopenia with maximum bone loss of 21% on L3 and spine, ribs, trunk, and arms with more on the left side.I had undergone the following investigations. Before three years, I had FNAC which showed invasive ductal carcinoma, right breast ER+, PR+, Hercep score \"0.\" Last month, I had an x-ray and MRI, which showed focal altered marrow intensity lesions seen in B/L pelvic bone, sacrum, and left upper femoral shaft consistent with metastasis. I also had a PET scan which showed metabolically active ill-defined lytic destructive lesions in post cortex shaft of left femur, right inferior pubic ramus, B/L iliac bones, sacrum, D5, 7, 11 and L1, 4, sternum, right 3, 5, 7 post ribs with mid-right paravertebral soft tissue lesion at D7 level likely metastasis.

Hello, Welcome to Chat Doctor forum. I do not have full information regarding the case from your query. The conclusion I can make from the information which you have given is that the patient has bone metastasis only. The treatment for such a case is a change in hormone therapy. Your medication has already been changed from Tamoxifen to Arimidex. I do not know since how many days or months you are taking Arimidex. Has it made any difference in intensity of your back pain? You also need to take Zole ChatDoctor. This also helps in bone metastasis. You also need adequate pain medications, maybe Morphine preparation to control your pain.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 35-year-old male. No episodes of herps except chickenpox in childhood. No Infection of HIV, clinically tested every six months for the last seven years. My partner and I both are not having HIV (clinically tested).I had a bacterial or fungal infection with pus and redness in the genital area. So I have done the blood test.HIV is negative.HSV-1 IgG 4.5 positive.HSV-1 IgM 0.29 negative.HSV-2 IgG 0.45 negative.HSV-2 IgM 0.69 negative.As HSV-1 is mostly non-genital infection. I did not have any episodes of HSV-1 type herps in my life. I never had HSV-1 type herpes anywhere in the body. I am straight and have a relationship only with my spouse.How can blood show HSV-1 IgG positive without any symptoms? Dermatologist says it is due to past infection and not about present infection. Doctor told I should take antiviral dose Acyclovir for 20 days for HSV-1 IgG past infection. Is it useful to take antiviral dose for the past HSV-1 type infection? Will it reduces IgG level in the blood? Is HSV-1 IgG is false positive? ### Response: Hi, Welcome to Chat Doctor forum. First understand the situation, IgM indicates recent infection and IgG indicate chronic infection. Since you have both the IgM negative, it means that there is no recent infection. Secondly, about 70- 80% of US population is HSV-1 (herpes simplex virus) positive, it means they are infected once in a life time and antibodies will remain for throughout life. But it does not mean that 80% of US population should start taking Acyclovir. There are no guidelines for taking Acyclovir until you are symptomatic. So do not think too much about this figure. If you had any other problems, you can revert back to me.

Hello doctor,I am a 35-year-old male. No episodes of herps except chickenpox in childhood. No Infection of HIV, clinically tested every six months for the last seven years. My partner and I both are not having HIV (clinically tested).I had a bacterial or fungal infection with pus and redness in the genital area. So I have done the blood test.HIV is negative.HSV-1 IgG 4.5 positive.HSV-1 IgM 0.29 negative.HSV-2 IgG 0.45 negative.HSV-2 IgM 0.69 negative.As HSV-1 is mostly non-genital infection. I did not have any episodes of HSV-1 type herps in my life. I never had HSV-1 type herpes anywhere in the body. I am straight and have a relationship only with my spouse.How can blood show HSV-1 IgG positive without any symptoms? Dermatologist says it is due to past infection and not about present infection. Doctor told I should take antiviral dose Acyclovir for 20 days for HSV-1 IgG past infection. Is it useful to take antiviral dose for the past HSV-1 type infection? Will it reduces IgG level in the blood? Is HSV-1 IgG is false positive?

Hi, Welcome to Chat Doctor forum. First understand the situation, IgM indicates recent infection and IgG indicate chronic infection. Since you have both the IgM negative, it means that there is no recent infection. Secondly, about 70- 80% of US population is HSV-1 (herpes simplex virus) positive, it means they are infected once in a life time and antibodies will remain for throughout life. But it does not mean that 80% of US population should start taking Acyclovir. There are no guidelines for taking Acyclovir until you are symptomatic. So do not think too much about this figure. If you had any other problems, you can revert back to me.

### Instruction: Answer this question truthfully ###Input: Hi doctor,My toddler was sneezing continuously yesterday and her nose was runny. However, it reduced to a large extent now. We had our room painted a day before yesterday. Could it be due to paint allergy? Will the allergy symptoms show up immediately or will take a day\\s time? My 2-year-old has never had a cold till now. I am just worried if she has ingested any foreign body as she has the habit of mouthing whatever she picks up. Would foreign body stuck in throat cause sneezing and runny nose? I am a paranoid mother and have subjected her to two unwanted X-rays to rule out battery ingestion so I do not want to go through another X-ray. I want to know what would be the symptoms of any foreign body like metal or plastic when stuck in the throat. She was having corn yesterday. If she had inhaled a corn granule through her nose would it pass beyond and would she be acting normally? Since today morning, she sneezed only thrice. If at all it was common cold can it get better in a day? How would I know if it was a foreign body ingestion or allergy or a viral? What would be the symptoms for each one? ### Response: Hi. I have gone through the query you posted. According to the history you have given, it is an allergy because of the paint smell. That is the reason he is getting sneezing and running nose. As you think, it is not because of some foreign body in the nose or in the throat. If the foreign body is in the throat, symptoms will be like a continuous cough, breathlessness. If the foreign body is in the nose, they will have a bad smell from nose and bleeding can happen with mucus secretions. So no need of any X-ray or investigations for the child. Differentiating between allergy and viral infection, you have to do some blood test and always viral infection will be associated with fever. So nothing major to worry. What is the weight of the child? Take care.

Hi doctor,My toddler was sneezing continuously yesterday and her nose was runny. However, it reduced to a large extent now. We had our room painted a day before yesterday. Could it be due to paint allergy? Will the allergy symptoms show up immediately or will take a day\\s time? My 2-year-old has never had a cold till now. I am just worried if she has ingested any foreign body as she has the habit of mouthing whatever she picks up. Would foreign body stuck in throat cause sneezing and runny nose? I am a paranoid mother and have subjected her to two unwanted X-rays to rule out battery ingestion so I do not want to go through another X-ray. I want to know what would be the symptoms of any foreign body like metal or plastic when stuck in the throat. She was having corn yesterday. If she had inhaled a corn granule through her nose would it pass beyond and would she be acting normally? Since today morning, she sneezed only thrice. If at all it was common cold can it get better in a day? How would I know if it was a foreign body ingestion or allergy or a viral? What would be the symptoms for each one?

Hi. I have gone through the query you posted. According to the history you have given, it is an allergy because of the paint smell. That is the reason he is getting sneezing and running nose. As you think, it is not because of some foreign body in the nose or in the throat. If the foreign body is in the throat, symptoms will be like a continuous cough, breathlessness. If the foreign body is in the nose, they will have a bad smell from nose and bleeding can happen with mucus secretions. So no need of any X-ray or investigations for the child. Differentiating between allergy and viral infection, you have to do some blood test and always viral infection will be associated with fever. So nothing major to worry. What is the weight of the child? Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My left eye developed a black wavy line that moves around every time I try to focus, at times obstructing my vision. After consulting a doctor and after an eye dilution test, she confirmed that bleeding had occurred in my eye around two weeks ago and the black line I could see was the blood that had spilled. She sent me to a retina doctor who said he had to inject me in the eye. He did not explain the reason why and was a bit unwelcoming to the point that he did not give me a chance to inquire. He prescribed two drugs (Maxidex sterile ophthalmic ointment) and Ceprolen-D eye, ear drops). I have been using these medications since I did not have money for the injection. I can see little improvement but I am afraid it is not cleared yet.All I want to inquire is, what could be wrong with me? I underwent many blood tests and passed them all. I have never been in accident. All I have had is little sensitivity to light. Also I had been working long hours in front of the computer without anti-glare glasses before my problem started. Do I need the injection or is there a medicine that is more appropriate? I am 21 years old..Please help me out. Thanks ### Response: Hi, Welcome to Chat Doctor forum. You seem to have vasculitis which is inflammation of blood vessels in your eye which makes your blood vessels leaky. Injections of an anti-VEGF compound are indicated in this but before this, you need laser therapy in your eye along with a course of steroids. You need to undergo fundus fluorescein angiography to locate the area of leaky vessels and we have to laser it. You also need to get a blood investigation to rule out infections like tuberculosis. After that is ruled out, we have to start steroids. Anti-VEGF injections come after that. Kindly do not delay it if this process continues. The visual prognosis becomes poorer if not done in time. You may need surgery which would be more costly.

Hello doctor,My left eye developed a black wavy line that moves around every time I try to focus, at times obstructing my vision. After consulting a doctor and after an eye dilution test, she confirmed that bleeding had occurred in my eye around two weeks ago and the black line I could see was the blood that had spilled. She sent me to a retina doctor who said he had to inject me in the eye. He did not explain the reason why and was a bit unwelcoming to the point that he did not give me a chance to inquire. He prescribed two drugs (Maxidex sterile ophthalmic ointment) and Ceprolen-D eye, ear drops). I have been using these medications since I did not have money for the injection. I can see little improvement but I am afraid it is not cleared yet.All I want to inquire is, what could be wrong with me? I underwent many blood tests and passed them all. I have never been in accident. All I have had is little sensitivity to light. Also I had been working long hours in front of the computer without anti-glare glasses before my problem started. Do I need the injection or is there a medicine that is more appropriate? I am 21 years old..Please help me out. Thanks

Hi, Welcome to Chat Doctor forum. You seem to have vasculitis which is inflammation of blood vessels in your eye which makes your blood vessels leaky. Injections of an anti-VEGF compound are indicated in this but before this, you need laser therapy in your eye along with a course of steroids. You need to undergo fundus fluorescein angiography to locate the area of leaky vessels and we have to laser it. You also need to get a blood investigation to rule out infections like tuberculosis. After that is ruled out, we have to start steroids. Anti-VEGF injections come after that. Kindly do not delay it if this process continues. The visual prognosis becomes poorer if not done in time. You may need surgery which would be more costly.

### Instruction: Answer this question truthfully ###Input: Hi doctor, My last exposure was protected but I am not sure about whether the vaginal fluid touched or not since I was drunk that time. After that, I went to an HIV specialist and he suggested me HIV DNA PCR test at 66 days period. The result is HIV 1 not detected.Then at 83 days, tridot rapid test is negative. 88-day tridot rapid test negative. 93-day tridot non-reactive. 99-day tridot (immuno filtration) antibodies 1 and 2 nonreactive. Then I took HbsAg, HCV, VRD total all are non-reactive.Is it enough for HIV testing? Is DNA PCR at 66 days (in window ) period useful? Is tridot test useful or not?In the window period time, I used fever tablets, antibiotics, and Levocetirizine many days. Will it affect my window period? Please give me brief information. I have a family and a child. Can I have sex with my wife without protection? Next test needed or not? ### Response: Hi, Welcome\\x80\\x8b to ChatDoctor. It is great that you have been found negative for HIV and other STIs (sexually transmitted infection). All the tests which you had taken for HIV were highly sensitive and specific and gives accurate results. It is unlikely for antibiotics and other medications which you had taken for fever could affect the result. Window period is the time taken for antibodies to develop after infection and then get detected by a particular test. The length of the window period varies between individuals. There are recommendations and I also suggest my patients to repeat the test at six months of last exposure. Testing at three and six months of possible exposure can detect almost all HIV infections. You can take precautions (consistently and correctively using a condom) with your wife until the time you are undergoing tests. I hope this helps. Take care.

Hi doctor, My last exposure was protected but I am not sure about whether the vaginal fluid touched or not since I was drunk that time. After that, I went to an HIV specialist and he suggested me HIV DNA PCR test at 66 days period. The result is HIV 1 not detected.Then at 83 days, tridot rapid test is negative. 88-day tridot rapid test negative. 93-day tridot non-reactive. 99-day tridot (immuno filtration) antibodies 1 and 2 nonreactive. Then I took HbsAg, HCV, VRD total all are non-reactive.Is it enough for HIV testing? Is DNA PCR at 66 days (in window ) period useful? Is tridot test useful or not?In the window period time, I used fever tablets, antibiotics, and Levocetirizine many days. Will it affect my window period? Please give me brief information. I have a family and a child. Can I have sex with my wife without protection? Next test needed or not?

Hi, Welcome\\x80\\x8b to ChatDoctor. It is great that you have been found negative for HIV and other STIs (sexually transmitted infection). All the tests which you had taken for HIV were highly sensitive and specific and gives accurate results. It is unlikely for antibiotics and other medications which you had taken for fever could affect the result. Window period is the time taken for antibodies to develop after infection and then get detected by a particular test. The length of the window period varies between individuals. There are recommendations and I also suggest my patients to repeat the test at six months of last exposure. Testing at three and six months of possible exposure can detect almost all HIV infections. You can take precautions (consistently and correctively using a condom) with your wife until the time you are undergoing tests. I hope this helps. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am having a headache along with congestion and confusion as well as an ear pain like if there is some pressure on it. I am not sure if this is an allergy like sinusitis because I barely have any other symptoms than I mentioned above.Sometimes, I feel a dry throat, but I think that is due to taking less fluids. I had this a few weeks before and had a stuffy nose. I got well in the middle, but it came back. I will mention the environmental conditions that I am currently living in. The weather is really dry and cold air blows mostly.Since there have been barely any rain in the past weeks, as well as there is a high proportion of pollen and pollution in the area as well. I have been to the doctor during the initial days of this problem, she prescribed me an antihistamine (Loratadine).But, I just took it for a day as I felt anxious and had panic attacks, which I believed happened due to its adverse effects.Currently, I am relying on the home remedies like steam inhalation and use of warm cloth on ears to relieve the ear pain. I need an urgent help to cure this because it is killing my productivity and preventing me to think and work efficiently. I am a high school student who will be having mid-year examinations in a couple of weeks. ### Response: Hi. From what you describe, it sounds like you may have an ear infection. In the initial stages of an ear infection, there will be severe ear pain, a feeling of blocked sensation in the ear, decreased hearing, fever and this usually happens along with a severe cold or sinusitis. In case of rupture of the ear ChatDoctor. In case of an ear infection, you will need antibiotics, which you can get after visiting an ENT surgeon for examination. I suggest the following medicines to help you. Consult your doctor, discuss with him or her and take the medicine with consent. Apart from these medicines you need to do steam inhalation thrice a day.

Hello doctor,I am having a headache along with congestion and confusion as well as an ear pain like if there is some pressure on it. I am not sure if this is an allergy like sinusitis because I barely have any other symptoms than I mentioned above.Sometimes, I feel a dry throat, but I think that is due to taking less fluids. I had this a few weeks before and had a stuffy nose. I got well in the middle, but it came back. I will mention the environmental conditions that I am currently living in. The weather is really dry and cold air blows mostly.Since there have been barely any rain in the past weeks, as well as there is a high proportion of pollen and pollution in the area as well. I have been to the doctor during the initial days of this problem, she prescribed me an antihistamine (Loratadine).But, I just took it for a day as I felt anxious and had panic attacks, which I believed happened due to its adverse effects.Currently, I am relying on the home remedies like steam inhalation and use of warm cloth on ears to relieve the ear pain. I need an urgent help to cure this because it is killing my productivity and preventing me to think and work efficiently. I am a high school student who will be having mid-year examinations in a couple of weeks.

Hi. From what you describe, it sounds like you may have an ear infection. In the initial stages of an ear infection, there will be severe ear pain, a feeling of blocked sensation in the ear, decreased hearing, fever and this usually happens along with a severe cold or sinusitis. In case of rupture of the ear ChatDoctor. In case of an ear infection, you will need antibiotics, which you can get after visiting an ENT surgeon for examination. I suggest the following medicines to help you. Consult your doctor, discuss with him or her and take the medicine with consent. Apart from these medicines you need to do steam inhalation thrice a day.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I recently had a full blood count done and would like a second opinion on the results. It was my cholesterol which surprised me. I have never suffered from high cholesterol but over the past three years, it has kept up and recent tests showed serum cholesterol 7 mmol/L/HDL, 1.25 mmol/L/LDL, 5.07 mmol/L, triglycerides 1.5 mmol/L. This surprised me as my cholesterol two years ago was 5.0 mmol/L and I gave up all meat four years ago.I am 45 years old, eat healthy, exercise 3 to 4 times a week. I find it weird that my cholesterol has gone up when I have given up meat though there does seem to be a family trait in my mother\\s side for high cholesterol. I have also been reading a lot recently that views on cholesterol are changing and studies show that it is not directly linked now to saturated fats and heart disease. The other test I wanted to briefly discuss was my liver results. My doctor said they were all fine. I have looked at them and they all do seem to be fine except I noticed my Bilburin level was up a bit to 24 umol/L which sits just outside of the norm. My doctor mentioned nothing about this. Is it a concern? ### Response: Hi, Welcome to Chat Doctor forum. I can understand your concern. I have gone through the reports you have attached (attachment removed to protect patient identity). Yes, your cholesterol is high especially LDL. This is more worrisome. Cholesterol runs in family. So, despite a healthy lifestyle, some patients fail to reduce cholesterol. Please let me know your weight, your height, any alcohol habit, are you taking any lipid-lowering ChatDoctor. For bilirubin, get done ultrasound abdomen for liver and biliary tract. Please let me know if the ultrasound is already done. I will be happy to help you further.

Hi doctor,I recently had a full blood count done and would like a second opinion on the results. It was my cholesterol which surprised me. I have never suffered from high cholesterol but over the past three years, it has kept up and recent tests showed serum cholesterol 7 mmol/L/HDL, 1.25 mmol/L/LDL, 5.07 mmol/L, triglycerides 1.5 mmol/L. This surprised me as my cholesterol two years ago was 5.0 mmol/L and I gave up all meat four years ago.I am 45 years old, eat healthy, exercise 3 to 4 times a week. I find it weird that my cholesterol has gone up when I have given up meat though there does seem to be a family trait in my mother\\s side for high cholesterol. I have also been reading a lot recently that views on cholesterol are changing and studies show that it is not directly linked now to saturated fats and heart disease. The other test I wanted to briefly discuss was my liver results. My doctor said they were all fine. I have looked at them and they all do seem to be fine except I noticed my Bilburin level was up a bit to 24 umol/L which sits just outside of the norm. My doctor mentioned nothing about this. Is it a concern?

Hi, Welcome to Chat Doctor forum. I can understand your concern. I have gone through the reports you have attached (attachment removed to protect patient identity). Yes, your cholesterol is high especially LDL. This is more worrisome. Cholesterol runs in family. So, despite a healthy lifestyle, some patients fail to reduce cholesterol. Please let me know your weight, your height, any alcohol habit, are you taking any lipid-lowering ChatDoctor. For bilirubin, get done ultrasound abdomen for liver and biliary tract. Please let me know if the ultrasound is already done. I will be happy to help you further.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 36 years old and had unprotected sex with my husband on 18th at night. Although he pulled out we are suspecting pregnancy as there can be 1 % chance of ejaculation. I had my last period on the 7th and usually, I get my periods one to three days before the expected time. I took Unwanted 72 on the 21st afternoon. But after taking it, I was feeling stomach and back pain in the lower region along with cramps. Though I am not feeling any other symptoms of pregnancy like nausea, vomiting etc, which I even did not have during my first pregnancy except stomach pain like periods. Will Unwanted 72 will be effective in my case? Can it stop fertilization/implantation? Am I pregnant or is it a side effect of the emergency pill? I am still feeling pain but it is less now. When can I expect my next period or when should I go for pregnancy kit test? I am already having a kid of 2 years and do not want a second one. In case I am pregnant, please guide me how to get it aborted. ### Response: Hello, Welcome to Chat Doctor forum. In your case, the unprotected intercourse took place at a very fertile time and the delayed intake of Unwanted 72 might render the pill useless. It is highly possible that you still might get pregnant despite the pill. However, the symptoms of back pain and stomach cramps are usually expected after taking the pill. So these symptoms are unlikely due to pregnancy and more likely due to the pill as pregnancy symptoms develop usually around five to six weeks of pregnancy. Expect your next periods to be a little delayed than usual and may look abnormal as well, like blackish in color. If your periods get delayed by over a week then take a pregnancy test and check. If positive, let me know and then we can discuss further. All the best. For more information consult an obstetrician and gynaecologist online

Hello doctor,I am 36 years old and had unprotected sex with my husband on 18th at night. Although he pulled out we are suspecting pregnancy as there can be 1 % chance of ejaculation. I had my last period on the 7th and usually, I get my periods one to three days before the expected time. I took Unwanted 72 on the 21st afternoon. But after taking it, I was feeling stomach and back pain in the lower region along with cramps. Though I am not feeling any other symptoms of pregnancy like nausea, vomiting etc, which I even did not have during my first pregnancy except stomach pain like periods. Will Unwanted 72 will be effective in my case? Can it stop fertilization/implantation? Am I pregnant or is it a side effect of the emergency pill? I am still feeling pain but it is less now. When can I expect my next period or when should I go for pregnancy kit test? I am already having a kid of 2 years and do not want a second one. In case I am pregnant, please guide me how to get it aborted.

Hello, Welcome to Chat Doctor forum. In your case, the unprotected intercourse took place at a very fertile time and the delayed intake of Unwanted 72 might render the pill useless. It is highly possible that you still might get pregnant despite the pill. However, the symptoms of back pain and stomach cramps are usually expected after taking the pill. So these symptoms are unlikely due to pregnancy and more likely due to the pill as pregnancy symptoms develop usually around five to six weeks of pregnancy. Expect your next periods to be a little delayed than usual and may look abnormal as well, like blackish in color. If your periods get delayed by over a week then take a pregnancy test and check. If positive, let me know and then we can discuss further. All the best. For more information consult an obstetrician and gynaecologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My friend is 20 years old, female. Before some days ago she was sense less on a train and then this again happened with her. She consulted a doctor and he says that she is suffering from the first stage of conversion reaction disease. But the doctor could not suggest any medicines but he says that the last stage of this disease is paralysis. Doctor says to my friend that do not take any tension and to keep her mind free all the time. She was feeling weak what will she do? ### Response: Hello. I have read and completely understand that you feel quite concerned for your friend. As you have mentioned that she has been diagnosed by the doctor as having conversion disorder, it is quite probable that she may undergo these conversion attacks at any time. There are purely psychological reasons behind this disorder, no medical cause lead to this condition. Therefore, generally, no medical treatment could be found a cure for these attacks. If the doctor has suggested this diagnosis after complete assessment then there may be no further need for the tests. If complete testing has not been administered yet then you may go to a psychologist for confirming the diagnosis after keenly observing her medical test reports. Needs to be differentiated for the types of conversion disorder according to the DSM-5 (diagnostic and statistical manual of mental disorder) criteria. Conversion disorder. Generally, no particular medication is prescribed for conversion disorder. However, some doctors may suggest medication after observing the patient\\s current condition (beware these medications would reduce anxiety or tension but would not cure the conversion disorder). The effective treatment for conversion disorder is found to be psychotherapy. Consult any psychologist or psychiatrist specialized in conducting psychotherapy sessions. Or you can suggest some online consultation sessions. Treatment mode can be cognitive behavioral therapy plus psycho-education. Must take expert guidance on how to deal with the patient behaviorally. Family members, closed ones of such patients also need guidance because their mishandling can increase the frequency of conversion attacks. Do take follow-up if you feel the need. Take care.

Hello doctor,My friend is 20 years old, female. Before some days ago she was sense less on a train and then this again happened with her. She consulted a doctor and he says that she is suffering from the first stage of conversion reaction disease. But the doctor could not suggest any medicines but he says that the last stage of this disease is paralysis. Doctor says to my friend that do not take any tension and to keep her mind free all the time. She was feeling weak what will she do?

Hello. I have read and completely understand that you feel quite concerned for your friend. As you have mentioned that she has been diagnosed by the doctor as having conversion disorder, it is quite probable that she may undergo these conversion attacks at any time. There are purely psychological reasons behind this disorder, no medical cause lead to this condition. Therefore, generally, no medical treatment could be found a cure for these attacks. If the doctor has suggested this diagnosis after complete assessment then there may be no further need for the tests. If complete testing has not been administered yet then you may go to a psychologist for confirming the diagnosis after keenly observing her medical test reports. Needs to be differentiated for the types of conversion disorder according to the DSM-5 (diagnostic and statistical manual of mental disorder) criteria. Conversion disorder. Generally, no particular medication is prescribed for conversion disorder. However, some doctors may suggest medication after observing the patient\\s current condition (beware these medications would reduce anxiety or tension but would not cure the conversion disorder). The effective treatment for conversion disorder is found to be psychotherapy. Consult any psychologist or psychiatrist specialized in conducting psychotherapy sessions. Or you can suggest some online consultation sessions. Treatment mode can be cognitive behavioral therapy plus psycho-education. Must take expert guidance on how to deal with the patient behaviorally. Family members, closed ones of such patients also need guidance because their mishandling can increase the frequency of conversion attacks. Do take follow-up if you feel the need. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 40-year-old dental surgeon with no past or present health issues and I am trying to conceive. I have a regular cycle of 28 days and I have consulted a gynaecologist before who has put me on Clomid for three months. I have also taken all the required fertility tests which show normal values that are needed for conceiving. This cycle I had all the pregnancy symptoms like implantation spotting for two days, tender breasts and lower abdominal mild cramps for a week after spotting. However, I have got a negative urine and blood test, blood hCG level being 1.2 mIU/mL. On the first day of the last period, there was spotting and light bleeding was seen for three to four days. I tested for blood hCG after seven days and it showed <1.2 mIU/mL. I want to know if there is still a chance that I could be pregnant and retest myself after a few days? ### Response: Hello. As your serum beta hCG (human chorionic gonadotropin) result is also negative it definitely indicates you have not got pregnant in this cycle. The symptoms you have mentioned could also be possible because of the progesterone hormone secretion in the postovulatory phase which may mimic pregnancy and the spotting could be due to the breakthrough bleed. A possibility of delayed conception can be taken into consideration but because the serum beta hCG is negative it is ruled out. I would suggest you get your day two LH (luteinizing hormone), FSH (follicle-stimulating hormone), prolactin, TSH (thyroid-stimulating hormone) levels, fasting blood sugar and postprandial blood sugar levels, and serum AMH (anti-Mullerian hormone) levels and an HSG (hysterosalpingography) done and let me know the results. The treatment plan would be ovulation induction with a follicular study. For more information consult an obstetrician and gynaecologist online

Hello doctor,I am a 40-year-old dental surgeon with no past or present health issues and I am trying to conceive. I have a regular cycle of 28 days and I have consulted a gynaecologist before who has put me on Clomid for three months. I have also taken all the required fertility tests which show normal values that are needed for conceiving. This cycle I had all the pregnancy symptoms like implantation spotting for two days, tender breasts and lower abdominal mild cramps for a week after spotting. However, I have got a negative urine and blood test, blood hCG level being 1.2 mIU/mL. On the first day of the last period, there was spotting and light bleeding was seen for three to four days. I tested for blood hCG after seven days and it showed <1.2 mIU/mL. I want to know if there is still a chance that I could be pregnant and retest myself after a few days?

Hello. As your serum beta hCG (human chorionic gonadotropin) result is also negative it definitely indicates you have not got pregnant in this cycle. The symptoms you have mentioned could also be possible because of the progesterone hormone secretion in the postovulatory phase which may mimic pregnancy and the spotting could be due to the breakthrough bleed. A possibility of delayed conception can be taken into consideration but because the serum beta hCG is negative it is ruled out. I would suggest you get your day two LH (luteinizing hormone), FSH (follicle-stimulating hormone), prolactin, TSH (thyroid-stimulating hormone) levels, fasting blood sugar and postprandial blood sugar levels, and serum AMH (anti-Mullerian hormone) levels and an HSG (hysterosalpingography) done and let me know the results. The treatment plan would be ovulation induction with a follicular study. For more information consult an obstetrician and gynaecologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have been suffering from a condition known as pruritus ani for almost a year. It gives me uncomfortable itching around the anal area. I have tried creams, seen a doctor and a colorectal specialist, taken Metamucil and sitz baths. I did pretty much everything, but the problem persists. Some days are better than others, but the problem has never entirely gone away, and I cannot take it anymore. Is there any way that this condition can be cured once and for all? I want my normal life back. Please help me. ### Response: Hi, Welcome to Chat Doctor forum. I can understand your concerns regarding pruritus ani as I have analyzed each detail that you have provided. I have managed lots of cases with a matching condition and feel that you too will make good use of the information and suggestions. First, please get your stool tests done on three consecutive days. You need to wear loose undergarments made of thin cotton and ChatDoctor. Use antibiotic and antifungal creams mixed in equal quantities to take care of any germs inhabiting the area. For now, no steroid creams need to be used. If you are using one, taper that off slowly till you are comfortable without one. It might lead to a temporary increase in discomfort, but it is an absolute requirement. You can have sufficient antiallergics like Levocetirizine once or twice a day to neutralize itching completely. The affected area need not be touched, and for that, the above medication helps a lot plus there is a useful contribution from one\\s determination too. Deworm your GI system with Albendazole or another suitable agent about which you can get advice from your physician. I am sure the problem can be managed even though it might not be possible to do so in a matter of days. The key to treatment is to let the skin heal, remove any cause of irritation, and break the cycle of itch and scratch, which is bound to have resulted in thickening of the affected skin.

Hello doctor,I have been suffering from a condition known as pruritus ani for almost a year. It gives me uncomfortable itching around the anal area. I have tried creams, seen a doctor and a colorectal specialist, taken Metamucil and sitz baths. I did pretty much everything, but the problem persists. Some days are better than others, but the problem has never entirely gone away, and I cannot take it anymore. Is there any way that this condition can be cured once and for all? I want my normal life back. Please help me.

Hi, Welcome to Chat Doctor forum. I can understand your concerns regarding pruritus ani as I have analyzed each detail that you have provided. I have managed lots of cases with a matching condition and feel that you too will make good use of the information and suggestions. First, please get your stool tests done on three consecutive days. You need to wear loose undergarments made of thin cotton and ChatDoctor. Use antibiotic and antifungal creams mixed in equal quantities to take care of any germs inhabiting the area. For now, no steroid creams need to be used. If you are using one, taper that off slowly till you are comfortable without one. It might lead to a temporary increase in discomfort, but it is an absolute requirement. You can have sufficient antiallergics like Levocetirizine once or twice a day to neutralize itching completely. The affected area need not be touched, and for that, the above medication helps a lot plus there is a useful contribution from one\\s determination too. Deworm your GI system with Albendazole or another suitable agent about which you can get advice from your physician. I am sure the problem can be managed even though it might not be possible to do so in a matter of days. The key to treatment is to let the skin heal, remove any cause of irritation, and break the cycle of itch and scratch, which is bound to have resulted in thickening of the affected skin.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 19 years old. I had sex four months before and ovulated on the second day after having sex. I got periods on the next month for four days, and after five days of my periods I got a Nexplanon birth control, and the doctor gave me a negative pregnancy test. I then had a period of 14 days in the next month and I am still spotting.I am just wondering if there is any way for me to be pregnant? I have not had sex since then. But I am paranoid that I am pregnant I cannot afford an abortion. Also, I cannot even afford to go to the doctor or have a way to buy a pregnancy test. For the past couple of days, I have felt movement, but it could be gas.I have also been having sharp pains in my lower abdomen for a while especially when sneezing or coughing hard. I always had very painful and heavy periods associated with sharp pains while pooping on period. The birth control has helped by stopping my period, but I still get the sharp pains randomly. Kindly advice. ### Response: Hello, Welcome to Chat Doctor forum. No, you are not pregnant as your pregnancy test was negative at the time you got Nexplanon implant, and you did not have had sex afterward. So calm down now and give relief to yourself. Your periods have reduced due to the effect of Nexplanon as it is a contraceptive as well as it also reduces blood loss during periods and some women get reduced bleeding or absent bleeding in the very start of the implantation. Your periods will slowly return to normal. So do not have to worry about pregnancy now. And secondly all of the symptoms you told are pointing towards anxiety, and you need some stress reliever. The problem with passing stools may be due to the lack of fiber in your diet. You must ChatDoctor. I hope it has helped you. If you require any further queries, please do not hesitate to contact me.

Hello doctor,I am 19 years old. I had sex four months before and ovulated on the second day after having sex. I got periods on the next month for four days, and after five days of my periods I got a Nexplanon birth control, and the doctor gave me a negative pregnancy test. I then had a period of 14 days in the next month and I am still spotting.I am just wondering if there is any way for me to be pregnant? I have not had sex since then. But I am paranoid that I am pregnant I cannot afford an abortion. Also, I cannot even afford to go to the doctor or have a way to buy a pregnancy test. For the past couple of days, I have felt movement, but it could be gas.I have also been having sharp pains in my lower abdomen for a while especially when sneezing or coughing hard. I always had very painful and heavy periods associated with sharp pains while pooping on period. The birth control has helped by stopping my period, but I still get the sharp pains randomly. Kindly advice.

Hello, Welcome to Chat Doctor forum. No, you are not pregnant as your pregnancy test was negative at the time you got Nexplanon implant, and you did not have had sex afterward. So calm down now and give relief to yourself. Your periods have reduced due to the effect of Nexplanon as it is a contraceptive as well as it also reduces blood loss during periods and some women get reduced bleeding or absent bleeding in the very start of the implantation. Your periods will slowly return to normal. So do not have to worry about pregnancy now. And secondly all of the symptoms you told are pointing towards anxiety, and you need some stress reliever. The problem with passing stools may be due to the lack of fiber in your diet. You must ChatDoctor. I hope it has helped you. If you require any further queries, please do not hesitate to contact me.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had a DVT with massive pulmonary embolism with infarction before four years. I had a few \\xc3\\xa4nxiety or panic attacks since then. Had a heart sonar and ECG done two months ago, which according to the physician was perfectly normal. I stopped taking Bisoprolol on his advice, and started with Alprazolam and Ativan when needed.Two weeks ago, I had an incident where I had my blood pressure shot up to 210/107 and a heart rate of 110 bpm. I went to the ER and had an ECG done as well as a cardio markers blood test is done. The doctor who did the ECG said that it looked like the right side of my heart did not get enough oxygen. I made another appointment with a physician, who now wants to send me for an angiogram. I want a second opinion on the latest ECG. The ER doctor said that a panic attack could also influence the ECG. ### Response: Hello. Your ECG is fine (attachment removed to protect patient identity). There is left axis deviation, which is expected in hypertension or with age. Probably this left axis deviation is mistakenly read as Q waves by a physician and thought of right side not getting enough oxygen. So, by viewing your attached ECG, I do not see any immediate need for an angiogram. However, considering your age and hypertension and a history of pulmonary embolism. It is better to obtain echo is not done recently. Also, better to get one stress test like treadmill test or stress echo. BP spike may be age-related combined with panic or anxiety, so you should have BP apparatus at home and monitor it frequently, at least thrice a day for a week. And if most of the BP readings are above 140/90 mmHg then you should have regular medicines for it. You should take low salt diet and do regular exercises as well. I hope this helps you and get back if you have any doubts.

