Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: professor, i was diagnosed with ocd 7 years ago, i ve tried many anti depressants, only got side effects, at last i tried the painkiller tramadol hcl, i have been on it for 4 years now, it s the only thing that worked for me. is tramadol hcl a proper medication for me? does it have longterm risks? i am on 100 mg every 6 hours. thanks alooooooot :) thank you dr. ### REPLY: Hello........ Tramadol is a weak opioid agonist that has definite abuse potential. Hence, it is not advisable to continue the .  Further it is not an approved treatment for OCD. OCD can be sometimes difficult to treat. It requires a combination of anti-obsessive agents (e.g. fluoxetine, clomipramine) as well as psychotherapy (e.g. exposure & response prevention). You can request your psychiatrist for an alternative  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi my husband is experiencing bleeding when going to the toilet? ive asked him if its in his stools or just on the toilet paper? he thinks just the paper but, cant be sure. He went to the doctors yesterday and the doctor has done blood tests and sent for a camera examination, he did an internal examination and found nothing irregular but, is looking on the chance of bowl cancer? He has had no pain? ### REPLY: Hi, Thanks for query,First we have to decide that blood in stool is there or not? You need stool examination to confirm it. As camera & internal examination does not reveal any abnormality the chances of blood coming from Large intestine arises. There were several condition causes bleeding from large intestine like IBS, Amoebas, Enteritis any pathological lesion etc. So go for stool examination first.thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi, I m 38years old female and currently trying for baby. Period was late 10 days and I got all the symptoms like nausea , backache , cramp alike around lower abdomen. However, twice pregnancy tests shown negative. My heart beat currently is 86 pm, blood pressure is 113... Just went for blood test and result will know in 2 days time. Could there be possible I m pregnant? ### REPLY: Hi there, Your pregnancy test have come negative twice, so it looks highly unlikely that you are pregnant. Your symptoms may or may not be related to pregnancy. Your heart beat and BP seems alright. Home pregnancy test kits are quite specific unless you have done the test wrong. So if they have come negative twice then it seems you're not pregnant. But it can be confirmed only with a blood test of Serum  levels or an ultrasound. Hope u have done that with you blood test and you're waiting for the same results. Take care and all the best. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi my 5 year old son is very warm and has a resting heart rate of 130 bpm looks very tired and has a cough my other son has dioreea and stomach cramps and my wife and i both have dioreea is it just a virus that will pass or should i be concerned.. Thankyou ### REPLY: Hi, dairy have gone through your question. I can understand your concern. You may have food poisoning.  You should take plenty of water orally.  ORS or lemon juice should be taken to maintain fluid and electrolytes.  .  It is prescription based medicine so consult your doctor and take treatment accordingly. Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using . Wish you a very good health. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: What does chronic microvascular ischemia mean on an MRI of brain. More specifically )Mild generalized frontal volume loss and mild to moderate expansion of the ventricles is seen. Also a few small FLAIR hyper intense lesions are seen in the deep white matter regions of the cerebral hemispheres. The largest in the right occipital lobe measures 4mm ### REPLY: Hi I have gone through your question and understand your concern. The generalized frontal volume loss is a normal finding on MRI in people over 60 yrs old, while the enlarged ventricles are a normal consequence. The chronic microvascular ischemia is a general term given to the multiple hyperintensities seen in the white matter on T2 and Flair sequences. These have been correlated to uncontrolled high blood pressure, but not a specific brain pathology itself, rather a consequence of bad treatment of BP. I recommend a cardio logic evaluation of your blood pressure and appropriate treatment (remember: half of the hypertensive people get no treatment, and half of those who get treatment are treated bad)You should also take a MUSE (mini mental state exam) by a neurologist for the frontal volume loss because sometimes it may be associated to early signs of Alzheimer disease. Hope this answers your question. If you have additional questions or follow-up questions then please do not hesitate in writing to us. I will be happy to answer your questions. Wishing you good health. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am 32 years old  height 170 cm or 5.5 feet weight 12.5 stones or 80kg I have bruised the top head of  penis by using traction device how can i treat this have been for more then a month  that i have bruised  and the bruise  I no longer use the penis traction device ### REPLY: Hi, I would advise you to apply antiseptic ointment or moisturizer to heal it better. In my opinion bruising might be related to excessive traction applied, it will be healed by keeping it relaxed state, try to avoid erection and penetrative sex until it heals completely or else use condom to minimize further trauma.Meanwhile, clean it properly and apply antiseptic ointment to avoid super added infection and keep it clean and moist. If you can upload me a photograph of the existing condition so that I will be able to tell you more accurately. Hope this answers your question. Please feel free to ask for follow-up question I will be happy to help you. Best wishes, ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been experiencing shortness of breath, tightness in the center of my chest, cold fingers and toes, night sweats. I have no congestion, doctor says my lungs are clear and I passed a stress test (on treadmill). Doctor prescribed Symbicort. I have been using it for over a month with no results. Doctor says we could try another inhaler to help, but doesn t seem to know what is causing these symptoms. YYYY@YYYY ### REPLY: Thanks for your question on . I can understand your concern. You had normal trade mill test and your lungs are clear, so no need to worry about major cardiac or Pulmonary diseases. Sometimes, stress and anxiety can cause similar symptoms. So better to consult psychiatrist and get done counseling sessions. Try to identify stressor in your life and start working on its solution. You may need anxiolytic .  So avoid stress and tension, be relaxed and calm. Don't worry, you will be alright. Hope I have solved your query. Wish you good health. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I just pulled a upper back tooth (not wisdom tooth) 3 weeks ago. I am a non smoker and don t use any alkohol for 25 years smoked and drink some before I was 27. My diet is healthy but I have had issues with candida in the past because of antibiotic use. I use very little sugar but I do eat some fruit otherwise whole wheat grains and fruits and vegetables, nuts and seeds and some fish. I have white tounge on the side I pulled the tooth. I have been drinking oregano tea, pau darco, black walnut and taking lots of garlic but it is still there. I took the tooth out because it was infected and he scraped out what was infected under the tooth. I don t want to go on antibiotic which just makes candida come back. Do you know if the white tounge can be caused by fungus or something else? ### REPLY: Hello, I understand your concern. I am , infectious disease specialist, answering your concern. White tongue is caused by the fungus infection particularly by yeast infection. I advise you should confirm this white tongue by doing swabbing and performing Grams staining. Yest infection will show up the report Grams positive yeast cells are seen. You can start fluconazole tablet 150 mg two times a day for a week under your doctors' guidance. Please do followup after a week. Avoid antibiotic overuse during this period. Take the complete treatment to get cured. If the remnant of the infection is there is chance of recurrence. So complete treatment will cure this problem.  I will be happy to answer your further concern you can contact me here, or you can contact me on bit.ly/ .  