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, im a male24 yrs old and have a hard type of lump underneath my skin and fat, its about 4 inches to the left of my belly button. it has been their for 10 months, and is the size of a pea. i do lots of labor for a living, could it be torn and re healed tissue or something ? ### REPLY: Hi, dairy have gone through your question. I can understand your concern. You may have some soft tissue tumor like neurofibroma, dermatofibroma sarcoma protuberance or some other mass.  Or it can be hernia. You should go for ultrasound study and if needed to go for fine needle aspiration cytology or biopsy. It will give you exact diagnosis. Then you should 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: My son is 5 months and at first didn t put on much weight. He has now started gaining weight - I have exclusively breastfed him. He looks healthy and is awake and alert for the majority of the day and completing his milestones well before he should be. I was seeing the paedatrician at our hospital who took blood from him to be tested. Two weeks later they said they will have to take again to test ALT levels as they were high (82), today (2 weeks later again) he had to have blood tests again as it is still quite high. I asked what it means and they just said it could be an infection?? I have tried looking on the internet and keep coming across ALT in the same sentence as liver disease. Can you give me some possibilties why this would be high and is it something to be very concerned about? Thanks ### REPLY: Dear Parent, A healthy and awake baby is a very reassuring sign. I totally understand your concern about the ALT tests being repeated. However, reference levels of ALT have not been established for infants. If liver cells to be damaged, the levels of ALT are usually elevated at least more than 3 times the upper limit. I suggest that you discuss your concerns with your pediatrician who can counsel you about what they are looking out for. ### 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"m a 72 year old woman in generally good health. Im on several meds for my heart:  amlodipe (5 mg), 81 mg aspirin, hydrochlorothiazide (12.5 mg), metoprolof (100 mg).About 18 months ago had a stent placed in my heart and am now off the specific meds for that operation. I am visiting OKlahoma at the present and for the last two weeks have had a tightness in my chest. Will not go away. ### REPLY: Hello, Tightness in the chest may be due to acid reflux or cardiac pain or infection of lung or bronchial asthma or anemia etc. Until the examination is done it is difficult to say what it is. Please get it done ECG, chest X-ray, echocardiography and spirometry. Please consult your physician/Cardiologist they will examine and treat you accordingly. 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: my daughter blood test report give below indications. may know it gives any problem. please clarifyReports details in below :-RBCs are mild anisopoikilocytosis. predominantly  normocyctic with ovalocytes. hyphochromic seen. WBCs are count normal in numbr. and distrubutions normal, normal morphology. platelets area adequate in number with normal morphology. platelets are  adequate in number with normal morpholgoy. No haemoparasites seen - Malarial paracyte & Micro filaria (MP & MF) ### REPLY: HiT hanks for your query. Based on your query and reports1. Your daughter has mild degree of anemia2. Probably iron deficiency anemia as most common cause of microcytic hypodermic anemia is iron deficiency.3. You can get an iron study done to confirm iron deficiency and treated accordingly.4. Improve her nutrition and also discuss with your doctor regarding deforming as parasites can cause iron deficiency. There is no need to worry. Hope this helpsRegards ### 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: Sir ive been facing breathing problem for the last 2/3years. But for the last three days I ve been facing difficult in breathing problem and there are mucus in my throat and itching in my chest also. I ve been taking PZ4 tablets also. For the last 10 days I m taking alcohol regularly.please suggest me what should I do. But for last three days I don t use alcohol. ### REPLY: Thanks for your question on . I can understand your situation and problem. By your history and description, possibility of bronchitis is more. Alcohol will not help you, so quit alcohol. Better to consult pulmonologist and get done clinical examination and PFT (Pulmonary Function Test). PFT is must for the diagnosis of bronchitis. It will also tell you about severity of the disease and treatment of bronchitis is based on severity only. You may need inhaled bronchodilators and inhaled corticosteroid. So first diagnose yourself and then start appropriate treatment. 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: Hello, about 5 days ago I developed what felt like a bit of a lump in my throat, it is making me do a lot of shallow burping. There is no pain or no difficulty swallowing, just really annoying, this lump in my throat feeling doesn t seem to shift, sometimes it feels more obvious than at other times. Hoping you can help. ### REPLY: HI, Welcome with your query to . Based on the facts of your query, you seem to have Globes Pharynges.Treatment-Physicians and ENT Surgeons Second Opinion to fix causes of HERD would treat the Globes Pharynges in your case. They would investigate your case cause of Globes feeling. Recent development indicates Acid Reflux as the cause of Your Globes Pharynges. Causes of the Acid-Reflux need to be ruled out for proper treatment of Acid reflux with Globes Pharynges. General Precautions-Bland Diet, Tab Proton-DTab ZincovitPlenty of fluids, Avoid Junk/street food. Avoid excess of tea/coffee/smoking/alcohol. Hope this would help you to resolve your worry. Welcome for any further query in this regard Will appreciate writing your feedback review comments, to help the needy patients like you at .  Good Day!!  . S. Genl-CVTS ### 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 a severe head ach since last sunday with neck pain and fever of 1100 to 100.7 and I start taken it down ice and cold drinks. Was told I have anterior spondylotic spur plus disc change, mild intervertabral disc space loss in height at C4-C5 and C5-C6 levels.. Straightening of lordosis, degenitive disc disease, And also had an interbody fusin on L4-L5 and S1 5 years ago. should I go to hospital ? ### REPLY: Hello ! Thank you for the question ! I understand your concern. The symptoms you have may be related to meningitis. I would like to know if you have nausea, vomiting or any other symptoms. The cervical spine degeneration do not cause fever. Another possible diagnosis would be a discuss in the cervical spine (and infection of the disc), but headache is not typical in this situation. You need more than cold .  I would recommend you to go to the hospital and have a full blood work and a neurological examination. You may need also a brain CT scan and a lumbar puncture to rule out meningitis. Hope to have been helpful. Thank you for using ! 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: While in Thialand i got an infected tow about 4 days before we came home, when we arrived home i noticed a pussy type sore come from no where appear on the top of my foot, then  acoup[le of days latter anther on my clf mascle of same leg then on my arm. A week and a half went by then one night i got a very high temperature and sweating and head aches. I have been to the doctor who hasgiven me antibiotics and took  a blood sample which has come back but i cant get in until Monday. Could this be a staf infection ### REPLY: Hello dear, Thank you for your contact to . I read and understand your concern. I am  answering your concern. Yes, it looks like some kind of infection. But confirmly only can say if the culture report available. I suggest you to do culture and sensitivity test from the first infection site and third infection site. Once the report available you can take the good treatment. If both the report are same than the infection is spreading from the same organism and single treatment is required. If both the reports are different from there is different treatment is required at both site. You can take definite tablet 200 mg three times a day under your doctors' guidance. You can also apply polypoid ointment on the infection site. Please maintain good hygiene as it is equally important as taking antibiotics. I will be happy to answer your further