Hello doctor,I had a DVT with massive pulmonary embolism with infarction before four years. I had a few \\xc3\\xa4nxiety or panic attacks since then. Had a heart sonar and ECG done two months ago, which according to the physician was perfectly normal. I stopped taking Bisoprolol on his advice, and started with Alprazolam and Ativan when needed.Two weeks ago, I had an incident where I had my blood pressure shot up to 210/107 and a heart rate of 110 bpm. I went to the ER and had an ECG done as well as a cardio markers blood test is done. The doctor who did the ECG said that it looked like the right side of my heart did not get enough oxygen. I made another appointment with a physician, who now wants to send me for an angiogram. I want a second opinion on the latest ECG. The ER doctor said that a panic attack could also influence the ECG.

Hello. Your ECG is fine (attachment removed to protect patient identity). There is left axis deviation, which is expected in hypertension or with age. Probably this left axis deviation is mistakenly read as Q waves by a physician and thought of right side not getting enough oxygen. So, by viewing your attached ECG, I do not see any immediate need for an angiogram. However, considering your age and hypertension and a history of pulmonary embolism. It is better to obtain echo is not done recently. Also, better to get one stress test like treadmill test or stress echo. BP spike may be age-related combined with panic or anxiety, so you should have BP apparatus at home and monitor it frequently, at least thrice a day for a week. And if most of the BP readings are above 140/90 mmHg then you should have regular medicines for it. You should take low salt diet and do regular exercises as well. I hope this helps you and get back if you have any doubts.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am urinating too frequently, around 10 to 15 times a day. If I drink a coffee or glass of water I will have to urinate around three times in the following hour. I often feel a sense of urgency before urination, and I often only produce a very small amount of urine when I go. Sometimes during or after sexual intercourse, I experience some pain like a sense of pressure in my lower region. Sometimes during exercise (or if I am jumping), I experience a small amount of urine leakage. I have had these symptoms for around two years. I have recently been visiting a urologist to discuss these symptoms. I have seen the urologist four times. Each time I visit I give a urine specimen. During my first three visits, bacteria and a high count of white blood cells were found in my urine, which was subsequently treated with a number of different antibiotics. The antibiotic that cleared the bacteria is called Levofloxacin. I was told to try daily Kegel exercising to help with urine incontinence, which I am currently doing.When I visited the urologist again yesterday I had an even higher count of white blood cells and bacteria than my previous visits. He has again prescribed Levofloxacin and told me to come back in two weeks. He suggested me taking one of two possible medications to control frequent urination called ### Response: Hi. Recurrent UTI is very common among young and sexually active females. The above symptoms can definitely be caused be it UTI or overactive bladder (the one which you are referring for long-term medicines). If your urine report is showing pus cells as in your case then we need to treat UTI only first. It would be advised to get a urine culture and sensitivity test done to know the type of organism and ChatDoctor. Simultaneously, you should take B3 stimulant or anticholinergic to relieve your symptoms till UTI gets cleared. Once UTI gets cleared, you should reassess to stop anticholinergic. Take care.

Hello doctor,I am urinating too frequently, around 10 to 15 times a day. If I drink a coffee or glass of water I will have to urinate around three times in the following hour. I often feel a sense of urgency before urination, and I often only produce a very small amount of urine when I go. Sometimes during or after sexual intercourse, I experience some pain like a sense of pressure in my lower region. Sometimes during exercise (or if I am jumping), I experience a small amount of urine leakage. I have had these symptoms for around two years. I have recently been visiting a urologist to discuss these symptoms. I have seen the urologist four times. Each time I visit I give a urine specimen. During my first three visits, bacteria and a high count of white blood cells were found in my urine, which was subsequently treated with a number of different antibiotics. The antibiotic that cleared the bacteria is called Levofloxacin. I was told to try daily Kegel exercising to help with urine incontinence, which I am currently doing.When I visited the urologist again yesterday I had an even higher count of white blood cells and bacteria than my previous visits. He has again prescribed Levofloxacin and told me to come back in two weeks. He suggested me taking one of two possible medications to control frequent urination called

Hi. Recurrent UTI is very common among young and sexually active females. The above symptoms can definitely be caused be it UTI or overactive bladder (the one which you are referring for long-term medicines). If your urine report is showing pus cells as in your case then we need to treat UTI only first. It would be advised to get a urine culture and sensitivity test done to know the type of organism and ChatDoctor. Simultaneously, you should take B3 stimulant or anticholinergic to relieve your symptoms till UTI gets cleared. Once UTI gets cleared, you should reassess to stop anticholinergic. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 5\\2\" female, 21 years old and weigh 60 kg. I have gained 10 kg in the past eight months though I was exercising. I cannot follow strict diets due to my lifestyle. My eating habits include more liquid like milk, cold coffee, water, etc. I do not eat much bread or rice but more vegetables, curd, and fruits. I eat junk food almost daily and cannot control cravings for desserts and sweets. My diet and lifestyle have been the same for years but I have started gaining weight recently. I need to lose weight and improve metabolism. Also please suggest the BMI I should maintain. I am asthmatic and cannot exercise vigorously. Currently, taking Deryphilene, Wysolone, inhaler and other medicines for asthma. ### Response: Hello, Welcome to Chat Doctor forum. I understand your concern. Since you have asthma, I understand that you cannot do rigorous exercises. In fact, to lose weight you do not need to do rigorous exercises. You can just do a brisk walk (brisk and fast are not the same). Just walk at a moderately brisk pace which you can do without gasping for breath. Do it for 30 to 45 minutes daily. As we grow older, our metabolism slows down. Your body may not be able to process all the junk food that you may be eating. As you have already mentioned that you eat junk food regularly, it is definitely a contributing factor to your weight gain. The ChatDoctor. Include natural sugars like fruits in your diet, but try to cut down on processed sugar. Processed sugar is not good for anybody. Focus on a healthy lifestyle. Increase fluid intake, increase intake of fruits and vegetables, do moderate exercise regularly, sleep and wake up on time, and try to eat home cooked food as much as possible. At your age, I think you can achieve a healthy weight by just following these tips. For more information consult a nutritionist online

Hi doctor,I am a 5\\2\" female, 21 years old and weigh 60 kg. I have gained 10 kg in the past eight months though I was exercising. I cannot follow strict diets due to my lifestyle. My eating habits include more liquid like milk, cold coffee, water, etc. I do not eat much bread or rice but more vegetables, curd, and fruits. I eat junk food almost daily and cannot control cravings for desserts and sweets. My diet and lifestyle have been the same for years but I have started gaining weight recently. I need to lose weight and improve metabolism. Also please suggest the BMI I should maintain. I am asthmatic and cannot exercise vigorously. Currently, taking Deryphilene, Wysolone, inhaler and other medicines for asthma.

Hello, Welcome to Chat Doctor forum. I understand your concern. Since you have asthma, I understand that you cannot do rigorous exercises. In fact, to lose weight you do not need to do rigorous exercises. You can just do a brisk walk (brisk and fast are not the same). Just walk at a moderately brisk pace which you can do without gasping for breath. Do it for 30 to 45 minutes daily. As we grow older, our metabolism slows down. Your body may not be able to process all the junk food that you may be eating. As you have already mentioned that you eat junk food regularly, it is definitely a contributing factor to your weight gain. The ChatDoctor. Include natural sugars like fruits in your diet, but try to cut down on processed sugar. Processed sugar is not good for anybody. Focus on a healthy lifestyle. Increase fluid intake, increase intake of fruits and vegetables, do moderate exercise regularly, sleep and wake up on time, and try to eat home cooked food as much as possible. At your age, I think you can achieve a healthy weight by just following these tips. For more information consult a nutritionist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 26 year old female. I had my period on 21st and had unprotected sex 12 days later. The next day I took an I-pill. Then, I have had unprotected sex three to four times in the last four days. What are the chances of me getting pregnant? What can I do to prevent pregnancy now? Should I take another I-pill or some other I-pill? I understand that I should be more careful about this from now on. ### Response: Hi, Welcome to Chat Doctor forum. If you have regular monthly menses, then mostly you will not have any problem. The second thing is that after four days you cannot do much more. If you have intercourse three to four times in the last four days, then you should have taken precautions or tablets before and not after four days. Now, you have to wait for your period to come. One positive thing is that, if you have regular monthly period, then your expected period is around the next two days. The last 10 days before menses are coming in safe period and you do not have chance of pregnancy if you have unprotected sex during this time. You can go to the doctor and ask for copper-T as emergency contraception today only. It can be placed up to five days after sex. It inhibits implantation of pregnancy. Also, there is no study if you take I-pill for two times in one cycle will be effective or not. So, it is not that easy and also, it can disturb your cycle for at least one or two cycles. Either go for the copper-T or wait for your period for more than four to five days. If you did not get period, then do a urine pregnancy test. If that is negative, then wait for sometime. If that is positive, then you will need early termination. Have protected sex and stay safe. I-pill is emergency contraception and it is not like you can take whenever you like.

Hi doctor,I am a 26 year old female. I had my period on 21st and had unprotected sex 12 days later. The next day I took an I-pill. Then, I have had unprotected sex three to four times in the last four days. What are the chances of me getting pregnant? What can I do to prevent pregnancy now? Should I take another I-pill or some other I-pill? I understand that I should be more careful about this from now on.

Hi, Welcome to Chat Doctor forum. If you have regular monthly menses, then mostly you will not have any problem. The second thing is that after four days you cannot do much more. If you have intercourse three to four times in the last four days, then you should have taken precautions or tablets before and not after four days. Now, you have to wait for your period to come. One positive thing is that, if you have regular monthly period, then your expected period is around the next two days. The last 10 days before menses are coming in safe period and you do not have chance of pregnancy if you have unprotected sex during this time. You can go to the doctor and ask for copper-T as emergency contraception today only. It can be placed up to five days after sex. It inhibits implantation of pregnancy. Also, there is no study if you take I-pill for two times in one cycle will be effective or not. So, it is not that easy and also, it can disturb your cycle for at least one or two cycles. Either go for the copper-T or wait for your period for more than four to five days. If you did not get period, then do a urine pregnancy test. If that is negative, then wait for sometime. If that is positive, then you will need early termination. Have protected sex and stay safe. I-pill is emergency contraception and it is not like you can take whenever you like.

### Instruction: Answer this question truthfully ###Input: Hello doctor,For almost a week now I have had recurring random pain just behind both of my ear lobes. It has been almost three weeks since I stopped Lyrica, Pregabalin completely for back pain. For the last week I have been experiencing something different which can be best described as random pressure or light pain almost behind both the ear lobes, sometimes the feeling is localized just there other times it travels towards the neck, occasionally towards the mastoid bone or it extends towards the lower jawline. I have been crazily searching to see if this is a result of any swollen lymph node fearing cancer but I could not find anything out of the ordinary on the body. Very rarely I feel this pressure going upwards to the ear and even more rarely a sudden pain arises inside the ear too but I hear no ringing or sounds. The weirdest thing is today I woke up with this sensation and I could feel heaviness behind my ears.This has come after an acute sinus infection, cough, night sweats (for which I had to take antibiotics) that hit me when I started tapering off Lyrica last month. I have had chronic sinus issues in the past too but this one was different, never had it progress to this level. I have uploaded an image of where exactly the pain or pressure originates but right now the pain or pressure is pretty spread out randomly across the neck. Can you please tell me what is going on and what could be the cause of this pain or pressure? Medicines ### Response: Hello. Pain may be due to mastoiditis seen in chronic allergy or middle ear infection or eustachian tube block patients. Get it done CT brain or X-ray of the mastoid. Avoid cool ChatDoctor. Use water vapor inhalation and salt water gargling thrice a day for five days. You may use Montelukast and Levocetirizine once a day for five days. If symptoms are not improved please consult your ENT specialist, he will examine and treat you accordingly. Take care.

Hello doctor,For almost a week now I have had recurring random pain just behind both of my ear lobes. It has been almost three weeks since I stopped Lyrica, Pregabalin completely for back pain. For the last week I have been experiencing something different which can be best described as random pressure or light pain almost behind both the ear lobes, sometimes the feeling is localized just there other times it travels towards the neck, occasionally towards the mastoid bone or it extends towards the lower jawline. I have been crazily searching to see if this is a result of any swollen lymph node fearing cancer but I could not find anything out of the ordinary on the body. Very rarely I feel this pressure going upwards to the ear and even more rarely a sudden pain arises inside the ear too but I hear no ringing or sounds. The weirdest thing is today I woke up with this sensation and I could feel heaviness behind my ears.This has come after an acute sinus infection, cough, night sweats (for which I had to take antibiotics) that hit me when I started tapering off Lyrica last month. I have had chronic sinus issues in the past too but this one was different, never had it progress to this level. I have uploaded an image of where exactly the pain or pressure originates but right now the pain or pressure is pretty spread out randomly across the neck. Can you please tell me what is going on and what could be the cause of this pain or pressure? Medicines

Hello. Pain may be due to mastoiditis seen in chronic allergy or middle ear infection or eustachian tube block patients. Get it done CT brain or X-ray of the mastoid. Avoid cool ChatDoctor. Use water vapor inhalation and salt water gargling thrice a day for five days. You may use Montelukast and Levocetirizine once a day for five days. If symptoms are not improved please consult your ENT specialist, he will examine and treat you accordingly. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,This query is for my father in law aged. He is 58 years old and is diabetic and currently under medication for BP also. He has a history of two major heart attacks. In the last five years, he did not have any major heart issues.Recently due to extensive amount of medications taken for a long time, he started showing signs of high amount of creatinine (currently 6.9). We did a few dialyses. Now doctors have advised doing an AV fistula on his left hand. His left hand is partially amputated from a previous septic shock treatment about four years back. His right hand is fine but an AV fistula there might terribly limit his movements and self-care. We wanted a medical opinion about where the fistula can be placed or can it be near to chest area as an alternate option? ### Response: Hi, Welcome to Chat Doctor forum. There are three main types of AVF (arteriovenous fistula). The radiocephalic fistula is a forearm fistula created by anastomosing the side of a radial artery to the end of a cephalic vein. It is also referred to as the Brescia-Cimino fistula. The brachiocephalic fistula is an upper arm fistula created by connecting the side of a brachial artery to the end of a cephalic vein or slightly central to the level of the elbow. Finally, the brachial artery\\x80\\x93to\\x80\\x93transposed basilic vein (BTB) fistula is another upper arm fistula. This fistula is created by anastomosing the side of a brachial artery to the end of a basilic vein that has been transposed laterally and elevated superficially to make it amenable to dialysis cannulation. Other sites could be leg also. I advise you to discuss it with your doctor. The patient requires dialysis for sure or you can put a central line and replace it every 15 to 20 days. But AV fistula is the best option.

Hello doctor,This query is for my father in law aged. He is 58 years old and is diabetic and currently under medication for BP also. He has a history of two major heart attacks. In the last five years, he did not have any major heart issues.Recently due to extensive amount of medications taken for a long time, he started showing signs of high amount of creatinine (currently 6.9). We did a few dialyses. Now doctors have advised doing an AV fistula on his left hand. His left hand is partially amputated from a previous septic shock treatment about four years back. His right hand is fine but an AV fistula there might terribly limit his movements and self-care. We wanted a medical opinion about where the fistula can be placed or can it be near to chest area as an alternate option?

Hi, Welcome to Chat Doctor forum. There are three main types of AVF (arteriovenous fistula). The radiocephalic fistula is a forearm fistula created by anastomosing the side of a radial artery to the end of a cephalic vein. It is also referred to as the Brescia-Cimino fistula. The brachiocephalic fistula is an upper arm fistula created by connecting the side of a brachial artery to the end of a cephalic vein or slightly central to the level of the elbow. Finally, the brachial artery\\x80\\x93to\\x80\\x93transposed basilic vein (BTB) fistula is another upper arm fistula. This fistula is created by anastomosing the side of a brachial artery to the end of a basilic vein that has been transposed laterally and elevated superficially to make it amenable to dialysis cannulation. Other sites could be leg also. I advise you to discuss it with your doctor. The patient requires dialysis for sure or you can put a central line and replace it every 15 to 20 days. But AV fistula is the best option.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have a two-year-old son who has a small hole in his ears. It started as a little spot and later degenerated into a small hole in the cartilage. Now it started spreading to another ear. I have gone to many ENT specialist and dermatologist, and they could not be able to figure out what it is. It began as a small dot or spot 17 months ago in the left ear and started becoming a hole. We noticed it in the right ear around seven months ago. The same way it started as a dot as seen in the right ear before it turned into a small hole as seen in the left ear. The one on the left ear is 17 months now. We have been to many ENT specialist and dermatologist, and they said they had not seen such thing before. They conducted a blood test on him and said everything is fine. It is disturbing me a lot and looking for a solution for it as I am scared, that it should not get bigger. I am using Fusibact ointment on the affected area. ### Response: Hi, Welcome to Chat Doctor forum. With your description and after reviewing the pictures (attachment removed to protect patient identity), I can think of a condition called angiolymphoid hyperplasia with eosinophilia (ALHE). It is a benign harmless condition that presents with bumps in the ears. ALHE is common in adults, but there are few cases of ALHE reported in chil ChatDoctor. This is an idiopathic condition, meaning the cause is not yet known. This condition has to be confirmed by skin biopsy. I understand it is difficult to do a biopsy in kids, but I feel biopsy is essential because this problem is present since 17months as you have mentioned. In about 20 % of cases, there will be elevated eosinophils in the blood. You have told that the blood tests are fine. I am not sure if the eosinophils were tested. For more information consult a dermatologist online

Hi doctor,I have a two-year-old son who has a small hole in his ears. It started as a little spot and later degenerated into a small hole in the cartilage. Now it started spreading to another ear. I have gone to many ENT specialist and dermatologist, and they could not be able to figure out what it is. It began as a small dot or spot 17 months ago in the left ear and started becoming a hole. We noticed it in the right ear around seven months ago. The same way it started as a dot as seen in the right ear before it turned into a small hole as seen in the left ear. The one on the left ear is 17 months now. We have been to many ENT specialist and dermatologist, and they said they had not seen such thing before. They conducted a blood test on him and said everything is fine. It is disturbing me a lot and looking for a solution for it as I am scared, that it should not get bigger. I am using Fusibact ointment on the affected area.

Hi, Welcome to Chat Doctor forum. With your description and after reviewing the pictures (attachment removed to protect patient identity), I can think of a condition called angiolymphoid hyperplasia with eosinophilia (ALHE). It is a benign harmless condition that presents with bumps in the ears. ALHE is common in adults, but there are few cases of ALHE reported in chil ChatDoctor. This is an idiopathic condition, meaning the cause is not yet known. This condition has to be confirmed by skin biopsy. I understand it is difficult to do a biopsy in kids, but I feel biopsy is essential because this problem is present since 17months as you have mentioned. In about 20 % of cases, there will be elevated eosinophils in the blood. You have told that the blood tests are fine. I am not sure if the eosinophils were tested. For more information consult a dermatologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 30 years old and got married a year ago. We are trying for a baby for the last three months. My LMP was on the 9th of last month. I never faced issues with my menstrual cycle. It is a regular 29 day cycle. We had an unprotected sex from 17th to 25th for every alternate day. I have started getting pain on the right pelvic or pubic bone area from 29th. The pain is not continuous. Sometimes, it was a severe stabbing pain. I have consulted a doctor and performed a vaginal test as well and no abnormalities have been noticed. Also, I have got an ultrasound and thyroid test in the past two months and no abnormalities have been noticed. I got spotted on the 8th and till continued till 10th. It has started as pink and turns into bright red and then dark brown. In the whole three days of my spotting, I had on and off pain. Whenever there is pain, there will be spotting, I can wipe it up with the tissue. On the 8th evening, the spotting continued for 2 hours with 15 to 20 drops and few clots as well. I am sure that was not my menstrual bleeding. I do have proper menstrual bleeding for all these years for three days. I have performed a beta hCG test on 10th and the test results came as negative with the value of less than 1. Please clarify my doubt. ### Response: Hello. If the serum beta hCG test (human chorionic gonadotropin) as on 10th is less than 1, then you are surely not pregnant. The symptoms are part of Premenstrual Syn ChatDoctor. But, full flow may be achieved in the next few days. There is likelihood that the flow may start in the next few days. Keep a watch, as you are not pregnant during this cycle for sure.

Hi doctor,I am 30 years old and got married a year ago. We are trying for a baby for the last three months. My LMP was on the 9th of last month. I never faced issues with my menstrual cycle. It is a regular 29 day cycle. We had an unprotected sex from 17th to 25th for every alternate day. I have started getting pain on the right pelvic or pubic bone area from 29th. The pain is not continuous. Sometimes, it was a severe stabbing pain. I have consulted a doctor and performed a vaginal test as well and no abnormalities have been noticed. Also, I have got an ultrasound and thyroid test in the past two months and no abnormalities have been noticed. I got spotted on the 8th and till continued till 10th. It has started as pink and turns into bright red and then dark brown. In the whole three days of my spotting, I had on and off pain. Whenever there is pain, there will be spotting, I can wipe it up with the tissue. On the 8th evening, the spotting continued for 2 hours with 15 to 20 drops and few clots as well. I am sure that was not my menstrual bleeding. I do have proper menstrual bleeding for all these years for three days. I have performed a beta hCG test on 10th and the test results came as negative with the value of less than 1. Please clarify my doubt.

Hello. If the serum beta hCG test (human chorionic gonadotropin) as on 10th is less than 1, then you are surely not pregnant. The symptoms are part of Premenstrual Syn ChatDoctor. But, full flow may be achieved in the next few days. There is likelihood that the flow may start in the next few days. Keep a watch, as you are not pregnant during this cycle for sure.

### Instruction: Answer this question truthfully ###Input: Hi doctor, I have hyperthyroidism. I also have tendonitis in both my shoulders. I have been having joint pain for years and I work a lot of physical jobs. Lots of bending, kneeling, lifting and twisting. I hang my hands quite a bit as well. I have been getting hives for the last two months, I have been using tide and gain in my laundry for eight months. My mom is allergic to Tide. My endocrinologist mentioned lupus because of joint pain and hives. I have an appointment with a rheumatologist in four months. I am considering changing my detergent back to see if the hives stop. Could it all be coincidental? How long would an allergy take to show? I have always thought it was the onset of arthritis. I never got a butterfly shaped rash on my face. I am currently taking Methimazole 10 mg, Multivitamins, and Gianvi birth control. ### Response: Hi. Well, the hives do go in favor of urticaria. It can be a part of lupus or can be independent as well. But usually, it is an autoimmune process triggered by some allergen (it is possible it is detergent in your case). But the joint pains you have do not really point towards lupus since it is only restricted to the shoulders. Most of the time, shoulders have a mechanical cause, that is you are overusing it in the wrong way. But never the less, since your appointment is far away, I would suggest you get a few tests done. Even with urticaria, we do these tests. Meanwhile, change your detergent and take a course of antiallergics and see if it improves. You can let me know the results when available. 1. CBC (complete blood count). 2. ESR (erythrocyte sedimentation rate). 3. ANA (antinuclear antibody). 4. CRP (C-reactive protein). 5. Ultrasound of the shoulder. Anti-allergics. With reports.

Hi doctor, I have hyperthyroidism. I also have tendonitis in both my shoulders. I have been having joint pain for years and I work a lot of physical jobs. Lots of bending, kneeling, lifting and twisting. I hang my hands quite a bit as well. I have been getting hives for the last two months, I have been using tide and gain in my laundry for eight months. My mom is allergic to Tide. My endocrinologist mentioned lupus because of joint pain and hives. I have an appointment with a rheumatologist in four months. I am considering changing my detergent back to see if the hives stop. Could it all be coincidental? How long would an allergy take to show? I have always thought it was the onset of arthritis. I never got a butterfly shaped rash on my face. I am currently taking Methimazole 10 mg, Multivitamins, and Gianvi birth control.

Hi. Well, the hives do go in favor of urticaria. It can be a part of lupus or can be independent as well. But usually, it is an autoimmune process triggered by some allergen (it is possible it is detergent in your case). But the joint pains you have do not really point towards lupus since it is only restricted to the shoulders. Most of the time, shoulders have a mechanical cause, that is you are overusing it in the wrong way. But never the less, since your appointment is far away, I would suggest you get a few tests done. Even with urticaria, we do these tests. Meanwhile, change your detergent and take a course of antiallergics and see if it improves. You can let me know the results when available. 1. CBC (complete blood count). 2. ESR (erythrocyte sedimentation rate). 3. ANA (antinuclear antibody). 4. CRP (C-reactive protein). 5. Ultrasound of the shoulder. Anti-allergics. With reports.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 17 years old. I had sex with my partner on the 24th day of the menustruation cycle. I used Today vaginal pill before intercourse. On the next day i.e. 25th day, within 30 hours, I also took i-pill to be sure not to be pregnant. Now my period which was on due is still missing. What are the chances of my pregnancy? What should I do to terminate it, if I am pregnant? Kindly help me out. ### Response: Hello. I have reviewed your query thoroughly. I-pill or emergency contraceptive pills have very minimal chance of failure if taken immediately after intercourse within 24 hours and chances of failure gradually increase after that even if taken within 72 hours. There is about one to two percent chance of failure of an emergency pill or i-pill in your case. But we can be quite sure of its success if with ChatDoctor. Based on the dates given by you, today must be 8 days following the date of the intercourse. In that case, to find out if you are pregnant, you can get a serum beta hCG (human chorionic gonadotrophin) testing done. For the urine pregnancy tests to show the result if pregnant, it must be at least 10 to 14 days following intercourse. If you want to know urgently whether you are pregnant, you can get serum beta hCG testing. If you can wait another week, you can get a urine pregnancy testing, which if positive must be followed up by ultrasound imaging. Only after then and after consulting an obstetrician, should the abortion be planned under guidance. Furthermore, if you are sexually active regularly, it is better to choose other regular contraceptive methods after consulting an obstetrician and gynecologist instead of i-pill. I-pills are meant to be taken only in case of unexpected accidental unprotected sex, but not on a regular basis.

Hello doctor,I am 17 years old. I had sex with my partner on the 24th day of the menustruation cycle. I used Today vaginal pill before intercourse. On the next day i.e. 25th day, within 30 hours, I also took i-pill to be sure not to be pregnant. Now my period which was on due is still missing. What are the chances of my pregnancy? What should I do to terminate it, if I am pregnant? Kindly help me out.

Hello. I have reviewed your query thoroughly. I-pill or emergency contraceptive pills have very minimal chance of failure if taken immediately after intercourse within 24 hours and chances of failure gradually increase after that even if taken within 72 hours. There is about one to two percent chance of failure of an emergency pill or i-pill in your case. But we can be quite sure of its success if with ChatDoctor. Based on the dates given by you, today must be 8 days following the date of the intercourse. In that case, to find out if you are pregnant, you can get a serum beta hCG (human chorionic gonadotrophin) testing done. For the urine pregnancy tests to show the result if pregnant, it must be at least 10 to 14 days following intercourse. If you want to know urgently whether you are pregnant, you can get serum beta hCG testing. If you can wait another week, you can get a urine pregnancy testing, which if positive must be followed up by ultrasound imaging. Only after then and after consulting an obstetrician, should the abortion be planned under guidance. Furthermore, if you are sexually active regularly, it is better to choose other regular contraceptive methods after consulting an obstetrician and gynecologist instead of i-pill. I-pills are meant to be taken only in case of unexpected accidental unprotected sex, but not on a regular basis.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Five weeks ago, I fell down while mountain-biking. I went over the handlebars and hit my head and chest. I was wearing a helmet and a chest protector and both of them had cracked as a result of the impact. The helmet strap had strangulated my neck pretty hard. Ever since I have been continuously having sensation pressure at the place where the strap had impacted. Activities like turning my neck, yawning, laughing cause some pain. Over the past five weeks, the symptoms have not improved. I am very worried because I am afraid I might have to deal with this forever. They did a CT scan and said that it was normal. Should I ask for an MRI? Could this be some kind of hernia? ### Response: Hi. Sorry to hear about your injury. Since your CT (computed tomography) scan is normal, it is very unlikely that there is any bony or skeletal injury hence reducing the possibility of something permanent. It appears that there is some soft tissue injury in the laryngopharyngeal region or a cartilaginous injury that is resolving very slowly. This indicates an injury closer to the voice box region because of constant movements during speech, laughter and swallowing delay recovery. This may also explain why it is taking so long to heal completely. In my opinion, an MRI (magnetic resonance imaging) is certainly indicated since there has been no improvement in symptoms for five weeks and to look for cartilaginous injury or soft tissue lesions such as a granuloma or hematoma following trauma. In addition, a video laryngoscopy performed by an ENT will help to evaluate the voice box and supporting apparatus internally for any injury (specifically the inter arytenoid region). A hernia in the neck or a laryngocele may be a possibility following neck injury but seems very unlikely in your case since there is no visible bulge in the neck which worsens on coughing, etc. There may be an internal laryngocele that may be picked up on video laryngoscopy. I hope this helps.

Hello doctor,Five weeks ago, I fell down while mountain-biking. I went over the handlebars and hit my head and chest. I was wearing a helmet and a chest protector and both of them had cracked as a result of the impact. The helmet strap had strangulated my neck pretty hard. Ever since I have been continuously having sensation pressure at the place where the strap had impacted. Activities like turning my neck, yawning, laughing cause some pain. Over the past five weeks, the symptoms have not improved. I am very worried because I am afraid I might have to deal with this forever. They did a CT scan and said that it was normal. Should I ask for an MRI? Could this be some kind of hernia?

Hi. Sorry to hear about your injury. Since your CT (computed tomography) scan is normal, it is very unlikely that there is any bony or skeletal injury hence reducing the possibility of something permanent. It appears that there is some soft tissue injury in the laryngopharyngeal region or a cartilaginous injury that is resolving very slowly. This indicates an injury closer to the voice box region because of constant movements during speech, laughter and swallowing delay recovery. This may also explain why it is taking so long to heal completely. In my opinion, an MRI (magnetic resonance imaging) is certainly indicated since there has been no improvement in symptoms for five weeks and to look for cartilaginous injury or soft tissue lesions such as a granuloma or hematoma following trauma. In addition, a video laryngoscopy performed by an ENT will help to evaluate the voice box and supporting apparatus internally for any injury (specifically the inter arytenoid region). A hernia in the neck or a laryngocele may be a possibility following neck injury but seems very unlikely in your case since there is no visible bulge in the neck which worsens on coughing, etc. There may be an internal laryngocele that may be picked up on video laryngoscopy. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 69 years old male with 184 lb and 6'1\" in height. For three years, my volume averaged 0.5 ml antegrade and 1.5 ml retrograde, motility 8 to 17 %, concentration 25 to 80 million. In the past two years, the volume has been 0.2 ml, concentration 20 to 30 million, motility either 0 or < 1 or 17. In the past two weeks, I have produced 0.3 ml total 15,000 sperms w 2 % motile and 0.1 ml with 0 sperms. 1.5-year-old tests done are PSA, FSH, LH, and it is all normal. Testosterone a little low. Prostate 70 cubic cm, no suggestion of ejaculatory duct obstruction.1. What can be done to determine it?2. What can be done to increase quality?3. What is the chance that I will produce viable semen in the future?4. How long might it take?5. How many donor or fresh eggs can be inseminated using IVF, ICSI, and a frozen specimen of volume 0.5 ml 70 million / ml concentration motility 15%? Volume 0.25 ml concentration 150 million / ml motility 15%? 0.3 ml total 15,000 sperms 2% motility?I am under Atorvastatin, clopidogrel, Doxazosin, Metoprolol, and Alfuzosin. ### Response: Hello. The causes for retrograde ejaculation can be many rights from ChatDoctor. They can be evaluated in detail, and the cause can be identified and treated upon. However, antidepressants like Imipramine have shown good results. However at 69 now, the quality of sperm has reduced

Hello doctor,I am 69 years old male with 184 lb and 6'1\" in height. For three years, my volume averaged 0.5 ml antegrade and 1.5 ml retrograde, motility 8 to 17 %, concentration 25 to 80 million. In the past two years, the volume has been 0.2 ml, concentration 20 to 30 million, motility either 0 or < 1 or 17. In the past two weeks, I have produced 0.3 ml total 15,000 sperms w 2 % motile and 0.1 ml with 0 sperms. 1.5-year-old tests done are PSA, FSH, LH, and it is all normal. Testosterone a little low. Prostate 70 cubic cm, no suggestion of ejaculatory duct obstruction.1. What can be done to determine it?2. What can be done to increase quality?3. What is the chance that I will produce viable semen in the future?4. How long might it take?5. How many donor or fresh eggs can be inseminated using IVF, ICSI, and a frozen specimen of volume 0.5 ml 70 million / ml concentration motility 15%? Volume 0.25 ml concentration 150 million / ml motility 15%? 0.3 ml total 15,000 sperms 2% motility?I am under Atorvastatin, clopidogrel, Doxazosin, Metoprolol, and Alfuzosin.

Hello. The causes for retrograde ejaculation can be many rights from ChatDoctor. They can be evaluated in detail, and the cause can be identified and treated upon. However, antidepressants like Imipramine have shown good results. However at 69 now, the quality of sperm has reduced

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 59 years old. I was diagnosed with hepatitis C alcoholic cirrhosis, acute pancreatitis and that was almost two years. I am currently taking Levothyroxine 50 mg once daily, Labetalol Hydrochloride 100 mg once daily, Lisinopril 20 mg once daily. I was in the hospital at first to stabilize my condition. My hepatitis C cleared but still of course I cannot change the damage to my liver.I was told I would only be given five to ten years if I would quit drinking. I kind of fell off the wagon about six months ago, about three liters a day. I weigh about 120 kg. I went to my family physician, he ordered a liver profile and complete blood work. I am going to get it done tomorrow, but the only concern I have is this day I have been having not much but had some black stools. Does this mean that my liver is failing? I tried calling my specialist but they had already left their office. Should I go to the ER or just wait till I call my specialists? I quit drinking about a week ago. Can you help me with some advice? ### Response: Hello, Welcome to Chat Doctor forum. Black stools are indicative of acute gastrointestinal hemorrhage. Melena or black stools can also turn into a medical emergency if a lot of blood is lost and hence my sincere advice to you would be to go see a doctor as soon as possible. This does not signify liver failure. However, with a history of ChatDoctor. But melena does not mean that your liver is failing. I will advise you on the following until you get to the doctor. Take Omeprazole 20 mg one tablet immediately, followed by one tablet every morning in the empty stomach. Sucralfate syrup two teaspoons immediately, followed by two teaspoons after every meal. This will help in coating the ulcer lining and help in healing. I hope this helps.

Hello doctor,I am 59 years old. I was diagnosed with hepatitis C alcoholic cirrhosis, acute pancreatitis and that was almost two years. I am currently taking Levothyroxine 50 mg once daily, Labetalol Hydrochloride 100 mg once daily, Lisinopril 20 mg once daily. I was in the hospital at first to stabilize my condition. My hepatitis C cleared but still of course I cannot change the damage to my liver.I was told I would only be given five to ten years if I would quit drinking. I kind of fell off the wagon about six months ago, about three liters a day. I weigh about 120 kg. I went to my family physician, he ordered a liver profile and complete blood work. I am going to get it done tomorrow, but the only concern I have is this day I have been having not much but had some black stools. Does this mean that my liver is failing? I tried calling my specialist but they had already left their office. Should I go to the ER or just wait till I call my specialists? I quit drinking about a week ago. Can you help me with some advice?