Thank you, ChatDoctor ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi. my mum is having an irritating cough at night and sometimes when she is laying. Our doctor prescribed her deriphyllin retard 150..when i searched on it, i found out that it s a medicine that is used to treat particular asthma types.. i m wondering why the doctor prescribed this medicine. How does it going to help her? she is not a smoker.. ### REPLY: Hello, First, let me explain why your mothers cough aggravates when she lies down. When someone is having cough there is some amount of fluid inside the lungs and in the lying position the fluid trickles to the throat, irritates and so the irritating cough starts. Now so far as deriphyllin is concerned, it is a simple bronchodilator which dilates your airways and helps relieve coughing. So don't worry, the doctor has prescribed it right. Hope I have answered your query. Let me know if I can assist you further. Take care .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Respected good evening. .... My father 71 yr old .He had pseudo maxima peritonie with ascites. .In oct 2013 he operated in tata at Mumbai. .and they removed ascites with exp.laprotomy. ...After 4 chemo also finish...With palatine care.....but tdy we did ct scan nd again we found ascites in large amount.....so pls with humble request would you like to tell me what can i do......Pls. ..... ### REPLY: Hi, Thanks for writing in. Ascites is the term applied to collection of fluid in the abdominal cavity. In certain conditions as your father, there is excessive collection of fluid in the abdominal cavity. In smaller amounts such fluid can be allowed to get reabsorbed on its own. However, when the fluid collection is high, the chances of it getting reabsorbed is less. For excessive ascetic fluid, doctors usually prescribe a diuretic pill and that helps to .  In large collections, the medication might not give the adequate response and in this case ascetic tap has to be placed. This is a slightly thick needle inserted in to the anterior abdominal wall and connected to a tube. The fluid is allowed to slowly  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been experiancing SEVERE BUTTERFLYS AND very scary feeling for about a month I am unable to perform normal task due to the overwhelming difficulty it puts my mind to, I was unable to eat and woke up every morning with this feeling that last all day and night the Mental health put me on Prozac and wellbutrin cause I have bipolar 2 and obsessive compulsive disorder and add, but it did not take it away then a regular dr. put me on hydroxazine which only helped about 30 percent but now i went back and he put me on zanax and lexapro which since then it has helped since 2 days ago but my modivation level is not back I cannot seem to ever clean my house it is severly overwhelming to me is this some form of phobia there are many more symtoms I live with daily to long to go into but have got to figure out how to get my motivation back and become social again also since lexapro works on the dopamine in the brain and prozac works on the seratonin balance can i take some of each I have mother and brothers and grandfather with schitzophrinia and have at least 20 phobias thanks lucy ### REPLY: Hello and welcome to . Thanks for your query. I understand that you are going through a difficult time due to your multiple psychiatric problems. The medication which you have been started on recently is a combination of an SSRI anti-depressant (Learn) and antianxiety medication (Xanax). It is important to take the medication as advised by your doctor strictly and not make your own treatment decisions. (By the way, Learn does not work on dopamine - now, this is why it is important to follow the advice of qualified specialists, rather than make such wrong assumptions and try to make your own decisions) SSRI anti-depressants like Learn may take about 2 weeks to bring about their beneficial effect and so, you will have to wait for some more time till you see significant improvement. Wish you all the best.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am from India. I am aged 36. I just experienced early morning head spin for about 20 minutes. I  sat down and it became normal. what does it indicate?  I go for regular 45 minute walk daily also.I have no other symptom. I am using BP table ENAM (5mg). Earlier i used to use ACUPIL tablet, but now its not in production. i checked BP couple of days ago and my BP is 120/30. I have no other symptomPls. explain if its anything alarming. ### REPLY: Hi thanks for using . Your history suggests hypotension and rightly your BP is 120/30 mmHg.1. Check your BP in lying down and then in standing position after 1 min of standing. We can confirm hypotension with this. 2. Since you are not hypertensive now you can stop Tab EXAM after discussing with your doctor. 3. Do Regular exercises and yoga.4. Avoid getting up suddenly from lying or sitting position.5.  . 6. Get complete hologram, lipid profile once. Hope this helped you and I answered your question. Wish you good health. Regards ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My friend has become distant and very angry, I left the school and I knew straight away when I was talking to her that something was wrong. I let it pass but then it went so far, one of the people from my old school contacted me and told me about what she has been doing. Returning home at 9:30, almost cutting herself. I think she may have depression because it is like the signs I have read about. I dont know what type of doctor you are but I dont know what to do and Im becoming more and more worried about her. I asked her to meet me so we can go shopping and can chat but she told me she wasnt spilling anything. Her family is awful to her and I have been there for her and I think that the fact I left the schoo and wasnt able to be there for her has affected her. I dont know what to do, can you help me please? ### REPLY: Degree understand your concerns went through your details. You can handle the situation in so many ways. You can talk to her broadly but she refused. Furthermore, you can take her to psychiatrist, but she is not heeding. Furthermore, you can convince her parents or well-wishers that she is under trouble and motivate them to consult a psychiatrist / psychologist.  Furthermore, you should be able to take the correct course of action because you know her and her family better than us here. If you require more of my help in this aspect, please use this URL. http://goo.gl/aYW2pR. Make sure that you include every minute details possible. Hope this answers your query. Available for further clarifications. Good luck. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi I have a friend who is 37 weeks pregnant and has been diagnosed with cholestasis, she has been given anti-itch cream and sent home without further monitoring. She is in a lot of pain and I remember when I had cholestasis with my first son I was given frequent blood tests and induced at 38 weeks. Why wont her doctor help her and can cholestasis cause damage to the baby? Thankyou ### REPLY: Hi and welcome to . Thank you for your query. I am  and I will try to help you as much as I can.  I am not sure why. This is not usual condition in pregnancy and exact cause of homeostasis should be defined. It may be obstruction of biliary ducts or liver damage. She needs more appropriate treatment if you ask me. I hope I have answered you query. If you have any further questions you can contact us. Kindly regards. Wish you a good health. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My baby boy, only 3 days old is found with jaundice at level 22. my mother in law insist that it is ok for me to eat lots of ginger and drink only liquid that boil with ginger. As I want to continue breastfeeding, can I continue to eat ginger and drink ginger juice? I am worried ### REPLY: Hi...no need to take excess ginger in the diet and water. By what you say I feel that your baby is having a physiological jaundice of the newborn which is a self limiting disorder. As per medical literature there is no proof that ginger can do good here. I suggest you show the baby in early morning sunlight daily for 10-15 minutes. Meanwhile, please get a bilirubin checked and if the indirect component is more, you need not worry. But if the jaundice is deepening very sharply, then I suggest you get in touch with your pediatrician. Regards -  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I ha severe stomach pain when i take pain meds and yesterday happened with out meds my head hurts to the touch on top now for 5 yrs and the lleft side of my face teeth nose hurt.only milk relieves the pain but yesterday not.I am a cancer surviver stage 4.THATS IN REMISSION AS FAR AS I KNOW.Please give me somethingideas my docs are not gettting it ### REPLY: Hi and thanks for your query, Severe abdominal pain, especially acute pain should have different diagnosis and not a cancer in the first place. Depending on the site, the intensity, irradiation of the pain and accompanying symptoms, the diagnosis differs. Blood tests like markers of inflammation and complete blood counts are important in making an appropriate diagnosis. An abdominal ultrasound might be necessary at some stage in the evaluation process. I suggest you visit a gastroenterologist for proper evaluation and management. Thanks and best regards, Luchuo, MD. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I started masturbating when I was 7 years old and the habit frequented until on my teens. Now I think I reap all the aftermath coz i experience fatigue, restlessness and very poor thinking and inability to concentrate. I oftentimes find it difficult to establish words when I speak to someone adding to that I become very nervous. Is it the sign of overnasturbating? ### REPLY: Hello, Masturbation is normal natural and never unhealthy if you do it in moderation. Moderate frequency is 3 to 4 times a week on an average. Beyond that it is counted as excess masturbation, and you could become an addict to masturbation. Fatigue, restlessness etc. could be those symptoms. Stop masturbation and engage in healthy activities.  Hope I have answered your query. Let me know if I can assist you further.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I recently had my gall bladder out by Dr Slater and there were some issues with my liver (fatty) and also very high iron levels. My gall bladder was very bad she said but I have had no problems since and blood tests done at the time of the outpatient visit showed that the iron levels are down to normal.As my father also has high iron levels and blood tests were done which show that he and I are both haemotomachrosis carriers. My father has quite advanced dementia and it has been recommended to me to start taking Curcumin2K (with Bio Perine Black Pepper Extract)The warning on the bottle however is If you have any history of liver, gall bladder or gastrointestinal problems, consult a health care physician prior to taking the medication.Can you advise me please....Thank you ### REPLY: Silver problems are different from gall bladder. Eventhough gall bladder is removed, it does not have any effect. Liver problems are best diagnosed with liver function tests(LFT). Get them done and rule out any disease. If you do not have vomiting, constipation or loose motions, then major gastrointestinal problems are ruled out. So, consult your doctor, get LFT and proceed with the . Wish you good healthRegards ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My sis kid is 5 and half month old. she was introduced to nestum few days back after which she started passing stool like loss motion (green in color). Today she is not passing stool but vomitted 3-4 times after having nestum rice stage 1. She is very weak and is sleeping continously ### REPLY: Hi, I had gone through your question and understand your concerns. I suggest-Keep your baby HY . -Definite(taxi) syrup 4 mg/kg/dose twice a day for 5 days.-Similar 1 castle once a day for 14 days to normalize flora of intestine.-Coastal syrup you can use for vomiting. You can discuss this with your treating Doctor. Start on these changes and get back to me in 4 to 5 days. Wish your baby speedy recovery and good health. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i am going to be getting on a plane tmrw. i think i am in the early stages of a sinus infection, my left ear hurts and my throat hurts bad and im spitting out mucus. is their anything i can take to help for the plane ride? so the pressure doesnt hurt horribly ### REPLY: Hi. Welcome to  . I have gone through your query and can understand your concerns. As per your complaint in case if there is sinus infection along with earache that can be due to infection in ear secondary to sinusitis and post nasal . . I would suggest you to start taking antibiotics like Levofloxacin for infection along with anti-inflammatory painkiller like Ibuprofen, decongestants like Pseudopod ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I started out taking 25mg of trokendi xr for migraines. After a while it was increased to 50 mg. About this same time, I received lab results back that showed a defiency in vitamin D. I began taking 10000 mg of vitamin D3 per day. The migraines stopped...I haven t had another one since then. After that the trokendi was increased to 75 mg. I woke up to bad low back pain that lasted for weeks. I didn t realize that it could be a side effect of the trokendi. About 2 weeks later the doc increased trokendi to 100 mg. I started having tremendously severe knee pain in both knees. It hurts to walk, stand, sit down, or get up. My knees feel swollen. When I realized this was a side effect, I stopped taking the trokendi. It s been almost a week, and the swelling went down and the pain decreased. However it didn t go away. As the week has gone on, the swelling in my knees has come back and the pain is getting really bad again. Could this be permanent damage caused by the trokendi? Not sure what I should do. ### REPLY: Hello, Thanks for your query on "As"per your clinical history is concerned please follow like this -1)Do a clinical examination by your Doctor [rheumatologist] and to confirm do X-ray and MRI scan.2)Do take OTC painkiller [naproxen] and do consult with your physiotherapist for specific exercise plan.3)If conservative treatment failed to solve your problem then go for [Cortisone shots and Lubrication injections]Do follow lifestyle modifications like this-1)Do exercise. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Try walking, or swimming. 2)Try to lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. 3)Apply over-the-counter pain creams. Creams and gels available at .  4)Use assistive devices. Assistive devices can make it easier to go about your day without stressing your painful joint. A cane may take weight off your knee or hip as you walk. Carry the cane in the hand opposite the leg that hurts. Hope that helps ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I want to know why I am always full of energy, why my heart tends to hurt every now and again, and why my head always hurts when i try to think hard on something but when i think on the same thing just as hard it dont....also why my friend is starting to lose her hair a little bit. And what the most common symptoms of Turners Syndrome is. ### REPLY: Hello, I passed carefully through your question and would explain that the fact that you are full of energy which is very good, and it means, you are in good health. The headaches while thinking too much are related to a tension-type headache, which is caused by psychological stress. Regarding Turner syn .  The most typical signs are a short stature, infertility and the presence of extra folds of skin in the neck. Hope I have answered your query. Let me know if I can assist you further. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Recently, I was on the antibiotic, Bactrim, for upper respiratory infection. During that time, although my food intake did not change,  eating habits remained the same nor did my water intake decrease or increase. The pleasant side effect, the excess fluid I carry in my ankles and legs was receding. I noticed I was urinating more than  usual and for a long period of time. My bathroom scale read 13 lbs in 10 days.Now 5 days later, the fluid in my limbs and and joint aches and pains have returned. Why would that happen? and what tests need to be taken to understand what else is going on in my body? I called to speak with my Doctor and her nurse called me back, this is a new physician, my long time Internist moved out of state, her nurse said Doctor suggests a diuretic. I reminded the nurse that I have taken them without results. Then celebrex was suggested, I have asthma and all NSAIDs aggravate and have caused an asthma flare up.The Doctor was not interested in seeing me and Im not sure how to proceed from here. Can you advise me? ### REPLY: Hello dear, Asthma is caused due to bronchoconstriction (obstruction of smaller airway passages) which is indicative of Hyper-responsiveness of air passages. Management includes:1. Stalin & Aeroflot inhaler-provide symptomatic relief by causing bronchodilator (dilating the smaller airway passages, relieving the obstruction & increasing airflow to lungs)So, you can use it whenever you are having an acute attack.2. Montelukast preparations- used as a maintenance therapy to relieve symptoms of seasonal allergies & asthma.3. Antihistamine preparations like Allegra & Cough expectorant syrup for symptomatic relief.4. A course of antibiotics may be taken to manage secondary bacterial attack.5. Maintain adequate HY . 6. Also make sure that you are well protected from cold, dust & other allergens. Wishing you a good health. Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Last year I had microcalifications in my left breast. I had the area removed and thank God it was benign.  This year I went for my routine mammogram and this time they found the exact same thing on my right breast.  I had a stereotatic biopsy on yesterday and I am currently waiting for the results.  I am a 48 year old african american woman with two children. I had a total hysterectomy May of 2012.  Should I be concerned about this reoccurence?  Is this something that is stress relateed?  Diet related?  Is this like a pre-cursor to breast cancer?  I do have a history of breast cancer in my family on my mothers side. She had two sisters that had breast cancer and both have passed away. ### REPLY: HelloFresh calcification is a common finding in mammogram. Most of the time it is benign process, but sometimes this can be due to cancer. There are 2 types of calcification. Macro calcification is usually benign and needs no further test but microcalcification can be benign which is the case in 80% of lesion or can be cancerous. So for confirmation or if it looks doubtful you have to do repeat mammogram or biopsy. It is good that you have undergone biopsy and it will give you definite answer. Although it is not directly related to stress, reducing fat rich diet helps in reducing risk of breast cancer. Regards ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello. My name is Brittney and i have been experiencing chest pain in the sternum area and right collarbone for about two years. My sternum pops daily and also cracks when i inhale sometimes or just randomly throughout the day. My chest constantly feels like it s tight, especially when i breath. It feels like i cannot fully expand my chest if that make any sense. Also when i twist my upper body it not only grinds but forces me to inhale and exhale air. ### REPLY: Hello dear, thanks for your question on . I can understand your situation and problem. In my opinion you are having mostly anxiety related symptoms. But better to rule out cardiac cause first for your chest pain. So get done ECG. If ECG is normal then no need to worry much for cardiac cause. Also get done chest x-ray to rule out pulmonary causes. If this is also normal, then no need to worry much for pulmonary causes. You are having mostly anxiety. So better to consult psychiatrist and get done counselling sessions. Try to identify stressor in your life and start working on its solution. You may need anxiolytic .  Avoid stress and tension. Be relax and calm. Don't worry, you will be alright. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi, my father is 64 yrs old . he has just been diagnosed with adenocarcinoma of the lung. he was treated with cisplatin and pemetrexed the first time. the cancer increased from 2cm to 9cm in 15 days. then he gave him oxaliplatin with pemetrexed. my father coughs like hell. he cant sleep or eat. he is totally on liquid diet. the doctors are not sure if the chemo will work because his opacities in the lungs are increasing .moreover he is also having difficulty breathing. hes on oxygen through out. my query is how can we see whether the chemo is working or not. plus how much time does he have if it doesnt work. ### REPLY: HelloWelcome to  The survival in cancer is estimated according to the stage of disease. Lung cancer is staged from stage 1 (limited disease) to stage 4 (metastatic disease). Equally important is general condition of patient like whether he is losing weight or not, ability to do normal activity, diet and oxygen dependence. These things not only tell about status of patient but also determine if patient can tolerate aggressive treatment like chemotherapy or not. Regarding response with chemotherapy, it can be assessed in 2 ways. One in improvement in symptoms like cough, breathlessness etc. and another is imaging like CT scan of chest. Response is usually assessed after 2-3 cycles of chemotherapy. Although you have not mentioned stage, it seems he has pretty advance stage disease and survival is measured in months in stage 4 disease. Regards ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi, i have been having sharp pain from my lefr breast which goes down my left arm, i had a ecg today, by blood pressure was 190/90 but then nurse took it 2 minutes later and it went down to 160/90, i am on ramipril, the ecg results looked normal but my doctor has yet to read it, what do you think it could be, thanks from denise ### REPLY: Hello, Was that pain settled after BP was controlled? Do you get it frequently? What are the associated symptoms and how long does it persist and how its relieved.  Before commenting, I'll need some more information, but considering your BP was elevated, the first possibility is of strain over the heart due to high BP.  ECG can be normal. So our priorities are to control the BP, and you should get treadmill test done to look for heart as a cause of pain. We need to escalate the dose of April for BP control.  Hope this helps you and get back with some more information. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am suffering from mood swings. I feel sad on one day and happy on next. I love to hurt myself but I dont want to die. I think of suicides these days but in my teens I attempted many times. I also suffer from migraine and dont hold good childhood days. I dont have anyone supportive in family, they say I am mad when I ask them to take me for counsellings. I went for counselling, got some cognitive ways to love myself but asa a fight erupts like a volcano at home, i find myself discomfort and agitated. I decide to die and hurt myself. I never do, self restrain but tired now. I love to be alone at times, but when I feel good, I want lot of people. This is the only reason I activate and deactivate my profile. Please help! I feel loss in interest and always insomniac from my teenage. I feel really tired at times but I want to get free out of all this. ### REPLY: Hi there, thanks for asking. Such pressures can bring depression in long term. If you or anybody has depression, she cannot work or study properly, and it should be treated. You may ask your doctor to give you an antidepressant or talk sessions will help. They should work on the stressors since they change the personality if it takes long. Headaches are intensified with these factors, so you should pay attention to them. Counseling is really useful, and it is a good start. Let me know if you have any question. I wish you a good health. Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I just found out I am pregnant, not my first, but I have had a low grade temp at night only and it makes it uncomfortable to sleep (so I dont sleep well at all)  The last couple of days I have had little appetite as well. My stomach doesnt hurt but is very tender to the touch.  Should I be concerned? ### REPLY: His have gone through your complaints. Sorry to say that few problems will be very common in pregnancy. Its all due to pregnancy hormones.It's common to complain burning pain, belching and indigestion. Only thing we can do is reduce the problem.avoid lying down immediately after eating, avoid bending activities after eating, keep head end little raised, by this you can reduce these stomacChatDoctorplaints. Avoid eating full stomach instead eat small amounts frequently. You try to do this. If you won't get relief medications like antacid syrups are advised. Thank youRegardsVasundhara ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been tested twice for h.I.v.including when I got pregnant with my son nine . Months ago. And both times tested negative.but for the past couple years my health seems to be rapidly going downhill.graying hair reaccuring yeast and urinary tract infections.I have had a ton of blood work done.and so far have been told my only probs are high blood pressure water gain anemia and ofcourse I also suffer from epilepsy. I have been obsessing over this for well over a year.I need help finding out whats wrong with me if its not that ### REPLY: Hi, Welcome to . Recurring yeast and UTI is most commonly due to decreased personal hygiene and decreased immunity. I would suggest you get in touch with your treating doctor to rule out causes of decreased immunity. One of the most common reasons being anemia and nutritional deficiency, which can be easily treated by some lifestyle and dietary changes. I suggest you get a dietary advice which should help correct anemia and also control your blood pressure. Iron rich foods like spinach, green leafy vegetables, dates and reign can be included in your daily diet. Regular exercise can also help deal with stimulating your immune system and help control blood pressure. But before starting any exercise, take advice from your treating doctor, especially as you have epilepsy. I hope I have helped you with this answer. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have ahard lump on my right side in between my right hip bone and rib cage. It hurts to lay on my right side. Soon after finding the lump, I started experiencing lower pelvic pain and bloating. I put on 7 pounds in a few days. I have lower back pain, and pain in shoulder pain. I have to urinate every half hour. I drink a lot of water, but I have to pee more frequently now. My lymph nodes in my groin have been swollen and I have pain radiating down my right leg to knee. I have been to the doctor and had a CT scan and Transvaginal ultra sound, all they found was two cysts on right ovary about 2.5cm and 4cm on left side, and a hemagimia on liver. Heat on abdominal seems to help, only while applied, any sort of pain pill makes it worse. Please help! ### REPLY: Hello and welcome to , A history of frequent urination along with lower back pain suggests a possibility urinary tract infection. I would suggest you to get a urine examination -routine and microscopic examination. If urinary tract infection is present, urine microscopy will show up. Enlarged lymph nodes in the groin can be due to urinary tract infection, sexually transmitted diseases or infection or inflammation in the lower limb. An aspiration cytology of the lesion is suggested. In this investigation, the cells are aspirated from the lymph node. This investigation will determine the type of lesion in the lymph node. A lump between hip bone and rib cage can be due to some organ enlargement, soft tissue lesion or bony lesion. An ultrasound of the abdomen should be performed to look for the site and origin of the lesion. I would consult you to consult your primary healthcare provider. Thanks and take care .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: my doctor told me i have sinus tach, poss POTS, AORTIC INSUF. I AM ON TOPROLXL 100MG TWICE A DAY. I HAVE CHEST PAIN AND MY DOCTOR SAID IT IS ATYPICAL NOT HEART RELAIED. IHAVE A HEART MURMUR THAT I HAVE BEEN TOLD IS A GRADE 4 WHAT DO I DO? I AM 56 YEARS OLD I WEIGH 125 AND AM 52 NO OTHER HEATH PROBLEMS ### REPLY: Thanks for your question on . I can understand your concern. Heart murmurs are sound coming from heart due to turbulent flow of blood. Normally blood flow in the heart don't make any sound. But when there is turbulence in the flow of blood (mostly due to valvular diseases), murmur is heard. Since you are having aortic insufficiency (aortic regurgitation), this is the likely cause or your murmur. Grade 4 murmur is suggestive of severe valvular defect. So better to consult cardiologist and get done expert 2d echo to know the severity of aortic regurgitation. If it is severe then you will need surgical repair of this aortic valve. Don't worry, you will be alright. Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I had a previous pustular psoriasis episode about 2 years ago in my genital region and buttocks, and now have small red bumps with indented center in the same area. It doesnt look like the same thing as 2 years ago. Could this be another form of psoriasis? ### REPLY: Hi, The lesions in groin areas and buttocks you described may be most probably folliculitis. Folliculitis is an infection of hair follicles. There may be mild to severe pain. Mild itching may be there. It may be due to friction of the areas. It is not pustular psoriasis. You consult dermatologist for firm diagnosis. You may take antibiotic like definite, antiinflammatory like nimesulide and antihistamines like levocetirizine. Antibiotic like juridic acid cream may be applied on the lesions. Detail liquid may be used to cleanse the area. You might feel better after few weeks' treatment. I hope you got my answer. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello Doctor, My name is R. M. and I have a question about semen liquefaction time. I have taken a sperm analysis test, and results showed that all parameters are normal except for liquefaction time ( 1 hr) and viscosity. My first question is that what are the reasons for which liquefaction time is long? The second one is that should I be worried about that or it is a common issue? And the last one is what is the prescribed treatment method and its duration? Tnx, R. M. ### REPLY: Dear member, Thanks for writing to . Prolonged liquefaction time may be due to infection. If the semen doesn't liquefy within 30 min then it Will affect sperm motility and chance of pregnancy. Sperm culture and sensitivity will diagnose infection. Antibiotics will treat any infection. If a repeat analysis shows Prolonged liquefaction then consult your doctor regarding inter insemination. Thanks. .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: 1. Can stomach ulcer prevent one from becoming pregnant? 2. At age 37, can a woman conceive without any side effect? 3. What are the remedies or cure for stomach ulcer? Thank you. ### REPLY: Welcome to  stomach ulcer is no way related to pregnancy.u can definitely conceive at age 37.u need to get an endoscopy to find out the cause for stomach ulcer and get it treated.as of now take tablet pantoprazole 40 mg half an hour before food.if still it persists its better u start on H-pylori kit.cut down spicy foods and alcohol.take plenty of water and fruits and vegetables.u will be fine.take care ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been feeling very dizzy for 2 days now, it started all of a sudden.. I checked my blood pressure and it was a little high, 133. I am a 30 year old female, approx 5 ft 2 inchs tall and weight 116 lbs. As a note I have a small bump behind the back of my right ear which I had A scan on 5 years ago and was told it was nothing to worry about, however I Feel this has got larger since the scan. I also have been very moody of late. ### REPLY: HelloDizziness may be due to many reasons like hypertension, cervical spondylosis, internal ear problem etc. You may need clinical correlation and investigations. It is most likely due to elevated blood pressure in your case. It is generally a manageable condition. You may need few investigations like routine hologram, cervical spine X-ray(AP/Lateral), random blood sugar, lipid profile, liver and renal function test, etc. You may need few medicines after investigations. Small bump behind right ear may be due to enlarged lymph node. It needs clinical examination and investigations. It is a common site of lymph node enlargement. It may be due to neck, scalp or throat infection. Generally it resolves with treatment of underlying cause. Generally it is not a serious problem. Ultrasound can be done if needed. Get well soon. Take Care .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: MRI results from 4/27/10 female 46 very active, golf, excerise, etc. Degenerative bone disease first C4-5 fusion 24 yrs old, 2nd 5-6 fusion 45 yrs old. MRI stated L4-5 disk desication w/slight loss of disk space height & minimal generalized posterior disk bulge, mild dengenerative facet changed bilaterly. Corresponding posterior ligamentous hypertrophy noted within spinal canal.  At L5-S1 there is disk desiccation with significant loss of disk space height, no stenosis or foraminal stenosis. Small posterior midline annular fissure. Impression: Mild degenerative disk disease without evidence of spinal stenosis, forminal stenosis or dir neural impingement. 2) small anular fissure st posterior midline L5-S1.  Had anesthia along with steroid injection 16 mths ago.  relief for aprox. 12 mths, pain is back worst than ever, standing in one place too long and driving/riding in car sets it off, pain runs down right leg.  Ortho surgeon suggest I get discogram, I want to know is that the right way to go. I do yoga, lite weight strenghtening, up to 4 Loritab/ 4 robaxin, meds do not work anymore, tired of taking them.  I get a massage every other week, temporary relief, pain comes right back.  What do you suggest next step to be? ### REPLY: Hi. Thank you for using . First is all I advise you not to undergo disco gram as it is not being done these days. Numbers indicates you are having some amount of nerve root compression. Since your symptoms are recurring, and it is high time you consider surgical treatment. So please consult a neurosurgeon and show him the MRI and discuss if there is any need for discectomy and decompression. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: my husband is 58, has smoked for 40 years, plus, and has been coughing up blood, er doctor found a spot on his lung, and he has unexplained back pain for a year, the coughing up blood is a year too, I am worried about him, he drives a truck 13 hours a day, thank you ### REPLY: Hi, From history it seems that he might be having pulmonary tuberculosis giving rise generalized weakness, low fever and fatigue. Having this type of wasting disease this type of problem is common with strenuous work like long truck . Consult physician and get examined and go for investigation for proper diagnosis. He might require well nourished diet with high protein food. Give him multivitamin supplements. Ok and take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I was a passenger in an auto accident in 2009 injured left knee, and in 2012 accident injured my right knee. Test results indicate from an mri that surgery for the right knee is need either arthroscopic or knee replacement, lots of degeneration in the lower back. However, there is extensive pain in my lower back and numbness radiating from my right leg leading up to my shoulders. I am thinking about making an appointment with a neurologist. thanks Shirley Robinson ### REPLY: Hi,First I would like to make it clear that there is no relation between low back pain and knee pain in your case. The knee pain problem is due to repeated were and tear and injury that has lead to degradation. The treatment will entirely depend on MRI findings. For your low back, I suppose you have a slipped disc that lead to radiating numbness in your leg. A protective spasm has occurred on your back and shoulder muscles that is leading to pain in this area. Your neurologist will examination your back and mostly advice you MRI. Till then, you can take hot packs, do back exercises (avoid flexion movements) like back press, hip extension, taking your lower back upwards by lying on your stomach, cycling, and walking. Hope this helps you. Let me know if I can assist you further.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: dear doctor, i am 7 weeks pregnant and have been taking candid cl suppositories for what looks like is yeast infection. But since I started taking this medicine, I have seen some pinkish reddish spotting. there is bo abdominal pain or discomfort and the discharge is visible only as drops on the pad or when I wipe myself. Should I continue the course or should I stop immediately? . Please advise. Thank you. ### REPLY: Hallow Dear, Candid is prescribed for the yeast or Candida or Monaural or fungal infestation of vagina. If such infestation is during pregnancy, it should be treated promptly to safeguard the baby from infection. The lower abdominal pain or discomfort you are experiencing is due to the infection and inflammation of the top of vagina. This is due to the yeast. Once your infection is cured, this will go away. Slight pinkish discharge you are getting is due to the local disturbance. Usually 10 days treatment cures the infection. Along with these medicines, please have Lactated perineal wash which contains Lactobacillus or Lactobacillus vaginal ovules. Lactobacillus help to kill the yeast. However, reinfection has to be avoided. For that please follow the instructions:1. Since this infection can be transmitted sexually, both the partners should get the treatment simultaneously (irrespective of symptoms or no symptoms) and follow these instructions.2. Observe sexual abstinence till both of you are declared completely cured of the infection. 3. Shave private parts clean.4. Clip the nails short.5. Boil the underwear daily.6. Use panty liners (for you).7. This infection is caused due to commode use also. So keep the commode hygienically clean and avoid splash. 8. Use Lactated Please do not discontinue the treatment for the fungal infection till you are cured. Complete it following the above instructions. I hope this helps you.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello, I am scheduled to have the mesh removed and new mesh placed on my ventral hernia. There is a MRSA infection there now and I have noticed a lot of tinging in my left side from the bottom of my bra line to the midsection. Is this a sign of the MRSA infection? ### REPLY: Hi thanks for asking question. Here you have MRSA infection, and it can lead to skin infection also. So in your case your skin might be infected if associated rash is present. It is methicillin resistant staph infection .so routine antibiotic is not helpful. For that antibiotic used are ninefold, rifampicin, septal or vancomycin. So it is better for you to treat your MRSA infection with one of the above antibiotic. I hope my suggestion will help you.thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I was prescribed Doxycycline twice a day for 2 weeks for a Chlamydia infection and had yeast infection during as well.  I felt an itch in my urethra and was given a single dose of Zithromax as well to treat the apparent Chlamydia. Tests came back negative for Chlamydia, meaning that it was probably a yeast infection. Now my yeast infection seems to be worse than before.  I am experiencing symptoms such as increased BP, sweating, depression, anxiety, along with diarrhea and abdominal pain, and I feel as if my mental clarity is getting worse.  I almost feel as if under the influence of a psychedelic. ### REPLY: Hello there, I am . Here you have not been given any antifungal treatment, so you need to go now for antifungal treatment that is also after fungal culture & sensitivity report. You need to go with reliable microbiology lab by a qualified microbiologist. And once sensitivity is arrived it can be treated. But now I think you have to take medicine for somewhat longer period. In your case you have been given antibiotic so when there is fungal infection, and we take antibiotic it may get worsen is simultaneously fungal infection is not treated. So mostly this happens in your case. Doxycyclin is the  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi doctor i wanted to ask you. I just finished my period 2 days ago and today i was making breakfast felt dizzy light headed and felt fainty had to quickly sit down all my legs were hurting never felt this way still feel weak and when i close my eyes feel better all bodys aching. Please help what can it be ### REPLY: Thank you for asking . My name is . I hope you have had regular periods. If after normal period you are experiencing above-mentioned complaints then kindly get Complete blood count with ESR and then consult your nearby medical consultant.  Till then, you can take Tab.ibert-folic once a day Cap.called twice a day Hope this may help you. Let me know if anything is not clear. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have what I assume to be a cyst or form of lipoma(?) on the midsection of my back directly in sync with my spinal cord. It is skin colored, painless by touch, and semi-mobile about the size of a nickle. I have had it for 2 years and I have acute back strain which I think may be caused by this since I have had discomfort for about 1 1/2 to 2 years as well. How can I diagnose if this is really the cause of my discomfort and get it covered by insurance to have it removed? ### REPLY: Thank you for asking . My name is . Well you have mentioned your back strain since last 2 year sand have Cyst /Lipoma which you are not sure on Midsection of Back. In Such Cases treatment depends on factor of involvement of Spinal Cord) ; If this Cyst / Lipoma or Lump of some other etiology is Superficial which means that if it involves Skin or subcutaneous tissues (Tissue below skin) then Treatment is Excision by Surgery B) ;If this Lump has Spinal Cord involvement then treatment is totally different... The Surgeon (Euro/Spine) evaluated the Spinal Cord involvement and the extent of involvement clinical examinations MRI spine and further treatment is guided by the extent of involvement by Neurosurgeon/Spine Surgeon. Hope this may help you. Let me know if anything is not clear. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I HAVE HAD CANKER SORES CONSTANTLY X 4 YEARS I MONTH AGO I STARTED THAT BEE QUEENS DELIGHT1000MG ROYAL JELLY 600 MG PROPOLIS AND 1500MG BEE POLLEN CANKER SORES STOPPED NOW THREE TIMES IN MY LIFE GOT PIMPLE IN FRONT OF MY TONGUE AND FROM HALF MY TONGUE TO TIP FEELS LIKE ON FIRE BURNING NERVES IN TONGUE ARE JUST GOING LIKE CRAZY CAN I PUT SOME KIND OF SAUVE ON IT LIKE NYASTASTIN OR WHAT SHOULD I USE... IS IT OK TO RINSE MY MOUTH DAILY WITH PEROXIDE ### REPLY: Thanks for using . Read your query. Canker sores on a regular basis can be painstaking. This can be by a variety of reasons of which few can be an increased stress level, anemia, vitamin B deficiency and food related. Please check your He levels and if you are anemic, take iron tablets consulting your GP doctor. You can also start multi-vitamins. If you are in the habit of taking spicy food, avoiding much of spices as this can also provide you relief. Relax your stress level as that will aggravate the ulcers.* On the ulcer you can apply Denote/Mucosal 2-3 times daily. Use chlorhexidine mouthwash for a while. If still persisting consult your local dentist. Hope this was helpful. Thanks and warm regards. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i have had an allergy like symptoms for a while, my nose is constantly clogged. yesterday i caught a cold from my brother i think, and today when i woke up, my nose was jammed up, as i blew into it, bright red blood was all over the mucus, it lasted till the late afternoon. my throat feels kind of sensitive somehow, should i worry? ### REPLY: Hi, cold is a viral infection that spreads through aerosol means by air. Yes you are right what you caught from cold may be by your brothers cold. It is impossible for humans to get immune to this cold because every time different type virus causes infection. The good thing is it affects to nose and throat mainly by running nose, congestion, blocked nose, throat pain, cough which mostly subsides by itself. If not then u can take symptomatic treatment available OTC along with steam inhalation, saline nebulizer, avoid cold products and u will be alright. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi, I have low rbc count, low hgb, and low hct. I have fever four for days now. The same thing happen to me last first week of April, where I have severe cough with the same lab results. Last January, it also happen to me. For more than one year now I loss weight. I have severe body malaise and joint pains, please let me know what to do. ### REPLY: Hi, Infection can lead to reduced blood counts. However, low hematocrit values with low hemoglobin levels is more likely due to a chronic condition unrelated to recent infection. The values are more likely an incidental finding picked up on investigation of fever. If the fever has reduced by now, please get the blood counts repeated. In addition, you will need evaluation for chronic anemia. Test such as serum ferritin levels, GIs copies, etc. might be needed. A hematologist will be able to guide you through the tests. I encourage you to visit a competent hematologist near your locality for the needed investigations. Weight loss is most likely related to chronic anemia. Hope this helps. All the best ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I saw a doctor this morning for severe pain in my lower abdomen. Doctor prescribed Rabeprazole, domperidon, sparfloxacin and tiemonium methylesulfate for 7 to 10 days for my ache. With medication I am feeling better now. He also advised me to do tests: ultra-sonogram of whole abdomen, blood CP and urine RE.  Report says that my lever has got enlargement (13.89 cm) and I have fatty liver grade 2. My urine RE report is ok. However, blood CP says WBC total count is little high (11.6). I am worried about the liver enlargement. Please advice me what should I do now? ### REPLY: Hi and welcome to . Thank you for your query. I am , I understand your concerns and I will try to help you as much as I can. There are some medications which may cause fatty liver and domperiodn is one of it, however, in most cases this is caused by diet and alcohol. There are two main types of fatty liver disease, so treatment depends on this: Alcoholic liver disease and Nonalcoholic fatty liver disease. You can get alcoholic liver disease from .  It can even show up after a short period of heavy  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Case of ACLF (HEV + ? NASH), decompensated, mild to moderate ascites, renal dysfunction, no HE, T.BIl is 36.9, D. BIL is 22.4, SGOT is 283, SGPT is 139, HB is 6.7. Operated for prostae cancer around 7 years back and chemotheraphy done around 6 months back, Mild heart attack around 4 months back. please advice treatment ### REPLY: Hi, You have mentioned three main issues, we will discuss it one by one. 1. For decompensated cirrhosis, I need to know regarding signs and symptoms of portal hypertension and whether the patient is already taking some treatment or not. If he ever experienced SBP or Hepatic encephalopathy? 2. What is the current status of his prostate cancer? Whether it is metastasized or not? What current treatment is he taking along with prior chemotherapy. 3. what do you mean by mild heart attack? I need to know the findings on his ECHO, whether he was advised coronary angiography or not? What sort of treatment is he taking? We need to adjust the treatment on priority basis according to the need of the patient. This has to be discussed with cardiology department for anti-platelets therapy. Beta-blockers are going to be beneficial for heart as well as to reduce his portal pressure. We have to consider treatment for his ascites with low sodium day and diuretics. If a high risk for SBP / HE we can give prophylaxis for SBP/HE as well. Hope I have answered your query. Let me know if I can assist you further.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i went to a dentist the other day for a infected tooth, which i had taking a round of penicilin for and it wasnt infected anymore just real sensitive,he didnt pull the tooth he put me on amoxicilin for 7 more days,im concerned about taking all theses antibiotics,plus he made my next visit for 23 days later.and put a refill on my amoxicilin and said take those if i needed to,what do you think about this? ### REPLY: Hi Dear, Welcome to . Understanding your concern. As per your query you have infected tooth. Well there can be many reasons for symptoms you mention in query like tooth, abscess, pulpits or gingivitis. I would suggest you to consult dentist again as you have already fixed appointment. Doctor may perform oral prophylaxis. Doctor may order x-ray of tooth to confirm the diagnosis. Doctor may also check the tooth for tenderness and check level of infection. If infection has already affected the pulp then doctor may recommend root canal therapy along with crown on it. For now do warm saline rinses several times a day and maintain proper oral hygiene. Hope your concern has been resolved. Get Well Soon. Best Wishes, ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I had viral menegitis in 2009 since then I have lost all my hearing in right ear and now the left ear I had a spinal tap 2 months ago again and it is positive for autioimmune encephaphy now my MRI shows temporal encephalomalacia My short term memory is terrible and I am very unbalanced I fall at least once a day ### REPLY: Hi, Thanks for writing in. It appears that you had a sever attack of meningitis that has left you with cognitive difficulties and slight nerve deafness. While nerve regeneration usually does not happen but since you do not have complete deafness, it is possible that you could still use an amplification device that will make sounds heard louder by you. It is important to get further hearing tests done and discuss autoimmune encephalitis with your doctor. Since there is temporal encephalomalacia, that part of brain related with memory has been affected. You can try to attend euro cognitive rehabilitation clinics and enhance your memory capabilities. There are many methods available as suitable to your condition, and it can take few months to learn new techniques to preserve your short term memory. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am a 67 year old male, in otherwise excellent health, who had my gall bladder (lapro) removed in May . There were no complications and I recovered quickly without any of the possible side effects of which I was informed could occur. But now, two months later, I experience a feeling of tightness in the lower right abdomen , in the area of the gall bladder. This does not register as pain, but rather discomfort, and is observed primarily when I am sitting or sleeping. Any suggestions? ### REPLY: Dear Ocoastalpost, Sorry to hear that you are experiencing problems even after successful gallbladder removal surgery. There are some possible explanations for your recurrent pain in that area. Most common one is, you may have some scarring or adhesions around the area of the gallbladder. This can cause some pulling or pinching sensation. If you had multiple stone sin your gallbladder, once in a while a small stone can be retained in the channel that carries the bile into the intestine causing problems. In such cases, pain could be persistent and may be associated with nausea or vomiting or even yellow jaundice. I don't believe you have this. With time, it should improve. Good health ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My spine is curved due to scoliosis. I had surgery for this condition. Since then my upper spine is curved so that I walk with a forward bend. I just cannot stand up straight. I am 71 and in good health. I have come through all my surgeries very well. From what I was told, there is a procedure that breaks the spine, straightens the spine and then inserts a rod. I am not looking for surgery, but if I would be able to stand up straight, I would do it. Thank you for your help in this matter. ### REPLY: Hi. Considering your age and condition(scoliosis) I would suggest you not to try any surgical interventions now. Reasons being1) if your lung functions are normal then spine correction is only for cosmetic purpose.2) spine correction can compromise on lung expansion and can lead to pulmonary congestion.3) post-operative lung infection, pneumonia are high chances.4) post multiple surgeries the anatomy of that region will be fibrotic and distorted and re exploring/ exposure becomes very difficult.5) post-operative neurological defects can occur.6)Age relate anesthetic complication can occur.7) post-operative infection/ implant failure. Most of these complications are doubled in older age group. If u have normal lung functions and a normal living I would suggest u to lead it alone. Thank you. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Yes I fell last tues at work from slipping off a mat. I landed on my buttock really hard. It felt like my insides shuck. I developed acid reflex the next day and my lower waist in the from aches on and off. Should I go to the hospital or is this normal after a fall a week later, ### REPLY: Hello, As the fall will never cause acid reflux. I think the trouble you're facing with the waist line is totally indicative of the bone and ligaments injury. I will advise for the x-ray of the lumbar spine and pelvic bone.  Once we get the report we can think of the next program. As per me, it might be just a bony hurt or maybe a hairline fracture which will heal on its own and nothing much to worry. Doing hot water fermentation followed by simple strengthening exercises will help improve the muscles to provide good control over the joints and reduce all the pain and aches. Hope I have answered your query. Let me know if I can assist you further. Jay In .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My neck started hurting yesterday when I got up but I thought I just slept wrong. Now my whole neck is in sever pain and I have chills. I can t sleep. No headache, no blurred vision. Just a lot of pain in my neck. I have been fighting what I think to be a head cold for a week or better. ### REPLY: Dear patient there is possibility of neck spasm considering your symptoms. Are you using large pillows? Avoid that. Use low high soft pillow while sleeping. Tab moral 4 mg twice a day with tab ibuprofen 400 mg thrice a day should be taken for 3 days. Hot water fomentation with water bag helps pain relief. Apply diclofenac gel locally over area of pain. If you are getting cold also please consult physician. Hope this is useful. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello , Im 30 years old woman, no children, with very high level of prolactine - 1061, MRI is fine, but I still have a  headache. I started to take dostinex last week- one tablet a week, but which one Dostinex or Bromocriptine is more suitable for me , if I want to get pregnant very soon? thank you ### REPLY: Hi there, Welcome to , Since you have already started Caroline (destined) and also that it is the newer and has less side effects you should continue it till your prolactin levels decrease. Do net plan pregnancy till your prolactin levels decrease to less than 30 and your symptoms are under control. I know you must be very anxious to conceive but if you conceive before the prolactin levels are normal it can create problems during pregnancy. Repeat prolactin in 3 months to know the response. Hope this helps. Regards ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi..work up 2 mornings ago with a painful lump more so than a pimple inside my instead behind the skin that seperatrs the nostrils so its hard to see what it looks like. Anyway this pain is ridiculous. My nose is very red and swollen. Whenever i bend forward they blood rushes to my nose causing a thumping beating pain. What is this from and when will it go away??? ### REPLY: Hi, Dear,Thanks for the query to . I studied your problem in depth and I understood your concerns. Cause and plan of Treatment-In my opinion on the given data, you seem to have boil in the nostril at the tip of the nose internally. It would go if you take proper treatment with Er Surgeon or Ent-SurgeonConsult Er Ent-Surgeon who would treat accordingly. So don't build up wrong concepts and self-medicate your self which would increase risks and costs to you.Instead, just ask a query to  and be comfortable to resolve your health issues. Welcome for any more query in this regard to . Write good reviews and Click thanks if you feel satisfied with my advice. Have a Good Day. . N. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: 5 days ago i developed severe pain under right rib cage with a low grade fever then the 3rd day a severe rash all over my buttocks, my back under my arms and muscle aches. went to primary took a cbc said my wbc was 15000 told me to come back in tomorrow. He thought it was contact dermatitis a severe case now he doesnt know because of high wbc and elevated liver enzymes. i am very concerned. any ideas/ thanks ### REPLY: Hi, Thanks for asking. Based on your clinical history and query, my opinion is as follows:1. High WBC count indicates infection. Differential leukocyte count is essential to possibly identify a bacterial or viral cause.2. Along with elevated liver enzymes, diagnosis of hepatitis is a possibility. Correlation with differential leukocyte count is essential.3. Get complete liver function tests, including bilirubin levels evaluated. Biopsy of liver might be necessary in the future. Hope it helps. Any further queries, happy to help again. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi am santosh.my posterior region of testis have changed to brown earlier it was red.i am still 16years.i havnt had any sex but i was penetrating the pennis or testis.when i do this white creamy comes from my testis.i have did this many times.now my testis posterior region colour slightly changed to brown. ### REPLY: Hello, I think you are too much concentrating on your penis. When masturbating creamy white liquid comes out is called semen and is normal sexual activity. Discoloration of testis should be consulted with a skin specialist. Therefore, I suggest consulting a skin specialist for physical examination, diagnosis and treatment. Hope I have answered your query. Let me know if I can assist you further. Take care  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am in my day 17 of my cycle and my follicle is up to 28 in size, and there are some lining seen inside it, I was asked to meet a specialist as it might be dangerous. what must have caused the delay and have I ovulated. Nb:am taking some ovulation induction. ### REPLY: Hi there, I have understood your concern and I will suggest you the best possible treatment options.First do not panic. As per your USG reports, you have not ovulated as yet. Usually, with such reports, I will suggest you to stop follicle study. Such situation is usually seen when ovaries do not respond to internal signal of ovulation and might need hormone support from outside in the form of  injection. Please seek prescription support from your treating doctor for Tablet Micronized natural progesterone 200 mg twice a day for next 10 days. You will get your periods within 3 to 10 days after finishing the tablets. Please get day 2 USG done to know about the previous cycle follicle of 28 mm, if it has disappeared or is persistent. And also get information about ovarian volume and number of astral follicles. Usually, I suggest to my patients to take injection  5000 IU once the follicle reaches 18 mm size. This helps to egg formation in 24 to 36 hours after the injection. Please opt for a healthy diet and regular exercise regimen. Start on Folic acid and vitamin B 12 supplements regularly. This helps to prevent various complications during conception, pregnancy and childbirth. I hope this answer helps you. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have many lumps under the skin in my arm up to my armpit, they do not hurt but there are a lot of them. I went to the doctor and they took blood tests and an xray.. I will be getting the results for those soon. But I was just wondering what they could possibly be from. ### REPLY: Welcome to . 1. The history suggest - possible cause could be enlarged lymph nodes.2. Lymph nodal enlargement is seen in case of any infection / inflammation, it can be localized or systemic. And lymph nodal pathology itself can cause the pathology.3. In this case an ultrasound examination of the lesions can help to evaluate the nature of the lump and its source, extensions.4. An FNAC - fine needle aspiration cytology for histological evaluation.5. Treat any underlying medical condition if they are any. Good luck. Hope I have answered your query.Anything to ask do not hesitate. Thank you. ### END