concern on bit.ly/ . Thank you, ChatDoctorInfectious diseases specialist, 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 mam is 81 yrs of age & suffers from asthma, osteoporosis, COPD, emphysema. She lost a lot of weight in the last year & a half, was 67kg & is now only 50+kg. She is under the care of a respitory consultant & together with her GP have had her through every test possible & says there is nothing sinister going on so why is she losing all the weight? ### REPLY: Thanks for your question on . I can understand your concern. At the age of 81 years if all blood investigations and other work up done is normal, then do not worry. Generally people with COPD have lesser muscle mass. If she has no other co-morbidities then a diet rich in protein and protein supplements will help her. Also get her hemoglobin and vitamin B 12 levels checked, if low will require supplementation. Hope I have solved your query. ### 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 CT with contrast on thurs...after 5 attempts of placing IV they chose to use the inside of my wrist....the vein has continued to protrude and is bruised all around it...where the vein is raised through the bruise its a different color ( lighter)...as the day goes on and I use the hand it gets very sore and swells more....any ideas? ### REPLY: Dear users symptoms of bruise and soreness of hand after iv administration refer to bacterial infection at the insertion site of iv intravenous needle or cannula penetrate the skin and should be sterile, and also your skin should be prepared with antiseptic as alcohol before administration ....this is what is called aseptic technique....if the care provider doe snot wash hands and wear clean gloves and cleanse your hand and apply alcohol it will be risky to infected any error of the technique cause bacterial invasion and so inflammation and infection occur result in these symptoms you feel of your hand if you get feverish you should do peripheral blood culture to detect micro organism till now the infection is localized, and only topical antibiotic cream will be helpful you need not worry as the cause is error of the aseptic technique of iv cannula insertion wish you healthy life ### 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: 29 yr old male / non-smoker / very light drinker Have had a kind of bubble thing at the back of tongue, going on for almost 4 years. It is highly movable, flexible . . . like a small balloon. It protrudes when I stick my tongue out as far as I can . . . it s located right where that flap of skin meets the tongue. It is squishy and pink . . . it doesn t hurt to the touch either. There isn t pain and I can t really tell it s there . . . hasn t gotten any larger either. I first noticed it after getting a chili pepper flake stuck in that part of my mouth . . . it s been there ever since. I think it s a swollen tastebud or something but sometimes I m a hypochondriac. I cannot afford to see anyone right now and I m just looking for whatever reassurance someone can provide. The surrounding tastebuds are slightly swollen on that side too. I have a slight crossbite with my molars, as the result of two missing incisors on my top bite. Additionally, one back molar feels a little jagged . . . maybe that s it? ### REPLY: As per the description given by you the location, duration and appearance of the lesion-bubble like, no pain on touching shows very less possibility of infection as it is chronic and do not accompanied by the pain. It can be the lesion caused by the spillage of the Murine from minor salivary glands located at the floor of the mouth. If it is not making you any trouble let it be there until you visit a dentist or a physician. But you should definitely concern to the doctor to evaluate it by examine and if it is a lesion what I said, it should be excised. There is nothing to worry much as you get time and fill comfortable visit your doctor. Hope you are satisfied by explanation. 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 am 32 year old female and my husband is 36.He is got very less sperm count,so our first baby is through IVF .Now we want to have another baby through IVF.I got all the test normal but my husband has stress and anxiety due to which hr is under medication,nexito 20mg and rivotril 0.5 mg.The doctor advised him to stop the medicines.we are very confused now to go for IVF or not.Is the medication going to effect the ivf procedure. please advise us. ### REPLY: Hi, thanks for using  Next is in the family of medication called SSRI and may cause erectile dysfunction and decreased libido as sexual side effects. This would not affect fertility in IVF because they would not affect the sperm count itself. Decreased organisms and erectile dysfunction can also occur with the other medication, but again this would not impact on your chances of fertility with IVF. If you were attempting to conceive without IVF, these side effects would impact on your chances of fertility. It would be important to consider whether your husband is psychologically ready since he is now being treated for anxiety and stress. He may need some time to sort out any present issues. I hope this 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: Hi, may I answer your health queries right now ?  Please type your query here...My baby is 6 months old and cutting through her third tooth (first on the top gum) She has been upset all day and Ive just noticed on her top gum, beside the new tooth, is an red open sore.  Its as though a tooth should be coming through but there isnt one there, it just looks red and sore.  When her other teetChatDoctore through they didnt look like that. ### REPLY: Hi. Welcome to  . I have gone through your query and can understand your concerns..... As per your complaint it seems that the open sore area over the gum behind the newly erupted milk tooth can be most probably due to the other tooth that might be going to erupt in the due course of time and the gum might be tearing to let the tooth erupt. Do not worry, you can apply a numbing gel over the sore but be precise to apply a very small quantity that too only on the sore but only after clinically getting her evaluated by a Pediatric dentist. You can also do cool compresses over it. Feed with cool milk. Hope this information helps. Thanks and 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 son inlaw is having this happening.... He started with a hoarseness, shortness of breath, now extended stomach and stomach pain. His bowels have been effected as well. However, his blood pressure is a 139 over 82 and he has been watching his diet for several weeks but has not loss. ### REPLY: Hi. Thanks for your query. Noted the history about your son-in-law having hoarseness, shortness of breath and now stomach pains. Clinically this looks to be flu giving the respiratory symptoms as well as the stomach pains. I would advise him the following:To get a clinical evaluation to get a confirmed /probable diagnosis and to get a proper symptomatic treatment and investigations of blood and others if needed. Review the case after a few days to see whether there is any development of further presentation and to get treated accordingly. ### 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 peritonsillar abscess a month ago. I healed well with a 10 day course of clindamycin and drainage. I had my teeth cleaned 2 weeks ago and I have no dental caries and excellent oral hygiene . 2 days after the cleaning my jaw felt a little stiff and the gums where my wisdom tooth was 20 years ago felt swollen. I went to urgent care last week thinking it was recurring. The MD said no it is pharyngitis . It came and went. Today it happened again and I now see a small, almost clear bubble at the base of my uvula. Could this be a recurring abcess? Should I take the Aumentin I was given in urgent care in case my throat were to get worse? ### REPLY: Hello there... Do you mean that your wisdom tooth was removed? If so when you have recurrent peri-tonsillar abscess (called Quinsy) the clinical symptoms are mainly pain while swallowing, swelling at your base of uvula, deviation of uvula to the opposite side, redness in the soft palate region, with an opening with pus discharge either adjacent to the uvula or over the consular region.  To the pus creeping into the adjacent spaces, there are chances that one might end up with difficulty in mouth opening. Though Augmenting is .  ### 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: This is what is happening. I feel tense all the time, short fuse, when something even something small upsets me i will a lot of times go into a rage, and become very irrational, then not even remember why I got mad in the first place. Then it turns to sadness and often cry because of my outburst. I feel confused a lot also i have trouble iterating with people as well unless I really know them for fear of some one thinking I am stupid or slow and always feel like people are talking about or just like I m paranoid or somthing. It s like i am on a roller coaster up then down...... ### REPLY: Dear serve understand your concerns went through your details. Mood swings, anger, melancholy, depression, aggressiveness, anxiety, irrational thinking etc. are usually symptoms of depression. Here you should understand the differences between depression and severe disappointment. Severe disappointment also bring on the same symptoms, but these are for a short period. Were you badly disappointed in the near past ? I suggest you to provide more information for diagnosis and further treatment. 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 been geting ectopic heart beats for years and am on propananol , but lately they are alot more before and after my period , i am 38 year old female , its getting me down and tearfull , i am on prozac and have been on them for years . the ectopic beats are all i think about day and night ,is there anything to stop these horrible things , can it be hormone realated ,, please help .... ### REPLY: Hi, hormones do have some effect but not this much. Do you smoke or do any ? Prozac has cardiac side, you can ask physician to change it, at least temporarily, and we can see the response.Also, these much are not normal, you should get yourself evaluated. Whether these VPC or something else. You will need ECG, echo to Find out the cause. These are precursor for some dangerous arrhythmia. ### 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 18 month ol son had a temperature 2 days ago and woke up with a fever yesterday morning. after administering nurofen ibruprofen temp. went down and he seemed a little perkier by the afternoon. Again this morning he has a fever and is svery sleepy. only wakes up for seconds then turns over and goes back to sleep. has eaten scrambled egg for breakfast this morning and a 150ml of juice as soon as he woke up. please help ### REPLY: Hi... Thank you for consulting in . Fever of few days without any localizing signs could as well a viral illness. Usually rather than fever, what is more important is the activity of the child, in between 2 fever episodes on the same day. If the kid is active and playing around when there is no fever, it is probably viral illness and it doesn't require antibiotics at all. Once viral fever comes it will there for 4-7 days. So do not worry about duration if the kid is active. Paracetamol can be given in the dose of 15 mg/kg/dose (maximum ceiling dose of 500 mg) every 4-6th hourly that too only if fever is more than 100F. I suggest not using combination medicines for fever, especially with Paracetamol. Hope my answer was helpful for you.  I am happy to help any time. Further clarifications and consultations on  are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid 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: There seems to be a tiny tear on the top of my penis where the frenulum attatches to the penis, it stings a small bit and especially when I pull my skin back. I have been stretching my foreskin rescue rly this may have caused it? What should I do about it? ### REPLY: HelloThanks for your query, based on the facts that you have posted it appears that you have sustained a trivial injury to the band of adhesion between frenulum and glans penis. Please do not worry this will get healed up within a week, You need to take broad spectrum antibiotic like Čeferin along with anti-inflammatory . Along with topical antibiotic ointment like Newsprint twice daily. Ensure to wash your genitals with warm water twice dailyEnsure to avoid sexual encounters till it heals up completely. ### 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 dr. My mother is facing back pain and after conducting MRI scanning dr. has said that there is a nerve compression in L4 and L5, hence they are suggesting a operation. what can be done as an alternate to operation. Thank You ### REPLY: The first step in the treatment of low back pain is to rest the spine. Because most cases of back pain are due to muscle strain, it is important to avoid further irritation to the spine and the muscles that surround the spinal column. Applications of heat packs help ease much of the discomfort associated with muscle spasm causing low back pain. Strengthening of back muscles is probably the most important step in treatment of most causes of back pain. Epidural steroid injections are an option for back pain treatment and inflammation around the spinal nerves. Spinal surgery is done when extensive efforts at conservative back pain treatment fails to relieve symptoms.  The surgery of herniated disc is called Microdiscectomy or microdecompression spinal surgery. In carrying out the surgery, the small portion of the cartilage or the bone is removed under the nerve root. This reliefs the neural impingement and more room for the nerve is thus provided. The nerve not only gets free from the thrust but also gets space for healing soon. Another form of surgery for herniated disk is called Percutaneous Microdecompression or Endoscopic Discectomy. In this form of surgery, lasers are used for shrinking the herniated disc. This is the most advanced form of spinal surgery that treats the patient without any cut or tear. There is enough evidence from clinical trials and data available from the past operations that surgery has proved ineffective in many cases. It is a proven fact that only one out of every 100 back pain cases is fit for surgery. The most startling revelation is that 67 % of low back pain surgeries became worse after surgery and 2/3 patients complained of more pain after the surgery. Also understand that back pain is often not a quick or easy fix. A dedicated approach to physical therapy and exercises will often alleviate back pain. ### 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 name is Jessica Potvin and i have family members in my family whom are bipolar and i am experiencing alot of problems within the last year that i would like to ask. First off i am 25 years old and i have 3 little boys. I am constantly fighting with my Husband over stupid things. I tend to cry alot when he says something to me that is not even mean. I also tend to tnrow things when i get angry and just hollar for no reason at all. My moods change frequently and i dont know why. One minute i will be watching tv very happy and the next i feel very irritable and crabby and that i have to do something. I feel sad most of the time and i do not sleep very good at night. just having my hair touch my face wrong sets me off. I would like to be able to discuss issues with my husband but every time we try it seems that i become very angry and start hollering and crying and thinking that i am the worst person in the world. I love my boys very much and i get very angry at them to the point where i feel annoyed and want to scream. I have really bad hot flashes, feel very lazy most of the time with spurts of uncontrollable energy. I see a doctor on the 14th but i just want an opinion of what to expect. I never give myself credit for anything and i constantly feel like whatever i am doing is wrong. I am just tired of my spurts affecting me being happy and letting my family be happy also. please let me know what you think. thank you ### REPLY: Hi dear, thank you for your query.First as your family member is suffering from bipolar illness, so there may be chance of bipolar disorder in you than other. But for proper diagnosis detail and mental status examination is necessary. What ever you described about you is suggestive of you have depression and due to that you sometimes feel annoyed. Also we need to assess your Pretoria personality for better diagnosis. There are many treatment ways and depends on severity of symptoms and mental status examination. As you are having family history than there is chance that the treatment by which your family member improved same treatment also helps you. Mood stabilizer medication and electroconvulsive therapy you. 