Hello, Welcome to Chat Doctor forum. Black stools are indicative of acute gastrointestinal hemorrhage. Melena or black stools can also turn into a medical emergency if a lot of blood is lost and hence my sincere advice to you would be to go see a doctor as soon as possible. This does not signify liver failure. However, with a history of ChatDoctor. But melena does not mean that your liver is failing. I will advise you on the following until you get to the doctor. Take Omeprazole 20 mg one tablet immediately, followed by one tablet every morning in the empty stomach. Sucralfate syrup two teaspoons immediately, followed by two teaspoons after every meal. This will help in coating the ulcer lining and help in healing. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My question is whether or not it is safe for me to use anesthesia to fall asleep while having all four of my wisdom teeth removed. I am a quiet person and did not ask many questions during my consultation. I cannot breathe very easily through my nose because I have some sort of sinus issues and it is worse when I am laying down flat on my back. I wrote down that I had sinus issues on the papers I filled out but half the time they do not look at them. I know i should have brought it up at the consultation but I was shy and nervous about the whole thing. They said they cannot even do the surgery if I have a cold. Can they do anesthesia if I have sinus issues? I would prefer to be knocked out when they take my teeth out but I am even more worried about not being able to breathe through my nose.As of right now, I am scheduled to have my wisdom teeth taken out at a hospital with many assistants who will monitor everything while the surgeon works. They also said they would be putting a tube down my throat in case I need help breathing. That makes me even more worried because I will not be able to breathe through my nose and my throat unless the people monitoring me are breathing for me the entire time during the operation. That worries me. My question is ### Response: Hello. You do not have to worry at all. There will be people concerned by you. Having a sinus issue is not a contraindication for anesthesia. You can have sedation supplemented with local anesthetics. In case you need endotracheal intubation, that will be safer for you because your nasal passage will be bypassed and you can be totally knocked off which is called general anesthesia. This will be done by a trained anesthesiologist. So, do not worry at all and leave your worries on your anesthesiologist. You will do absolutely fine. Wish you all the luck. For more information consult an anesthesiologist online Take care.

Hello doctor,My question is whether or not it is safe for me to use anesthesia to fall asleep while having all four of my wisdom teeth removed. I am a quiet person and did not ask many questions during my consultation. I cannot breathe very easily through my nose because I have some sort of sinus issues and it is worse when I am laying down flat on my back. I wrote down that I had sinus issues on the papers I filled out but half the time they do not look at them. I know i should have brought it up at the consultation but I was shy and nervous about the whole thing. They said they cannot even do the surgery if I have a cold. Can they do anesthesia if I have sinus issues? I would prefer to be knocked out when they take my teeth out but I am even more worried about not being able to breathe through my nose.As of right now, I am scheduled to have my wisdom teeth taken out at a hospital with many assistants who will monitor everything while the surgeon works. They also said they would be putting a tube down my throat in case I need help breathing. That makes me even more worried because I will not be able to breathe through my nose and my throat unless the people monitoring me are breathing for me the entire time during the operation. That worries me. My question is

Hello. You do not have to worry at all. There will be people concerned by you. Having a sinus issue is not a contraindication for anesthesia. You can have sedation supplemented with local anesthetics. In case you need endotracheal intubation, that will be safer for you because your nasal passage will be bypassed and you can be totally knocked off which is called general anesthesia. This will be done by a trained anesthesiologist. So, do not worry at all and leave your worries on your anesthesiologist. You will do absolutely fine. Wish you all the luck. For more information consult an anesthesiologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am suffering from high blood pressure for the last three years. During discomfort, the reading comes around 140-148/90-98 mmHg. In normal times, it is 120/80 mmHg. Presently, I have been taking Cilacar 10 in the morning after breakfast and Ecosprin AV 75 at night as suggested by my doctor. I am taking Cilacar since nine months and started Ecosprin just five to six months back. Earlier, I was taking Telma 40. But, my high BP has not cured fully. Sometimes, particularly in the evening due to the anxiety I feel some discomfort and uneasiness in the left chest. But, I do not have any pain. I am getting sleep only after some struggle for an hour or two. But after deep sleep, I feel relieved. My blood sugar level, lipid profile and last ECG report were fine. My doctor did not advise for echo or any further test. I have attached my latest blood report. I do not smoke and drink. But, inactive lifestyle due to sitting in front of a computer for hours. Please suggest some alternate or additional medicine to cure my hypertension and anxiety. Thank you. ### Response: Hi. You have hypertension (high blood pressure), which is out of control occasionally during episodes of anxiety. The baseline BP control is fine. I would suggest adding a new medicine, tablet Concor 2.5 mg (Bisoprolol) once daily at 8 AM. Consult your specialist doctor, discuss with him or her and take the medicine with consent. Let me encourage you to develop a more healthy lifestyle. One practical suggestion would be to join a good gym and have a trainer. You should start with elliptical trainer and treadmill. You need to change your sedentary lifestyle and that in turn will help you to decrease the number of medicines. Also, having a personal trainer will help you to have a sustainable activity program.

Hi doctor,I am suffering from high blood pressure for the last three years. During discomfort, the reading comes around 140-148/90-98 mmHg. In normal times, it is 120/80 mmHg. Presently, I have been taking Cilacar 10 in the morning after breakfast and Ecosprin AV 75 at night as suggested by my doctor. I am taking Cilacar since nine months and started Ecosprin just five to six months back. Earlier, I was taking Telma 40. But, my high BP has not cured fully. Sometimes, particularly in the evening due to the anxiety I feel some discomfort and uneasiness in the left chest. But, I do not have any pain. I am getting sleep only after some struggle for an hour or two. But after deep sleep, I feel relieved. My blood sugar level, lipid profile and last ECG report were fine. My doctor did not advise for echo or any further test. I have attached my latest blood report. I do not smoke and drink. But, inactive lifestyle due to sitting in front of a computer for hours. Please suggest some alternate or additional medicine to cure my hypertension and anxiety. Thank you.

Hi. You have hypertension (high blood pressure), which is out of control occasionally during episodes of anxiety. The baseline BP control is fine. I would suggest adding a new medicine, tablet Concor 2.5 mg (Bisoprolol) once daily at 8 AM. Consult your specialist doctor, discuss with him or her and take the medicine with consent. Let me encourage you to develop a more healthy lifestyle. One practical suggestion would be to join a good gym and have a trainer. You should start with elliptical trainer and treadmill. You need to change your sedentary lifestyle and that in turn will help you to decrease the number of medicines. Also, having a personal trainer will help you to have a sustainable activity program.

### Instruction: Answer this question truthfully ###Input: Hello doctor,So, I just got back from the dentist today but my dentist did not give me a chance to ask further questions today, she just said I have short roots and left. I suppose she was in a rush? Not to mention she discovered four cavities under sealants I have had in the past. I have been here checking online about short roots and making myself paranoid. I wish I had a picture of my X-rays from today to make this more clear. But my main concerns are just does this have anything to do with root resorption and are my retainers making my short roots worse? I have not had braces since I was 14 and I have always worn my retainers since. I cannot sleep without them. But are my retainers causing my short roots more stress? And can this lead to root resorption? ### Response: Hello, Welcome to Chat Doctor forum. I understand how you feel. But, root resorption occurs in deciduous teeth prior to shedding. In permanent teeth, root resorption occurs during pathology/disease. Regarding the cavities, if it is not near to pulp (blood vessel of the tooth), you can get it filled. There is nothing to worry about short roots. If the cavity is near the pulp, you will have to go for a root canal and again short roots will not create a problem with that but the crown placement might be affected. Yes, orthodontic treatment causes mild tooth resorption for tooth movement but is compensated and retainers will not cause much of root resorption. You may genetically or developmentally have short roots. Nothing to worry much, if there is no pathology, problem or mobility. I would suggest you remove the retainers at night as the tissues need some rest (eight hours). I hope I have answered your doubt. If you want, you can add up further details like which tooth or any other symptoms associated with it, like pain or sensitivity or swelling, etc., in detail. For more information consult a dentist online

Hello doctor,So, I just got back from the dentist today but my dentist did not give me a chance to ask further questions today, she just said I have short roots and left. I suppose she was in a rush? Not to mention she discovered four cavities under sealants I have had in the past. I have been here checking online about short roots and making myself paranoid. I wish I had a picture of my X-rays from today to make this more clear. But my main concerns are just does this have anything to do with root resorption and are my retainers making my short roots worse? I have not had braces since I was 14 and I have always worn my retainers since. I cannot sleep without them. But are my retainers causing my short roots more stress? And can this lead to root resorption?

Hello, Welcome to Chat Doctor forum. I understand how you feel. But, root resorption occurs in deciduous teeth prior to shedding. In permanent teeth, root resorption occurs during pathology/disease. Regarding the cavities, if it is not near to pulp (blood vessel of the tooth), you can get it filled. There is nothing to worry about short roots. If the cavity is near the pulp, you will have to go for a root canal and again short roots will not create a problem with that but the crown placement might be affected. Yes, orthodontic treatment causes mild tooth resorption for tooth movement but is compensated and retainers will not cause much of root resorption. You may genetically or developmentally have short roots. Nothing to worry much, if there is no pathology, problem or mobility. I would suggest you remove the retainers at night as the tissues need some rest (eight hours). I hope I have answered your doubt. If you want, you can add up further details like which tooth or any other symptoms associated with it, like pain or sensitivity or swelling, etc., in detail. For more information consult a dentist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 19-year-old male. I have been to a few ophthalmologists about this and they seem to think it is benign. But I want to get some other input on this. If I widen my eyes and move my head around, I can see shadows in my far peripheral vision moving as my head does. And it seems that the shadows change and become different sizes as time goes on.Now I do have astigmatism in my right eye and from time to time I get aching, almost gnawing pains that are with the movement of the eye. And has happened in both at the same time before. I find that it happens mostly when I am in a place with very weird or bright lighting or when I am looking at a bright screen in a weirdly lit room.I suffer from anxiety and depression which is why I guess I am coming out to ask some more questions. And I also have Asperger's syndrome. The aches radiate to my temple as well. But as I have said I have been to doctors and they have dilated my pupils and looked at my retina and ocular nerves and told me they looked good. So I honestly do not know what could be causing these weird shadows. I have had them for quite a while. And they also get bigger and more noticeable with head tilt like when I exercise or go running or do something very physical.I currently take Prozac 20 mg and Pantoprazole 10 mg. ### Response: Hello. What you are describing is most probably breaks in the gel shaped part of the eye and is called floaters. It is a normal and physiological condition that we see in patients that have refractive errors and have no significant consequences. If these symptoms persist and are causing you discomfort look for an ophthalmologist that does a procedure called laser vitreolysis who could break them down into smaller bits so that you do not notice them that much and that is pretty much the only method of treatment.

Hello doctor,I am a 19-year-old male. I have been to a few ophthalmologists about this and they seem to think it is benign. But I want to get some other input on this. If I widen my eyes and move my head around, I can see shadows in my far peripheral vision moving as my head does. And it seems that the shadows change and become different sizes as time goes on.Now I do have astigmatism in my right eye and from time to time I get aching, almost gnawing pains that are with the movement of the eye. And has happened in both at the same time before. I find that it happens mostly when I am in a place with very weird or bright lighting or when I am looking at a bright screen in a weirdly lit room.I suffer from anxiety and depression which is why I guess I am coming out to ask some more questions. And I also have Asperger's syndrome. The aches radiate to my temple as well. But as I have said I have been to doctors and they have dilated my pupils and looked at my retina and ocular nerves and told me they looked good. So I honestly do not know what could be causing these weird shadows. I have had them for quite a while. And they also get bigger and more noticeable with head tilt like when I exercise or go running or do something very physical.I currently take Prozac 20 mg and Pantoprazole 10 mg.

Hello. What you are describing is most probably breaks in the gel shaped part of the eye and is called floaters. It is a normal and physiological condition that we see in patients that have refractive errors and have no significant consequences. If these symptoms persist and are causing you discomfort look for an ophthalmologist that does a procedure called laser vitreolysis who could break them down into smaller bits so that you do not notice them that much and that is pretty much the only method of treatment.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 15 years old. I am having abdominal pain for a month now. Sometimes localized on the right side or left side. Mostly, the pain is all over the abdomen and going to the back and pelvis as well slightly. It is recurring, sometimes serious, sometimes dull ache and sometimes mild. Also, I have not had my menstruation for two months. Doctor recommended ultrasound and ultrasound came with a report of mild appendicitis. I went to the ER, but the pain subsided by then and was recommended to go back home and come when it is severe. When pain gets severe, by the time we reach the hospital it subsides. I went to the doctor again, they gave me pills for irregular menstruation. I have a loss of appetite. I do not want a temporary solution for my pain as I have already visited three different doctors (one in the ER, one who gave Ultrasound, and one who gave hormonal pills). I am having a doubt if it could be pancreatic cancer or ovarian cancer? I am very scared. Also, I have not started the pills yet and it is three months now I did not get my menstruation. My menstruation started three years ago. I do not have diarrhea or constipation. No headaches and nausea. ### Response: Hello, Welcome to Chat Doctor forum. The first thing to be ruled out in amenorrhea or not having menstruation is pregnancy, get a urine pregnancy test done. If there is no possibility of such a thing, then start your hormonal pills and get your menstruation. Amenorrhea could also be due to stress, yet times stay cool. Prolong amenorrhea causes lower abdominal discomfort. If once you get menstruation your symptoms may subside. It could not be ovarian or pancreatic cancer chances are very less. Regarding appendicitis, it is often associated with fever and vomitings and the pain does not subside until the appendix is removed. Sometimes in mild cases, it can be treated with antibiotics. If you are still suspicious get a repeat scan done.

Hello doctor,I am 15 years old. I am having abdominal pain for a month now. Sometimes localized on the right side or left side. Mostly, the pain is all over the abdomen and going to the back and pelvis as well slightly. It is recurring, sometimes serious, sometimes dull ache and sometimes mild. Also, I have not had my menstruation for two months. Doctor recommended ultrasound and ultrasound came with a report of mild appendicitis. I went to the ER, but the pain subsided by then and was recommended to go back home and come when it is severe. When pain gets severe, by the time we reach the hospital it subsides. I went to the doctor again, they gave me pills for irregular menstruation. I have a loss of appetite. I do not want a temporary solution for my pain as I have already visited three different doctors (one in the ER, one who gave Ultrasound, and one who gave hormonal pills). I am having a doubt if it could be pancreatic cancer or ovarian cancer? I am very scared. Also, I have not started the pills yet and it is three months now I did not get my menstruation. My menstruation started three years ago. I do not have diarrhea or constipation. No headaches and nausea.

Hello, Welcome to Chat Doctor forum. The first thing to be ruled out in amenorrhea or not having menstruation is pregnancy, get a urine pregnancy test done. If there is no possibility of such a thing, then start your hormonal pills and get your menstruation. Amenorrhea could also be due to stress, yet times stay cool. Prolong amenorrhea causes lower abdominal discomfort. If once you get menstruation your symptoms may subside. It could not be ovarian or pancreatic cancer chances are very less. Regarding appendicitis, it is often associated with fever and vomitings and the pain does not subside until the appendix is removed. Sometimes in mild cases, it can be treated with antibiotics. If you are still suspicious get a repeat scan done.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a CAD patient for the past 10 years with 50% blockage. I have uploaded the image for your reference. I am taking Prolomet XL 50, Monit SR 30, Deplatt A 75, Lipicard 160 and Amixide H. I am suffering from headache since one year. My neurologist prescribed me Tryptomer 10 at first and then changed to Zapiz. But, my headache has not reduced. My scan report is normal. I am in a trouble with this continuous headache. Is it a side effect of my cardiac problem medication? How to get rid of this condition?I also suffer from mild chest pain. Recently, I had a blood test and all are fine except lipid profile, HDL cholesterol 36 and SGPT 91. Also, my red cell distribution width is 16.2 and the normal range is 11.6 to 14. So, is my value dangerous? I had Deanxit for 5 years, according to the prescription and stopped before 2 years. Is my heart disease dangerous? Please help me. ### Response: Hi, Welcome to Chat Doctor forum. I have gone through your query in detail. There are certain things that would need more clarity for a complete diagnosis. First, it is strange that you have a blockage at such young age. I would suggest that you should get yourself revaluated for CAD (coronary artery disease). The possible reason for the headache is your medicine Monit SR (Isosorbide mononitrate) can be a cause of headache. Nitrate headaches are well known and we would need to see if this is the reason in your case. Also, since you have CAD at such a young age, there can be a possibility of carotid artery blockage which might be giving you a headache. Get that evaluated. Revert back with the reports to a cardiologist online

Hi doctor,I am a CAD patient for the past 10 years with 50% blockage. I have uploaded the image for your reference. I am taking Prolomet XL 50, Monit SR 30, Deplatt A 75, Lipicard 160 and Amixide H. I am suffering from headache since one year. My neurologist prescribed me Tryptomer 10 at first and then changed to Zapiz. But, my headache has not reduced. My scan report is normal. I am in a trouble with this continuous headache. Is it a side effect of my cardiac problem medication? How to get rid of this condition?I also suffer from mild chest pain. Recently, I had a blood test and all are fine except lipid profile, HDL cholesterol 36 and SGPT 91. Also, my red cell distribution width is 16.2 and the normal range is 11.6 to 14. So, is my value dangerous? I had Deanxit for 5 years, according to the prescription and stopped before 2 years. Is my heart disease dangerous? Please help me.

Hi, Welcome to Chat Doctor forum. I have gone through your query in detail. There are certain things that would need more clarity for a complete diagnosis. First, it is strange that you have a blockage at such young age. I would suggest that you should get yourself revaluated for CAD (coronary artery disease). The possible reason for the headache is your medicine Monit SR (Isosorbide mononitrate) can be a cause of headache. Nitrate headaches are well known and we would need to see if this is the reason in your case. Also, since you have CAD at such a young age, there can be a possibility of carotid artery blockage which might be giving you a headache. Get that evaluated. Revert back with the reports to a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am concerned about the medication that my 13 year old son is currently taking for bipolar disorder. He was diagnosed bipolar disorder at the age of 7. After trying several medications Depakote was the one that worked best. My ex-husband got custody of him 4 years ago and pulled him off from his medication. Last month my son threatened suicide and was hospitalized and placed on Zoloft. I recently spoke with my son\\s counselor and she said that Zoloft is used to treat depression and that he should be on a secondary medication for bipolar. His past medicines are Intuniv and Depakote and his current medicines are Zoloft and Vyvanse. I have tried speaking with my son\\s therapist. However, my ex-husband has told her not to speak to me regarding my son\\s treatment. I have noticed in conversations as well as visits with my son that he sometimes seems more depressed and agitated even threatening to run away from home. Is Zoloft used to treat bipolar without any secondary medication? Is it safe for a 13 year old? ### Response: Hi. First of all, I want to inform you that Vyvanse (Lisdexamfetamine) and Intuniv (Guanfacine) tablets are indicated for Attention deficit hyperactivity disorder (ADHD). Depakote (Valproic acid) is an antiepileptic and mood stabilizer. It is useful for bipolar disorder. If your child is diagnosed with bipolar, then he should receive Depakote or other mood stabilizer. Zoloft (Sertraline) is an antidepressant and by this chance of switch to mania is there. So, in bipolar patients if depressive symptoms are prominent, then antidepressant can be given only under the cover of mood stabilizer. Antidepressant should not be used for long term in bipolar patients. Once depressive symptoms get resolve, patient should maintain only on mood stabilizer. Antidepressant should get taper off gradually.

Hi doctor,I am concerned about the medication that my 13 year old son is currently taking for bipolar disorder. He was diagnosed bipolar disorder at the age of 7. After trying several medications Depakote was the one that worked best. My ex-husband got custody of him 4 years ago and pulled him off from his medication. Last month my son threatened suicide and was hospitalized and placed on Zoloft. I recently spoke with my son\\s counselor and she said that Zoloft is used to treat depression and that he should be on a secondary medication for bipolar. His past medicines are Intuniv and Depakote and his current medicines are Zoloft and Vyvanse. I have tried speaking with my son\\s therapist. However, my ex-husband has told her not to speak to me regarding my son\\s treatment. I have noticed in conversations as well as visits with my son that he sometimes seems more depressed and agitated even threatening to run away from home. Is Zoloft used to treat bipolar without any secondary medication? Is it safe for a 13 year old?

Hi. First of all, I want to inform you that Vyvanse (Lisdexamfetamine) and Intuniv (Guanfacine) tablets are indicated for Attention deficit hyperactivity disorder (ADHD). Depakote (Valproic acid) is an antiepileptic and mood stabilizer. It is useful for bipolar disorder. If your child is diagnosed with bipolar, then he should receive Depakote or other mood stabilizer. Zoloft (Sertraline) is an antidepressant and by this chance of switch to mania is there. So, in bipolar patients if depressive symptoms are prominent, then antidepressant can be given only under the cover of mood stabilizer. Antidepressant should not be used for long term in bipolar patients. Once depressive symptoms get resolve, patient should maintain only on mood stabilizer. Antidepressant should get taper off gradually.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Ropinirole to boost dopamine after Paliperidone treatment for schizophrenia?I am a 46-year-old male. I have been in hospital a couple of times recently, in their judgment I was quite unwell (paranoid about spooks after certain events), diagnosed with schizophrenia (though I am not sure, although I was extremely paranoid), and they put me on a CTO for injections of Paliperidone, which I have been on for the last 18 months or so. 100mg I believe for 6 to 12 months, then 75 mg for six months, and now on the lowest dose that it comes in and have been completely free of thoughts of spooks for nine months, so I am well. But I notice that I seem to be a little zombified due to the effects of the drug, and am worried about Dopamine impact (an important chemical), and frankly, I would like to try to help restore Dopamine to a healthier level. I am not sure that is going to happen naturally, so was wondering about a low dose of a Dopamine agonist like Ripinirole for perhaps a year or so, to get things moving in the right direction. Whether this would actually help restore dopamine function though I am not sure. Also, it can increase the chance of psychosis, hence the preference for low dosage. What I am after then is some brief comment on whether you would recommend this or not (at a glance), or something else. Any comment would be appreciated. ### Response: Hi. Taking Dopamine agonist to restore dopamine level in the brain after giving antipsychotics for schizophrenia is not a suitable choice because of relapse of psychotic symptoms or exacerbation of symptoms not only psychotic symptoms but mood symptoms, these side effects are called extrapyramidal symptoms which can be managed to give anticholinergic medications along with antipsychotics, better to visit your treating doctor to have healthy discussion on this.

Hello doctor,Ropinirole to boost dopamine after Paliperidone treatment for schizophrenia?I am a 46-year-old male. I have been in hospital a couple of times recently, in their judgment I was quite unwell (paranoid about spooks after certain events), diagnosed with schizophrenia (though I am not sure, although I was extremely paranoid), and they put me on a CTO for injections of Paliperidone, which I have been on for the last 18 months or so. 100mg I believe for 6 to 12 months, then 75 mg for six months, and now on the lowest dose that it comes in and have been completely free of thoughts of spooks for nine months, so I am well. But I notice that I seem to be a little zombified due to the effects of the drug, and am worried about Dopamine impact (an important chemical), and frankly, I would like to try to help restore Dopamine to a healthier level. I am not sure that is going to happen naturally, so was wondering about a low dose of a Dopamine agonist like Ripinirole for perhaps a year or so, to get things moving in the right direction. Whether this would actually help restore dopamine function though I am not sure. Also, it can increase the chance of psychosis, hence the preference for low dosage. What I am after then is some brief comment on whether you would recommend this or not (at a glance), or something else. Any comment would be appreciated.

Hi. Taking Dopamine agonist to restore dopamine level in the brain after giving antipsychotics for schizophrenia is not a suitable choice because of relapse of psychotic symptoms or exacerbation of symptoms not only psychotic symptoms but mood symptoms, these side effects are called extrapyramidal symptoms which can be managed to give anticholinergic medications along with antipsychotics, better to visit your treating doctor to have healthy discussion on this.

### Instruction: Answer this question truthfully ###Input: Hello doctor,About a month ago, I developed what I thought was a pinched nerve in my neck. I had numbing and tingling in my left arm and my hand would go numb while sleeping. However, over the next couple weeks the numbing, tingling, moved to my right arm then my legs and feet to include muscle twitching/ spasms. Now, these symptoms have mostly left my arms other than occasional slight sensation in my fingers. However, my legs and left foot continue to have this sensation. I do not have any pain other than the sensation and can move normally. However, exerting myself seems to elevate the sensation. I visited my doctor and they ran a complete set of lab work and everything was normal other than slightly low vitamin D. Also scheduled to MRI on the spine to rule out MS. After doing some reading, I think I developed a case of peripheral neuropathy. My question is could this be something else? Is it possible that with rest it will go away? Are there any supplements I could take to help? Any other thoughts or suggestions? ### Response: Hello, Welcome to Chat Doctor forum. I read your question carefully and would explain that your symptoms are not typical of a peripheral neuropathy. They could be related to a bulging disc in the cervical vertebral column. That is why it is necessary to perform a cervical spine MRI study. MS (multiple sclerosis) would be an exceptional diagnosis at your age. Vitamin D deficiency may lead to muscle twitching and also joint pain, associated with chronic fatigue. As it resulted low, it is necessary to take vitamin D supplements. I would also like to know if you checked vitamin B12 levels and thyroid hormone levels. Vitamin B12 deficiency can mimic this clinical situation. Regarding peripheral neuropathy, I would recommend performing a nerve conduction study (electroneurography) to exclude this possibility, although it is really less likely that you suffer from this disorder. Hope you will find this answer helpful. For more information consult a neurologist online

Hello doctor,About a month ago, I developed what I thought was a pinched nerve in my neck. I had numbing and tingling in my left arm and my hand would go numb while sleeping. However, over the next couple weeks the numbing, tingling, moved to my right arm then my legs and feet to include muscle twitching/ spasms. Now, these symptoms have mostly left my arms other than occasional slight sensation in my fingers. However, my legs and left foot continue to have this sensation. I do not have any pain other than the sensation and can move normally. However, exerting myself seems to elevate the sensation. I visited my doctor and they ran a complete set of lab work and everything was normal other than slightly low vitamin D. Also scheduled to MRI on the spine to rule out MS. After doing some reading, I think I developed a case of peripheral neuropathy. My question is could this be something else? Is it possible that with rest it will go away? Are there any supplements I could take to help? Any other thoughts or suggestions?

Hello, Welcome to Chat Doctor forum. I read your question carefully and would explain that your symptoms are not typical of a peripheral neuropathy. They could be related to a bulging disc in the cervical vertebral column. That is why it is necessary to perform a cervical spine MRI study. MS (multiple sclerosis) would be an exceptional diagnosis at your age. Vitamin D deficiency may lead to muscle twitching and also joint pain, associated with chronic fatigue. As it resulted low, it is necessary to take vitamin D supplements. I would also like to know if you checked vitamin B12 levels and thyroid hormone levels. Vitamin B12 deficiency can mimic this clinical situation. Regarding peripheral neuropathy, I would recommend performing a nerve conduction study (electroneurography) to exclude this possibility, although it is really less likely that you suffer from this disorder. Hope you will find this answer helpful. For more information consult a neurologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,My son, who is 26 years old, now has been diagnosed with ADHD when he was 5 years old. He went to various psychiatrist to make sure that he is actually ADHD. Six doctors confirmed that he has ADHD and two doctors said he has bipolar disorder. He says that he was given Xanax as a treatment for the anxiety caused by ADHD and bipolar. He takes 10 tablets of 1 mg Xanax a day and sometimes, 11 to 12 tablets a day. Occasionally, when he takes less tablets, he smokes weed. He says that the combination of 5 to 8 tablets of Xanax with weed is equal to 10 tablets of 1 mg Xanax a day. He also takes tablet 300 mg Seroquel at night to help him sleep. My questions are is Xanax considered a medication for ADHD or bipolar? Is it advised to take 10 to 12 tablets of 1 mg Xanax a day? Is it fine to mix Xanax with weed? What is the appropriate medication for ADHD and bipolar? If xanax is appropriate for ADHD and bipolar, then how much is the appropriate dosage? Does he need to go to rehabilitation to clean his body of the high amount of Xanax and weed? Is it compulsory to continue a low dose of Xanax lifelong? ### Response: Hi, Welcome to Chat Doctor forum. Attention deficit hyperactivity disorder also called as ADHD is a problem with hyperactivity and decrease attention. Bipolar disorder is the disorder in which increase talk, tall claims, decrease need for sleep and high energy are the most common symptoms. Xanax (Alprazolam) is a benzodiazepine. Xanax is not a suitable ChatDoctor. It can be given in low dose for the acute phase of bipolar. Also, it is not advisable to take around 10 tablets a day. Both, weed abuse and Xanax abuse are very bad for health.

Hi doctor,My son, who is 26 years old, now has been diagnosed with ADHD when he was 5 years old. He went to various psychiatrist to make sure that he is actually ADHD. Six doctors confirmed that he has ADHD and two doctors said he has bipolar disorder. He says that he was given Xanax as a treatment for the anxiety caused by ADHD and bipolar. He takes 10 tablets of 1 mg Xanax a day and sometimes, 11 to 12 tablets a day. Occasionally, when he takes less tablets, he smokes weed. He says that the combination of 5 to 8 tablets of Xanax with weed is equal to 10 tablets of 1 mg Xanax a day. He also takes tablet 300 mg Seroquel at night to help him sleep. My questions are is Xanax considered a medication for ADHD or bipolar? Is it advised to take 10 to 12 tablets of 1 mg Xanax a day? Is it fine to mix Xanax with weed? What is the appropriate medication for ADHD and bipolar? If xanax is appropriate for ADHD and bipolar, then how much is the appropriate dosage? Does he need to go to rehabilitation to clean his body of the high amount of Xanax and weed? Is it compulsory to continue a low dose of Xanax lifelong?

Hi, Welcome to Chat Doctor forum. Attention deficit hyperactivity disorder also called as ADHD is a problem with hyperactivity and decrease attention. Bipolar disorder is the disorder in which increase talk, tall claims, decrease need for sleep and high energy are the most common symptoms. Xanax (Alprazolam) is a benzodiazepine. Xanax is not a suitable ChatDoctor. It can be given in low dose for the acute phase of bipolar. Also, it is not advisable to take around 10 tablets a day. Both, weed abuse and Xanax abuse are very bad for health.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Just two days ago I found out I was about 1-2 weeks pregnant. And it has been about 4 1/2 weeks since my last menstrual period. Unfortunately with labor day being this weekend I have been unable to see my regular OBGYN. But I did go to the ER to confirm the pregnancy 2 days ago. So my blood results came back with an HCG OF 248 and the doctor said I am right around 1-2 weeks.So, here is my question. I have been stressing out badly due to the fact I have been on Lorazepam 1 mg every night for anxiety and PD for the last 2 years as well as Percocet 10 mg as needed for back pain. I have been taking both of the medications during my pregnancy when I had no idea I was pregnant. Since finding out I have tried tapering on both medications. The Percocet is making me sweat and very agitated and when I tried to cut down on the Lorazepam I was shaking and almost hallucinating and delusion. I also tried not taking the Lorazepam at all and woke up crying, shaking and sweating. I want to be off both these medicines but I am worried more about the Lorazepam as it is a class D pregnancy drug. I have read about the terrible problems this causes for infants. I am so scared that I am considering abortion. I do not want to be a terrible mother before I even give birth. I have been having bad panic attacks over this and cannot seem to relax as the complications of these medicines are always on my mind. Any advice at all would be very much appreciated. ### Response: Hello, Welcome to Chat Doctor forum. Well in your case, as you said rightly Lorazepam is category D ChatDoctor. Ideally we advise avoidance of this medicine during and even before till 12 weeks pregnancy to avoid congenital malformations. You have tried leaving/ reducing it, but your with

Hello doctor,Just two days ago I found out I was about 1-2 weeks pregnant. And it has been about 4 1/2 weeks since my last menstrual period. Unfortunately with labor day being this weekend I have been unable to see my regular OBGYN. But I did go to the ER to confirm the pregnancy 2 days ago. So my blood results came back with an HCG OF 248 and the doctor said I am right around 1-2 weeks.So, here is my question. I have been stressing out badly due to the fact I have been on Lorazepam 1 mg every night for anxiety and PD for the last 2 years as well as Percocet 10 mg as needed for back pain. I have been taking both of the medications during my pregnancy when I had no idea I was pregnant. Since finding out I have tried tapering on both medications. The Percocet is making me sweat and very agitated and when I tried to cut down on the Lorazepam I was shaking and almost hallucinating and delusion. I also tried not taking the Lorazepam at all and woke up crying, shaking and sweating. I want to be off both these medicines but I am worried more about the Lorazepam as it is a class D pregnancy drug. I have read about the terrible problems this causes for infants. I am so scared that I am considering abortion. I do not want to be a terrible mother before I even give birth. I have been having bad panic attacks over this and cannot seem to relax as the complications of these medicines are always on my mind. Any advice at all would be very much appreciated.

Hello, Welcome to Chat Doctor forum. Well in your case, as you said rightly Lorazepam is category D ChatDoctor. Ideally we advise avoidance of this medicine during and even before till 12 weeks pregnancy to avoid congenital malformations. You have tried leaving/ reducing it, but your with

### Instruction: Answer this question truthfully ###Input: Hello doctor,After how many days a normal person (22 years) suffering from all symptoms and just have tested HIV 1 and 2, and tridot test with negative result at 120 days develop antibodies? I have symptoms from day 10. Is my test at 120 days conclusive? I tested that six months back and I am very worried about HIV. Will I die with it? Or is it a normal virus that can be controlled? Is the result of 120 days test accurate? Please provide information as I am suffering from lots of tensions. I gained weight in the last two months. I have stretch marks on my body with pimples and headaches. There is a blood vessel break in my eyes and it is like a red dot. Should I get a test for HIV again? Or else should I relax? ### Response: Hi, Welcome to Chat Doctor forum. Antibodies are the proteins produced by the body in response to fight the foreign substance (antigen, virus, infectious agent) it enters the body. When antigen enters the body, it stimulates the immune system to produce antibodies. It is very difficult to tell that how much time a particular person takes to develop antibodies. Your negative HIV antibody test at 120 days means that 99.9% of your body has not been exposed to HIV. The test kits used these days are highly sensitive and specific and give accurate results.120 days HIV negative test is highly conclusive of your negative HIV status. But, I think that you are not letting it go. The symptoms are more likely due to stress. There are very rare cases reported in the literature where the person has been exposed to antigen but the time taken by the body to produce detectable antibodies was longer, up to six months. There are recommendations and I also suggest to my patients to repeat the test at six months and if that will be negative you need not repeat it further. I hope this helps.

Hello doctor,After how many days a normal person (22 years) suffering from all symptoms and just have tested HIV 1 and 2, and tridot test with negative result at 120 days develop antibodies? I have symptoms from day 10. Is my test at 120 days conclusive? I tested that six months back and I am very worried about HIV. Will I die with it? Or is it a normal virus that can be controlled? Is the result of 120 days test accurate? Please provide information as I am suffering from lots of tensions. I gained weight in the last two months. I have stretch marks on my body with pimples and headaches. There is a blood vessel break in my eyes and it is like a red dot. Should I get a test for HIV again? Or else should I relax?

Hi, Welcome to Chat Doctor forum. Antibodies are the proteins produced by the body in response to fight the foreign substance (antigen, virus, infectious agent) it enters the body. When antigen enters the body, it stimulates the immune system to produce antibodies. It is very difficult to tell that how much time a particular person takes to develop antibodies. Your negative HIV antibody test at 120 days means that 99.9% of your body has not been exposed to HIV. The test kits used these days are highly sensitive and specific and give accurate results.120 days HIV negative test is highly conclusive of your negative HIV status. But, I think that you are not letting it go. The symptoms are more likely due to stress. There are very rare cases reported in the literature where the person has been exposed to antigen but the time taken by the body to produce detectable antibodies was longer, up to six months. There are recommendations and I also suggest to my patients to repeat the test at six months and if that will be negative you need not repeat it further. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 24 year old male. I am working as a software developer. Sometimes, I feel a sharp pain in my right lower part of the stomach. When I am trying to bend down, I am feeling some pain inside the pelvic bone. After eating meals and dinner, I am getting excess burping and feeling of bloating and tightness in the right lower abdomen. I am also having constipation problem for more than a year.I have consulted a gastroenterologist for physical evaluation. He diagnosed me and prescribed some medicines. After some time, I had an endoscopy and he found I have H.pylori infection. He prescribed medicine for the same. After a month, bloating and burping are less but the pain still persists. I have consulted one more gastroenterologist who evaluated me with some blood test and ultrasound of the whole abdomen and said nothing to worry as everything is normal in my report (including pancreas and kidney).Now again from last three to four days, I feel my urine flow is slow and I have a burning sensation in the penis. I have excess burping, bloating, and pain in the right chest. As I have consulted many doctors and they reported as I have nothing, I am confused with my stomach pain now and much worried as what could be the factor behind the pain? What should I do now? Please help. ### Response: Hi. I read your history. As per your description, it seems to be a functional bowel disorder, it may be associated with what called as irritable bowel syn ChatDoctor. Bowel illnesses are difficult to prove medically, and mostly they are a matter of exclusion. Infection like H.pylori may be the reason for your burping, but it would not be the cause for right lower abdominal pain. After reading all this do not worry that you have any major illness. I guess your appetite is normal and your weight too. Now I would suggest you do a few things. Take care.

Hi doctor,I am a 24 year old male. I am working as a software developer. Sometimes, I feel a sharp pain in my right lower part of the stomach. When I am trying to bend down, I am feeling some pain inside the pelvic bone. After eating meals and dinner, I am getting excess burping and feeling of bloating and tightness in the right lower abdomen. I am also having constipation problem for more than a year.I have consulted a gastroenterologist for physical evaluation. He diagnosed me and prescribed some medicines. After some time, I had an endoscopy and he found I have H.pylori infection. He prescribed medicine for the same. After a month, bloating and burping are less but the pain still persists. I have consulted one more gastroenterologist who evaluated me with some blood test and ultrasound of the whole abdomen and said nothing to worry as everything is normal in my report (including pancreas and kidney).Now again from last three to four days, I feel my urine flow is slow and I have a burning sensation in the penis. I have excess burping, bloating, and pain in the right chest. As I have consulted many doctors and they reported as I have nothing, I am confused with my stomach pain now and much worried as what could be the factor behind the pain? What should I do now? Please help.

Hi. I read your history. As per your description, it seems to be a functional bowel disorder, it may be associated with what called as irritable bowel syn ChatDoctor. Bowel illnesses are difficult to prove medically, and mostly they are a matter of exclusion. Infection like H.pylori may be the reason for your burping, but it would not be the cause for right lower abdominal pain. After reading all this do not worry that you have any major illness. I guess your appetite is normal and your weight too. Now I would suggest you do a few things. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had a painful, swollen, reddish boil under my armpit two days ago. I went to a doctor yesterday and he put me on antibiotics. Yesterday night, when I took the antibiotics, after some time I got the feeling of stiffness in my right calf and thigh. My leg felt heavy and affected my walking a bit for some time too. I had thought it was due to a little bit of walking I had done yesterday. When I woke up in the morning, the stiffness was gone and my leg felt fine. In the morning again after taking the medicine, I felt stiffness in the right leg, and it is still there (it is late evening now) though less than before. Left leg appears to be fine. I also have a ringing sensation in my ears.I am wondering if this is due to antibiotics? Or is it just coincidence? I am not seeing any noticeable swelling in my right leg, but not very sure. Maybe there is a little bit. Please let me know your thoughts. Is it an emergency? I am in my office now and cannot go to the doctor before tomorrow morning unless it is an emergency. The boil has subsided quite a bit, and is much less swollen and painful. It is not reddish anymore. I am taking Pantozec 40 and Augmed 625. I am fine with stopping the medicine if needed. I am supposed to take it after dinner again tonight. ### Response: Hello, Welcome to Chat Doctor forum. The antibiotic which you are taking does not have the side effect of myalgia and stiffness or joint pains. However, Pantoprazole may cause some times such symptoms. I think the boil itself can cause the myalgia and there is nothing serious. You need to complete at least three days of antibiotics because once you stop these medicines the symptoms will also resolve. I suggest you complete three days at least or if possible take for five days. For more information consult an internal medicine physician online

Hello doctor,I had a painful, swollen, reddish boil under my armpit two days ago. I went to a doctor yesterday and he put me on antibiotics. Yesterday night, when I took the antibiotics, after some time I got the feeling of stiffness in my right calf and thigh. My leg felt heavy and affected my walking a bit for some time too. I had thought it was due to a little bit of walking I had done yesterday. When I woke up in the morning, the stiffness was gone and my leg felt fine. In the morning again after taking the medicine, I felt stiffness in the right leg, and it is still there (it is late evening now) though less than before. Left leg appears to be fine. I also have a ringing sensation in my ears.I am wondering if this is due to antibiotics? Or is it just coincidence? I am not seeing any noticeable swelling in my right leg, but not very sure. Maybe there is a little bit. Please let me know your thoughts. Is it an emergency? I am in my office now and cannot go to the doctor before tomorrow morning unless it is an emergency. The boil has subsided quite a bit, and is much less swollen and painful. It is not reddish anymore. I am taking Pantozec 40 and Augmed 625. I am fine with stopping the medicine if needed. I am supposed to take it after dinner again tonight.

Hello, Welcome to Chat Doctor forum. The antibiotic which you are taking does not have the side effect of myalgia and stiffness or joint pains. However, Pantoprazole may cause some times such symptoms. I think the boil itself can cause the myalgia and there is nothing serious. You need to complete at least three days of antibiotics because once you stop these medicines the symptoms will also resolve. I suggest you complete three days at least or if possible take for five days. For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 30 year old male. My height is 155 cm and I weigh 63 kg. I am facing hair fall for one year. Now it is even more severe. Till last year, I was having dandruff problem also, but after mundan (hair tonsuring), there is not much dandruff but hair fall has not stopped. Below are the symptoms.I used to wash my hair once in 3 days earlier. But within 2 days, my hair becomes wet even without applying oil. Because of that reason, nowadays, I wash my hair once in 2 days. Because of any reason, if I do not have a hair wash for 3 to 4 days, my head smells very bad and becomes wet. I do not know about my hair type, so I used to change my hair shampoo frequently between anti-dandruff and anti-hair fall. I got married four years back. Till that time, there was no hair loss and I had not observed any baldness. My father has baldness but, he got it at 40 years of age. But now, it looks like I am in the final stage of becoming bald. I have attached pictures of the same. I travel to South Korea very frequently for a minimum of 3 months a year. This weekend, I am traveling to a foreign country, so I need to buy any medication for hair fall (if needed) before going. I want to know my hair type and remedies for hair fall. ### Response: Hi.I have worked through your query and have understood your health issues. I have gone through the pictures (attachment removed to protect patient identity), I assure you not to worry. This is the most common disease of men at this age. It is actually the male pattern baldness and you are lucky that you had noticed at such an early stage. It is stage 2 baldness and has just started. Take care.

Hello doctor,I am a 30 year old male. My height is 155 cm and I weigh 63 kg. I am facing hair fall for one year. Now it is even more severe. Till last year, I was having dandruff problem also, but after mundan (hair tonsuring), there is not much dandruff but hair fall has not stopped. Below are the symptoms.I used to wash my hair once in 3 days earlier. But within 2 days, my hair becomes wet even without applying oil. Because of that reason, nowadays, I wash my hair once in 2 days. Because of any reason, if I do not have a hair wash for 3 to 4 days, my head smells very bad and becomes wet. I do not know about my hair type, so I used to change my hair shampoo frequently between anti-dandruff and anti-hair fall. I got married four years back. Till that time, there was no hair loss and I had not observed any baldness. My father has baldness but, he got it at 40 years of age. But now, it looks like I am in the final stage of becoming bald. I have attached pictures of the same. I travel to South Korea very frequently for a minimum of 3 months a year. This weekend, I am traveling to a foreign country, so I need to buy any medication for hair fall (if needed) before going. I want to know my hair type and remedies for hair fall.

Hi.I have worked through your query and have understood your health issues. I have gone through the pictures (attachment removed to protect patient identity), I assure you not to worry. This is the most common disease of men at this age. It is actually the male pattern baldness and you are lucky that you had noticed at such an early stage. It is stage 2 baldness and has just started. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 30 year old woman. I found blood in my stool this morning, for the first time in life. I am sure that is not period. Is it a sign of bowel cancer? ### Response: Hello, Welcome to Chat Doctor forum. I assure you not to worry a lot as things can be settled with proper care and follow up. There are some reasons for fresh blood in stools, with stools, before or after stools other than menstrual blood.First of all, it may be hemorrhoids. You may have felt some dilated small lesions on the anal opening before or after passing stools ( if this was bleeding hemorrhoid). It is due to a disease named portal hypertension and you need to follow it up and it will settle down with treatment. Your general surgeon is the person to decide the stage of hemorrhoids and treatment goes accordingly. He may do proctoscopy, colonoscopy or digital rectal examination. The other cause is anal fissure bleed. When stools get hard due to constipation and when patient forcibly defecates, it causes a breach in the mucosal lining of the rectum and anus and it bleeds in the form of fresh blood. Lactulose syrup, whole grain foods, dietary fiber supplements, plenty of fluids and a good physical activity will help improve this condition. But it may also need treatment with antibiotics to avoid severe infection. General surgeon consultation for a physical examination is my suggestion. Last but not least is the cancerous growth. It is serious but less likely in your case. But if you have a family history of colon cancer, have a change in bowel habits, lost weight, loss in appetite, constipation or diarrhea, You may be having cancer. A general surgeon will diagnose with colonoscopy and barium tests through radiologic studies. Final suggestion - avoid constipation, keep a good physical activity, avoid fast foods, processed meats, low fiber diet, and soft ChatDoctor. Go to a general surgeon in person for proper evaluation and treatment.

Hi doctor,I am a 30 year old woman. I found blood in my stool this morning, for the first time in life. I am sure that is not period. Is it a sign of bowel cancer?

Hello, Welcome to Chat Doctor forum. I assure you not to worry a lot as things can be settled with proper care and follow up. There are some reasons for fresh blood in stools, with stools, before or after stools other than menstrual blood.First of all, it may be hemorrhoids. You may have felt some dilated small lesions on the anal opening before or after passing stools ( if this was bleeding hemorrhoid). It is due to a disease named portal hypertension and you need to follow it up and it will settle down with treatment. Your general surgeon is the person to decide the stage of hemorrhoids and treatment goes accordingly. He may do proctoscopy, colonoscopy or digital rectal examination. The other cause is anal fissure bleed. When stools get hard due to constipation and when patient forcibly defecates, it causes a breach in the mucosal lining of the rectum and anus and it bleeds in the form of fresh blood. Lactulose syrup, whole grain foods, dietary fiber supplements, plenty of fluids and a good physical activity will help improve this condition. But it may also need treatment with antibiotics to avoid severe infection. General surgeon consultation for a physical examination is my suggestion. Last but not least is the cancerous growth. It is serious but less likely in your case. But if you have a family history of colon cancer, have a change in bowel habits, lost weight, loss in appetite, constipation or diarrhea, You may be having cancer. A general surgeon will diagnose with colonoscopy and barium tests through radiologic studies. Final suggestion - avoid constipation, keep a good physical activity, avoid fast foods, processed meats, low fiber diet, and soft ChatDoctor. Go to a general surgeon in person for proper evaluation and treatment.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I had a month old twin baby girls. They were born in the 34th week of pregnancy. One baby was 2.2 Kg, and the other was a little weaker weighing 2 Kg. Since there is not enough mother\\s milk after several attempts, I had to go for artificial milk powder. Initially, as suggested by the hospital pediatrician, they were given Dexolac Special Care, but after 20th day when their weight was around 2.4 Kg, they were given to Dexolac Premium 1. Out of the 2 babies, the weaker baby is responding well and quickly gaining weight (taking around 75 ml milk every 3 hours). But the baby which was born stronger is not drinking sufficient milk (45 ml in one feed, at an interval of around 3 hours), and is taking around an hour to take one feed. Also, she is having issues of gas and constipation. Because of constipation, she keeps crying. Now, this baby is not gaining weight and seem to be weaker. Please suggest what we can do in this case and shall we switch her milk to Lactogen or some other company? ### Response: Hello. Keep trying to give breastfeeds as much as possible till 6 months completion. Different brands of milk powder have different tastes. So, you can change what they like (as advised). Do not dilute more or give more concentrated milk. Usually, dilution mentioned on the package can be followed, that is, 30 ml for 1 scoop for most of the brands. But check with the manufractures\\ note. Do not use feeding bottle. Use bowl and spoon.You can use undiluted dairy milk (pasteurized). Check with your local pediatrician for supplements if needed. Check if there is adequate weight gain. Maintain proper hygiene while feeding, when using formula feed or top milk. Do not compromise on hygiene. I would like to know the following

Hi doctor,I had a month old twin baby girls. They were born in the 34th week of pregnancy. One baby was 2.2 Kg, and the other was a little weaker weighing 2 Kg. Since there is not enough mother\\s milk after several attempts, I had to go for artificial milk powder. Initially, as suggested by the hospital pediatrician, they were given Dexolac Special Care, but after 20th day when their weight was around 2.4 Kg, they were given to Dexolac Premium 1. Out of the 2 babies, the weaker baby is responding well and quickly gaining weight (taking around 75 ml milk every 3 hours). But the baby which was born stronger is not drinking sufficient milk (45 ml in one feed, at an interval of around 3 hours), and is taking around an hour to take one feed. Also, she is having issues of gas and constipation. Because of constipation, she keeps crying. Now, this baby is not gaining weight and seem to be weaker. Please suggest what we can do in this case and shall we switch her milk to Lactogen or some other company?

Hello. Keep trying to give breastfeeds as much as possible till 6 months completion. Different brands of milk powder have different tastes. So, you can change what they like (as advised). Do not dilute more or give more concentrated milk. Usually, dilution mentioned on the package can be followed, that is, 30 ml for 1 scoop for most of the brands. But check with the manufractures\\ note. Do not use feeding bottle. Use bowl and spoon.You can use undiluted dairy milk (pasteurized). Check with your local pediatrician for supplements if needed. Check if there is adequate weight gain. Maintain proper hygiene while feeding, when using formula feed or top milk. Do not compromise on hygiene. I would like to know the following

### Instruction: Answer this question truthfully ###Input: Hi doctor,My wife has completed 39 weeks of pregnancy. We got an ultrasound yesterday, and the report is completely normal. But her labor pain is not getting induced, so the doctor is suggesting cesarean, as the baby\\s weight is 3.65 kg. My wife would like to have a normal delivery by inducing pain artificially. Our first baby was normally delivered six years ago, by inducing pain artificially when he was 3.33 kg.My wife is 35 years old, and I am attaching the latest ultrasound reports. Is there any harm to the baby during normal delivery in our case? Is there any chance of the head or shoulder getting stuck? Is the baby\\s weight more than normal? What is the possibility of normal delivery after inducing pain? Thanks and regards. ### Response: Hi. I have seen the reports (attachment removed to protect patient identity), and it is normal. No, delivery is risk-free, normal or caesarean. If her BP (blood pressure) and blood sugar are normal, then there is no contraindication to normal delivery. Regarding the chances of the head getting stuck, it can be assessed only at the onset of labor by internal physical examination of her pelvis and relative size to head of the baby. A baby of this size may be delivered vaginally, but many parameters should be optimum. She had normal delivery six years back, she is 35 now, her pelvic bones and muscles may have become less stretchable, and she may not get good enough contractions, and the labor may become prolonged in that case the baby in the womb may get less oxygen. These are possibilities that may or may not happen, if she goes into labor, she and the baby has to be carefully monitored, and if the things do not go wrong, then she may deliver normally. Until the outcome, no prediction can be made with surety. For more information consult an obstetrician and gynaecologist online

Hi doctor,My wife has completed 39 weeks of pregnancy. We got an ultrasound yesterday, and the report is completely normal. But her labor pain is not getting induced, so the doctor is suggesting cesarean, as the baby\\s weight is 3.65 kg. My wife would like to have a normal delivery by inducing pain artificially. Our first baby was normally delivered six years ago, by inducing pain artificially when he was 3.33 kg.My wife is 35 years old, and I am attaching the latest ultrasound reports. Is there any harm to the baby during normal delivery in our case? Is there any chance of the head or shoulder getting stuck? Is the baby\\s weight more than normal? What is the possibility of normal delivery after inducing pain? Thanks and regards.

Hi. I have seen the reports (attachment removed to protect patient identity), and it is normal. No, delivery is risk-free, normal or caesarean. If her BP (blood pressure) and blood sugar are normal, then there is no contraindication to normal delivery. Regarding the chances of the head getting stuck, it can be assessed only at the onset of labor by internal physical examination of her pelvis and relative size to head of the baby. A baby of this size may be delivered vaginally, but many parameters should be optimum. She had normal delivery six years back, she is 35 now, her pelvic bones and muscles may have become less stretchable, and she may not get good enough contractions, and the labor may become prolonged in that case the baby in the womb may get less oxygen. These are possibilities that may or may not happen, if she goes into labor, she and the baby has to be carefully monitored, and if the things do not go wrong, then she may deliver normally. Until the outcome, no prediction can be made with surety. For more information consult an obstetrician and gynaecologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor, I am a 45-year-old female. I was treated with intravenous Cortisone injection therapy for a week for having acute demyelinating symptoms for almost two months that appeared together with a new lesion at the cerebellum area of my brain. There had been three other there, supposedly migraine type. Lumbar showed oligoclonal zones both in the blood and spinal cord. My problem is that since then, and even if the cerebellum lesion has disappeared, I still experience symptoms not as acute as it had been during the episode, but quite annoying to disturb my everyday life.I have pain in my left arm and joints, left leg, and joints of both of my legs. I also have back pain and tremor but not always. I get tired very easily. But tired does not mean tired. It means that I start having problems with my balance in the left leg, tingling, eye sight problem, cannot cope with too much noise, argues and fights with family gets me worse. Nobody understands there is something going on. The last neurologist I saw said that it is a matter of stress so he suggested to consult a psychiatrist. My psychiatrist says stress does not cause this sort of pains as I already get a depression treatment for seven years. However, let me say they are gonna get me crazy with all this. Do you have any idea? How I might proceed? ### Response: Hello. I read carefully your question and would explain that your symptoms could be related to chronic lesions of multiple sclerosis MS (sometimes there is no total improvement after steroid therapy). Anyway, I would recommend starting Gabapentin for chronic pain or switch from Zoloft to Duloxetine which is better for chronic pain. I would also recommend performing a new brain and spine MRI (magnetic resonance imaging) in order to exclude possible new lesions. It is also necessary to check thyroid hormone levels for possible hormonal imbalance and vitamin D plasma levels for possible deficiency. I hope this helps. Take care.

Hi doctor, I am a 45-year-old female. I was treated with intravenous Cortisone injection therapy for a week for having acute demyelinating symptoms for almost two months that appeared together with a new lesion at the cerebellum area of my brain. There had been three other there, supposedly migraine type. Lumbar showed oligoclonal zones both in the blood and spinal cord. My problem is that since then, and even if the cerebellum lesion has disappeared, I still experience symptoms not as acute as it had been during the episode, but quite annoying to disturb my everyday life.I have pain in my left arm and joints, left leg, and joints of both of my legs. I also have back pain and tremor but not always. I get tired very easily. But tired does not mean tired. It means that I start having problems with my balance in the left leg, tingling, eye sight problem, cannot cope with too much noise, argues and fights with family gets me worse. Nobody understands there is something going on. The last neurologist I saw said that it is a matter of stress so he suggested to consult a psychiatrist. My psychiatrist says stress does not cause this sort of pains as I already get a depression treatment for seven years. However, let me say they are gonna get me crazy with all this. Do you have any idea? How I might proceed?

Hello. I read carefully your question and would explain that your symptoms could be related to chronic lesions of multiple sclerosis MS (sometimes there is no total improvement after steroid therapy). Anyway, I would recommend starting Gabapentin for chronic pain or switch from Zoloft to Duloxetine which is better for chronic pain. I would also recommend performing a new brain and spine MRI (magnetic resonance imaging) in order to exclude possible new lesions. It is also necessary to check thyroid hormone levels for possible hormonal imbalance and vitamin D plasma levels for possible deficiency. I hope this helps. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 28-year-old female. I have been on Nucynta for over a year. I take Nucynta ER 50 mg BID and Nucynta IR 50 mg once a day. For the last two months, my urine tests (immunoassay and lab testing) have come back negative. Two weeks ago a blood test was done and it was also negative. I religiously take these medicines as prescribed by my pain management doctor. Due to these negatives he is now refusing to prescribe any oral medications (including my Flexeril, Gabapentin, and oral Ketamine). I understand his need to be able to prove to Nucynta in my system but he is also refusing to try anything else.I am a walking genetic defect. I also have known pharmacogenetic and pharmacokinetic issues. I also have EDS, CRPS, POTS, MCAS, gastroparesis (severe enough that EGD showed food in my stomach 18 hours after last eating), endometriosis. Could any of this be causing the problem? Could any of the medicines I take be causing the problem? My medicines are Lopressor, Trazadone, Fetzima, Zyrtec, Ketamine, Magnesium Citrate pills, Melatonin, Gabapentin, Flexeril, Nucynta, Junel Fe. What suggestions do you have? Is there any research to help me? ### Response: Hi. Nucynta is an opioid analgesic, that has high first-pass metabolism when administered orally. It means only 32 % of orally administered dose reaches blood. After it produces its effect, 97 % gets metabolized in gastrointestine and liver and gets excreted out from body through urine. In your case, you have delayed (slow) intestinal movements, hence the ChatDoctor. Hence, I think it is not detectable in blood or urine. Another possibility is very less amount of

Hello doctor,I am a 28-year-old female. I have been on Nucynta for over a year. I take Nucynta ER 50 mg BID and Nucynta IR 50 mg once a day. For the last two months, my urine tests (immunoassay and lab testing) have come back negative. Two weeks ago a blood test was done and it was also negative. I religiously take these medicines as prescribed by my pain management doctor. Due to these negatives he is now refusing to prescribe any oral medications (including my Flexeril, Gabapentin, and oral Ketamine). I understand his need to be able to prove to Nucynta in my system but he is also refusing to try anything else.I am a walking genetic defect. I also have known pharmacogenetic and pharmacokinetic issues. I also have EDS, CRPS, POTS, MCAS, gastroparesis (severe enough that EGD showed food in my stomach 18 hours after last eating), endometriosis. Could any of this be causing the problem? Could any of the medicines I take be causing the problem? My medicines are Lopressor, Trazadone, Fetzima, Zyrtec, Ketamine, Magnesium Citrate pills, Melatonin, Gabapentin, Flexeril, Nucynta, Junel Fe. What suggestions do you have? Is there any research to help me?

Hi. Nucynta is an opioid analgesic, that has high first-pass metabolism when administered orally. It means only 32 % of orally administered dose reaches blood. After it produces its effect, 97 % gets metabolized in gastrointestine and liver and gets excreted out from body through urine. In your case, you have delayed (slow) intestinal movements, hence the ChatDoctor. Hence, I think it is not detectable in blood or urine. Another possibility is very less amount of

### Instruction: Answer this question truthfully ###Input: Hello doctor,Since last year, I am having a lot of health problems such as back pain, fingers joint dull pain, chest inflammation, irritation at penile area, inflammation inside the penile hole, body irritation, body weakness, fever. I often do sense inside my head, i.e., pricking with pins and needles and flu-like symptoms all the time.The reasons for the above-mentioned problems are due to unprotected sex with a creature (dog). Under the heavy influence of an alcohol, such a blunder was committed. I have an apprehension of contracting rabies from that encounter. Can rabies be sexually transmitted? Please suggest me what test should I need to do to rule out the above-mentioned symptoms. I have great hope in you as you are one of experienced and best doctor cum pathologist. Please advice me the test so that I can perform the test and revert it to you for treatment. ### Response: Hello, Welcome to Chat Doctor forum. Rabies can spread sexually but your symptoms do not classically point towards rabies infection. The neurological symptoms like confusion, nausea, excess salivation, etc., are missing. So the chance of rabies is less as per my opinion. However, for rabies, testing multiple samples like saliva, spinal CSF fluid, etc., like examination are needed. You can rule out leptospirosis by serological ELISA testing as you have a history of sex with the dog. There are many zoonotic diseases which mean those infections which spread from animal to human. HIV also can be ruled out by ELISA testing. So your detailed evaluation is needed to do further work up. For primary work-up, you can investigate as follows. Blood pressure measurement, serum all vitamin B estimation, SGPT, SGOT, urea, creatinine estimation, ESR, full CBC, serum ionized calcium estimation, serum vitamin (OH) D estimation. You can revert back with reports. For your detailed physical examination, you need to consult nearby internal medicine specialist.

Hello doctor,Since last year, I am having a lot of health problems such as back pain, fingers joint dull pain, chest inflammation, irritation at penile area, inflammation inside the penile hole, body irritation, body weakness, fever. I often do sense inside my head, i.e., pricking with pins and needles and flu-like symptoms all the time.The reasons for the above-mentioned problems are due to unprotected sex with a creature (dog). Under the heavy influence of an alcohol, such a blunder was committed. I have an apprehension of contracting rabies from that encounter. Can rabies be sexually transmitted? Please suggest me what test should I need to do to rule out the above-mentioned symptoms. I have great hope in you as you are one of experienced and best doctor cum pathologist. Please advice me the test so that I can perform the test and revert it to you for treatment.

Hello, Welcome to Chat Doctor forum. Rabies can spread sexually but your symptoms do not classically point towards rabies infection. The neurological symptoms like confusion, nausea, excess salivation, etc., are missing. So the chance of rabies is less as per my opinion. However, for rabies, testing multiple samples like saliva, spinal CSF fluid, etc., like examination are needed. You can rule out leptospirosis by serological ELISA testing as you have a history of sex with the dog. There are many zoonotic diseases which mean those infections which spread from animal to human. HIV also can be ruled out by ELISA testing. So your detailed evaluation is needed to do further work up. For primary work-up, you can investigate as follows. Blood pressure measurement, serum all vitamin B estimation, SGPT, SGOT, urea, creatinine estimation, ESR, full CBC, serum ionized calcium estimation, serum vitamin (OH) D estimation. You can revert back with reports. For your detailed physical examination, you need to consult nearby internal medicine specialist.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My daughter is 17 years old. She had a cold for about four days when she started complaining of bad ear pain. She was seen in urgent care a week ago and was diagnosed with a middle ear infection. The APRN noted her ear was pretty angry and prescribed Amoxicillin 500 mg. She is supposed to take two pills in the morning and two at night, which she has. She also suggested to continue Mucinex D (which is how I was treating the cold). Her severe ear pain did resolve in a day or two, but she still complains of ear pain intermittently. I am worried about taking Mucinex D for so long, but even if she does not take it she complains of ear pain. She is also saying that she cannot hear out of the ear. To be fair, she says the pain is not as bad initially, but I am still worried. I gave her a Claritin last night thinking it may help, but it just made her stuffy. I know we still have three days on the antibiotic, but should it be completely cleared up by now? Should I take her back to the doctor? Or try something else? ### Response: Hi, Welcome to ChatDoctor. Complete the course of antibiotics. Take Mucinex D (Guaifenesin) once or twice a day, like how you have been taking for another three to four days. If Mucinex D has an antiallergic component then no need for Claritin or Allegra. Otherwise, add either of those to be taken once a day. This will help to clear out ear secretions. Let water not enter the ear while bathing. Let her take rest and refrain from going to school or playing until she is better. After the course of antibiotics gets over it will be prudent to show the ENT specialist once so that he can look into the ear with an otoscope and check if the problem has resolved or not.

Hello doctor,My daughter is 17 years old. She had a cold for about four days when she started complaining of bad ear pain. She was seen in urgent care a week ago and was diagnosed with a middle ear infection. The APRN noted her ear was pretty angry and prescribed Amoxicillin 500 mg. She is supposed to take two pills in the morning and two at night, which she has. She also suggested to continue Mucinex D (which is how I was treating the cold). Her severe ear pain did resolve in a day or two, but she still complains of ear pain intermittently. I am worried about taking Mucinex D for so long, but even if she does not take it she complains of ear pain. She is also saying that she cannot hear out of the ear. To be fair, she says the pain is not as bad initially, but I am still worried. I gave her a Claritin last night thinking it may help, but it just made her stuffy. I know we still have three days on the antibiotic, but should it be completely cleared up by now? Should I take her back to the doctor? Or try something else?

Hi, Welcome to ChatDoctor. Complete the course of antibiotics. Take Mucinex D (Guaifenesin) once or twice a day, like how you have been taking for another three to four days. If Mucinex D has an antiallergic component then no need for Claritin or Allegra. Otherwise, add either of those to be taken once a day. This will help to clear out ear secretions. Let water not enter the ear while bathing. Let her take rest and refrain from going to school or playing until she is better. After the course of antibiotics gets over it will be prudent to show the ENT specialist once so that he can look into the ear with an otoscope and check if the problem has resolved or not.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have been having issues of on and off periods for nearly four years now. When I started my periods, they were completely normal, neither heavy nor light and nothing unusual. But, I started missing my cycle for about six months and then I would come back completely normal. My last episode of missing my periods had lasted for nearly 10 months and I have had no unusual symptoms, discharge or pain. I have been to my doctors twice and I have had an ultrasound, which came back completely normal, many blood tests and hormone tests, which also did not pick up anything unusual. I just want to get to the bottom of this problem. Is there anything else you think I could do? What do you reckon about this? I am not stressed, obese or underweight. I do not smoke or drink. I am a healthy 18 year old. Any of your advice would be very grateful. Thank you. ### Response: Hello, Welcome to Chat Doctor forum. The menstrual pattern you quote sounds like PCOS (polycystic ovarian syn ChatDoctor. It is a hormonal imbalance characterized by menstrual abnormalities. To diagnose and classify the type of PCOS, following hormonal tests should be done on day 2 of periods. The timing is very important. Once you had all these tests done on day 2 of periods, I request you to upload the reports as it is the ratio of hormonal levels rather than their absolute values that are deranged in PCOS. Since you say certain hormonal tests were done and came out normal, I presume that your thyroid and prolactin levels were normal. Get them done too if the report is more than three months old. Please do tell me if you have already missed a period by a month in this cycle, so that I can suggest medication to induce periods. Please give the exact date of periods in that case. If you have not missed your periods yet, then wait for your periods and get the test repeated on day 2.

Hello doctor,I have been having issues of on and off periods for nearly four years now. When I started my periods, they were completely normal, neither heavy nor light and nothing unusual. But, I started missing my cycle for about six months and then I would come back completely normal. My last episode of missing my periods had lasted for nearly 10 months and I have had no unusual symptoms, discharge or pain. I have been to my doctors twice and I have had an ultrasound, which came back completely normal, many blood tests and hormone tests, which also did not pick up anything unusual. I just want to get to the bottom of this problem. Is there anything else you think I could do? What do you reckon about this? I am not stressed, obese or underweight. I do not smoke or drink. I am a healthy 18 year old. Any of your advice would be very grateful. Thank you.

Hello, Welcome to Chat Doctor forum. The menstrual pattern you quote sounds like PCOS (polycystic ovarian syn ChatDoctor. It is a hormonal imbalance characterized by menstrual abnormalities. To diagnose and classify the type of PCOS, following hormonal tests should be done on day 2 of periods. The timing is very important. Once you had all these tests done on day 2 of periods, I request you to upload the reports as it is the ratio of hormonal levels rather than their absolute values that are deranged in PCOS. Since you say certain hormonal tests were done and came out normal, I presume that your thyroid and prolactin levels were normal. Get them done too if the report is more than three months old. Please do tell me if you have already missed a period by a month in this cycle, so that I can suggest medication to induce periods. Please give the exact date of periods in that case. If you have not missed your periods yet, then wait for your periods and get the test repeated on day 2.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 38 year old male, and I have been feeling twitches in my arm. I started feeling this constant twitch about six weeks ago. I did not experience any weakness in that arm or anywhere else in the body. The twitches lasted for about a week and then went away.The twitches have now appeared four weeks later in the same area (upper arm). Again, there is no apparent weakness, which I have tested by lifting weights at the gym and both my upper and lower body strength seems to be fine.What is worrying me to death is, could these twitches be an early sign of ALS? Is it possible that weakness will follow even though I do not have it now? Do ALS twitches go away for four weeks at a time and reappear?If I started to experience constant twitches six weeks ago, if this was ALS should not I have experienced some weakness by now? Is the fact that the twitches are localized to the same place a bad thing? ### Response: Hello, Welcome to Chat Doctor forum. I have read your query and understand your concerns. First of all, I will suggest you consider other possibilities before jumping to conclusions. There are a number of conditions which can present with twitches without any disease, and ALS (amyotrophic lateral sclerosis) is one of the remotest possibility for a 38 year old young male. The commonest cause for twitches is simple worry or anxiety. I know at least 100 individuals with anxiety, who presented with simple twitches and no other symptoms. In my opinion, you need to see whether these twitches have any relationship with your anxiety level. The another common conditions which present with twitches is endocrine abnormalities, such as thyroid and parathyroid disorders. In case the stress level is not able to explain the twitches, an evaluation for endocrine abnormality is indicated. The list may go on in a similar fashion. Find the answers to your questions below

Hi doctor,I am a 38 year old male, and I have been feeling twitches in my arm. I started feeling this constant twitch about six weeks ago. I did not experience any weakness in that arm or anywhere else in the body. The twitches lasted for about a week and then went away.The twitches have now appeared four weeks later in the same area (upper arm). Again, there is no apparent weakness, which I have tested by lifting weights at the gym and both my upper and lower body strength seems to be fine.What is worrying me to death is, could these twitches be an early sign of ALS? Is it possible that weakness will follow even though I do not have it now? Do ALS twitches go away for four weeks at a time and reappear?If I started to experience constant twitches six weeks ago, if this was ALS should not I have experienced some weakness by now? Is the fact that the twitches are localized to the same place a bad thing?