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: Hi doctor..my husband has suffered frm severe stomach pain on 30th dec in the midnight. ..when it was so severe he woke me up n asked to take him to d hospital..bt after smtym pain stopped...we consulted the doctor on next day...he said may b chances of stones..so then doc asked him to go for certain investigations...sonography of whole abdomen..it shws the mild enlargement of the liver ### REPLY: Hi, thank you for posting. The causes of enlargement of liver are different. This disease is caused from infective(hepatitis and liver abscess), toxic(alcohol), and metabolic causes. To determine the right diagnosis your husband needs:- Blood test.- Liver function test.- Abdominal Ct-scan.- Endoscopic retrograde cholangiopancreatography (ERCP). The results will determine the treatment. I recommend you to contact your gastrohepatologist. I hope you find this helpful. 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 Doctor My son undergone the menegitis treatment. he isjured menengaitis at his 2nd week of age. In brain water has clat. doctors put nurve from right ear to stomock. now he is Ok. but now its effect to his right hand and right leg. Right leg is small than the left leg. Right leg is not growing well. Right leg is bit short. Please advise me is there any treatment to grow the Right leg. ### REPLY: Hello dear!you are talking about a complication of meningitis that is HY . Your child has right sided hemiplegia probably what I understood from your text. There is no permanent cure to neuronal damage but yes you can improve the quality of life. Physiotherapy plays an important part in this. I would recommend getting an appointment from physiotherapist and occupational therapist in your country. Physiotherapy can do miracles. With the help of the splints and special shoes, they can even make the child walk normally if the response to physiotherapy is good initially. The right leg is having disuse atrophy, and it can be made to near normal with the help of regular exercises taught by physiotherapist according to the condition and the severity of illness of the child. Hope it will help. Be blessed :-) ### 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, about a week ago I had fallen down the stairs and landed on my back. It knocked the wind out of me, but after that I was only sore for a few days after. Two days ago, I had an attack where my back muscles started spasming, and it got to the point to where I was gasping for air. I had went to the ER and waited for about 4 hours and still wasn t called back so I just went home to sleep because I was extremely exhausted. I ve been alternating cold and hot compresses to the area that s most sore. Last night and tonight when I lay down to rest my back I hear crackling noises in my lungs, but they feel like they re pressing up against my ribcage. I can breathe, but it does hurt when I inhale deeply. I have insurance, but it s not all that great and I don t really want to have to go and get it looked at if it s something that will solve itself if it s a pulled muscle. The muscle is right behind my ribcage, close to my kidney region. ### REPLY: Thanks for your question on . I can understand your situation and problem. In my opinion you are having blunt back and chest trauma. Since you are having muscular back pain with breathing difficulties and cracking sound from lungs, we need to rule out these possible complications. 1. Rib and vertebrae fracture. 2. Pulmonary contusions3. Pneumothorax4. Muscular injury. So get done chest ray and x-ray of doraolumber spine to rule out all these. If both are normal than mostly you are having muscular pain. Try to follow these steps for better symptomatic relief. 1. Avoid heavy weight lifting and strenuous exercise. 2. Avoid bad postures in sleep. 3. Take good painkiller and muscle relaxant. 4. Apply warm water pad on affected site. ### 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 34 years old women with two kids. Recently I started experiencing lower left side abdomen pain. Also the pain extended to left side stomach, left leg, left hand, left side shoulder and right side ear. In addition to that swelling in hands, legs and some time throughout the body and heaviness in head, All the above said pain are experiencing at different timings...Kindly help me to direct into a right treatment...thank you.... ### REPLY: Hi welcome to  forum.  Thanks for asking a question to . F.  You are 34 years old women, with 2 kids. Recently you had pain in the left lower part of abdomen. sometimes extended to left leg, hand, shoulder, and right side ear. Sometimes have swelling of hands, legs, whole body, and have heavy head. All the above are at different times.  The pain in the left lower abdomen suggests urinary tract infection, stones in the urinary tract, If infection is marked you can have all other pains. Infection may also cause swelling of body sometimes. Ear pain may be different.  I advise you to consult a urologist for diagnosis and treatment. You may need to have M.R.I.of left lower abdomen, besides other routine tests for confirmation.  Wishing for a quick and complete recovery.  Best 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 injured my knee while bowling and think I may have a torn meniscus. An MRI showed no tear, but did show wear and tear and a small bone spur on the knee. I also have tingling sensations in the upper and lower leg, hip and lower back pain, numbness and burning in the toes. ### REPLY: Hello, As these symptoms are indicative of nerve pull or disc injury ban MRI is suggested. Due to the spinal nerve pathology, there are abnormal sensory changes in the nerve supplied dermatomes and motors. Due to which there will be back pain, tingling, numbness, burning, etc. I will advise for MRI of the lumbar spine. Post which with exercises you should do well. Exercise includes - core stability, spinal muscle strengthening, hip muscle strengthening, static hamstring, static Qua .  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: I am 53 with MS. I am on Betaseron and Ampyra. My GFR in June of 2011 was 62.1, January 2012 was 55.4, May 2012 was 75, November 2012 was 58 and last week was 52. I started Betaseron in April of 2012 and Amprya June 28th 2012. Should I be concerned that my GFR is decreasing due to the medications and why is there such fluctuation?? MDW Mom ### REPLY: Hi Welcome to ChatDoctorBetaseron is a one of the effective treatment for MS, however decrease in GFR (decline in kidney function) has been reported in conditions such as hypertension, diabetes. If you experience dizziness, headaches, flashes of light please consult your primary physician for a consult. However, looks like your GFR was already lower before you started with the fore-mentioned .  ### 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: Im 8 weeks pregnant and i have had a really bad cough for 2 weeks.  I recently went to a clinic and was prescribed teva-amoxicillian (250 mg) 4 tablets/day for 10 days.  Im nervous about taking it, is it safe for my pregnancy this early? ### REPLY: Hello, Amoxicillin and its different forms have been categorized under category B by FDA. Animal studies have shown no teratogenicity while there are no well documented human studies. The medication may be used if benefits outweigh the risks. Please remember that a severe cough is equally bad for an early pregnancy due to the constant pressure exerted on the abdomen and pelvis due to the strain apart from the infection per se. If I were to treat you, I would suggest the medication. Please get further suggestions from your consultant. Hope this 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 fell over on my ankle over 4 months ago and a hard lump has appeared. it has been x rayed and it is not fractured but it is painful and the lump is still there 4 months on. i have taken pain killers and refrained from exercise but it is still no better. ### REPLY: Hi, dear. I have gone through your question. I can understand your concern.  You may have some soft tissue injury like muscle or ligaments tear or strain. You should take anti-inflammatory .  Yew can also take some enzymes like choral forte according to your doctors' advice. Give rest to that part. It will be cured within few days. If not cured then go for MRI. 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: I had a tooth removed 2 weeks ago, everything was fine but now I have bulges of gum that bleed when touched sticking out of the hole. Is it an infection because my dentist gave me a precription of antibiotics should I need it. Will it clear up from using antibiotics? ### REPLY: Hello, thank you for consulting with . This bulge of gums looks that it is a sinus opening, which has occurred because of infection only. It can be possible that some part of root might be left after removal of tooth.  