Hello, Welcome to Chat Doctor forum. I have read your query and understand your concerns. First of all, I will suggest you consider other possibilities before jumping to conclusions. There are a number of conditions which can present with twitches without any disease, and ALS (amyotrophic lateral sclerosis) is one of the remotest possibility for a 38 year old young male. The commonest cause for twitches is simple worry or anxiety. I know at least 100 individuals with anxiety, who presented with simple twitches and no other symptoms. In my opinion, you need to see whether these twitches have any relationship with your anxiety level. The another common conditions which present with twitches is endocrine abnormalities, such as thyroid and parathyroid disorders. In case the stress level is not able to explain the twitches, an evaluation for endocrine abnormality is indicated. The list may go on in a similar fashion. Find the answers to your questions below

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 24-year-old female. My weight is 57 kg, height is 163 cm. My complaint is face chubbiness, and I gained about 5 kg for the past 6 months, and the main problem is that I am missing my menses this month. My LMP was on 15th April.As per gynecologist advise I did CBC, fasting sugar, TSH, prolactin, HCG, total testosterone, DHEAS, FSH, LH, USG pelvis for PCOD. Doctor advised to take Primolut N but I have not yet started the tablet. Do I need to start that and what is the line of treatment? All reports were normal except the two TSH -13.740, DHEAS-53.19. Please help. ### Response: Hello. Yes, you can take the Primolut N tablet as advised by your gynecologist. As your periods have gotten delayed by almost more than 45 days, it is unlikely that they would come naturally, even if it does, it may not be similar to your natural menstrual pattern, this is because this is an anovulatory cycle (meaning no ovulation must have occurred in this cycle). Usually, when periods come after such a delay, it could range from spotting to scanty flow to excess flow, or sometimes prolonged bleeding which may need hormonal medications to stop the bleeding. I would like to know if you face any acne or unwanted facial hair growth problems, if so, then you must be having PCOS (even if the USG is normal). And yes, you definitely need to start treatment for your hypothyroidism as your TSH (thyroid-stimulating hormone) level is high. Thyroid hormonal disturbance are quite common with PCOS (polycystic ovary syn ChatDoctor. So, definitely you need to start your thyroxine replacement medications. DHEAS (dehy Take care.

Hello doctor,I am a 24-year-old female. My weight is 57 kg, height is 163 cm. My complaint is face chubbiness, and I gained about 5 kg for the past 6 months, and the main problem is that I am missing my menses this month. My LMP was on 15th April.As per gynecologist advise I did CBC, fasting sugar, TSH, prolactin, HCG, total testosterone, DHEAS, FSH, LH, USG pelvis for PCOD. Doctor advised to take Primolut N but I have not yet started the tablet. Do I need to start that and what is the line of treatment? All reports were normal except the two TSH -13.740, DHEAS-53.19. Please help.

Hello. Yes, you can take the Primolut N tablet as advised by your gynecologist. As your periods have gotten delayed by almost more than 45 days, it is unlikely that they would come naturally, even if it does, it may not be similar to your natural menstrual pattern, this is because this is an anovulatory cycle (meaning no ovulation must have occurred in this cycle). Usually, when periods come after such a delay, it could range from spotting to scanty flow to excess flow, or sometimes prolonged bleeding which may need hormonal medications to stop the bleeding. I would like to know if you face any acne or unwanted facial hair growth problems, if so, then you must be having PCOS (even if the USG is normal). And yes, you definitely need to start treatment for your hypothyroidism as your TSH (thyroid-stimulating hormone) level is high. Thyroid hormonal disturbance are quite common with PCOS (polycystic ovary syn ChatDoctor. So, definitely you need to start your thyroxine replacement medications. DHEAS (dehy Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 22-year-old girl. I have had eye problems for around nine months and have seen several eye doctors and ophthalmologists who all have told me different things and tried a lot of different treatments that have not worked. I am a contact lens wearer with extremely bad eyesight and first had eye problems eight months back. It started after a plane ride and assumed it was an eye infection from being on a dirty plane and touching my eyes.My eyes were stinging and crying and red and I could not bear to put contacts in. Nine months later I am still having this problem. I was first treated with antibacterial drops by a normal doctor then referred to an eye doctor when this did not fix it. The eye doctors diagnosed me with ocular rosacea, blepharitis, and MGD.I have rosacea on my face too. I have done eye compresses, gotten a liposcan (meibomian glands were not clogged enough to need lipoflow), I have punctal plugs in both eyes and I took Doxycycline for over three months which did nothing but destroy my digestion. I have been prescribed Restasis and Lotemax which I use multiple times a day. I use lid scrubs and a tea tree oil eye and face cleanser. But my symptoms are still severe, I have extremely dry eyes, my eyes are bloodshot 24/7. I have red lower lid margins and cannot bear to wear contacts which is extremely upsetting because I am an athlete and this is really impacting my athletic ability and quality of life. I just really hope someone has an answer and treatment that will work. ### Response: Hi. I can imagine the situation you are going through. MGD (meibomian gland dysfunction) with ChatDoctor. Your doctor is treating it very well but in spite of all, you are still having problems. You have done warm compresses, taken oral and topical antibiotics and steroid

Hi doctor,I am a 22-year-old girl. I have had eye problems for around nine months and have seen several eye doctors and ophthalmologists who all have told me different things and tried a lot of different treatments that have not worked. I am a contact lens wearer with extremely bad eyesight and first had eye problems eight months back. It started after a plane ride and assumed it was an eye infection from being on a dirty plane and touching my eyes.My eyes were stinging and crying and red and I could not bear to put contacts in. Nine months later I am still having this problem. I was first treated with antibacterial drops by a normal doctor then referred to an eye doctor when this did not fix it. The eye doctors diagnosed me with ocular rosacea, blepharitis, and MGD.I have rosacea on my face too. I have done eye compresses, gotten a liposcan (meibomian glands were not clogged enough to need lipoflow), I have punctal plugs in both eyes and I took Doxycycline for over three months which did nothing but destroy my digestion. I have been prescribed Restasis and Lotemax which I use multiple times a day. I use lid scrubs and a tea tree oil eye and face cleanser. But my symptoms are still severe, I have extremely dry eyes, my eyes are bloodshot 24/7. I have red lower lid margins and cannot bear to wear contacts which is extremely upsetting because I am an athlete and this is really impacting my athletic ability and quality of life. I just really hope someone has an answer and treatment that will work.

Hi. I can imagine the situation you are going through. MGD (meibomian gland dysfunction) with ChatDoctor. Your doctor is treating it very well but in spite of all, you are still having problems. You have done warm compresses, taken oral and topical antibiotics and steroid

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a patient of PCOD. I had my last periods before nine days. I took tablet Letrozole 2.5 mg from the second day of my periods and continued for five days. My USG findings of today as after ten days is right ovary follicle is 23.4 mm, and ET is 6.7. I will be able to meet my husband only after three days.My query is when shall I take injection hCG, as I can afford to have intercourse only after three days. My second query is with such a background, is there a possibility of cyst formation? ### Response: Hello, Welcome to Chat Doctor forum. As the follicular size has already crossed 22 mm, there are high chances that you would ovulate in the next 24 hours naturally. However, by rule hCG dose is offered when the largest follicular size has crossed 20 mm, so you should be taking it today. After the injection, the ovulation is expected in the next 36 hours after the LH (luteinizing hormone) surge. So we advise intercourse from the very next day of hCG injection daily for the next three days to increase chances of conception. After ovulation, the egg is available for the next 24 hours when fertilization can occur as the egg starts to degenerate post 24 hours of ovulation. It has to be followed daily transvaginal ultrasound to watch for ovulation. If you ovulate by today night and see a ruptured follicle tomorrow then next 24 hours would be crucial for conception. In your case where sex is planned on three days from now if the follicle does not rupture naturally then you can take an hCG injection in the morning before the day of meeting your husband. And you expect egg after ovulation to be viable till that day and the next day when you can opt for frequent sex to increase chances of conception. All this provided follicle does not rupture until tomorrow evening.

Hello doctor,I am a patient of PCOD. I had my last periods before nine days. I took tablet Letrozole 2.5 mg from the second day of my periods and continued for five days. My USG findings of today as after ten days is right ovary follicle is 23.4 mm, and ET is 6.7. I will be able to meet my husband only after three days.My query is when shall I take injection hCG, as I can afford to have intercourse only after three days. My second query is with such a background, is there a possibility of cyst formation?

Hello, Welcome to Chat Doctor forum. As the follicular size has already crossed 22 mm, there are high chances that you would ovulate in the next 24 hours naturally. However, by rule hCG dose is offered when the largest follicular size has crossed 20 mm, so you should be taking it today. After the injection, the ovulation is expected in the next 36 hours after the LH (luteinizing hormone) surge. So we advise intercourse from the very next day of hCG injection daily for the next three days to increase chances of conception. After ovulation, the egg is available for the next 24 hours when fertilization can occur as the egg starts to degenerate post 24 hours of ovulation. It has to be followed daily transvaginal ultrasound to watch for ovulation. If you ovulate by today night and see a ruptured follicle tomorrow then next 24 hours would be crucial for conception. In your case where sex is planned on three days from now if the follicle does not rupture naturally then you can take an hCG injection in the morning before the day of meeting your husband. And you expect egg after ovulation to be viable till that day and the next day when you can opt for frequent sex to increase chances of conception. All this provided follicle does not rupture until tomorrow evening.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My father is 61 years old known case of CKD with hypertension. He has been on dialysis for a couple of weeks, sum total of ten dialysis have been done out of which one dialysis was done using an online hemodiafiltration technique. His creatinine has subsequently reduced from 8.6 to 6.5, however, he had pneumonia patch in the right lung and took antibiotics and has recovered from that. But he has been coughing quite a lot with only secretions coming out and no sputum. There is some fluid in his lungs for which he has been advised to go for HDF and mild pericardial effusion. AFB for TB is negative. Can you please suggest what can be the cause of severe coughing, shortness of breath and the treatment for the same? If needed, I can send out the x-ray to you for evaluation.He is currently on Flavedon, Minipress XL, Metolar XR, Torsemide 40, Vitamins, and Calcium tablets. His lab report shows TLC is raised to 12 which was earlier 5. Please help. ### Response: Hi, Welcome to ChatDoctor. There could be a few causes for the wet cough with phlegm. Despite taking antibiotics for pneumonia, the opacity in the lung takes a few weeks to completely disappear. The cough in such a case can last for a month. If the patient has no fever I will not worry. CHF (congestive heart failure) is also one of the causes in elderly patients in addition to environmental factors. I would advise you to continue supporting treatment for cough as advised by your doctor. If there is fever in such a case you must report back to the doctor to rule out any other cause. If the x-ray reviled plural effusion then probably other continuation like TB (tuberculosis), etc., should be considered. You can send me the chest x-ray to comment better. I hope this helps.

Hello doctor,My father is 61 years old known case of CKD with hypertension. He has been on dialysis for a couple of weeks, sum total of ten dialysis have been done out of which one dialysis was done using an online hemodiafiltration technique. His creatinine has subsequently reduced from 8.6 to 6.5, however, he had pneumonia patch in the right lung and took antibiotics and has recovered from that. But he has been coughing quite a lot with only secretions coming out and no sputum. There is some fluid in his lungs for which he has been advised to go for HDF and mild pericardial effusion. AFB for TB is negative. Can you please suggest what can be the cause of severe coughing, shortness of breath and the treatment for the same? If needed, I can send out the x-ray to you for evaluation.He is currently on Flavedon, Minipress XL, Metolar XR, Torsemide 40, Vitamins, and Calcium tablets. His lab report shows TLC is raised to 12 which was earlier 5. Please help.

Hi, Welcome to ChatDoctor. There could be a few causes for the wet cough with phlegm. Despite taking antibiotics for pneumonia, the opacity in the lung takes a few weeks to completely disappear. The cough in such a case can last for a month. If the patient has no fever I will not worry. CHF (congestive heart failure) is also one of the causes in elderly patients in addition to environmental factors. I would advise you to continue supporting treatment for cough as advised by your doctor. If there is fever in such a case you must report back to the doctor to rule out any other cause. If the x-ray reviled plural effusion then probably other continuation like TB (tuberculosis), etc., should be considered. You can send me the chest x-ray to comment better. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I do not know how to explain my situation, but shortly, I have an emotionally abusive father and two siblings younger than me. He drained me emotionally for 18 years, and now he is aiming for my siblings. I am now used to his anger issues, insults, the traumas he manages to give my mother and me. But he is going too far, and I cannot stand him hating my siblings.I always wanted him to go away, and I hate him. Today after he beat our cat just because it tried to run away from home, I decided I want him to die. But when he comes home from work as nothing happened, everyone in the house acts like he is not a monster, this is a habit we all have now. So when he is not home I pray that he should die and not come back, but when he is at home I serve him his food, his tea, etc. and have cheerful conversations with him.I hate him, but when he is in front of me, I cannot act the way I feel. I am not even forcing myself to work happy, and it just happens like I am a robot. What kind of situation I am in? I am sure I want him to die, but he is too good at taking our entire family hostage. I am afraid of losing my sanity completely. I know when I am alone, I act like a crazy person. I do not know what is wrong with me. Please help. ### Response: Hello. Abusive relationships are quite painful to live in and survive. Especially when these are closed ones like father-child, siblings, etc., they left marked emotional pain through in life if left unhealed. I am afraid you did not mention anything about my mother. Her role here is also important to understand the core problem. It seems she is also one of the victims. As per your query, it is ChatDoctor. Sometimes when chil

Hello doctor,I do not know how to explain my situation, but shortly, I have an emotionally abusive father and two siblings younger than me. He drained me emotionally for 18 years, and now he is aiming for my siblings. I am now used to his anger issues, insults, the traumas he manages to give my mother and me. But he is going too far, and I cannot stand him hating my siblings.I always wanted him to go away, and I hate him. Today after he beat our cat just because it tried to run away from home, I decided I want him to die. But when he comes home from work as nothing happened, everyone in the house acts like he is not a monster, this is a habit we all have now. So when he is not home I pray that he should die and not come back, but when he is at home I serve him his food, his tea, etc. and have cheerful conversations with him.I hate him, but when he is in front of me, I cannot act the way I feel. I am not even forcing myself to work happy, and it just happens like I am a robot. What kind of situation I am in? I am sure I want him to die, but he is too good at taking our entire family hostage. I am afraid of losing my sanity completely. I know when I am alone, I act like a crazy person. I do not know what is wrong with me. Please help.

Hello. Abusive relationships are quite painful to live in and survive. Especially when these are closed ones like father-child, siblings, etc., they left marked emotional pain through in life if left unhealed. I am afraid you did not mention anything about my mother. Her role here is also important to understand the core problem. It seems she is also one of the victims. As per your query, it is ChatDoctor. Sometimes when chil

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 25-years-male. Before two months back, I got into a very fearful situation and I felt panicked at that time. I consulted a psychiatrist and he gave me Clonezopam, Propranolol and anti-depressants. After using it for seven to ten days I stopped them by knowing that they are addictive. And after stopping I felt new kind of problems such as heart palpitations whenever I try to sleep in the day time and I get irregular sleep at night, feeling anxious. For many days I kept tolerating them, after many days now the symptoms have diminished but still, I get palpitations whenever I try to sleep, then I took Medhavati for 12-14 days. My sleeping time at night somewhat increased but I did not use to get a refreshed sleep. I consulted a general doctor, he told me it is just a phobia and gave me Stalopam (Clonezepam and Escitalopram) for 15 days and multivitamins tablets. Then I consulted an ayurvedic specialist, he gave Manasamitra vatakam, Stresswin and Saraswatiristam. Please help me whether I should take these ayurvedic medicines or take antidepressants for 15 days? Are Manasamitra and Saraswatiristam safe for me and do not have side effects? And what time does it take to show effects and for much duration should I take them? Now I am almost fine but unable to sleep at daytime due to palpitations and getting some negative fearful thoughts at some times. Does Manasamitra increase serotonin in the brain and give enthusiasm. I am thinkng of going for allopathy for 15 days or will ayurveda medicines show early results? Please help. ### Response: Hello, Welcome to Chat Doctor forum. I could understand how much confusion you experience and your mental pain. So far, fewer studies have been done if we combine allopathy ChatDoctor.

Hello doctor,I am a 25-years-male. Before two months back, I got into a very fearful situation and I felt panicked at that time. I consulted a psychiatrist and he gave me Clonezopam, Propranolol and anti-depressants. After using it for seven to ten days I stopped them by knowing that they are addictive. And after stopping I felt new kind of problems such as heart palpitations whenever I try to sleep in the day time and I get irregular sleep at night, feeling anxious. For many days I kept tolerating them, after many days now the symptoms have diminished but still, I get palpitations whenever I try to sleep, then I took Medhavati for 12-14 days. My sleeping time at night somewhat increased but I did not use to get a refreshed sleep. I consulted a general doctor, he told me it is just a phobia and gave me Stalopam (Clonezepam and Escitalopram) for 15 days and multivitamins tablets. Then I consulted an ayurvedic specialist, he gave Manasamitra vatakam, Stresswin and Saraswatiristam. Please help me whether I should take these ayurvedic medicines or take antidepressants for 15 days? Are Manasamitra and Saraswatiristam safe for me and do not have side effects? And what time does it take to show effects and for much duration should I take them? Now I am almost fine but unable to sleep at daytime due to palpitations and getting some negative fearful thoughts at some times. Does Manasamitra increase serotonin in the brain and give enthusiasm. I am thinkng of going for allopathy for 15 days or will ayurveda medicines show early results? Please help.

Hello, Welcome to Chat Doctor forum. I could understand how much confusion you experience and your mental pain. So far, fewer studies have been done if we combine allopathy ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had receptive oral sex (received fellation) with an escort girl three weeks ago. Since then, I have got urethritis three days after. I have been treated with Levofloxacin for 10 days. The urethritis got cured, but I kept getting some strange burning sensations in my scrotum and the top of my buttock, but no lesions or bumps were visible. Only redness.The symptoms then disappeared then for four days, I got ticklings on my back, arms, chests, but again nothing visible on my skin. Since two days I have got paresthesia on my left foot, left arm and left hand that does not seems to stop (sometimes I feel it more or less) and sometimes some cramps in my leg or arm. I got a 4th generation HIV test at three weeks, which was negative. Do you think I have a chance to have HIV? Do I need to retest at four weeks or six weeks? If you do not think I have a chance of getting HIV, what options should I look for? ### Response: Hello, Welcome to Chat Doctor forum. Oral sex is least related to HIV. Symptoms are very bizarre and mostly by oral sex HSV, and STI is common. The tickling sensation is different as such, may be seen in vitamin B 12 deficiency, and anxiety. Symptoms come but goes in a particular time. You can still go for the HSV test. And STD panel test. No signs you had related to both. Till then you can take, Tablet Mecobalamin (Methylcobalamin) 1500 mg one at night for one month. If you feel better, you can continue for another a month if at all required. Tablet Escitalopram 10 mg (esitelop10) one at night for ten to fifteen days if at all needed. It is not at all HIV. I hope you have understood.

Hello doctor,I had receptive oral sex (received fellation) with an escort girl three weeks ago. Since then, I have got urethritis three days after. I have been treated with Levofloxacin for 10 days. The urethritis got cured, but I kept getting some strange burning sensations in my scrotum and the top of my buttock, but no lesions or bumps were visible. Only redness.The symptoms then disappeared then for four days, I got ticklings on my back, arms, chests, but again nothing visible on my skin. Since two days I have got paresthesia on my left foot, left arm and left hand that does not seems to stop (sometimes I feel it more or less) and sometimes some cramps in my leg or arm. I got a 4th generation HIV test at three weeks, which was negative. Do you think I have a chance to have HIV? Do I need to retest at four weeks or six weeks? If you do not think I have a chance of getting HIV, what options should I look for?

Hello, Welcome to Chat Doctor forum. Oral sex is least related to HIV. Symptoms are very bizarre and mostly by oral sex HSV, and STI is common. The tickling sensation is different as such, may be seen in vitamin B 12 deficiency, and anxiety. Symptoms come but goes in a particular time. You can still go for the HSV test. And STD panel test. No signs you had related to both. Till then you can take, Tablet Mecobalamin (Methylcobalamin) 1500 mg one at night for one month. If you feel better, you can continue for another a month if at all required. Tablet Escitalopram 10 mg (esitelop10) one at night for ten to fifteen days if at all needed. It is not at all HIV. I hope you have understood.

### Instruction: Answer this question truthfully ###Input: Hello doctor,It has been two years since marriage but I have never felt sexually attracted to my wife, no matter what I do. I have tried Viagra and ayurvedic medicines to increase sexual drive but no results. My parents had compelled me into this marriage. Since I never had sex before marriage, they said that couple gets automatically attracted towards each other no matter what feeling they have towards each other before marriage. I tried sex several times. Erection is maintained for a few minutes that also after thinking about some other girl but ejaculation never happens. Now for the last five months, even erection is not happening. I was diagnosed with hypothyroidism last year but that is under control now. I was also diagnosed with increased prolactin levels recently and I am currently taking medicines for that. I think the problem is more psychological. Please advise me what to do. I am currently on Thyronorm 100 mg per day and Cabgolin 0.25 mg per week. Please help. ### Response: Hello. Hypothyroidism and high prolactin explain a few symptoms that you are suffering from. So before jumping to conclusion that it is psychological, I would suggest you that further investigation is required such as serum testosterone, serum LH (luteinizing hormone) and FSH (follicle-stimulating hormone). You may also need sonography of testes and visualization of the duct to see if they are blocked or not and also prostate if it is enlarged or not. Most often psychological anejaculation is situational and not permanent or complete, while you mentioned that you never had it. So I recommend that you consult a urologist for your symptoms and get investigated properly to find the cause of your problem. It is a treatable condition and can be treated accordingly. If the investigation comes normal then you can think that this is due to psychological in origin. Then counseling and sex therapy will be helpful. For more information consult a sexologist online Take care.

Hello doctor,It has been two years since marriage but I have never felt sexually attracted to my wife, no matter what I do. I have tried Viagra and ayurvedic medicines to increase sexual drive but no results. My parents had compelled me into this marriage. Since I never had sex before marriage, they said that couple gets automatically attracted towards each other no matter what feeling they have towards each other before marriage. I tried sex several times. Erection is maintained for a few minutes that also after thinking about some other girl but ejaculation never happens. Now for the last five months, even erection is not happening. I was diagnosed with hypothyroidism last year but that is under control now. I was also diagnosed with increased prolactin levels recently and I am currently taking medicines for that. I think the problem is more psychological. Please advise me what to do. I am currently on Thyronorm 100 mg per day and Cabgolin 0.25 mg per week. Please help.

Hello. Hypothyroidism and high prolactin explain a few symptoms that you are suffering from. So before jumping to conclusion that it is psychological, I would suggest you that further investigation is required such as serum testosterone, serum LH (luteinizing hormone) and FSH (follicle-stimulating hormone). You may also need sonography of testes and visualization of the duct to see if they are blocked or not and also prostate if it is enlarged or not. Most often psychological anejaculation is situational and not permanent or complete, while you mentioned that you never had it. So I recommend that you consult a urologist for your symptoms and get investigated properly to find the cause of your problem. It is a treatable condition and can be treated accordingly. If the investigation comes normal then you can think that this is due to psychological in origin. Then counseling and sex therapy will be helpful. For more information consult a sexologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have a feeling of mucus or something in my throat for the last three weeks. For a week I had a feeling of swallowing issues, where I felt not all of it was sticking to my throat. Now that sensation has more or less gone away, I still do feel like grain in my throat after finishing the meal. I have a lot of dry coughs and my throat feels like irritated constantly. I am not sure if its due to GERD or LPR. I am taking Prevacid 30 mg since last week. I am not sure if that is the reason for my swallowing getting better, but the sensation is still there. Now I am worried that this could be some neurological issue. I am going to see an ENT, but that is a month from now.My question is how is muscle weakness of the throat diagnosed? Is my issue more of an indication of some neurological issues or anxiety and GERD? I also feel like the mucus or the foreign object sometimes interferes with my breathing. When I am tensed or anxious it feels like a ball, when I am calm I do seldom feel it. But when I take a big swallow I feel something in the middle of my throat.I have done an endoscopy, pH and manometry test which does not show much. My doctor diagnosed me with IBS. ### Response: Hello, Welcome to ChatDoctor. The symptoms you are experiencing classically fit into globus pharyngeus. Manometric studies, endoscopy being normal, organic causes are ruled out. Hypo or hypomotility disorders would present in a typical manner and manometric studies would have shown something. Neurological or neuromuscular afflictions would have other symptoms. Globus sensation can be a headache to deal with. Nervous dyspepsia, IBS (irritable bowel disease) globus sensation are all parts of a spectrum of conditions involving gut-brain axis. Cutting down on anxiety is of prime importance. Take care.

Hello doctor,I have a feeling of mucus or something in my throat for the last three weeks. For a week I had a feeling of swallowing issues, where I felt not all of it was sticking to my throat. Now that sensation has more or less gone away, I still do feel like grain in my throat after finishing the meal. I have a lot of dry coughs and my throat feels like irritated constantly. I am not sure if its due to GERD or LPR. I am taking Prevacid 30 mg since last week. I am not sure if that is the reason for my swallowing getting better, but the sensation is still there. Now I am worried that this could be some neurological issue. I am going to see an ENT, but that is a month from now.My question is how is muscle weakness of the throat diagnosed? Is my issue more of an indication of some neurological issues or anxiety and GERD? I also feel like the mucus or the foreign object sometimes interferes with my breathing. When I am tensed or anxious it feels like a ball, when I am calm I do seldom feel it. But when I take a big swallow I feel something in the middle of my throat.I have done an endoscopy, pH and manometry test which does not show much. My doctor diagnosed me with IBS.

Hello, Welcome to ChatDoctor. The symptoms you are experiencing classically fit into globus pharyngeus. Manometric studies, endoscopy being normal, organic causes are ruled out. Hypo or hypomotility disorders would present in a typical manner and manometric studies would have shown something. Neurological or neuromuscular afflictions would have other symptoms. Globus sensation can be a headache to deal with. Nervous dyspepsia, IBS (irritable bowel disease) globus sensation are all parts of a spectrum of conditions involving gut-brain axis. Cutting down on anxiety is of prime importance. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a patient of bipolar disorder. I am not experiencing bipolar disorder symptoms for more than two years. So, can I leave medication gradually? I have completed my education during my treatment. I was diagnosed with this disorder a few years back. I am constantly being treated for the past six years until now and unable to understand the timing of leaving the medication. I skipped the medicines all of a sudden two times before but not after that. My psychiatrist says that you are in a stable condition, but I cannot tell you when I shall end your minimal medicines. He even does not give any clues about this to my parents. And, all of us are confused and upset because of this condition. Please advise.I am currently taking Adablizer 10 mg 1/4th tablet only at night, Oxalepsy 300 mg one in the morning and one at night. ### Response: Hello. Normally, after the first episode of bipolar illness, medicines are advised to be taken for one year and stopped slowly. After a second relapse it is advised for two or three years and then stopped. For the third relapse, it is to be continued lifelong. If you have taken them regularly as you have said, you can try reducing them slowly over course of four to six weeks and if you feel that symptoms are recurring you might need to go back to the previous dose you felt comfortable on. Reduce Aripiprazole 10 mg to 5 mg for four to six weeks. Then reduce Oxcarbazepine 300 twice to 300 half in the morning and one at night for four weeks. Then make it just one tablet at night. Then Aripiprazole 5 mg half for four weeks. Then 300 mg half for four weeks. Finally, you can stop Oxcarbazepine and lastly after another four weeks stop Aripiprazole. Take care.

Hello doctor,I am a patient of bipolar disorder. I am not experiencing bipolar disorder symptoms for more than two years. So, can I leave medication gradually? I have completed my education during my treatment. I was diagnosed with this disorder a few years back. I am constantly being treated for the past six years until now and unable to understand the timing of leaving the medication. I skipped the medicines all of a sudden two times before but not after that. My psychiatrist says that you are in a stable condition, but I cannot tell you when I shall end your minimal medicines. He even does not give any clues about this to my parents. And, all of us are confused and upset because of this condition. Please advise.I am currently taking Adablizer 10 mg 1/4th tablet only at night, Oxalepsy 300 mg one in the morning and one at night.

Hello. Normally, after the first episode of bipolar illness, medicines are advised to be taken for one year and stopped slowly. After a second relapse it is advised for two or three years and then stopped. For the third relapse, it is to be continued lifelong. If you have taken them regularly as you have said, you can try reducing them slowly over course of four to six weeks and if you feel that symptoms are recurring you might need to go back to the previous dose you felt comfortable on. Reduce Aripiprazole 10 mg to 5 mg for four to six weeks. Then reduce Oxcarbazepine 300 twice to 300 half in the morning and one at night for four weeks. Then make it just one tablet at night. Then Aripiprazole 5 mg half for four weeks. Then 300 mg half for four weeks. Finally, you can stop Oxcarbazepine and lastly after another four weeks stop Aripiprazole. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I had a protein shake for three weeks, around five scoops a day. Since then I get a pulsation in my buttocks and legs. This also causes dizziness most of the time. If I eat too much this problem gets worse. Drinking a lot of water helps but it is not sorting out the problem. I was advised to see a toxicologist for this problem as someone said to me that it could have given me protein toxicity.Anything I eat with high protein like chicken, lamb, fish, etc., makes this problem go worse. I also tried to stop eating that for a bit. It did help a little but again it did not sort out the problem. I have tried taking Detox as well.I am suffering through this problem for the last one year. I have been running around my gp. I am really fed up with this problem. All blood tests were done and everything normal. I have also tried taking vitamin C it did help a lot. But I experienced some pains around my kidney area so I stopped taking that too. This shake has definitely done something to me and nothing was helpful. I have tried a lot to find a toxicologist because I think who is the right person to help me with this issue. Could you please suggest me the correct medication for this problem as it is messing me up and stopping me from work as well? Please help. ### Response: Hi, Welcome to Chat Doctor forum. After going through your question I feel that you are really worried about the ill effects of protein shake. Let me assure you that a protein shake is perfectly safe even if you have taken in large quantities as mentioned. The fact that even after three weeks it has not altered your renal function or liver function itself is the proof that you need not worry about the toxic effect of the protein shake. ChatDoctor. Just bring down your weight. It will ease your problem a lot. Do not worry. You will be all right.

Hi doctor,I had a protein shake for three weeks, around five scoops a day. Since then I get a pulsation in my buttocks and legs. This also causes dizziness most of the time. If I eat too much this problem gets worse. Drinking a lot of water helps but it is not sorting out the problem. I was advised to see a toxicologist for this problem as someone said to me that it could have given me protein toxicity.Anything I eat with high protein like chicken, lamb, fish, etc., makes this problem go worse. I also tried to stop eating that for a bit. It did help a little but again it did not sort out the problem. I have tried taking Detox as well.I am suffering through this problem for the last one year. I have been running around my gp. I am really fed up with this problem. All blood tests were done and everything normal. I have also tried taking vitamin C it did help a lot. But I experienced some pains around my kidney area so I stopped taking that too. This shake has definitely done something to me and nothing was helpful. I have tried a lot to find a toxicologist because I think who is the right person to help me with this issue. Could you please suggest me the correct medication for this problem as it is messing me up and stopping me from work as well? Please help.

Hi, Welcome to Chat Doctor forum. After going through your question I feel that you are really worried about the ill effects of protein shake. Let me assure you that a protein shake is perfectly safe even if you have taken in large quantities as mentioned. The fact that even after three weeks it has not altered your renal function or liver function itself is the proof that you need not worry about the toxic effect of the protein shake. ChatDoctor. Just bring down your weight. It will ease your problem a lot. Do not worry. You will be all right.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 25 years old. I am 6 feet tall and my weight is 86 kg. Basically my entire problem starts at night while lying down. Three to four years back, I had mild pain. While lying down I feel acute pain or some tingling in my left chest sometime it goes down around my body. When I am about to get sleep I feel short of breath then I had to wake up and sit for a while. And also my nostrils are too often blocked. For few days I had Levocetirizine and currently just using nasal drops. Consulted many doctors over the years. As per the doctors I have nasal muscle swollen or increased which is blocking the way. I had undergone some tests of heart (ECG) and took chest x-ray. Everything was pretty normal. But from last 3-4 days my nights are hell. I could not sleep at all. I am a smoker (half cigarette per day) and drinks alcohol twice a week. Please tell me which doctor to consult? Is it something serious? ### Response: Hello, Welcome to Chat Doctor forum. I have checked your x-ray reports (attachment removed to protect patient identity). 1. You have deflected nasal septum with C-shaped deformity of the septal bone and cartilage. Due to this reason you are getting sleep apnea, breathless nights that makes you to wake up and sit for a while to catch the breath.2. Chest pain is an additional symptom that may be due to smoking and it is giving bad impact on your lungs.3. Smoking keeps lung tissue irritated and causing inflammation and then healing. This gets repeated in your case.4. You need to curb smoking and alcoholic beverages.5. Consult a sleep apnea specialist for better management. If felt necessary he will advise medication or will refer you to an otorhinolarngologist for nasal defects. That may need surgical correction. Consult your doctor for prescription of

Hello doctor,I am 25 years old. I am 6 feet tall and my weight is 86 kg. Basically my entire problem starts at night while lying down. Three to four years back, I had mild pain. While lying down I feel acute pain or some tingling in my left chest sometime it goes down around my body. When I am about to get sleep I feel short of breath then I had to wake up and sit for a while. And also my nostrils are too often blocked. For few days I had Levocetirizine and currently just using nasal drops. Consulted many doctors over the years. As per the doctors I have nasal muscle swollen or increased which is blocking the way. I had undergone some tests of heart (ECG) and took chest x-ray. Everything was pretty normal. But from last 3-4 days my nights are hell. I could not sleep at all. I am a smoker (half cigarette per day) and drinks alcohol twice a week. Please tell me which doctor to consult? Is it something serious?

Hello, Welcome to Chat Doctor forum. I have checked your x-ray reports (attachment removed to protect patient identity). 1. You have deflected nasal septum with C-shaped deformity of the septal bone and cartilage. Due to this reason you are getting sleep apnea, breathless nights that makes you to wake up and sit for a while to catch the breath.2. Chest pain is an additional symptom that may be due to smoking and it is giving bad impact on your lungs.3. Smoking keeps lung tissue irritated and causing inflammation and then healing. This gets repeated in your case.4. You need to curb smoking and alcoholic beverages.5. Consult a sleep apnea specialist for better management. If felt necessary he will advise medication or will refer you to an otorhinolarngologist for nasal defects. That may need surgical correction. Consult your doctor for prescription of

### Instruction: Answer this question truthfully ###Input: Hello doctor,My brother has swelling on his left foot. He has a boil on his left inner leg 4 inches above his left ankle inner bone. The doctor he visited gave him medicines for his boil and said the boil will come out in some days. The swelling in his foot has increased and so he visited the same doctor the next day and was advised to see an orthopedic. The orthopedic doctor did not diagnose it but referred him to a general doctor who again did not diagnose it but said there is pus buildup inside the foot and it needs surgery. My father who accompanied my brother asked the doctor whether it will subside with medicines or if surgery is needed. The doctor simply said you can use the medicine or you can do the surgery.I am out of the country and feel the doctor may have not specified the situation correctly to my father and also may have not clearly explained why he suggested the surgery. I needed a second opinion, as I want my brother to receive proper treatment and identify if it is a serious condition and I need to know the best solution. I also want to know why the doctor mentioned surgery for a pus buildup and what is the diagnosis of the foot condition. I can provide pictures of my brother\\s foot if needed. ### Response: Hello, Welcome to Chat Doctor forum. He is having diabetes? If yes, what is the sugar level? If yes, first you have to control the sugar level. He is having a deep infected ulcer with cellulitis. What medications he is on? Since it is a deep and swelling extended up to the foot better open the wound and ChatDoctor. Meantime, start tablet Pan 40 (Pantoprazole) one-two times daily before food, tablet Ciprofloxacin 500 mg two times daily, tablet Combiflam (Ibuprofen) one tablet twice daily, and tablet Chymorol forte one tablet thrice times daily for five days after food, and wound

Hello doctor,My brother has swelling on his left foot. He has a boil on his left inner leg 4 inches above his left ankle inner bone. The doctor he visited gave him medicines for his boil and said the boil will come out in some days. The swelling in his foot has increased and so he visited the same doctor the next day and was advised to see an orthopedic. The orthopedic doctor did not diagnose it but referred him to a general doctor who again did not diagnose it but said there is pus buildup inside the foot and it needs surgery. My father who accompanied my brother asked the doctor whether it will subside with medicines or if surgery is needed. The doctor simply said you can use the medicine or you can do the surgery.I am out of the country and feel the doctor may have not specified the situation correctly to my father and also may have not clearly explained why he suggested the surgery. I needed a second opinion, as I want my brother to receive proper treatment and identify if it is a serious condition and I need to know the best solution. I also want to know why the doctor mentioned surgery for a pus buildup and what is the diagnosis of the foot condition. I can provide pictures of my brother\\s foot if needed.

Hello, Welcome to Chat Doctor forum. He is having diabetes? If yes, what is the sugar level? If yes, first you have to control the sugar level. He is having a deep infected ulcer with cellulitis. What medications he is on? Since it is a deep and swelling extended up to the foot better open the wound and ChatDoctor. Meantime, start tablet Pan 40 (Pantoprazole) one-two times daily before food, tablet Ciprofloxacin 500 mg two times daily, tablet Combiflam (Ibuprofen) one tablet twice daily, and tablet Chymorol forte one tablet thrice times daily for five days after food, and wound

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 60, weight is 44 kg, height is 5.6, diabetes for past 25 years, on low carbohydrate diet for 80 days, taking no medicine for diabetes now. Sugar levels are under control, checking every day. The problem from past 50 days is that there are feet and ankle swelling that disappears in the morning and comes back by night. No pain or weight loss. Kidney function test, liver function test, 2D echo, thyroid test, HbA1C, lipid profile, stool examination, B12 tests were done. Met local doctor, and he said it is nutritional pedal edema or malabsorption. Prescribed below medicine. Oroalbumen powder three times for 30 days. Revidox LB twice a day for five days. Lasilactone 25 mg once in the morning for three days. Along with the above, taking Thyronorm 25 mcg, Vitamin C, multivitamin tablet, Omega 3 fish oil, Ecosprin 75. It has been three days, did not see much improvement. Vitamin B12 was 1271. My questions are why is Vitamin B12 high? Could this be small intestine bacterial overgrowth? Taking lots of proteins and healthy food, but no use. Could you please help to get the food absorbed. ### Response: Hi, Welcome to Chat Doctor forum. High vitamin B12 can result from multiple causes. Since your liver function test, kidney function test, peripheral blood smear, etc., are normal (attachment removed to protect patient identity), we can rule out these as the cause. Other causes like diabetes (which you have as evidenced by HBA1c), nonvegetarian diet (do not know your status) and vitamin supplementation (which you are on) can also cause mild elevations. Small intestinal bacterial overgrowth results in Vitamin B12 deficiency.

Hello doctor,I am 60, weight is 44 kg, height is 5.6, diabetes for past 25 years, on low carbohydrate diet for 80 days, taking no medicine for diabetes now. Sugar levels are under control, checking every day. The problem from past 50 days is that there are feet and ankle swelling that disappears in the morning and comes back by night. No pain or weight loss. Kidney function test, liver function test, 2D echo, thyroid test, HbA1C, lipid profile, stool examination, B12 tests were done. Met local doctor, and he said it is nutritional pedal edema or malabsorption. Prescribed below medicine. Oroalbumen powder three times for 30 days. Revidox LB twice a day for five days. Lasilactone 25 mg once in the morning for three days. Along with the above, taking Thyronorm 25 mcg, Vitamin C, multivitamin tablet, Omega 3 fish oil, Ecosprin 75. It has been three days, did not see much improvement. Vitamin B12 was 1271. My questions are why is Vitamin B12 high? Could this be small intestine bacterial overgrowth? Taking lots of proteins and healthy food, but no use. Could you please help to get the food absorbed.

Hi, Welcome to Chat Doctor forum. High vitamin B12 can result from multiple causes. Since your liver function test, kidney function test, peripheral blood smear, etc., are normal (attachment removed to protect patient identity), we can rule out these as the cause. Other causes like diabetes (which you have as evidenced by HBA1c), nonvegetarian diet (do not know your status) and vitamin supplementation (which you are on) can also cause mild elevations. Small intestinal bacterial overgrowth results in Vitamin B12 deficiency.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 31 years old, who weighs 160 lbs and 5.10 feet tall. I drink alcohol on and off since I was 18 years old. Once I got back from deployment, I drank pretty hard with friends. I would say 3 to 8 beers every other night and then 12 to 16 on weekends. I quit drinking cold turkey a month and a few weeks ago, but then I started having weird symptoms. I get panic attacks, my heart would race, and I would get dizzy and light headed. About the same time, I hurt my lower back using an ab roller. Now, my heart still beats faster than it normally does, especially in the mornings when I first get out of the bed. It almost slows back down to normal when my wife and I go on walks though. My back is still hurting as I am waiting for my MRI, but I have been to the ER four times in a month with chest tightness and a racing heart. The last time I went, I was given Morphine, which brought all my vitals back to normal. Am I at risk for alcohol neuropathy or could the racing heart and sometimes shortness of breath be attributed to a potential back injury? ### Response: Hello, Welcome to Chat Doctor forum. After quitting alcohol, many patients get alcohol with ChatDoctor. Chest tightness and racing heart can be because of some cardiac problem like rhythm disturbance or ischemic heart disease, or it can also be due to severe anxiety or panic attack. But it does not seem to be related to the back injury. Chronic alcoholismis a risk factor for developing heart problem also. For back pain, you can get an MRI of the spine. As you have consumed alcohol for such a long time, there is a possibility that it might have affected your nerves already, which may be subclinical and can be looked for by doing the following tests

Hello doctor,I am a 31 years old, who weighs 160 lbs and 5.10 feet tall. I drink alcohol on and off since I was 18 years old. Once I got back from deployment, I drank pretty hard with friends. I would say 3 to 8 beers every other night and then 12 to 16 on weekends. I quit drinking cold turkey a month and a few weeks ago, but then I started having weird symptoms. I get panic attacks, my heart would race, and I would get dizzy and light headed. About the same time, I hurt my lower back using an ab roller. Now, my heart still beats faster than it normally does, especially in the mornings when I first get out of the bed. It almost slows back down to normal when my wife and I go on walks though. My back is still hurting as I am waiting for my MRI, but I have been to the ER four times in a month with chest tightness and a racing heart. The last time I went, I was given Morphine, which brought all my vitals back to normal. Am I at risk for alcohol neuropathy or could the racing heart and sometimes shortness of breath be attributed to a potential back injury?

Hello, Welcome to Chat Doctor forum. After quitting alcohol, many patients get alcohol with ChatDoctor. Chest tightness and racing heart can be because of some cardiac problem like rhythm disturbance or ischemic heart disease, or it can also be due to severe anxiety or panic attack. But it does not seem to be related to the back injury. Chronic alcoholismis a risk factor for developing heart problem also. For back pain, you can get an MRI of the spine. As you have consumed alcohol for such a long time, there is a possibility that it might have affected your nerves already, which may be subclinical and can be looked for by doing the following tests

### Instruction: Answer this question truthfully ###Input: Hi doctor,This is in regards to my daughter who is 5 years old. Four days back suddenly she developed a fever. Fever was around 100 degrees F. Yesterday her fever subsided and now she does not have the same. She did not have a cough, cold, etc. But she lost appetite and she also had left eye white area red. The redness also has disappeared now. She did complain of a little bit of nausea and headache. But yesterday everything subsided and she recovered well. But, yesterday night we saw red bumps around her face, forehead and chest area. It itches sometimes. I am attaching the image for your reference. These bumps are slightly raised. Rest she seems fine now. Her appetite has increased as well.On the second day of her fever, she fainted briefly (a little bit of saliva came out from her mouth) for 5 to 10 seconds. She recovered quickly in a minute or two. This happened in the early morning when she woke up and stood. She had moderately high fever throughout the night. ### Response: Hi, Welcome to Chat Doctor forum. It is urticaria. It happens commonly in chil ChatDoctor. In your daughter's case, that patient may develop this kind of rashes. It will need 5 to 7 days antihistaminics. Tablet Xyzal 5 mg daily for seven days. It is safe and does not have any major or common side effects. It will be fine in 1 to 2 doses but stop it after 5 to 7 days later. As the baby is otherwise fine, no need of other investigations at this moment. But I would like to highlight a point to you that, the possibility of recurrent episodes may be there in future. Whenever it happens you may take Xyzal (Levocetirizine) in an emergency but consult the doctor too without much delay. For more information consult a dermatologist online

Hi doctor,This is in regards to my daughter who is 5 years old. Four days back suddenly she developed a fever. Fever was around 100 degrees F. Yesterday her fever subsided and now she does not have the same. She did not have a cough, cold, etc. But she lost appetite and she also had left eye white area red. The redness also has disappeared now. She did complain of a little bit of nausea and headache. But yesterday everything subsided and she recovered well. But, yesterday night we saw red bumps around her face, forehead and chest area. It itches sometimes. I am attaching the image for your reference. These bumps are slightly raised. Rest she seems fine now. Her appetite has increased as well.On the second day of her fever, she fainted briefly (a little bit of saliva came out from her mouth) for 5 to 10 seconds. She recovered quickly in a minute or two. This happened in the early morning when she woke up and stood. She had moderately high fever throughout the night.

Hi, Welcome to Chat Doctor forum. It is urticaria. It happens commonly in chil ChatDoctor. In your daughter's case, that patient may develop this kind of rashes. It will need 5 to 7 days antihistaminics. Tablet Xyzal 5 mg daily for seven days. It is safe and does not have any major or common side effects. It will be fine in 1 to 2 doses but stop it after 5 to 7 days later. As the baby is otherwise fine, no need of other investigations at this moment. But I would like to highlight a point to you that, the possibility of recurrent episodes may be there in future. Whenever it happens you may take Xyzal (Levocetirizine) in an emergency but consult the doctor too without much delay. For more information consult a dermatologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,Over six months I have had what was thought to be an epidermoid cyst at the end of the right side of my nose. I have taken antibiotics on a regular basis as there is redness, swelling and tenderness in the area when inflamed. Approximately 2 weeks ago this cyst on my nose became very inflamed or infected. I was experiencing headache, sore neck, painful and uncomfortable nose and facial pressure (swelling), pressure in my ears and dry infected eye that too right side consequently. I visited GP and had CT scan of paranasal sinuses. I hope you could provide me the explanation for the below sentence, which I am unable to understand. The nasal septum deviates towards the right associated with a large right sided bony spur which abuts the right middle turbinate. Pneumatization of the left middle turbinate (concha bullosa) noted. In simple terms what does this mean? What is the likely recommended action for this? Are these comments and findings consistent with the symptoms I have experienced? ### Response: Hi, Welcome to Chat Doctor forum. It means there is obstruction to your sinus ChatDoctor. Due to retained secretions in the paranasal sinuses there is infection and headache. Nasal septum deviation to the right means that the central bone of your nose is not straight and is bent towards the right side. A surgical procedure called septoplasty is done to correct the deviated nasal septum. It is an intranasal operative procedure may be performed under local or general anesthesia. Turbinates are bony structures that project from the side of the nose that function to humidify and warm the air. Concha bullosa is presence of an air cell inside the turbinate. The middle turbinates have an inner core of thin, single-layered bone covered with the normal nasal membranes. Occasionally that bone can get pneumatized and results in a much bulkier structure. This will lead to blockage of breathing passages as well as obstruction of sinus

Hi doctor,Over six months I have had what was thought to be an epidermoid cyst at the end of the right side of my nose. I have taken antibiotics on a regular basis as there is redness, swelling and tenderness in the area when inflamed. Approximately 2 weeks ago this cyst on my nose became very inflamed or infected. I was experiencing headache, sore neck, painful and uncomfortable nose and facial pressure (swelling), pressure in my ears and dry infected eye that too right side consequently. I visited GP and had CT scan of paranasal sinuses. I hope you could provide me the explanation for the below sentence, which I am unable to understand. The nasal septum deviates towards the right associated with a large right sided bony spur which abuts the right middle turbinate. Pneumatization of the left middle turbinate (concha bullosa) noted. In simple terms what does this mean? What is the likely recommended action for this? Are these comments and findings consistent with the symptoms I have experienced?

Hi, Welcome to Chat Doctor forum. It means there is obstruction to your sinus ChatDoctor. Due to retained secretions in the paranasal sinuses there is infection and headache. Nasal septum deviation to the right means that the central bone of your nose is not straight and is bent towards the right side. A surgical procedure called septoplasty is done to correct the deviated nasal septum. It is an intranasal operative procedure may be performed under local or general anesthesia. Turbinates are bony structures that project from the side of the nose that function to humidify and warm the air. Concha bullosa is presence of an air cell inside the turbinate. The middle turbinates have an inner core of thin, single-layered bone covered with the normal nasal membranes. Occasionally that bone can get pneumatized and results in a much bulkier structure. This will lead to blockage of breathing passages as well as obstruction of sinus

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have been getting acne for a few months. Two years back, I skipped a period. Then, my periods are regular, but the cycle is usually delayed by four to five days and sometimes more than that. My period lasts for 3 days rather than 5 to 7 days. I consulted a gynecologist and underwent some hormone tests and ultrasound. I am sharing the reports with you. Please let me know whether I am a patient of PCOS. Will PCOS cause acne? What could be done to prevent cycle delay? How to resolve this PCOS problem? My gynecologist prescribed Gynex syrup and Ovalife tablets for three months. However, I have not started yet. Please provide a second opinion. ### Response: Hi, Welcome to Chat Doctor forum. I have seen your reports (attachment removed to protect patient identity). According to the ultrasound report, it is PCOS only (polycystic ovarian syn ChatDoctor. All other tests ordered are normal. To confirm this by hormonal correlation, you need to get your FSH (follicle stimulating hormone) and LH (Luteinizing hormone) levels done on day 2 of cycle. It is the reversal of this ratio in PCOS. You may take Ovalife tablet. It is just a supplement. PCOS is not a disease, but just hormonal imbalance. You are a lean PCOS as you are very thin with a BMI of 23. Try to maintain your weight by a good and balanced diet and regular exercise. For reduction of acne and maintaining regularity of your cycles, I suggest tablet Diane 35 (Ethinyl estradiol) once a day for 21 days starting from day 2 of the cycle. Consult your specialist doctor, discuss with him or her and take the medicine with consent. However, regarding acne, your male hormone testosterone levels and also free insulin levels are within normal range and probably not the cause of acne. Consult a dermatologist for acne.

Hi doctor,I have been getting acne for a few months. Two years back, I skipped a period. Then, my periods are regular, but the cycle is usually delayed by four to five days and sometimes more than that. My period lasts for 3 days rather than 5 to 7 days. I consulted a gynecologist and underwent some hormone tests and ultrasound. I am sharing the reports with you. Please let me know whether I am a patient of PCOS. Will PCOS cause acne? What could be done to prevent cycle delay? How to resolve this PCOS problem? My gynecologist prescribed Gynex syrup and Ovalife tablets for three months. However, I have not started yet. Please provide a second opinion.

Hi, Welcome to Chat Doctor forum. I have seen your reports (attachment removed to protect patient identity). According to the ultrasound report, it is PCOS only (polycystic ovarian syn ChatDoctor. All other tests ordered are normal. To confirm this by hormonal correlation, you need to get your FSH (follicle stimulating hormone) and LH (Luteinizing hormone) levels done on day 2 of cycle. It is the reversal of this ratio in PCOS. You may take Ovalife tablet. It is just a supplement. PCOS is not a disease, but just hormonal imbalance. You are a lean PCOS as you are very thin with a BMI of 23. Try to maintain your weight by a good and balanced diet and regular exercise. For reduction of acne and maintaining regularity of your cycles, I suggest tablet Diane 35 (Ethinyl estradiol) once a day for 21 days starting from day 2 of the cycle. Consult your specialist doctor, discuss with him or her and take the medicine with consent. However, regarding acne, your male hormone testosterone levels and also free insulin levels are within normal range and probably not the cause of acne. Consult a dermatologist for acne.

### Instruction: Answer this question truthfully ###Input: Hello doctor,For the last almost three weeks, I am having a pain in the lower right-hand side of the soft palate while swallowing saliva (or while swallowing on empty, without food. It does not happen all the time, but it is frequent. When I swallow food or liquid, there is no pain. I feel that the pain originates somewhere behind the skin of the soft palate, or within the soft palate itself.When touching that region with my finger, there is no pain. I do not see any redness in the back of my mouth, and generally, I do not see any irregularities. However, this is not a doctor, but me viewing. Also, I noticed that the arc of the right-hand side soft palate is a bit dropped compared to the one on the left-hand side. I do not know if this condition was present before (I never paid attention to that) or is something that I have for a while, or since birth. I am 51 and have regular yearly medical exams (complete blood work, biomarkers, abdomen, prostate, etc.). I do not take any medications. So far, I have been a healthy man. Any advice is welcome. Any suggestions on what to check, look, or do, too. I am asking for advice because I do not have at the moment medical insurance. I will be back at home in three months. ### Response: Hello. I have seen the pictures, and your oral cavity seems to be normal. Can you highlight the area where you have pain? Do you have acidity? Generally in any infection of the oral cavity or larynx pain is more while swallowing saliva than swallowing solid bland food or liquid. So if you have a mild infection, you will not have much pain or any pain while having food. Also, let me know if the pain is associated with the diurnal variation. Any complaints of the ChatDoctor. Do you consume alcohol, tobacco?

Hello doctor,For the last almost three weeks, I am having a pain in the lower right-hand side of the soft palate while swallowing saliva (or while swallowing on empty, without food. It does not happen all the time, but it is frequent. When I swallow food or liquid, there is no pain. I feel that the pain originates somewhere behind the skin of the soft palate, or within the soft palate itself.When touching that region with my finger, there is no pain. I do not see any redness in the back of my mouth, and generally, I do not see any irregularities. However, this is not a doctor, but me viewing. Also, I noticed that the arc of the right-hand side soft palate is a bit dropped compared to the one on the left-hand side. I do not know if this condition was present before (I never paid attention to that) or is something that I have for a while, or since birth. I am 51 and have regular yearly medical exams (complete blood work, biomarkers, abdomen, prostate, etc.). I do not take any medications. So far, I have been a healthy man. Any advice is welcome. Any suggestions on what to check, look, or do, too. I am asking for advice because I do not have at the moment medical insurance. I will be back at home in three months.

Hello. I have seen the pictures, and your oral cavity seems to be normal. Can you highlight the area where you have pain? Do you have acidity? Generally in any infection of the oral cavity or larynx pain is more while swallowing saliva than swallowing solid bland food or liquid. So if you have a mild infection, you will not have much pain or any pain while having food. Also, let me know if the pain is associated with the diurnal variation. Any complaints of the ChatDoctor. Do you consume alcohol, tobacco?

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am having -9 spherical and -2 and -1.5 cylindrical power in my eyes. I have a border line eye pressure. Doctor said I cannot take laser or ICL surgery but can have ReLex Smile for that power. But it also needs some cornea tissues which is a risk factor for glaucoma. I do not know what to do now? Which treatment is better for me and the doctor just gave normal lubricant drops? Is there any treatment for me for refractive surgery by controlling eye pressure? ### Response: Hi, Welcome to Chat Doctor forum. How much is your eye pressure? Did the doctor measure it with an instrument that puffs out air at you or was it a blue light instrument that he used to touch your eye with? From what you have told me, I understand that you are interested in refractive surgery. But the doctor refused to operate on you saying your pressures are high and that your power is too high for lasik. It is true that your power is on the higher end of the patients we usually consider for surgery so doing lasik and PRK (photorefractive keratectomy) is not possible on the eye with -9D but can be done on the eye with -2 and -1.5D. Putting an ICL (implantable contact lens) in your eye might increase your eye pressure. So I will not recommend that. ReLex SMILE can be tried in both your eyes if the surgeon is confident. I am guessing that he would have asked you to come for a follow up to re-check pressures. If the pressures were too high, he would have asked for visual fields and a few other tests for glaucoma. In either case, it all depends on the surgeon\\s experience and your eye pressures. If you can tell me about your eye pressure and your vision in each eye with -9D and -2/-1.5D, I could help you better.

Hello doctor,I am having -9 spherical and -2 and -1.5 cylindrical power in my eyes. I have a border line eye pressure. Doctor said I cannot take laser or ICL surgery but can have ReLex Smile for that power. But it also needs some cornea tissues which is a risk factor for glaucoma. I do not know what to do now? Which treatment is better for me and the doctor just gave normal lubricant drops? Is there any treatment for me for refractive surgery by controlling eye pressure?

Hi, Welcome to Chat Doctor forum. How much is your eye pressure? Did the doctor measure it with an instrument that puffs out air at you or was it a blue light instrument that he used to touch your eye with? From what you have told me, I understand that you are interested in refractive surgery. But the doctor refused to operate on you saying your pressures are high and that your power is too high for lasik. It is true that your power is on the higher end of the patients we usually consider for surgery so doing lasik and PRK (photorefractive keratectomy) is not possible on the eye with -9D but can be done on the eye with -2 and -1.5D. Putting an ICL (implantable contact lens) in your eye might increase your eye pressure. So I will not recommend that. ReLex SMILE can be tried in both your eyes if the surgeon is confident. I am guessing that he would have asked you to come for a follow up to re-check pressures. If the pressures were too high, he would have asked for visual fields and a few other tests for glaucoma. In either case, it all depends on the surgeon\\s experience and your eye pressures. If you can tell me about your eye pressure and your vision in each eye with -9D and -2/-1.5D, I could help you better.

### Instruction: Answer this question truthfully ###Input: Hello doctor,On March 1st I flew to Utah from Texas and developed cold symptoms after three days. It was a normal cold, but as it was almost gone (no more congestion, did not feel sick anymore), I lost the sense of taste and smell overnight. I have not had a sense of taste or smell for 11 days now. I do have a history of losing my sense of taste and smell for a few days during cold with congestion and for four weeks when I had mono.I did speak with a general doctor and he seems to think my loss of taste and smell is cold or allergy-related so he does not think I have Coronavirus. However, this loss of sense of smell is different than all the rest. I have never been without smell for this long after a normal cold and I have had a fairly clear nose for the entire duration of it so it cannot be due to congestion. I just wanted to get a second opinion on if you think it could be Coronavirus as news has just come out that this is a possible symptom of asymptomatic Coronavirus carriers.I am currently on Amoxicillin for sinus infection. ### Response: Hello. I appreciate your timely picking up of the signs and reaching out to us. We have two scenarios. First, is that you have Coronavirus infection and the cold, allergy, and loss of smell are due to it unless you develop more severe symptoms like fever, temperature, breathing difficulty, respiratory distress, you do not go anywhere out of home. You are gonna remain quarantined till 15 days from now. Take plenty of fluids and water. Eat good and normal diet. Exercise indoors if you can. Second, it is allergy-related. In this case, it should subside in some time. You can try some nasal steroids and other measures told above. In the first scenario also nasal steroids can be tried. You can revert back to us if you need any further support. Take care.

Hello doctor,On March 1st I flew to Utah from Texas and developed cold symptoms after three days. It was a normal cold, but as it was almost gone (no more congestion, did not feel sick anymore), I lost the sense of taste and smell overnight. I have not had a sense of taste or smell for 11 days now. I do have a history of losing my sense of taste and smell for a few days during cold with congestion and for four weeks when I had mono.I did speak with a general doctor and he seems to think my loss of taste and smell is cold or allergy-related so he does not think I have Coronavirus. However, this loss of sense of smell is different than all the rest. I have never been without smell for this long after a normal cold and I have had a fairly clear nose for the entire duration of it so it cannot be due to congestion. I just wanted to get a second opinion on if you think it could be Coronavirus as news has just come out that this is a possible symptom of asymptomatic Coronavirus carriers.I am currently on Amoxicillin for sinus infection.

Hello. I appreciate your timely picking up of the signs and reaching out to us. We have two scenarios. First, is that you have Coronavirus infection and the cold, allergy, and loss of smell are due to it unless you develop more severe symptoms like fever, temperature, breathing difficulty, respiratory distress, you do not go anywhere out of home. You are gonna remain quarantined till 15 days from now. Take plenty of fluids and water. Eat good and normal diet. Exercise indoors if you can. Second, it is allergy-related. In this case, it should subside in some time. You can try some nasal steroids and other measures told above. In the first scenario also nasal steroids can be tried. You can revert back to us if you need any further support. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,From the past five days, I am sending my 21 month old son to a daycare. For the first three days, they allowed me inside the campus. Since I was close by, he was playing well. But, from the last two days, they are not allowing me inside and hence he is crying a lot. Today he was a bit fine but, not actually enjoying. Will it affect my child\\s health? Will it create any psychological problem in him? I have heard that the cortisol hormone levels will be changed. Is that true? My in-laws are not staying with us. So, I have to either send him to the day care or I will have to send him to my in-laws\\. Which is the best option? ### Response: Hello, Welcome to Chat Doctor forum. I have gone through your query and understood your concern. Yes, it is true that the child may suffer from some psychological problems when not staying with the parents or the regular care giver as it occurs in some foster homes. But, as you mentioned that it is only for a few hours every day, it does not affect significantly. Make sure you are available to the child after your office hours and then take proper care of him physically and emotionally. Since in a daycare system, there will be other chil ChatDoctor. So, it is not a problem. After a few days in the daycare, if you observe some changes in the baby, you may assume that the baby is not comfortable there. But, in the initial days, it is normal for him to behave like this as the baby has anxiety from the unknown surroundings and people. Leaving the baby at your in laws\\ place is a good option, provided they are able to take care of him. You can wait for a few days or weeks to see if the baby is comfortable in that place and then decide. Regards. For more information consult a psychiatrist online

Hello doctor,From the past five days, I am sending my 21 month old son to a daycare. For the first three days, they allowed me inside the campus. Since I was close by, he was playing well. But, from the last two days, they are not allowing me inside and hence he is crying a lot. Today he was a bit fine but, not actually enjoying. Will it affect my child\\s health? Will it create any psychological problem in him? I have heard that the cortisol hormone levels will be changed. Is that true? My in-laws are not staying with us. So, I have to either send him to the day care or I will have to send him to my in-laws\\. Which is the best option?

Hello, Welcome to Chat Doctor forum. I have gone through your query and understood your concern. Yes, it is true that the child may suffer from some psychological problems when not staying with the parents or the regular care giver as it occurs in some foster homes. But, as you mentioned that it is only for a few hours every day, it does not affect significantly. Make sure you are available to the child after your office hours and then take proper care of him physically and emotionally. Since in a daycare system, there will be other chil ChatDoctor. So, it is not a problem. After a few days in the daycare, if you observe some changes in the baby, you may assume that the baby is not comfortable there. But, in the initial days, it is normal for him to behave like this as the baby has anxiety from the unknown surroundings and people. Leaving the baby at your in laws\\ place is a good option, provided they are able to take care of him. You can wait for a few days or weeks to see if the baby is comfortable in that place and then decide. Regards. For more information consult a psychiatrist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 31 year old male. For about two weeks or more, I have been experiencing a mild nonspecific pain in my upper body. It is mostly at the upper back, at the center and slightly towards the right. At times, it occurs in the middle and lower back, at the sides, behind the right upper arm, and occasionally around the chest and right collarbone. Mostly it is in the upper back at the center and slightly towards the right. The pain is mild and not at all severe or crippling. The feeling is sometimes of little stiffness, and sometimes a throbbing or pounding. I do not feel any trouble in doing my usual chores.I have a habit of examining my body, pressing here and there to feel anything unusual and on one such occasion, I had found a couple of places on my chest which was painful when pressed deeply, but I do not feel anything unusual under the skin. In fact, several months ago, I had found a couple of other places on the sides which were painful when pressed deeply. I have a desk job, though I get up and move around quite regularly. I do not remember having any injury. I have never had any major accident. My queries are, what may be the possible causes and could they be serious? And, is there any chance this has any connection with lungs? I do not have any breathing difficulty and do not feel any pain or anything unusual while deep breathing. In fact, I have a habit of walking, and only a couple of days ago, I had walked 4 km at a stretch without any extra effort or discomfort. Please advice. ### Response: Hello, I went through your detailed post. The predominant complaint is a mild pain in the upper back and around the arm. If these possibilities are excluded by investigations and a clinical examination, then a chest X-ray is warranted. Regards. For more information consult an internal medicine physician online

Hello doctor,I am a 31 year old male. For about two weeks or more, I have been experiencing a mild nonspecific pain in my upper body. It is mostly at the upper back, at the center and slightly towards the right. At times, it occurs in the middle and lower back, at the sides, behind the right upper arm, and occasionally around the chest and right collarbone. Mostly it is in the upper back at the center and slightly towards the right. The pain is mild and not at all severe or crippling. The feeling is sometimes of little stiffness, and sometimes a throbbing or pounding. I do not feel any trouble in doing my usual chores.I have a habit of examining my body, pressing here and there to feel anything unusual and on one such occasion, I had found a couple of places on my chest which was painful when pressed deeply, but I do not feel anything unusual under the skin. In fact, several months ago, I had found a couple of other places on the sides which were painful when pressed deeply. I have a desk job, though I get up and move around quite regularly. I do not remember having any injury. I have never had any major accident. My queries are, what may be the possible causes and could they be serious? And, is there any chance this has any connection with lungs? I do not have any breathing difficulty and do not feel any pain or anything unusual while deep breathing. In fact, I have a habit of walking, and only a couple of days ago, I had walked 4 km at a stretch without any extra effort or discomfort. Please advice.

Hello, I went through your detailed post. The predominant complaint is a mild pain in the upper back and around the arm. If these possibilities are excluded by investigations and a clinical examination, then a chest X-ray is warranted. Regards. For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hi doctor,My daughter is 20 years old and studying in a hostel. For the last one month, she is suffering from a headache. After taking painkiller it subsides and again it stars on the next day. So after three days, I consulted an ENT doctor and he after examining and after taking X-ray, diagnosed it as sinus headache and gave antibiotics and painkillers for five days. She completed the course and while using the tablets she did not have a headache. Now, again she has a headache.Kindly advise whether the headache is really from sinusitis. Why am I doubting that she has only headache with mild nose block and no other symptoms like discharge or fever. So, my doubt is whether it is sinus headache or not and if it is due to sinusitis even after completing the course why again headache? ### Response: Hi, Welcome to Chat Doctor forum. Headache can be of many reasons but while pertaining it to ENT, it is mostly due to sinusitis. For declaring the headache due to sinusitis you should have got done a nasal diagnostic endoscopy by an ENT surgeon or should get a CT scan of the paranasal sinus. X-rays are of the very very old generation and no one is using it as a tool to diagnose it. But since you have got the X-ray done, kindly share it along with the reports. Kindly understand that if at all the sinusitis persists the medical management which may completely reduce sinus infection is antibiotics up to 4 to 6 weeks (for a permanent cure) along with mucolytics, a short course of oral steroids and nasal spray if the patient is allergic to dust or pollen. If the above medical management fails then the patient has to be subjected to surgery which we can decide with our CT scan. As you have also mentioned regarding nose block a deviated nasal septum can also be a cause for headache. So kindly share the X-ray report.

Hi doctor,My daughter is 20 years old and studying in a hostel. For the last one month, she is suffering from a headache. After taking painkiller it subsides and again it stars on the next day. So after three days, I consulted an ENT doctor and he after examining and after taking X-ray, diagnosed it as sinus headache and gave antibiotics and painkillers for five days. She completed the course and while using the tablets she did not have a headache. Now, again she has a headache.Kindly advise whether the headache is really from sinusitis. Why am I doubting that she has only headache with mild nose block and no other symptoms like discharge or fever. So, my doubt is whether it is sinus headache or not and if it is due to sinusitis even after completing the course why again headache?

Hi, Welcome to Chat Doctor forum. Headache can be of many reasons but while pertaining it to ENT, it is mostly due to sinusitis. For declaring the headache due to sinusitis you should have got done a nasal diagnostic endoscopy by an ENT surgeon or should get a CT scan of the paranasal sinus. X-rays are of the very very old generation and no one is using it as a tool to diagnose it. But since you have got the X-ray done, kindly share it along with the reports. Kindly understand that if at all the sinusitis persists the medical management which may completely reduce sinus infection is antibiotics up to 4 to 6 weeks (for a permanent cure) along with mucolytics, a short course of oral steroids and nasal spray if the patient is allergic to dust or pollen. If the above medical management fails then the patient has to be subjected to surgery which we can decide with our CT scan. As you have also mentioned regarding nose block a deviated nasal septum can also be a cause for headache. So kindly share the X-ray report.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have been dealing with anxiety since childhood. I am 22 years old now. I have been smoking weed for about six months and my quality of life drastically improved. Now, I could sleep at night. I went back to being myself happy. My confidence went up and my social anxiety virtually disappeared. Once, while watching videos on the internet, I came across one talking about reality and how we might be part of some sort of virtual reality. When I started thinking about that, it really freaked me out and I had a panic attack. Then, the mixture of the anxiety and being high made me really entertain the idea of this reality was fake. I was in a constant state of being on the brink of a panic attack for a few days afterwards, even while being completely sober. I am better now, through the day I am fine even thinking back on it makes me kind of laugh. But, when I am alone at night the thought comes back and no matter how hard I try, I cannot take my mind off it. I could not sleep because of the anxiety related symptoms, putting on a podcast and listening to people talk is the only way to calm me down. I hate this and I cannot stop thinking about how I may become this crazy person who truly believes were in some sort of matrix and end up in some asylum rocking back and forth. Should I be worried about this? Am I going crazy? I do not want to develop schizophrenia and lose touch with reality. I have not smoked since the incident and I have gotten better. But, I am worried that I will never be able to shake off these thoughts, although I know these thoughts are completely ludacris and I am truly fine. Will time resolve this? ### Response: Hi, Welcome to Chat Doctor forum. I read your query and understand your concerns. Before I answer your question I like to congratulate you for taking the necessary step of stopping cannabis.

Hi doctor,I have been dealing with anxiety since childhood. I am 22 years old now. I have been smoking weed for about six months and my quality of life drastically improved. Now, I could sleep at night. I went back to being myself happy. My confidence went up and my social anxiety virtually disappeared. Once, while watching videos on the internet, I came across one talking about reality and how we might be part of some sort of virtual reality. When I started thinking about that, it really freaked me out and I had a panic attack. Then, the mixture of the anxiety and being high made me really entertain the idea of this reality was fake. I was in a constant state of being on the brink of a panic attack for a few days afterwards, even while being completely sober. I am better now, through the day I am fine even thinking back on it makes me kind of laugh. But, when I am alone at night the thought comes back and no matter how hard I try, I cannot take my mind off it. I could not sleep because of the anxiety related symptoms, putting on a podcast and listening to people talk is the only way to calm me down. I hate this and I cannot stop thinking about how I may become this crazy person who truly believes were in some sort of matrix and end up in some asylum rocking back and forth. Should I be worried about this? Am I going crazy? I do not want to develop schizophrenia and lose touch with reality. I have not smoked since the incident and I have gotten better. But, I am worried that I will never be able to shake off these thoughts, although I know these thoughts are completely ludacris and I am truly fine. Will time resolve this?