Better you continue with the antibiotics and if the infection is of low grade it will heal on antibiotic, otherwise you have to go for removal of infected part. Hope it will help 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: Hi, i recently had my 4 wisdom teeth removed under anestisia and my swelling is gone and my teeth don t hurt but my jaw is locked and i cannot open my mouth more then 2 fingers, i am also still on antibiotics but i stoped the pain meds .. I am now also feeling shortness of breath, hot flashes, fatigued, weak and i get headaches frequently.. What is going on? I am a16 year old girl and i get tired walking from class to class and sometimes im to tired to talk to my friends on my way to class. What could be the problem? ### REPLY: Thanks for your query, I have gone through your query. The limited mouth opening can be because of the inflammation at the site of injection or because of the sutures. The other possible cause can be a disc displacement, if you had kept your mouth open for long time during extraction. Nothing to be panic, Take an analgesic with muscle relaxant like ibuprofen and chlorzoxazone (if you are not sensitive or allergic). The weakness might be because of poor nutrition following extraction. Do saline gargling. Consume a lot of water, take nutritious food. Shortness of breath is not related to extraction. I hope my answer will help you, 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: Hi, I have narcolepsy and got my diagnosis 2011. I was vaccinated against swine flu in December 2009, the doctors that I ve talked to believe that vaccination has triggered this. It is now proven that the vaccine caused many cases of this diagnosis. Today one person told me that she has the same sleeping problems as me. She has not been to the doctor to investigate these symptoms and therefore have no diagnosis. This woman claims she had her problems as a result of ECT treatment she got against depression. I myself have received several treatments with ECT because I also have bipolar disorder. Now I want to know if there is any risk to suffer from narcolepsy as a result of ECT. Is there any research in this area? I m from Sweden and writes not so good at English so I apologize for all the errors, but I hope you understand what I wonder about. Sincerely, Ann-Charlotte ### REPLY: Thanks for your question on . I can understand your situation and problem. But there is no connection between narcolepsy and ECT (Electron Convulsive Therapy). This is proven thing. So need to worry much for this. And yes, swine flu vaccine can trigger narcolepsy in many cases. Better to consult psychiatrist and start the treatment.  Stress and anxiety are common risk factors.  So avoid stress and tension. Be relax and calm. ### 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 fever a day before yeterday with shivering.den i took some medicines as well as paracetamol and my fever was gone.but the next day i was having a bad taste in my mouth and a feeling of vomiting.also i was feeling as if my stomach is not well.i was not feeling hungry. ### REPLY: Hi Dear, Welcome to . Understanding your concern. As per your query you have symptoms of fever and upset stomach. Well the symptoms you mention in query can occur due to many reasons like infection of the gut, electrolyte imbalance in body, food poisoning, inflammation of the gut colitis, food intolerance and various rare disorders of the gut. Need not worry. I would suggest you to consult gastroenterologist once for proper examination. Doctor may prescribe operative, laxative, omeprazole and antacids. For now give your child fruits like banana and a lot of fluid. You should take oral rely .  ### 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 dad has chronic liver cirrossis and has been in the hospital for two weeks. His hemoglobin is stable but now he is having high fevers with all testing being normal. cxr cat scan, blood cultures. he is on avelox and becomes afebrile but then his fever jumps up again. Now his potassium is 2.9 he is recieving iv potassium. I am a nurse so I know alot of what is happening , but i wish i could figure out if all this is just due to the liver ### REPLY: Hi, Thanks for posting your query. Fever in a cirrhotic patient as common as in normal person but the only difference is that cirrhotic patient has decreased immunity. Kindly mention other symptoms along with fever. Does he have chest pain/ cough/ breathlessness/ sputum production? Does he have vomiting/ watery shit/ spasmodic abdominal pain? Does he have burning and increased frequency of urination? Fever occurring in body is associated with other symptoms also. Correct antibiotics' selection may prevent septicemia and proper treatment at time. You should consult with physician and should go for complete blood count, urine routine & microscopy, tidal test for enteric fever, malaria parasite examination. Lowering of potassium ion may cause decreased intestinal movement with development of paralytic illus. 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: hi I am 31 years old, married 8 months ago, and I am planning now to get pregnant, but i discover that i have no immunity to rubella as my rubella IgG is negative but i know that i had taken my MMR vaccine while I am child ! so now some advise me to take the vaccine and postpone the pregnancy for 2 months (which i dont want to) and other advise me not to take the vaccine until after my first delivery ! so what is better, need your help. thanks ### REPLY: Hello, Welcome to . I appreciate your concern. Your blood test is Negative for rubella Egg which suggests susceptibility to the disease. Standard guidelines say that you need to get vaccinated for rubella at least a month before you get pregnant. This is for the good of your baby. Rubella during pregnancy may lead to serious congenital malformations which you may be already aware of. My advice would be to get vaccine and also confirm immunity before getting pregnant. Hope this will be helpful. Thanks for your question. 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: my name chandan. my sister name is munmun biswas . my sister going to mental disoder.age = 32+,weight=53kgs,many medical titment going to done.but they not best my sister still have a problem mental disoder.We go to cmc hospital after two monyh titment my sister going to be ok.But when we return to our home village the same problem are to grow.My sister divorse by her husbend 5 years ago.my fathers is sugar paitiont .my mothers is high passur paitiont.we are two brothers.we are married.every one day my family going to be face the mental disoder of my sister.My sister is so sweet and briliyend.she pass graduted. how did she going to shes normal life please tell me the advise ### REPLY: Degree understand your concerns went through your details. I suggest you not to worry much. From the description it is not clear that what type of mental problem your sister is suffering from. You had not given any noteworthy symptoms also. But for mental illness, A qualified psychiatrist is the right specialist. But she also needs psychotherapy and relaxation. Medicines alone cannot cure mental disorders. Lifestyle changes, change in thought structure and pattern are essential. Psychotherapy is the correct therapy procedure, and it shall give you good result if provided along with psychiatric treatment. Hope this answers your query. If you need more of my help on this regard, please post a direct query. Please provide every detail as possible. I shall teach some tailor made psychotherapy techniques which should be of immense help.  I am always available to clear your doubts. 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 doctor...i have a querry related to harpies.I have never had chicken pox nor measles all my life..i was given MMR Vaccination,that was the best vaccination which was invented during my childhood..some of the oldies are scaring me dat those who havent had those diseases,will get harpies during oldage...is it true...????????? ### REPLY: Hello, Welcome to . I understand your concern.MMR vaccine is not related to chickenpox. It gives protection against 3 diseases namely, Measles, Mumps & rubella. Chickenpox is totally a different disease. If you are vaccinated with MMR but not with chickenpox vaccine than you are susceptible to develop chickenpox if you come in contact with an individual affected with chickenpox or herpes zoster(Shingles). If you never had chickenpox in your life, then you will not develop herpes zoster. Hope this will be helpful. Do ask if any more question is there. 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: Had a bone scan recently.  Found an abnomanily in my skull.  (bone scan ordered because of problems with my foot)  Anyway given 3 probabilities  1)  hyperostosis,  2)  prominant venous lake and 3)  metastatic cancer.  Ive ruled out option 3,  but the venous lake thing has me wondering if you treat it.  And if you do, what kind of treatment? ### REPLY: Hi, Thanks for writing in. Your CT scan shows an abnormality in the skull. It has been described as a possible likely(i) Hyperiostosis: this is a condition in which there is excess deposition of calcium and minerals on the bone surface. This can be due to many causes and is a usually a benign finding.(ii) Prominent venous lake: in this condition there nonproliferation vascular lesions that are not treatable via medical means. It is a blood filled space between the skull tables. No treatment is necessary/(iii) Metastasis: this is a sign of cancer spread. If you do not have any cancer in your body then this is least likely. Metastasis is not treatable. ### 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 19 year old female who is almost 40 weeks pregnant, i have this clear non smelling liquid discharge i think it might be my water leaking but its not constant it only comes out when i sit or sometimes just randomly but its all day long this happens ### REPLY: Hi there,Clear non-smelling liquid at 40 weeks of pregnancy it is necessary to rule out leak of amniotic fluid. Because if the membranes around the baby have ruptured there will be a leak, and it may necessitate induction of labor and delivery. As you have already crossed 40 weeks this should not be a concern. You need to go to a doctor/midwife to know if the neck of the womb has opened or still closed and if a leak is present. This will need an internal examination. You could go into labor any time. 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: I have had stage II c rectal cancer removed, chemo, radiation, 2 1/2 yrs. ago, had also LAR a year 1/2 ago. So far blood tests were okay and this month am going for a CT scan but in the meantime I have difficutly with my BM, I push so hard and is painful.  I have no more rectum so I feel the stool dropping down cause of the excruciating pain and have to push it out.  Went to my surgeon who is now away for 2 months, said cannot do colnoscopy since I have severe hemorrhoids and to see him in 8 weeks. I am using Anusol suppositories, Solfax, and Diltiazem. So far, it is still painful when the feces drops and I push it out, took Advil which relieves the pain. My question is the next two weeks I am having an abdominal CT scan as part of cancer check-up, will it make the hemorrhoids worse? ### REPLY: Hello, I went through your reports. Two and half years back ANO Rectal Surgery was performed followed by Chemotherapy and radiotherapy. Your main complaints are painful constipated stool and bleeding. These two complaints are the common problems post operative in this operation. How is the operated area wound. If the wound is there proper cleaning and .  Even if the wound has healed well, Site bath (sitting in a Betadine diluted warm water 20 MTS for as much time as possible) after each defecation, Laxatives at night and painkillers 2 or 3 times a day may be helpful.  Anvil PM you can take in the night. Other  ### 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 brother in law 52 years of age has been sick for probably 5 or more years and is afraid to go to a doctor. He is getting worse. His wife has cancer and I am trying to figure out what we are gonna do with him. He has begin to fall out of bed and tonight my husband had to go help him get off the side of the bed he was bent over forward and could not get up. He has had slurred speech for several years, he is bending over more and more every year. He is losing muscles slowly. His mind is great. He is very slow to react and move. His legs has begin to cramp very bad lately. We first thought a stroke, but I don t think that is it, because he has gotten worse by time not all at once. I thought maybe thyroid. But I don t know, I just know he will not be he a year from now if we don t do something. What could this be? ### REPLY: Hi, thank you for providing the brief history. As mentioned the slurred speech and muscle weakness, also as years passed by his condition worsened I will request you to check it out once with a physician and maybe you need an MRI of brain. Which can help reveal some soft tissue Injury. As you mentioned the condition is progressing as days pass by it is hard to come to a conclusion. However, as you said he is having too much weakness, in a way to help is to get into a physical therapy activity. Like exercises. But seeing to his condition it is advisable to check as it may be a Parkinson disease or may be some other. With the grace of God I wish for 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: Im going to a friends house tonight and spending the night. I love going there because shes one of my best friends, and we always have a great time, but her house triggers my allergies even when Ive taken my medicine. She has 2 cats, 2 dogs, and a guinea pig in her house. I thought taking my medicine (Allegra of some sort) an hour or so before I go would make it fine, but its always really bad; Im sneezing like crazy and my nose is runny, and I cough a lot. Im not allergic to cats or dogs or guinea pigs per se, but they do bother me a little but not as much as they do at her house. Im only supposed to take it once every 12 hours, but my mom is a nurse and she said it wouldnt kill me to take it again when I was at this girls house before. So I took it a few hours after I had the first time, and my allergies were fine after that, but I was SOOO sleepy, I was the only one to sleep that night because a few other friends were there too. I want to stay up and have fun, but I dont want to be miserable. What should I do about it? ### REPLY: Hello. Thank you for asking at . I went through your history and would like to make following suggestions for you:1. Yes, antihistamines (commonly used for allergies) can cause sedation. Were I treating you, I would suggest you to take combination of fexofenadine and montelukast which will be more effective than fexofenadine (Allegra) alone. You can take a single dose approx 1-2 hours before going to your friends house.2. If this does not help you, I would suggest you to keep an intranasal spray like elastane with you, you could use it when you develop symptoms. As it is a local spray, it causes the least sedation. Hope above suggestions will be helpful to you. Should you have any further query, please feel free to ask at . Wish you the best of the health ahead. Thank you & 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 80 year old father is complaining about a sore mouth and gritty feeling on his tongue and teeth. Doctor did blood test and showed nothing. He is taking flomax, lisinopril and finastbride. He recently had a tooth pulled that was pussy. Went back to dentist and had doctor look there, but they said it looks fine. ### REPLY: Hello, Your father has returned to the dentist to find out that area is healing well after the extraction, but has he had an exam and recent cleaning? I can assume the tooth was infected due to your description of pus, but do not know the general condition of his oral health. The infections affect the entire mouth and body.  