Hi, Welcome to Chat Doctor forum. I read your query and understand your concerns. Before I answer your question I like to congratulate you for taking the necessary step of stopping cannabis.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 32-year-old woman. The one with whom I am in love sometimes behave rudely to me. He remains silent whenever he dislikes anything that I say. I am a bit outspoken, and I am unable to control this. His silence kills me. I find it difficult to do routine work. I feel so sad and shattered. He will not answer my messages and will not pick up my call even if I had called 50 times a day. I feel like hurting myself. I suffer from depression since childhood, and I am taking Amitriptyline since the last 13-14 years. How can I divert my mind and focus on my work during those times? It happens almost twice a month. We are together for five years now. ### Response: Hello. It looks like you and your partner have different personality styles and deal with conflicts differently. For example, if you are an extrovert, you would like to talk your way through issues. But if your partner is an introvert, he may have an aversion to conflict and arguments and may with ChatDoctor. This is a natural way of responding to some people and not to be taken personally. If your partner is otherwise fine and treats you well, it may be helpful to have an open and honest discussion with him when both of you are calm. Write down your thoughts if direct talking can be difficult and ask your partner to reply. Both of you have to respect each other and learn to form your ways of dealing with conflict as a couple. It is natural for all couples to have disagreements, try not to overthink in such situations. Try relaxation techniques and carry on with your usual routines. If needed, you can try counseling or couples therapy. Also, look after your emotional health. Consult your doctor to review your mental health and the need for continuing anti-depressants. I hope this helps. Take care.

Hello doctor,I am a 32-year-old woman. The one with whom I am in love sometimes behave rudely to me. He remains silent whenever he dislikes anything that I say. I am a bit outspoken, and I am unable to control this. His silence kills me. I find it difficult to do routine work. I feel so sad and shattered. He will not answer my messages and will not pick up my call even if I had called 50 times a day. I feel like hurting myself. I suffer from depression since childhood, and I am taking Amitriptyline since the last 13-14 years. How can I divert my mind and focus on my work during those times? It happens almost twice a month. We are together for five years now.

Hello. It looks like you and your partner have different personality styles and deal with conflicts differently. For example, if you are an extrovert, you would like to talk your way through issues. But if your partner is an introvert, he may have an aversion to conflict and arguments and may with ChatDoctor. This is a natural way of responding to some people and not to be taken personally. If your partner is otherwise fine and treats you well, it may be helpful to have an open and honest discussion with him when both of you are calm. Write down your thoughts if direct talking can be difficult and ask your partner to reply. Both of you have to respect each other and learn to form your ways of dealing with conflict as a couple. It is natural for all couples to have disagreements, try not to overthink in such situations. Try relaxation techniques and carry on with your usual routines. If needed, you can try counseling or couples therapy. Also, look after your emotional health. Consult your doctor to review your mental health and the need for continuing anti-depressants. I hope this helps. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My brother, 46, has ALD cirrhosis. He was admitted to a hospital. Day-6 now. And is undergoing withdrawal and other treatment. MELD score is 22-24; ammonia 40 (down from 70). Low platelets, lot of bruises from falling pre-admittance. Signs of advanced hepatic encephalopathy. Treatment includes Rocephin, Librium, Lasix, Lactulose, Keppra, Magnesium and multivitamins, Presnison, Rifaximin, and Spironolactone.Prognosis is very unclear as assessments are day by day. Due to the UNOS policy, any transplant (including live donor, which I would do) will not happen for six months due to a waitlist. It is almost a death sentence and unfair. Especially in the context of a live family donor.What else can we do to immediately treat his degrading condition from a medical perspective? He has zero energy, cannot feed himself, barely can talk. Just last week, he was walking around and fairly alright (according to wife). Can we introduce alternative medicine? ### Response: Hi, Welcome to Chat Doctor forum. First of all, you need to understand that alternative therapies do not work in acute severe states. You can consider them later once he recovers. At this point of time, apart from medical management that is already being done, you can discuss with your doctor for liver assisted therapy in which there is a machine that acts as a pseudo liver. This is used till a liver transplant is arranged. The second option is shifting him to countries where you can still go for emergency transplant provided you have a donor. Discuss with your doctor regarding partial liver transplant in which a live donor can give a partial portion of his liver to him. That donor can be from your family. You need to check if your hospital provides these facilities. For more information consult a medical gastroenterologist online

Hello doctor,My brother, 46, has ALD cirrhosis. He was admitted to a hospital. Day-6 now. And is undergoing withdrawal and other treatment. MELD score is 22-24; ammonia 40 (down from 70). Low platelets, lot of bruises from falling pre-admittance. Signs of advanced hepatic encephalopathy. Treatment includes Rocephin, Librium, Lasix, Lactulose, Keppra, Magnesium and multivitamins, Presnison, Rifaximin, and Spironolactone.Prognosis is very unclear as assessments are day by day. Due to the UNOS policy, any transplant (including live donor, which I would do) will not happen for six months due to a waitlist. It is almost a death sentence and unfair. Especially in the context of a live family donor.What else can we do to immediately treat his degrading condition from a medical perspective? He has zero energy, cannot feed himself, barely can talk. Just last week, he was walking around and fairly alright (according to wife). Can we introduce alternative medicine?

Hi, Welcome to Chat Doctor forum. First of all, you need to understand that alternative therapies do not work in acute severe states. You can consider them later once he recovers. At this point of time, apart from medical management that is already being done, you can discuss with your doctor for liver assisted therapy in which there is a machine that acts as a pseudo liver. This is used till a liver transplant is arranged. The second option is shifting him to countries where you can still go for emergency transplant provided you have a donor. Discuss with your doctor regarding partial liver transplant in which a live donor can give a partial portion of his liver to him. That donor can be from your family. You need to check if your hospital provides these facilities. For more information consult a medical gastroenterologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,For three months now, two days after finishing a 21-day course of antibiotics to clear an E.Coli UTI, I have redness on my meatus and lighter redness on my glans and also intermittent irritation of the foreskin. All this with no itching, no discharge or pain whatsoever. I have been tested for UTI again and also all possible STD\\s and all are negative. I was sent to a dermatologist and she told me it might be a yeast infection and prescribed a two time 150 mg of Fluconazole which had absolutely no effect. I also prior to all my visits to the doctors tried treating myself topically a week at a time with multiple creams such as Canesten, Fucidin, coconut oil, shea butter which all do nothing but hydrate the skin. I have been taking probiotics and antifungal supplements, following a low sugar diet for almost a month and nothing cuts it.I am starting to wonder if it could be something else than a fungal infection since nothing I have tried is working. Could it be bacterial? Are symptoms different? And if my symptoms are causing no pain could it be something else than an infection? ### Response: Hi. I have gone through your query and would like to know a few more details to answer your query better. Based on your history of medication, it is unlikely for any bacterial infection to be persistent for such a long time and without any overt symptoms. Fungal infections may persist and may require prolonged treatment sometimes, a simple skin scraping test can help diagnose it. Another possibility is non-infectious inflammation, which is common around the meatus and glans called BXO (balanitis xerotica obliterans) which in early stages can cause similar symptoms but needs a clinical examination to diagnose. I would advise you to visit your local urologist who can clinically examine you and identify your problem. For more information consult an urologist online Take care.

Hello doctor,For three months now, two days after finishing a 21-day course of antibiotics to clear an E.Coli UTI, I have redness on my meatus and lighter redness on my glans and also intermittent irritation of the foreskin. All this with no itching, no discharge or pain whatsoever. I have been tested for UTI again and also all possible STD\\s and all are negative. I was sent to a dermatologist and she told me it might be a yeast infection and prescribed a two time 150 mg of Fluconazole which had absolutely no effect. I also prior to all my visits to the doctors tried treating myself topically a week at a time with multiple creams such as Canesten, Fucidin, coconut oil, shea butter which all do nothing but hydrate the skin. I have been taking probiotics and antifungal supplements, following a low sugar diet for almost a month and nothing cuts it.I am starting to wonder if it could be something else than a fungal infection since nothing I have tried is working. Could it be bacterial? Are symptoms different? And if my symptoms are causing no pain could it be something else than an infection?

Hi. I have gone through your query and would like to know a few more details to answer your query better. Based on your history of medication, it is unlikely for any bacterial infection to be persistent for such a long time and without any overt symptoms. Fungal infections may persist and may require prolonged treatment sometimes, a simple skin scraping test can help diagnose it. Another possibility is non-infectious inflammation, which is common around the meatus and glans called BXO (balanitis xerotica obliterans) which in early stages can cause similar symptoms but needs a clinical examination to diagnose. I would advise you to visit your local urologist who can clinically examine you and identify your problem. For more information consult an urologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My mother is 51 years old and she had thyroid sometime in the past. There are no signs of it from the last one year. However, she has these bulging eyes all the time, but she can perfectly see everything with her spectacles. I do not really know what happened to her the other day. She was watching her favorite TV show and all of sudden, her right eye popped out of her eye socket and she started shouting. It was such a scary and frightening situation where I and my dad did not know what to do and out of nowhere, my dad suddenly pushed her eye with a little pressure and the eye was back in its position as usual. My mom experienced severe pain after this incident when she was rushed to an Ophthalmologist. The doctor had no clue about the reason for her eye pop out. However, I advised her to go through a few medical tests and the results are yet to come. Meantime, I just want to understand why this happened to her and will this happen regularly and what is the treatment needed to prevent this from happening again. I just do not want to think of any situation where she is alone in the home and the same happens to her. I just want her to be completely cured from this one. Please help me with my query. ### Response: Hello, Welcome to Chat Doctor forum. From your question, it is not mentioned if it is hypo or hyperthyroid. But the symptoms suggest it would be hyperthyroidism or Graves' disease. I hope your mother is on medication otherwise the condition might worsen. The condition occurs due to overgrowth of tissues around the eyeball which occurs in this disease. It is not reversible but you can consult an oculoplasty clinic where a surgical decompression can be done. These are complications of the thyroid disease. It would have not developed if diagnosed earlier. T3, T4, TSH (thyroid stimulating hormone), and antithyroid antibodies.

Hello doctor,My mother is 51 years old and she had thyroid sometime in the past. There are no signs of it from the last one year. However, she has these bulging eyes all the time, but she can perfectly see everything with her spectacles. I do not really know what happened to her the other day. She was watching her favorite TV show and all of sudden, her right eye popped out of her eye socket and she started shouting. It was such a scary and frightening situation where I and my dad did not know what to do and out of nowhere, my dad suddenly pushed her eye with a little pressure and the eye was back in its position as usual. My mom experienced severe pain after this incident when she was rushed to an Ophthalmologist. The doctor had no clue about the reason for her eye pop out. However, I advised her to go through a few medical tests and the results are yet to come. Meantime, I just want to understand why this happened to her and will this happen regularly and what is the treatment needed to prevent this from happening again. I just do not want to think of any situation where she is alone in the home and the same happens to her. I just want her to be completely cured from this one. Please help me with my query.

Hello, Welcome to Chat Doctor forum. From your question, it is not mentioned if it is hypo or hyperthyroid. But the symptoms suggest it would be hyperthyroidism or Graves' disease. I hope your mother is on medication otherwise the condition might worsen. The condition occurs due to overgrowth of tissues around the eyeball which occurs in this disease. It is not reversible but you can consult an oculoplasty clinic where a surgical decompression can be done. These are complications of the thyroid disease. It would have not developed if diagnosed earlier. T3, T4, TSH (thyroid stimulating hormone), and antithyroid antibodies.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Last month I had I-pill (within 48hours of intercourse) after 18 days of onset of my periods. I did not have any side effects like withdrawal bleeding, nausea, etc., after taking the I-pill. I got my periods on the 1st of this month. I am unsure if this is my normal period or bleeding due to the side effect of I-pill? Please help me to clarify this. If it is my regular periods, then there is no delay in it (a week before or week after than expected date). Is it normal? Is there a need to take a test or any chances of pregnancy? If yes, when to take the test? ### Response: Hello, Welcome to Chat Doctor forum. Let me start by assuring you that you are not pregnant and need not worry. If you have had your periods 18 days before taking I-pill, your ovulation would have been around 13 to 15 days after that. Life of egg is only one day. So there is no chance of an egg being alive on that day of sex. I-pill or emergency contraception pill is a high dose of progesterone hormone. After ovulation, your ovary also will be producing the same hormone. As you have taken it after the ovulation date, the thickness of the inner uterine lining would have increased further. But would not have shed. Usually, if you take it before ovulation, your bleeding will start within a few days. So you should have had your regular periods, slightly thicker or more than usual. If you had bleeding almost like regular periods, then the inner lining of the uterus has been shed. There is no chance of pregnancy if at all, to catch inside the uterus. So do not worry, your next period will be one month from this period. I hope I have clarified your query, do write back if any more questions and for your feedback.

Hello doctor,Last month I had I-pill (within 48hours of intercourse) after 18 days of onset of my periods. I did not have any side effects like withdrawal bleeding, nausea, etc., after taking the I-pill. I got my periods on the 1st of this month. I am unsure if this is my normal period or bleeding due to the side effect of I-pill? Please help me to clarify this. If it is my regular periods, then there is no delay in it (a week before or week after than expected date). Is it normal? Is there a need to take a test or any chances of pregnancy? If yes, when to take the test?

Hello, Welcome to Chat Doctor forum. Let me start by assuring you that you are not pregnant and need not worry. If you have had your periods 18 days before taking I-pill, your ovulation would have been around 13 to 15 days after that. Life of egg is only one day. So there is no chance of an egg being alive on that day of sex. I-pill or emergency contraception pill is a high dose of progesterone hormone. After ovulation, your ovary also will be producing the same hormone. As you have taken it after the ovulation date, the thickness of the inner uterine lining would have increased further. But would not have shed. Usually, if you take it before ovulation, your bleeding will start within a few days. So you should have had your regular periods, slightly thicker or more than usual. If you had bleeding almost like regular periods, then the inner lining of the uterus has been shed. There is no chance of pregnancy if at all, to catch inside the uterus. So do not worry, your next period will be one month from this period. I hope I have clarified your query, do write back if any more questions and for your feedback.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Three months ago I had chest pain with nausea and shortness of breath. Since the BP got controlled, the sob decresed. Though they increased the Nitropatch to 0.6 and started the beta blockers, I am having a fewer episodes.I had an angiogram last week. It showed no major arteries blocked. The cardiologist mentioned thickened heart muscles are due to high blood pressure. I would like to know how to get tested for the micro angina and is there a need to go to emergency when I have severe chest pain? Why am I getting chest pain with no major blockages?I have diabetes, copd, severe arthritis in my spine, and diabetic neuropathy in my feet that could also partially be nerve pain from my spine. I have had two knee replacements and at present have carpal tunnel in both hands but have not delt with that yet. Also with the thickened heart muscle, will that be the cause for acute chest pain? ### Response: Hello, Welcome to Chat Doctor forum. Microvascular angina can be diagnosed on nuclear stress test with perfusion defects if any and also on angiography which shows slow flow in the absence of blockages in major arteries. So, if these tests are showing any abnormalities, then we have to consider the possibility of microvascular angina. Another modality is a treadmill test which can also show changes, but another test is not necessary as two tests are normal and you were not able to complete it. And microvascular angina usually causes pain on exertion rather than severe chest pain at rest. So we have to find other causes for it. If you had been evaluated or examined and had ECG etc., at the time of chest pain, then it also rules out other causes like vasospastic angina or accelerated hypertension as a cause of chest pain, which are relatively rarer causes. So, overall appears to be noncardiac pain. I hope this helps you and get back if you have any doubts.

Hello doctor,Three months ago I had chest pain with nausea and shortness of breath. Since the BP got controlled, the sob decresed. Though they increased the Nitropatch to 0.6 and started the beta blockers, I am having a fewer episodes.I had an angiogram last week. It showed no major arteries blocked. The cardiologist mentioned thickened heart muscles are due to high blood pressure. I would like to know how to get tested for the micro angina and is there a need to go to emergency when I have severe chest pain? Why am I getting chest pain with no major blockages?I have diabetes, copd, severe arthritis in my spine, and diabetic neuropathy in my feet that could also partially be nerve pain from my spine. I have had two knee replacements and at present have carpal tunnel in both hands but have not delt with that yet. Also with the thickened heart muscle, will that be the cause for acute chest pain?

Hello, Welcome to Chat Doctor forum. Microvascular angina can be diagnosed on nuclear stress test with perfusion defects if any and also on angiography which shows slow flow in the absence of blockages in major arteries. So, if these tests are showing any abnormalities, then we have to consider the possibility of microvascular angina. Another modality is a treadmill test which can also show changes, but another test is not necessary as two tests are normal and you were not able to complete it. And microvascular angina usually causes pain on exertion rather than severe chest pain at rest. So we have to find other causes for it. If you had been evaluated or examined and had ECG etc., at the time of chest pain, then it also rules out other causes like vasospastic angina or accelerated hypertension as a cause of chest pain, which are relatively rarer causes. So, overall appears to be noncardiac pain. I hope this helps you and get back if you have any doubts.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am trying to conceive for the past six months. So, I keep tracking my period on my phone. My usual cycles were around 30 days. Before two months, my cycle lasted for 43 days and I thought I was pregnant. But, I was not and had a period that was heavy and passed several clots. After it was over about two weeks went by and then I started spotting brown. It lasted for almost three weeks straight now and it has not stopped at all. It has remained very light the whole time.Yesterday, it got really heavy and red again, so I thought it was my period coming around but today it has stopped. It is just light spotting. This cycle now has been 46 days long. I am not sure what is going on. I am really worried because before now my cycle was always normal for around 30 days.I had been to a gynecologist for painful periods before and he told me that I had cysts on my ovaries and may possibly be getting endometriosis. Before that I had been somewhere else and he told me that I had hormonal imbalance. Did you get any clue what is going on? Should I be afraid that I am not fertile?The longer cycles and constant spotting really worries me. Please let me know your opinion. ### Response: Hello, Welcome to Chat Doctor forum. You seem to be experiencing periods irregularity since last two months where I believe your stress levels have been high, which could have delayed your menses. The presence of continued spotting from the mid cycle to till date in this cycle is possibly due to serum progesterone deficiency or luteal phase defect (phase after ovulation and before menses). The presence of ovarian pain was probably indicative of ovulation called mittelschmerz, which was normal guess. Anyhow, you need to get an ultrasound pelvis to rule out any adnexal masses or even PCOS (polycystic ovarian syn ChatDoctor.

Hi doctor,I am trying to conceive for the past six months. So, I keep tracking my period on my phone. My usual cycles were around 30 days. Before two months, my cycle lasted for 43 days and I thought I was pregnant. But, I was not and had a period that was heavy and passed several clots. After it was over about two weeks went by and then I started spotting brown. It lasted for almost three weeks straight now and it has not stopped at all. It has remained very light the whole time.Yesterday, it got really heavy and red again, so I thought it was my period coming around but today it has stopped. It is just light spotting. This cycle now has been 46 days long. I am not sure what is going on. I am really worried because before now my cycle was always normal for around 30 days.I had been to a gynecologist for painful periods before and he told me that I had cysts on my ovaries and may possibly be getting endometriosis. Before that I had been somewhere else and he told me that I had hormonal imbalance. Did you get any clue what is going on? Should I be afraid that I am not fertile?The longer cycles and constant spotting really worries me. Please let me know your opinion.

Hello, Welcome to Chat Doctor forum. You seem to be experiencing periods irregularity since last two months where I believe your stress levels have been high, which could have delayed your menses. The presence of continued spotting from the mid cycle to till date in this cycle is possibly due to serum progesterone deficiency or luteal phase defect (phase after ovulation and before menses). The presence of ovarian pain was probably indicative of ovulation called mittelschmerz, which was normal guess. Anyhow, you need to get an ultrasound pelvis to rule out any adnexal masses or even PCOS (polycystic ovarian syn ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 19 years old, and I am not sexually active. I have pain in the breast on both sides. It got started before few days, and my left breast has got changed in texture close to my nipple. It is too sore. The breast pain is not constant. It happens when I wake up, when I run or when I press them. I have not got my periods this month. It is not abnormal. I got a heavy period last month, and I have pain in my lower abdomen for a few months. It is always sudden and sharp. It is not constant. I do not know the reason for having this problem. I had vitamin D deficiency before few years. Please suggest. ### Response: Hi, Welcome to Chat Doctor forum. There are many possible causes for having breast pain. Hormonal fluctuations related to menstruation or pregnancy are often responsible for breast tenderness. Having some degree of swelling and tenderness just before a period is reasonable. The common causes of breast pain are menstruation and pregnancy. Breast pain is common during the first trimester. Breast pain also occurs when having a pregnancy at a young age, and when having puberty in both girls and boys. The other reasons can be breastfeeding, fibrocystic breast changes, and mastitis in which a blocked and infected milk duct have some redness. It is usually associated with breastfeeding and during premenstrual syn ChatDoctor. Please say whether you had any discharge from your nipples, like blood or pus. Please tell if you had any breast infection with localized redness, pus or fever. Please say whether you had any new lump associated with pain. You have to wear a well-fitting brassiere for support, especially if your breasts are large. You can have lower abdominal pain due to some reasons ranging from caliculi to appendicitis. Vitamin D deficiency does not cause these symptoms. You can apply ointment over the breast if you have any superficial infection.

Hi doctor,I am 19 years old, and I am not sexually active. I have pain in the breast on both sides. It got started before few days, and my left breast has got changed in texture close to my nipple. It is too sore. The breast pain is not constant. It happens when I wake up, when I run or when I press them. I have not got my periods this month. It is not abnormal. I got a heavy period last month, and I have pain in my lower abdomen for a few months. It is always sudden and sharp. It is not constant. I do not know the reason for having this problem. I had vitamin D deficiency before few years. Please suggest.

Hi, Welcome to Chat Doctor forum. There are many possible causes for having breast pain. Hormonal fluctuations related to menstruation or pregnancy are often responsible for breast tenderness. Having some degree of swelling and tenderness just before a period is reasonable. The common causes of breast pain are menstruation and pregnancy. Breast pain is common during the first trimester. Breast pain also occurs when having a pregnancy at a young age, and when having puberty in both girls and boys. The other reasons can be breastfeeding, fibrocystic breast changes, and mastitis in which a blocked and infected milk duct have some redness. It is usually associated with breastfeeding and during premenstrual syn ChatDoctor. Please say whether you had any discharge from your nipples, like blood or pus. Please tell if you had any breast infection with localized redness, pus or fever. Please say whether you had any new lump associated with pain. You have to wear a well-fitting brassiere for support, especially if your breasts are large. You can have lower abdominal pain due to some reasons ranging from caliculi to appendicitis. Vitamin D deficiency does not cause these symptoms. You can apply ointment over the breast if you have any superficial infection.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I got pregnant in march this year and got it aborted through medicines (Cytotec). I took two doses as the first dose failed to work. Till this month, my monthly period cycle was absolutely fine. I was supposed to have periods on the 21st of june. Still I have not got my periods. I did a my pregnancy test onthe 26th or 27th of june and it was negative. I took an ECP on 28th to get my periods. I have realized that after this, I am not going to affect my cycle anymore and no more unprotected intercourse. I used to have periods always on time. Can you please guide me on health repercussions because of abortion pills and ECP? Have I done something terrible to my health and what to do if I am pregnant again? Can I get it aborted through medicines again? I will never affect my cycle hereafter. ### Response: Hello, Welcome to Chat Doctor forum. Health issues because of abortion pills are that you may continue to bleed for 16 days or so, and also there may be incomplete abortion or some times no effect at all (failure) as you have already experienced. So it is not possible to continue pregnancy also after taking the pills (abortion or ECP) as there will be congenital malformations in the baby. Yes, of course, the cycle date will change every time. ECP is meant for emergencies only and not to be taken after every unprotected sex. If you are pregnant again, I will advise you to get a scan done and rule out any chances of ectopic pregnancy before taking abortion pills at any time. You can take it again if required, but then consult and follow up with the doctor is a must. After you are clear with all issues, I will advise you to take contraceptive pills regularly to avoid all this, and this will regularize your cycles also and nothing to worry.

Hello doctor,I got pregnant in march this year and got it aborted through medicines (Cytotec). I took two doses as the first dose failed to work. Till this month, my monthly period cycle was absolutely fine. I was supposed to have periods on the 21st of june. Still I have not got my periods. I did a my pregnancy test onthe 26th or 27th of june and it was negative. I took an ECP on 28th to get my periods. I have realized that after this, I am not going to affect my cycle anymore and no more unprotected intercourse. I used to have periods always on time. Can you please guide me on health repercussions because of abortion pills and ECP? Have I done something terrible to my health and what to do if I am pregnant again? Can I get it aborted through medicines again? I will never affect my cycle hereafter.

Hello, Welcome to Chat Doctor forum. Health issues because of abortion pills are that you may continue to bleed for 16 days or so, and also there may be incomplete abortion or some times no effect at all (failure) as you have already experienced. So it is not possible to continue pregnancy also after taking the pills (abortion or ECP) as there will be congenital malformations in the baby. Yes, of course, the cycle date will change every time. ECP is meant for emergencies only and not to be taken after every unprotected sex. If you are pregnant again, I will advise you to get a scan done and rule out any chances of ectopic pregnancy before taking abortion pills at any time. You can take it again if required, but then consult and follow up with the doctor is a must. After you are clear with all issues, I will advise you to take contraceptive pills regularly to avoid all this, and this will regularize your cycles also and nothing to worry.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Three days ago, I had my atlas adjusted and now for two days, the lymph nodes (cervical lymph nodes) in my neck have been extremely painful and swollen for the last two days. I have no fever or other symptoms. Should I be concerned? I had my atlas which was supposedly two degrees off by an atlas orthogonal chiropractor. I originally went in because of my knee and wrist pain then before I knew it, I was having my atlas adjusted by a machine. My last few days I have been miserable and feeling awful. Exhausted, my lymph nodes are so painful on the sides of my neck I have been in bed all day. I just feel this might be related but I do not know. ### Response: Hello, Welcome to Chat Doctor forum. What I see there might be some changes in the muscles which may have led to compression over the lymph nodes? Few basic things to ask before I proceed. Are you having pain in the neck? Is the pain sharp shooting or dull aching? Are you feeling any kind of muscle tightness near the neck? Any signs of swelling? The pain in the knee and wrist can be of different pathology and need a different approach. Coming back to the history, the swelling in lymph node if you suspect then you need a physician approach than the chiropractor. We need to check out why the lymph nodes got swollen. Is it due to any pathology or due to some external factors. Usually, this area does not allow lymph nodes to get swollen sooner until there is some pathology and it is always good on our side to take care of our body in proper guidelines. Hope you take this matter to a physician first rather than a chiropractor. As per my practice of 12 years I never recommend cases with lymph node issue to chiropractor as the job is different. Degenerative disc disease. MRI cervical spine. Trapezitis. Neck pain. Ice pack and rest.

Hello doctor,Three days ago, I had my atlas adjusted and now for two days, the lymph nodes (cervical lymph nodes) in my neck have been extremely painful and swollen for the last two days. I have no fever or other symptoms. Should I be concerned? I had my atlas which was supposedly two degrees off by an atlas orthogonal chiropractor. I originally went in because of my knee and wrist pain then before I knew it, I was having my atlas adjusted by a machine. My last few days I have been miserable and feeling awful. Exhausted, my lymph nodes are so painful on the sides of my neck I have been in bed all day. I just feel this might be related but I do not know.

Hello, Welcome to Chat Doctor forum. What I see there might be some changes in the muscles which may have led to compression over the lymph nodes? Few basic things to ask before I proceed. Are you having pain in the neck? Is the pain sharp shooting or dull aching? Are you feeling any kind of muscle tightness near the neck? Any signs of swelling? The pain in the knee and wrist can be of different pathology and need a different approach. Coming back to the history, the swelling in lymph node if you suspect then you need a physician approach than the chiropractor. We need to check out why the lymph nodes got swollen. Is it due to any pathology or due to some external factors. Usually, this area does not allow lymph nodes to get swollen sooner until there is some pathology and it is always good on our side to take care of our body in proper guidelines. Hope you take this matter to a physician first rather than a chiropractor. As per my practice of 12 years I never recommend cases with lymph node issue to chiropractor as the job is different. Degenerative disc disease. MRI cervical spine. Trapezitis. Neck pain. Ice pack and rest.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 30 year old male, who is a competitive athlete. I do not have any structural or plumbing heart issues. I have been diagnosed with WPW accidentally, and I am waiting for an ablation in 17 days. I am mostly asymptomatic, and I never had any extremely rapid heart rates. My resting heart rate is actually in the 40\\s. However, I do sometimes get palpitations and every once in awhile get a run of 5 to 7 in a row. The EP I saw in the hospital prescribed me Flecainide 50 mg, twice daily. I saw another EP, who was a much older guy, as a second opinion. He seems to think I do not need the Flecainide, and maybe not even the ablation. I do not agree with him on the ablation due to recent medical studies on WPW and how ablation is recommended even for asymptomatic patients, especially athletes.My question is regarding Flecainide. I have not had any palpitations since I began taking it a few days ago, but I want to make sure this drug is not putting me at risk for creating a dangerous rhythm. Reading case studies and medical journals, it seems there is some risk. I have not been known to go into AF, and besides palpitations, I am asymptomatic with WPW. Do you think Flecainide at this dosage is safe and reasonable for the next two weeks, until my ablation? ### Response: Hi. In WPW (Wolff-Parkinson-White) syn ChatDoctor. I can present as palpitation, but the timing cannot be predicted. Regarding Flecainide, I do not think you need to continue for next two weeks. But, your cardiologist who will perform this surgery, is the best judge to advise you whether he wants to continue it prophylactically or not. For more information consult a cardiologist online

Hello doctor,I am a 30 year old male, who is a competitive athlete. I do not have any structural or plumbing heart issues. I have been diagnosed with WPW accidentally, and I am waiting for an ablation in 17 days. I am mostly asymptomatic, and I never had any extremely rapid heart rates. My resting heart rate is actually in the 40\\s. However, I do sometimes get palpitations and every once in awhile get a run of 5 to 7 in a row. The EP I saw in the hospital prescribed me Flecainide 50 mg, twice daily. I saw another EP, who was a much older guy, as a second opinion. He seems to think I do not need the Flecainide, and maybe not even the ablation. I do not agree with him on the ablation due to recent medical studies on WPW and how ablation is recommended even for asymptomatic patients, especially athletes.My question is regarding Flecainide. I have not had any palpitations since I began taking it a few days ago, but I want to make sure this drug is not putting me at risk for creating a dangerous rhythm. Reading case studies and medical journals, it seems there is some risk. I have not been known to go into AF, and besides palpitations, I am asymptomatic with WPW. Do you think Flecainide at this dosage is safe and reasonable for the next two weeks, until my ablation?

Hi. In WPW (Wolff-Parkinson-White) syn ChatDoctor. I can present as palpitation, but the timing cannot be predicted. Regarding Flecainide, I do not think you need to continue for next two weeks. But, your cardiologist who will perform this surgery, is the best judge to advise you whether he wants to continue it prophylactically or not. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 59-year-old female who was diagnosed five years back with the rare I have not had an MRI scan or seen by a neurologist for a follow-up. Since I was diagnosed, I have not been given a prognosis of myelopathy associated with Hashimoto's. I was paralyzed from the chest down before diagnosis. I was put on a course of three months Steriods and then 125 mg Azathioprine which was in last year and increased to 150 mg currently. I get three hours of physio a week and three monthly blood tests, full blood count, TPO, and TSH.In your opinion what would be the expected neurological care for this condition, and the absolute minimum acceptable standard of care? Is an annual MRI necessary? Should a specialist be able to provide a prognosis on my condition? Any other advice you consider helpful to me. ### Response: Hi. I am sorry to hear about your illness. You are likely suffering from Hashimoto\\s myelopathy based on your description. It is rare condition and only a handful of cases have been described worldwide. It is known to be very steroid responsive and there should be a remarkable improvement with steroids injections. If you had no response to the injections, I wonder about other diagnoses as well, given you have a history of cervical disc bulge causing weakness. The best way I can come to a better answer is by looking at the MRI images of the spine and brain, report of CSF studies with CSF level of anti-thyroglobulin and anti-microsomal antibodies. If we are seeing damage in the cord and the muscle power testing is weak with atrophy of muscles, for the past three years, then the recovery will be guarded. I will strongly advise, rehabilitation with PT, OT and botulinum toxin injections or spinal cord pump installation if significant spasticity is there in both legs. Take care.

Hello doctor,I am a 59-year-old female who was diagnosed five years back with the rare I have not had an MRI scan or seen by a neurologist for a follow-up. Since I was diagnosed, I have not been given a prognosis of myelopathy associated with Hashimoto's. I was paralyzed from the chest down before diagnosis. I was put on a course of three months Steriods and then 125 mg Azathioprine which was in last year and increased to 150 mg currently. I get three hours of physio a week and three monthly blood tests, full blood count, TPO, and TSH.In your opinion what would be the expected neurological care for this condition, and the absolute minimum acceptable standard of care? Is an annual MRI necessary? Should a specialist be able to provide a prognosis on my condition? Any other advice you consider helpful to me.

Hi. I am sorry to hear about your illness. You are likely suffering from Hashimoto\\s myelopathy based on your description. It is rare condition and only a handful of cases have been described worldwide. It is known to be very steroid responsive and there should be a remarkable improvement with steroids injections. If you had no response to the injections, I wonder about other diagnoses as well, given you have a history of cervical disc bulge causing weakness. The best way I can come to a better answer is by looking at the MRI images of the spine and brain, report of CSF studies with CSF level of anti-thyroglobulin and anti-microsomal antibodies. If we are seeing damage in the cord and the muscle power testing is weak with atrophy of muscles, for the past three years, then the recovery will be guarded. I will strongly advise, rehabilitation with PT, OT and botulinum toxin injections or spinal cord pump installation if significant spasticity is there in both legs. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,My ESR is too high that is 25 mm/hr. Granulocytes % is high and lymphocytes % is low. The main thing is the RDW is low. I am having too much body pain and leg pain in my body. Even pain-killers not working at all. Too much pain. I am having trouble to move my arms and legs when I wake up in the morning. Also having difficulty sleeping. No fever. The pain inside of the body. Cough sometime. And pain under the left ribs. Pain around neck, back and shoulder also. Do you think I have multiple myeloma? Because all my symptoms are in favour of multiple myeloma. My question is as ESR is too high is there any kind of cancer in my bodies such as leukemia or lymphoma or bone marrow cancer? Why my pain is not going away after using too many Ibuprofen? Do you want me to go to hematologist or oncologists? Please, how can I overcome from this problem? ### Response: Hello, Welcome to Chat Doctor forum. The chronic whole body pain does not necessarily mean leukemia. Your CBC report is within limits as attached herewith (attachment removed to protect patient identity). For your condition, your physical examination first should be done in the form of liver, spleen and lymph nodes palpation. Check your calcium level as well. Your vitamin D level is slightly low below reference range and for that Cholecalciferol sachet with milk 50000 IU per ml can be prescribed once a week for six weeks. Check your liver and kidney profiles report as well. High ESR could be from inflammation or infection as well. Check your thyroid status as well by serum TSH (thyroid stimulating hormone) estimation. CT scan like higher investigation can be planned if needed. Serum protein immunofixation electrophoresis will be beneficial to rule out multiple myeloma if needed. Take care. For more information consult a hematologist online

Hi doctor,My ESR is too high that is 25 mm/hr. Granulocytes % is high and lymphocytes % is low. The main thing is the RDW is low. I am having too much body pain and leg pain in my body. Even pain-killers not working at all. Too much pain. I am having trouble to move my arms and legs when I wake up in the morning. Also having difficulty sleeping. No fever. The pain inside of the body. Cough sometime. And pain under the left ribs. Pain around neck, back and shoulder also. Do you think I have multiple myeloma? Because all my symptoms are in favour of multiple myeloma. My question is as ESR is too high is there any kind of cancer in my bodies such as leukemia or lymphoma or bone marrow cancer? Why my pain is not going away after using too many Ibuprofen? Do you want me to go to hematologist or oncologists? Please, how can I overcome from this problem?