Please follow up with a full dental exam if your father has not completed this. If this does not resolve the condition, other systemic deficiencies or disease possibilities need to be considered. Correct diet, needed vitamins and keeping well HY . I have concerns with the quality of his saliva and adequate flow of saliva. His medications may cause  ### 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: Sir. i am 43 years old. My problem is this my hearts beats missed after eating mostly in when I take lunch.I often use homeopathy medicine. This happens not in routien. but mostly. My digsetion power is always weak. . I have already check my hearts tests but all are ok. I have taken some medicine like. pulsetilla/carboveg/nux vom/natrum phos etc. but not get a good result. pl help me  in only homeopathy medicine. ThanksPankaj Bhatia0000 YYYY@YYYY ### REPLY: Hi. . The feeling of mislead can be due to many reasons. If it's causing any symptoms like giddiness or palpitations or chest pain, then it's of importance. Just having a MIS beat is not of much importance. However if u want to be certain, get an ECG and consult a cardiologist .if need be 24 hrs holder may need to be done to rule out any arrhythmia. The MIS beat after food can be commonly due to legal stimulation. Try having multiple small meals. It may help ### 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 ended up getting a pain in my elbow that had swelling and was warm to the touch.  I am currently icing it, taking ibroprufen, and using compression.  After 3 days, the pain definitely has gone down, but the swelling has seemed to increase slightly.  Any ideas of what it could be? ### REPLY: Hello, The swelling and pain on the elbow suggest olecranal bursitis(inflammation of olecranal Bursa present in the back of elbow). The causes are repeated trauma(even if its mild)on the elbow, exerting over pressure on elbow as in while writing, sepsis, arthritis and repeated elbow movements. You need an X-ray to confirm the diagnosis and a blood test to confirm the cause(in case of sepsis)As a part of treatment you are doing it right(RICE), and depending upon the blood test you need to take appropriate antibiotics, so,it would be good if you visit a physician for the prescription. Post treatment you need to protect you elbow from repeated trauma to prevent reoccurrence. Hope this helps you 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: Hi.. im glad there s a certain topic like this where people can ask their problems.by the way i,m XXXX a 30 yr old female i just recently got married last yr.im a nurse working here in XXXX. last sept. my husband came and now where living together.we were wanting to have a baby but i have hormonal probs. and my husband has problem on his semen count.he had consult a urologist and he said SA result is okay now.what we should do.pls help us..thanks ### REPLY: HIA simple question? - with wide possibilities and answers!  > The first thing is to have the man investigated.  Obviously, he has seen one urologist (incidentally they are an .  / Settled... > The next thing is the woman.  Have your hormonal problem treated!  And allow sufficient time - together for one year ... Follow up with your obstetrician / there are several options - of increasing complexity and cost / step by step -/ as nurse, you may be weather chances are right God bless you 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: I had a bad vertigo attack almost one year ago. I have gone thru MRI s , neck xrays, inner ear test, et - all come back showing nothing wrong. I continue to experience dizziness especially if I turn too fast or get up too fast. It has affected my eyes. One day my head jerked violently as the movement in my eyes were affected and it thru me off. Since then, depending on the position of my head, I get a neurological feeling that runs from the to of my eyes, down my left jaw line. My eyes sometimes get watery and sometime dry but makes me off balance. Can someone give me an idea if this is inner ear or a TMJ problem as my jaws do crack and pop. I am just tired of feeling wierd and out of it . ### REPLY: Hello, I can understand your concern. TMJ problems can sometimes contribute to the vertigo problems a patient may experience. In addition, as your jaw is making cracking and popping sounds every time you open the jaw, it adds to the diagnosis of the TMJ problems. However, the watery and .  It might be an effect of the vertigo you are experiencing. Regarding TMJ, the problems may include subluxation of the TMJ, degenerative joint disease or infection in relation with the joint. As you do not have any ear or neck related problem, I would recommend you to visit an oral and maxillofacial surgeon for examination of the TMJ. You might have to go through x-ray and CT Scan of the joint for diagnosis of the problem. Based on the results, confirmed diagnosis and treatment can be suggested. I hope this information helps you. Thank you for choosing . I wish you feel better soon. 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: Should I worry or not, I was on the train about an hour ago and progressivly everything got brighter, my hearing was extreamly vague (I couldnt hear people but they were standing all around me) I couldnt breath properly and my whole body went into a hot flush? also after that my chest felt like it had just had bricks on it. Im on 23 so I didnt know if its just something that comes and goes. I feel really faint and dizzy still ### REPLY: Respected user, Welcome to .come have evaluated your query thoroughly.* This is in relation with altered homeostatic mechanism of the body during or soon after the certain type of travelling.* This is mediated by labyrinthine center with altered levels of hormones in the body.* Suggestions for better recovery - Adequate rest.- Maintaining HY . - Control of BP and blood sugar. Hope this clears your query. Welcome for further guidance. 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 got stung by a jelly fish in SC on vacation. The last few weeks, I have sweating and feel hot all the time, arthralgias and myalgias. I have fibromyalgia and a connective tissue disease, could this be related to the jelly fish sting, I still have the marks. ### REPLY: Hello, I understand your concern. I am , infectious diseases specialist, answering your query. Yes, it can cause such type of reactions I would like to suggest to you that you should undergo blood testing. Without testing, it will be very difficult to diagnose such condition because you have connective tissue disease also. Jelly bean sting can be associated with such a reaction because it can be image myoglobin in the muscle. I will be happy to answer your further concern, you can ask me on bit.ly/ .  Thank you. ChatDoctorInfectious diseases specialist. ### 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 sir yesterday my wife has undergone regular medical & blood tests being she is a fifth month pregnant. the blood test results are showing that HIV 1 & 2 : Non reactive, HBS AG : NEGATIVE, VDRL : NON REACTIVE. I want to know is every thing is all right? ### REPLY: Hi, Thanks for the query.  I understand your concern.  HIV1,2/ V . . Which are -ve in your wives sample. Both the tests are nonreactive. & you need not worry. Its normal. There is no risk in pregnancy.  HBS Ag is the test for Hepatitis B. Which usually accompanies sexually transmitted diseases. Hepatitis is B is transmitted through blood. & there is possibility of baby getting infected from maternal infection in pregnancy/ as well as the medical staff conducting delivery are at risk of getting the infection, if the patient is + ve for HBS.AG.  But its also negative in your wives blood. SO don't worry, every thing is alright.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: My 5 month old has been sick with cold and/or allergy like symptoms since 4 weeks with no break, the symptoms my become more minor but have never cleared. They include cough in all form but never wheezing or whooping , itchy eyes which have gotten worst since the weather has gotten warmer and we have started opening windows, she has had a ear infection, runny nose that will become green and thick and then she runs a fever of 100 to 103. We suction her nose all the time along with saleen, use herbal rubs, and humidifiers. This will become clear again and she stops running the fever and the cough becomes more dry but never goes away and the other symptoms will still remain. The clearing up of the symptoms last for about a week and has happened 3 times. She still eats well, as long as long as the fever is not high and can be cranky with short spells of her being in a good mood. I have heard of babies being sick with colds often but 4 straight months this is crazy. Please help! ### REPLY: Hello. Kindly provide detailed history including family history of allergy. Its probably allergic rhinitis along with spells of acute Otis media and pharyngitis.I would recommend to start Mobil(125 mg/5ml. 2.5 ml three times a day during acute phase of fever and discharging ears for 5-7 days)continue some anti-allergic medicines like cetirizine 2.5 ml at night and montelukast sachet 4 mg at night(both for 3 months).clean the ears meanwhile with