Hello, Welcome to Chat Doctor forum. The chronic whole body pain does not necessarily mean leukemia. Your CBC report is within limits as attached herewith (attachment removed to protect patient identity). For your condition, your physical examination first should be done in the form of liver, spleen and lymph nodes palpation. Check your calcium level as well. Your vitamin D level is slightly low below reference range and for that Cholecalciferol sachet with milk 50000 IU per ml can be prescribed once a week for six weeks. Check your liver and kidney profiles report as well. High ESR could be from inflammation or infection as well. Check your thyroid status as well by serum TSH (thyroid stimulating hormone) estimation. CT scan like higher investigation can be planned if needed. Serum protein immunofixation electrophoresis will be beneficial to rule out multiple myeloma if needed. Take care. For more information consult a hematologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor, I am a teenager and I got periods five and a half years back. In the start they were irregular. I took medicines for 21 days and I got my periods after a month but as soon as I left them after three months my periods became irregular. Then for some time I did not take any medicine, but still, my periods were irregular. I used to get two to three menses in a month. I got very sick and anemic. I stayed in the hospital for three days where I was given intravenous iron treatment, three bottles. I had regular periods after that for a year or less. But my doctor told me to consult a specialist. After that, they were again irregular and then I had them for five months without stopping. I have taken many medicines but all in vain. It has been five years and my periods are irregular. Still, I have got two menses in this month. I have become so skinny and my weight has not increased for the last five years. I will be very grateful if you suggest me something to get better. My ultrasound results do not have any problem. ### Response: Hello, Welcome to Chat Doctor forum. I understand you are deeply troubled by your menstrual cycles. Heavy and frequent bleeding as you suggested will cause anemia and weakness and needs to be treated. On the other hand, if periods are infrequent and less flow, you can treat it without medications too. In your case, your BMI (body mass index) is very low which is not healthy at all. First, you need to eat healthily. Include lots of proteins and lots of iron-rich foods in your diet. Secondly, the cause of this bleeding is a hormonal imbalance which usually gets better as you move on to your 20s. Meanwhile, you will have to take hormonal tablets regularly for at least one to two years at a go without changing the medications. I hope this helps.

Hello doctor, I am a teenager and I got periods five and a half years back. In the start they were irregular. I took medicines for 21 days and I got my periods after a month but as soon as I left them after three months my periods became irregular. Then for some time I did not take any medicine, but still, my periods were irregular. I used to get two to three menses in a month. I got very sick and anemic. I stayed in the hospital for three days where I was given intravenous iron treatment, three bottles. I had regular periods after that for a year or less. But my doctor told me to consult a specialist. After that, they were again irregular and then I had them for five months without stopping. I have taken many medicines but all in vain. It has been five years and my periods are irregular. Still, I have got two menses in this month. I have become so skinny and my weight has not increased for the last five years. I will be very grateful if you suggest me something to get better. My ultrasound results do not have any problem.

Hello, Welcome to Chat Doctor forum. I understand you are deeply troubled by your menstrual cycles. Heavy and frequent bleeding as you suggested will cause anemia and weakness and needs to be treated. On the other hand, if periods are infrequent and less flow, you can treat it without medications too. In your case, your BMI (body mass index) is very low which is not healthy at all. First, you need to eat healthily. Include lots of proteins and lots of iron-rich foods in your diet. Secondly, the cause of this bleeding is a hormonal imbalance which usually gets better as you move on to your 20s. Meanwhile, you will have to take hormonal tablets regularly for at least one to two years at a go without changing the medications. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Right ovary contains 3.6x2.1x3.1cm cyst, thick septation and few punctate echogenic lesions within lumen. Previously cyst measured 3.8x2.4cm abutting ovary. Adjacent ovarian parenchyma contains 6 mm and 15 mm follicles. Small amount of fluid was seen in para-adnexal area and posterior CDS.My questions are ### Response: Hello, Welcome to Chat Doctor forum. I will try to give you answers to the best of my knoweldge. Small amount of fluid is expected near posterior cul de sac and para adnexal area during ovulation time. Although it can be seen during pelvic inflammatory disease. Multiple follicle grow every month in both the ovaries which later on is dominated by a single follicle which continues to grow to a certain size, and later ruptures releasing the egg. So your 6 mm and 15 mm follicles are normal to be there. Without doing a histopathological examination, it is difficult to tell about the origin of the thick septation but as most of the ovarian cysts are epitheleal in origin, so 90 % chances are they are made of some kind of epitheleal tissue. Any kind of debris inside the cyst will give rise to echogenicity in USG. It could be blood, it could be tissues of different origin. There are different types of ovarian cyst, to rule out malignancy you need to do certain tumor markers like CA 125, etc., and MRI or CT scan. Since it is receding in size, my best guess that your cyst is some kind of retention cyst of ovary. There is a large possibility that the cyst will regress soon. I think your cyst is an incidental finding as you have stated there is minimal symptom. Your gynecologist will be the best person to advise you in this matter. So discuss with her about the various possibilities and methods of treatment.

Hello doctor,Right ovary contains 3.6x2.1x3.1cm cyst, thick septation and few punctate echogenic lesions within lumen. Previously cyst measured 3.8x2.4cm abutting ovary. Adjacent ovarian parenchyma contains 6 mm and 15 mm follicles. Small amount of fluid was seen in para-adnexal area and posterior CDS.My questions are

Hello, Welcome to Chat Doctor forum. I will try to give you answers to the best of my knoweldge. Small amount of fluid is expected near posterior cul de sac and para adnexal area during ovulation time. Although it can be seen during pelvic inflammatory disease. Multiple follicle grow every month in both the ovaries which later on is dominated by a single follicle which continues to grow to a certain size, and later ruptures releasing the egg. So your 6 mm and 15 mm follicles are normal to be there. Without doing a histopathological examination, it is difficult to tell about the origin of the thick septation but as most of the ovarian cysts are epitheleal in origin, so 90 % chances are they are made of some kind of epitheleal tissue. Any kind of debris inside the cyst will give rise to echogenicity in USG. It could be blood, it could be tissues of different origin. There are different types of ovarian cyst, to rule out malignancy you need to do certain tumor markers like CA 125, etc., and MRI or CT scan. Since it is receding in size, my best guess that your cyst is some kind of retention cyst of ovary. There is a large possibility that the cyst will regress soon. I think your cyst is an incidental finding as you have stated there is minimal symptom. Your gynecologist will be the best person to advise you in this matter. So discuss with her about the various possibilities and methods of treatment.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My husband is mostly sad and depressed. He cannot listen a word against him or his family(mom, dad & sister). He gets mad and behaves very rudely with everyone if they do not agree to what he says. He fought with his boss in his company for silly reasons. He abuses me emotionally and mentally. He hides from colleagues and friends about his marital status, to some he says he is not married and to some, he says he is married, and his wife stays with his family and works in a bank (but I live with him and work in MNC). He always uses to tell a lie to me in small things also, he is never ready to accept his fault. Even if it is evident that it is his fault, he will never agree. He was flirting with some girl and went to meet her, and I got to know this when I checked his phone when I confronted him, he got mad at me. He is not ready to accept that he is at fault. He never answers my questions, always diverts the discussion. He does not have any plan. He hates my family for no reason and always say abusive things against them. He says he loves me but never let me live happily. In short, he is still right. Is he mentally ill? ### Response: Hello, Welcome to Chat Doctor forum. I can understand your concern. Considering the history of the symptoms you have mentioned, there are few possibilities. One is some underlying mood disturbance which could part of bipolar disorder. This should be appropriately evaluated to make a diagnosis. Repetitive mood swings, keeping grudges, anger outbursts, repetitive lying, etc., are seen commonly. Such symptoms can occur as part of some personality disturbance. Anger, irritation, etc., could be related to personality issues. Please talk to him and if possible, consult a psychiatrist. Mood stabilizers can be used to control his anger and mood swings.

Hello doctor,My husband is mostly sad and depressed. He cannot listen a word against him or his family(mom, dad & sister). He gets mad and behaves very rudely with everyone if they do not agree to what he says. He fought with his boss in his company for silly reasons. He abuses me emotionally and mentally. He hides from colleagues and friends about his marital status, to some he says he is not married and to some, he says he is married, and his wife stays with his family and works in a bank (but I live with him and work in MNC). He always uses to tell a lie to me in small things also, he is never ready to accept his fault. Even if it is evident that it is his fault, he will never agree. He was flirting with some girl and went to meet her, and I got to know this when I checked his phone when I confronted him, he got mad at me. He is not ready to accept that he is at fault. He never answers my questions, always diverts the discussion. He does not have any plan. He hates my family for no reason and always say abusive things against them. He says he loves me but never let me live happily. In short, he is still right. Is he mentally ill?

Hello, Welcome to Chat Doctor forum. I can understand your concern. Considering the history of the symptoms you have mentioned, there are few possibilities. One is some underlying mood disturbance which could part of bipolar disorder. This should be appropriately evaluated to make a diagnosis. Repetitive mood swings, keeping grudges, anger outbursts, repetitive lying, etc., are seen commonly. Such symptoms can occur as part of some personality disturbance. Anger, irritation, etc., could be related to personality issues. Please talk to him and if possible, consult a psychiatrist. Mood stabilizers can be used to control his anger and mood swings.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Six months back, I had a bad sinus infection with a cough that caused a left internal carotid artery dissection. I had a stroke as well that left infarcts on my left parietal lobe and caused problems with my speech and I was not able to use my cellphone correctly. Thankfully I had no lingering damage. Two months back, I had my 3 month MRI rescan and it said the artery had healed and the infarcts were smaller. I have had a sinus infection again which started about a week and a half ago with a cough again.Earlier in the week I was having on and off dizzy spells for a few days and that has passed. Now I am having sensations in the right side of my face around my cheekbone, cheek, top of right lip, around the right side of my nose. I can also feel it around my right bicep, and sometimes my right calf. There is no drooping of my smile or eyebrows. I can raise my arms without drooping. Everything seems to work correctly. These sensations have been going on for at least four days. I have sleep apnea so I sleep with a full face mask and I lay on my right side with my right arm under my head. What could these sensations be? ### Response: Hi, Welcome to Chat Doctor forum. Post stroke, during periods of illness, fever, cold, etc., previous symptoms of stroke may reappear but to lesser degree. They usually go away as the illness resolve. It does not mean you have new stroke. With left parietal stroke, one can expect sensory symptoms over right side and depending on your location, body part, need to see your previous MRI which can help identify if your face region was in previous stroke region or scar tissue is there. If you are very concerned, then you can go for another MRI brain to look for any new stroke. MRI brain if symptom worsen or if no scar tissue in facial region on previous MRI

Hello doctor,Six months back, I had a bad sinus infection with a cough that caused a left internal carotid artery dissection. I had a stroke as well that left infarcts on my left parietal lobe and caused problems with my speech and I was not able to use my cellphone correctly. Thankfully I had no lingering damage. Two months back, I had my 3 month MRI rescan and it said the artery had healed and the infarcts were smaller. I have had a sinus infection again which started about a week and a half ago with a cough again.Earlier in the week I was having on and off dizzy spells for a few days and that has passed. Now I am having sensations in the right side of my face around my cheekbone, cheek, top of right lip, around the right side of my nose. I can also feel it around my right bicep, and sometimes my right calf. There is no drooping of my smile or eyebrows. I can raise my arms without drooping. Everything seems to work correctly. These sensations have been going on for at least four days. I have sleep apnea so I sleep with a full face mask and I lay on my right side with my right arm under my head. What could these sensations be?

Hi, Welcome to Chat Doctor forum. Post stroke, during periods of illness, fever, cold, etc., previous symptoms of stroke may reappear but to lesser degree. They usually go away as the illness resolve. It does not mean you have new stroke. With left parietal stroke, one can expect sensory symptoms over right side and depending on your location, body part, need to see your previous MRI which can help identify if your face region was in previous stroke region or scar tissue is there. If you are very concerned, then you can go for another MRI brain to look for any new stroke. MRI brain if symptom worsen or if no scar tissue in facial region on previous MRI

### Instruction: Answer this question truthfully ###Input: Hi doctor,My father has suffered from a stroke 12 years back (left hemisensory infarct) and four years back has undergone CABG. He is also a diabetic for the past 27 years. Three days back he developed high fever 103.5 with stomach ache and chills. 650 or Meftal forte SOS for high fever. He is better now but during that time he noticed frothy urine so we got his urine microalbumin test done. The levels are a little high. Six months back they were within range. He has no other problem like swelling, etc. His BP is also under control. Also, his other parameters like creatinine, etc., done two weeks back are fine. Only his HbA1c is 7.8.My query is that since the tests were just the next day after fever can they be incorrect? Can the urine be foamy due to fever? Will better sugar control help to resolve this problem? When should we repeat this test again? His current medications are Mixtard Insulin 30/70 - 48 units morning, 13 units night, Glycomet GP2 1-0-1, Linagliptin 5 mg 1-0-0, Fibator 10 mg 0-0-1, Metolar XR 25 1-0-0, Dynapress 0.4 0-0-1, Arreno 1-0-1, Ecosprin 75 1-0-0. ### Response: Hi, Welcome to Chat Doctor forum. Yes, an acute infection is known to cause protein in the urine that can cause frothy urine. Moreover, urinary tract infection can also cause this. I would recommend you to get his urine test repeated after two weeks. A strict blood sugar and blood pressure control would control proteinuria.

Hi doctor,My father has suffered from a stroke 12 years back (left hemisensory infarct) and four years back has undergone CABG. He is also a diabetic for the past 27 years. Three days back he developed high fever 103.5 with stomach ache and chills. 650 or Meftal forte SOS for high fever. He is better now but during that time he noticed frothy urine so we got his urine microalbumin test done. The levels are a little high. Six months back they were within range. He has no other problem like swelling, etc. His BP is also under control. Also, his other parameters like creatinine, etc., done two weeks back are fine. Only his HbA1c is 7.8.My query is that since the tests were just the next day after fever can they be incorrect? Can the urine be foamy due to fever? Will better sugar control help to resolve this problem? When should we repeat this test again? His current medications are Mixtard Insulin 30/70 - 48 units morning, 13 units night, Glycomet GP2 1-0-1, Linagliptin 5 mg 1-0-0, Fibator 10 mg 0-0-1, Metolar XR 25 1-0-0, Dynapress 0.4 0-0-1, Arreno 1-0-1, Ecosprin 75 1-0-0.

Hi, Welcome to Chat Doctor forum. Yes, an acute infection is known to cause protein in the urine that can cause frothy urine. Moreover, urinary tract infection can also cause this. I would recommend you to get his urine test repeated after two weeks. A strict blood sugar and blood pressure control would control proteinuria.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My mother is 65 years old. She is diagnosed with stomach cancer stage 4. We consulted the situation with five top oncologists and based on their suggestions we decided not to put her under chemotherapy. We are keeping her under supportive care at home. She is not taking any medicine for cancer as of today.The current concern is that she is 45 kg in weight and is able to take only liquid food since diagnosis. She does take semi-solid (mashed) food sometimes but it maybe twice or thrice in a week. As you can see in her PET scan attached, the tumor may be causing physical obstruction for the food to pass from stomach to the path down and also from time to time she feels some liquid with stale smell raising up her stomach. She wants to eat but unable to do so because of this weird nausea-like feeling.Can you please suggest some medications to overcome the above problem? Or is there any other way she could be given enough nutrition to manage the situation? Looking for your help at the earliest possible. ### Response: Hello. I have gone through her reports. (attachment removed to protect patient identity). As per the above reports, it looks like metastatic stage 4 gastric cancer. And as I can gather from history above, the decision of supportive care only without any chemotherapy is taken. For gastric cancer, surgery remains the best palliative treatment specially if there are features of obstruction as seen in her case. But usually, surgery is not preferred in view of its invasive nature. Her symptoms can be explained by moderate luminal obstruction of the stomach. In that case, another option is to go ahead with percutaneous jejunostomy for feeding which bypasses the stomach and helps in maintaining nutrition. If such a facility is not available then an endoscopic feeding jejunostomy tube can be tried. Sadly only medications such as antinausea ChatDoctor. I hope this helps.

Hello doctor,My mother is 65 years old. She is diagnosed with stomach cancer stage 4. We consulted the situation with five top oncologists and based on their suggestions we decided not to put her under chemotherapy. We are keeping her under supportive care at home. She is not taking any medicine for cancer as of today.The current concern is that she is 45 kg in weight and is able to take only liquid food since diagnosis. She does take semi-solid (mashed) food sometimes but it maybe twice or thrice in a week. As you can see in her PET scan attached, the tumor may be causing physical obstruction for the food to pass from stomach to the path down and also from time to time she feels some liquid with stale smell raising up her stomach. She wants to eat but unable to do so because of this weird nausea-like feeling.Can you please suggest some medications to overcome the above problem? Or is there any other way she could be given enough nutrition to manage the situation? Looking for your help at the earliest possible.

Hello. I have gone through her reports. (attachment removed to protect patient identity). As per the above reports, it looks like metastatic stage 4 gastric cancer. And as I can gather from history above, the decision of supportive care only without any chemotherapy is taken. For gastric cancer, surgery remains the best palliative treatment specially if there are features of obstruction as seen in her case. But usually, surgery is not preferred in view of its invasive nature. Her symptoms can be explained by moderate luminal obstruction of the stomach. In that case, another option is to go ahead with percutaneous jejunostomy for feeding which bypasses the stomach and helps in maintaining nutrition. If such a facility is not available then an endoscopic feeding jejunostomy tube can be tried. Sadly only medications such as antinausea ChatDoctor. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My son is 6 years old. He got lung allergy so the doctor gave Levolin 100 and Budecort inhalers and some syrup like Montair LC kid. So my son is getting free from the fever, coughs, and cold by using these medicines. After completion of these medicines course, he is repeating with the same cough, cold and fever. Where as he will not eat any foods like chocolates and other flavored items, but he eats very rarely.On using these medicines is there any side effect in his growing future? I want to know is there any permanent solution for him without using these medicines and being healthy? And he is getting this problem when there are changes in weather and if he eats any chocolate and other foods. My son gets a fever with a high temperature of 101 and goes to 103 degree celcius. Sometimes we used to give him Meftal 8 ml and P-250 or Calpol for every four hours when the temperature was 100. After giving these medicines he was being sweated a lot specially on his head. Why there is sweating from head? Is this sweating from head cause any problem? How long should he use these mediciens? What are the foods that are good for him and can we give him dry fruits and fruits? Which are best for him? ### Response: Hello, Welcome to Chat Doctor forum. The doctor has given the right treatment and please follow his instructions. The inhalers are safe and do not have any side effects as the dose of medicine is in micrograms which is very small. The allergic problem will resolve by itself as he grows. Sweating when fever reduces is very common and not a matter of concern. After the course of calcium and vitamin D3 sweating problem will also reduce. About the food discuss with your pediatrician as it depends on the individual child. ChatDoctor.

Hello doctor,My son is 6 years old. He got lung allergy so the doctor gave Levolin 100 and Budecort inhalers and some syrup like Montair LC kid. So my son is getting free from the fever, coughs, and cold by using these medicines. After completion of these medicines course, he is repeating with the same cough, cold and fever. Where as he will not eat any foods like chocolates and other flavored items, but he eats very rarely.On using these medicines is there any side effect in his growing future? I want to know is there any permanent solution for him without using these medicines and being healthy? And he is getting this problem when there are changes in weather and if he eats any chocolate and other foods. My son gets a fever with a high temperature of 101 and goes to 103 degree celcius. Sometimes we used to give him Meftal 8 ml and P-250 or Calpol for every four hours when the temperature was 100. After giving these medicines he was being sweated a lot specially on his head. Why there is sweating from head? Is this sweating from head cause any problem? How long should he use these mediciens? What are the foods that are good for him and can we give him dry fruits and fruits? Which are best for him?

Hello, Welcome to Chat Doctor forum. The doctor has given the right treatment and please follow his instructions. The inhalers are safe and do not have any side effects as the dose of medicine is in micrograms which is very small. The allergic problem will resolve by itself as he grows. Sweating when fever reduces is very common and not a matter of concern. After the course of calcium and vitamin D3 sweating problem will also reduce. About the food discuss with your pediatrician as it depends on the individual child. ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 33 year old male. I have had chronic constipation since my childhood. The doctors said that my gastric motility is a bit under-par. To rule out any physical damage, I went through colonoscopy three years ago. The reports only mentioned small hemorrhoids. I was on a brief course of antacids and laxatives after that, which gave me temporary relief. Constipation had reduced considerably by the end of last year. However, I have been experiencing acid reflux since early this year. This is the first time that I have had regular episodes of reflux. So, I did my endoscopy four months back. It revealed ulcers in the esophagus near the sphincter (GERD). It also revealed a small sliding hiatus hernia. No metaplasia seen in biopsy. The doctors said that since I am a young patient, surgery is not recommended. They said I have to rely on lifestyle modifications and antacids. Currently, I am taking Nexpro RD 20 mg capsules and Riflux Forte syrup. I have cut down on spicy food, and also have altered my meal times since the past one and a half months.The acid reflux has reduced by 60 to 70 % since the lifestyle change. However, I still experience some really disturbing symptoms ### Response: Hello, Welcome to Chat Doctor forum. Your treatment till date is on the right track and I appreciate your adherence to the same. You have a small hiatus hernia, which is not an abnormal finding always. The reflux of acid from the stomach to the esophagus (chest) is causing your current symptoms including the small ulcers. Now you can deal the problem with few dietary and non-medical tips. Please consider the following tests too. Hope I have cleared you doubts to your satisfaction. You can review with the reports when it is done and revert as needed if any fresh queries. For more information consult a medical gastroenterologist online

Hello doctor,I am a 33 year old male. I have had chronic constipation since my childhood. The doctors said that my gastric motility is a bit under-par. To rule out any physical damage, I went through colonoscopy three years ago. The reports only mentioned small hemorrhoids. I was on a brief course of antacids and laxatives after that, which gave me temporary relief. Constipation had reduced considerably by the end of last year. However, I have been experiencing acid reflux since early this year. This is the first time that I have had regular episodes of reflux. So, I did my endoscopy four months back. It revealed ulcers in the esophagus near the sphincter (GERD). It also revealed a small sliding hiatus hernia. No metaplasia seen in biopsy. The doctors said that since I am a young patient, surgery is not recommended. They said I have to rely on lifestyle modifications and antacids. Currently, I am taking Nexpro RD 20 mg capsules and Riflux Forte syrup. I have cut down on spicy food, and also have altered my meal times since the past one and a half months.The acid reflux has reduced by 60 to 70 % since the lifestyle change. However, I still experience some really disturbing symptoms

Hello, Welcome to Chat Doctor forum. Your treatment till date is on the right track and I appreciate your adherence to the same. You have a small hiatus hernia, which is not an abnormal finding always. The reflux of acid from the stomach to the esophagus (chest) is causing your current symptoms including the small ulcers. Now you can deal the problem with few dietary and non-medical tips. Please consider the following tests too. Hope I have cleared you doubts to your satisfaction. You can review with the reports when it is done and revert as needed if any fresh queries. For more information consult a medical gastroenterologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I got married before 10 months and since then my lifestyle has changed. As a result of this, I am suffering from increased bowel movement. Over last three months it has become very frequent for almost two to three times a day. Sometimes they are fine but at times stools are like soft porridge and even undigested particles in it. Stomach has become a bit sensitive towards infection. Kindly help. ### Response: Hello. I want to assure you need not have to worry as everything is going to be fine, if proper care and treatment is opted in for. I have gone through your case thoroughly and can understand your genuine health concerns. 1. It can be a gastrointestinal infection and needs care and treatment. 2. Change of diet and emotional changes also play a role in post-marriage stomach upset in some cases. 1. You need to get a complete stool culture and stool culture and sensitivity test done from a laboratory.2. Once you get the stool laboratory reports, do upload the reports in the follow up question directly.3. If there is a need to deworm, then you can start taking medicine Albendazole.4. If you feel good with the above mentioned treatment, then no need for any further investigations.5. In case you feel nothing is working, then you can consult a gastroenterologist for physical evaluation and get a diagnostic colonoscopy done, if the need arises. 1. I would advise you to have Rifaximin.2. In case of loose stools take Imodium immediately.3. Citrucel (Methylcellulose) dietary fiber supplement is good for your health. 1. Stop consumption of caffeinated ChatDoctor. 2. Do not take refined meat and red meat.3. Take Pedialyte that helps to replenish water and to keep electrolyte in balance. Revert back with the laboratory investigation reports to an medical gastroenterologist online.-

Hi doctor,I got married before 10 months and since then my lifestyle has changed. As a result of this, I am suffering from increased bowel movement. Over last three months it has become very frequent for almost two to three times a day. Sometimes they are fine but at times stools are like soft porridge and even undigested particles in it. Stomach has become a bit sensitive towards infection. Kindly help.

Hello. I want to assure you need not have to worry as everything is going to be fine, if proper care and treatment is opted in for. I have gone through your case thoroughly and can understand your genuine health concerns. 1. It can be a gastrointestinal infection and needs care and treatment. 2. Change of diet and emotional changes also play a role in post-marriage stomach upset in some cases. 1. You need to get a complete stool culture and stool culture and sensitivity test done from a laboratory.2. Once you get the stool laboratory reports, do upload the reports in the follow up question directly.3. If there is a need to deworm, then you can start taking medicine Albendazole.4. If you feel good with the above mentioned treatment, then no need for any further investigations.5. In case you feel nothing is working, then you can consult a gastroenterologist for physical evaluation and get a diagnostic colonoscopy done, if the need arises. 1. I would advise you to have Rifaximin.2. In case of loose stools take Imodium immediately.3. Citrucel (Methylcellulose) dietary fiber supplement is good for your health. 1. Stop consumption of caffeinated ChatDoctor. 2. Do not take refined meat and red meat.3. Take Pedialyte that helps to replenish water and to keep electrolyte in balance. Revert back with the laboratory investigation reports to an medical gastroenterologist online.-

### Instruction: Answer this question truthfully ###Input: Hello doctor,My sister was experiencing irregular periods and sometimes bleeding was heavy during the menstrual period. We consulted a gynecologist. She suggested taking pelvis scan where they observed that endometrium line became thick. They informed that it was due to hormonal imbalance. Later we approached an endocrinologist where she has advised us some hormonal tests (prolactin, testosterone, thyroid tests). It seems the report was normal. For the past two months, she is taking Meprate 10 mg tablet from the 16th day to 25th day of menstrual cycle. And the subsequent falling period is normal. However, during the recent review with the gynecologist, she has advised taking full abdomen scan with the pelvis and there are no findings. Even the endometric layer is normal. Hence she came to an opinion like menstrual disorder is due to hormonal imbalance. The doctor advised undergoing for copper-T which is the only solution for hormonal imbalance and menstrual disorder. The endocrinologist said reports are fine. Both the statements are contrary. We are just confused to go ahead with the copper-T process. Please see the reports and kindly provide us the detailed clarification on this. ### Response: Hello, Welcome to Chat Doctor forum. I do not think the doctor has advised copper-T. I think she would have advised intrauterine hormonal device called LNG (Levonorgestrel) which contains hormone progesterone. It will regularise the cycles and control heavy flow and need not take oral medicines. It is up to you to take the advice. As she is getting regular cycles now, you may wait. However, if the bleeding is heavier and any disturbances in the cycle, then go for the device. Also, a D and C (dilation and curettage) for endometrial evaluation and histopathology is advisable to rule out other causes like endometrial hyperplasia and the likes. For more information consult an obstetrician and gynaecologist online

Hello doctor,My sister was experiencing irregular periods and sometimes bleeding was heavy during the menstrual period. We consulted a gynecologist. She suggested taking pelvis scan where they observed that endometrium line became thick. They informed that it was due to hormonal imbalance. Later we approached an endocrinologist where she has advised us some hormonal tests (prolactin, testosterone, thyroid tests). It seems the report was normal. For the past two months, she is taking Meprate 10 mg tablet from the 16th day to 25th day of menstrual cycle. And the subsequent falling period is normal. However, during the recent review with the gynecologist, she has advised taking full abdomen scan with the pelvis and there are no findings. Even the endometric layer is normal. Hence she came to an opinion like menstrual disorder is due to hormonal imbalance. The doctor advised undergoing for copper-T which is the only solution for hormonal imbalance and menstrual disorder. The endocrinologist said reports are fine. Both the statements are contrary. We are just confused to go ahead with the copper-T process. Please see the reports and kindly provide us the detailed clarification on this.

Hello, Welcome to Chat Doctor forum. I do not think the doctor has advised copper-T. I think she would have advised intrauterine hormonal device called LNG (Levonorgestrel) which contains hormone progesterone. It will regularise the cycles and control heavy flow and need not take oral medicines. It is up to you to take the advice. As she is getting regular cycles now, you may wait. However, if the bleeding is heavier and any disturbances in the cycle, then go for the device. Also, a D and C (dilation and curettage) for endometrial evaluation and histopathology is advisable to rule out other causes like endometrial hyperplasia and the likes. For more information consult an obstetrician and gynaecologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 32-year-old male. I weigh about 80 kg with a height of 5\\9\". I am facing erection issues since last week though there is no change in my sex drive. Also, I feel reduced morning erections too. I feel aroused but the erection does not come as it used to before a week. Healthwise, I have sound health and have a moderately active lifestyle and pretty normal sleep pattern. Anxiety level is suboptimal due to COVID19 situation. I was using a semen volumizer herbal supplement intermittently. I am not sure if this plays any role in it too. I drink occasionally in limits and I am a vegetarian. My food habits are healthy and I avoid junk food as such. These erection problems started just a few days ago and now they are troubling me to a bigger extent. Please help. ### Response: Hi. I can understand your concern. According to your statement, you have been suffering from erectile dysfunction for the last few days. Erectile dysfunction is usually caused by low blood flow to the penis or problems of nerve of penis which control erections. Most common cause of erectile dysfunction is psychological reasons such as stress or depression. It may have resulted from the hardening of arteries, high blood pressure, high blood glucose, high cholesterol, medications, BPH, prostatitis, hormonal disturbances, etc. Usually, erectile dysfunction is common in everyone\\s life due to many causes. In most cases, it goes away over time and no treatment is needed. You can do some investments like CBC (complete blood count), urine R/M/E, RBS (random blood sugar), lipid profile, USG of W/A, PSA, etc and hormonal tests such as testosterone, LH, prolactin, thyroid function test, etc., to find out the underlying the causes which are responsible for your present sufferings and then treat them accordingly.

Hello doctor,I am a 32-year-old male. I weigh about 80 kg with a height of 5\\9\". I am facing erection issues since last week though there is no change in my sex drive. Also, I feel reduced morning erections too. I feel aroused but the erection does not come as it used to before a week. Healthwise, I have sound health and have a moderately active lifestyle and pretty normal sleep pattern. Anxiety level is suboptimal due to COVID19 situation. I was using a semen volumizer herbal supplement intermittently. I am not sure if this plays any role in it too. I drink occasionally in limits and I am a vegetarian. My food habits are healthy and I avoid junk food as such. These erection problems started just a few days ago and now they are troubling me to a bigger extent. Please help.

Hi. I can understand your concern. According to your statement, you have been suffering from erectile dysfunction for the last few days. Erectile dysfunction is usually caused by low blood flow to the penis or problems of nerve of penis which control erections. Most common cause of erectile dysfunction is psychological reasons such as stress or depression. It may have resulted from the hardening of arteries, high blood pressure, high blood glucose, high cholesterol, medications, BPH, prostatitis, hormonal disturbances, etc. Usually, erectile dysfunction is common in everyone\\s life due to many causes. In most cases, it goes away over time and no treatment is needed. You can do some investments like CBC (complete blood count), urine R/M/E, RBS (random blood sugar), lipid profile, USG of W/A, PSA, etc and hormonal tests such as testosterone, LH, prolactin, thyroid function test, etc., to find out the underlying the causes which are responsible for your present sufferings and then treat them accordingly.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have pain in the right knee for two months. While using a staircase, it used to pain initially whenever I starting walking or running. The pain is exactly on the front side of the knee and just below the left side of the kneecap. I started jogging a year back and continued for six months, during jogging or walking I was feeling a cracking sound but I thought it was normal. Recently, my weight started increasing so again I started jogging and gym workouts. In the gym, I was doing leg workouts like squats, leg extension, leg press, and deadlift. Knee pain started and I realized I was doing squats and deadlift in the wrong form. Later, I corrected and started doing workouts in proper form and pain is slightly reduced. I have consulted a doctor regarding this and he gave me some medicine and said it as early osteoarthritis. Kindly advise me whether I can continue my workouts, is this issue curable, how to manage this. Medicines which I am taking now is Fixit 300 (Nizatidine 300 mg), Loflam (Aceclofenac 100 mg), Joint free triple action (Glucosamine, Chondroitin, and MSM). ### Response: Hello, Welcome to Chat Doctor forum. Your X-rays are normal for age (attachment removed to protect patient identity). What you describe is patellofemoral compression syn ChatDoctor. Physiotherapy to do like closed chain exercises, leg presses with knee not bending more than 30 degrees, patellar taping, core strengthening exercises, gluteal clam shells, hamstring stretches, VMO (vastus medialis) exercise, etc. Take NSAID like Aceclofenac but I see no role of Glucosamine combination tablets. The process of relief takes a long time so do not get frustrated and believe me this is a curable condition but effort has to be yours.

Hello doctor,I have pain in the right knee for two months. While using a staircase, it used to pain initially whenever I starting walking or running. The pain is exactly on the front side of the knee and just below the left side of the kneecap. I started jogging a year back and continued for six months, during jogging or walking I was feeling a cracking sound but I thought it was normal. Recently, my weight started increasing so again I started jogging and gym workouts. In the gym, I was doing leg workouts like squats, leg extension, leg press, and deadlift. Knee pain started and I realized I was doing squats and deadlift in the wrong form. Later, I corrected and started doing workouts in proper form and pain is slightly reduced. I have consulted a doctor regarding this and he gave me some medicine and said it as early osteoarthritis. Kindly advise me whether I can continue my workouts, is this issue curable, how to manage this. Medicines which I am taking now is Fixit 300 (Nizatidine 300 mg), Loflam (Aceclofenac 100 mg), Joint free triple action (Glucosamine, Chondroitin, and MSM).

Hello, Welcome to Chat Doctor forum. Your X-rays are normal for age (attachment removed to protect patient identity). What you describe is patellofemoral compression syn ChatDoctor. Physiotherapy to do like closed chain exercises, leg presses with knee not bending more than 30 degrees, patellar taping, core strengthening exercises, gluteal clam shells, hamstring stretches, VMO (vastus medialis) exercise, etc. Take NSAID like Aceclofenac but I see no role of Glucosamine combination tablets. The process of relief takes a long time so do not get frustrated and believe me this is a curable condition but effort has to be yours.