cotton wick just from outside, dnt insert it inside the canal. Hope it will help. ### 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 had a pacemaker put in because my pulse was at 40 for two days- then ecg showed a complete block. The doc is checking me for Lyme disease involvement. I also had elevated mercury in my blood at same time as benigh arythmic symptioms started (2000). Can mercury be involved in this blockage? ### REPLY: Hi dear Mercury collects in the heart muscle and valves and has been found at 22,000 times the levels found in the blood. Mercury is strongly associated with elevated levels of homocysteine and cholesterol and heart attacks and can precipitate various arrhythmias and can even cause third degree av block, all of these are documented side effect of mercury toxicity, all sorts of arrhythmias, palpitations etc. are caused by mercury toxicity answer to your question is yes ### 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 shiver whenever im infornt of a crowd, when i speak (standing or seating or behind a pulpit), i move, i dance, i walk, i cant help it. I cant control it. The more im trying to control it, it worsens. Eversince i noticed myself so nervous, im trying to work it out by always trying to stand in a crowd whenever necessary, but its been years, am still the same. Should i think of something to lessen or control it. ### REPLY: Hi, I read your query and can understand your concerns regarding your symptoms. You seem to be suffering from anxiety disorder which is resulting in your being fidgety in front of crowd. I suggest you seek psychiatric consultation for your symptoms. Your condition is amenable to treatment. Medications like selective serotonin reuptake inhibitors are safe and effective. Alternatively you can consider treatment with cognitive behavior therapy, where regular sessions will be taken focusing on relaxation and changing the fear of crowds. Hope this information was helpful. 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: Hi I have been having this weird pain in my lower left abdomen and especially hurts when I jump. Almost as if something is bouncing and straining something. I also had very intense me trial cramps after running. This was in June or July though. But was the worst pain I have ever felt. I also get very sharp pains in my anus and have a very big hemorrhoid . I have lost quite a bit of weight. I was around 135 this time last year and now am just under 120. Lost most of the weight within a month which was last December or Jan. I wasn t sick or anything and was eating normal. Then steadily lost weight till august/septmber where I plateaued to just under120. It hurts when I push on my left side of stomach. My bowel movements vary but mostly I m going three times a day. Or will hit a day where I don t go at all. I find I m very thirsty sometimes(an unquenchable thirst) and get full very quickly. I have also been having heart palpitations every day. This started in September I think. I also have been getting quick intense sharp pains in lower abdomen. They don t happen as often though. Also had this cirrhosis like rash on neck that has mostly gone away except for these two small raised red bumps. Think it was an allergic reaction to several mosquito bites. I m also very sensitive to smells. I am on tricyclen lo birth control and have been having my period regularly and not so irregular( was still getting period every month bug would be few days late sometimes. Would be nice to know what is going on. I should also mention that sometimes I would get nauseous for no apparent reason and would vomit several times in the night. Other times I would wake a up and be nauseous and very sweaty and warm and feel the need to defecate. The nausea would usually go away after I had a bm but the one time I was extremely nauseous for a couple hrs after. This happened mostly in august and September but not happening as often now nor as severe. Im a 20 year old female with allergies or any medical conditions. Hope u can help me. ### REPLY: Hello k, You have a myriad of symptoms and am unable to like all these together for one diagnosis. It is likely that all are unrelated apart from the rashes on the neck and red raised bumps that is likely to be urticaria. You may have fibromyalgia, but it is important that you exclude other medical causes before coming to that diagnosis. Blood tests such as CBC, ESR, Liver profile, ANA, lipid profile, fasting sugar, TPO antibodies, thyroid profile would be a start. U/S abdomen for your pains + UGI endoscopy to exclude HERD. Only then one can try and get to a treatment plan. 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: My 12 year old son informed me that 3 times today he peed an red came out. He said it stings when he pees but no pain beyond that. I had him pee and it looked clear but when he started to pee a brownish flake came shooting out. A few to minutes later he had a little pee dripping and I saw the droplets looked pink. A minute after that he was touching his penis and a small reddish flake came out. No symptoms beyond these. I plan on taking him to the doctor within 12 to 14 hours (it is now almost 11 PM). What can this be and is it safe to wait until morning or should we go to the emergency room? ### REPLY: HelloThanks for your query, based on the facts that you have posted it appears that your son has Acute UTI. Please get his routine urine test and urine culture done to find out the organisms causing this infection and antibiotics to which they are sensitive to. Please give broad spectrum antibiotics like Čeferin along with urinary antiseptic like Nitrofurantoin twice daily and urine alkalizer thrice daily. Later on switch on to appropriate antibiotics as per culture report. Get the prescription of medicines from your family Physician. Ensure he . To keep his urine dilute This will help to control dysuria. ### 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 significant other has been having problems. He used to be a heavy smoker and even smoked a fair amount of synthetic marijuana. He hasnt smoked anything at all for over a year because it started scaring him. He often felt like he couldnt breath or get a full breathe. I suppose I should add that he gets severe heartburn at least twice a day; sometimes more. For the past few days his hands have been going numb and locking up. Last night he said he felt a stab in his chest and today he tried running. He used to run five miles a day and now he never does. He ran this morning and stopped after maybe a minute. He couldnt get a breathe and he said he felt stabbing pains in his chest again. Both sides of his chest. What could it be? Or should we focus on heart or lungs? ### REPLY: Thanks for your question on . I can understand his condition and problem. Smoking is the biggest risk factor for heart and lung disease. His symptoms are more in favor of cardiac disease. So better to get done ECG and 2d echo first. If both are normal then no need to worry about cardiac cause. Bronchitis can also cause shortness of breath and stabbing chest pain. So get done chest x-ray and PFT (Pulmonary Function Test) to rule out bronchitis. So consult doctor and discuss all these, first diagnose himself and then start appropriate treatment. Hope I have solved your query. Wish him 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: hi i had an episode that i dont know what it was, my face went numb and i couldnt get my words out it was like i slowed down and couldnt speak, my arms also went numb and i collapsed on the couch it took about 4 hours before i came right i went to hospital and had a ct scan and blood tests were all good and they said it may be anxiety but i am concerned it may have been a mini stroke or something? can you help me? ### REPLY: Hi, I am .  I have read your question with care and understand your concerns. Let me try to help you The episode which you have narrated > can be a 1) TIA : Transient Ischemic Attacks or 2) RIND : Reverse Ischemic Neurological Deficit As the names imply, these are temporary events due to low blood flow to brain and if the blood flow is restored soon the functions will be restored the blood flow is not restored, it will progress to strokes, I would suggest you to consult a Neurosurgeon / Neurologist and Do tests to check blood Flow in the vessels that supply brain (4 Vessel Angiogram or CT Angiogram) Hope you found the answer helpful. If you need any clarification / have doubts / have additional questions / have follow-up questions, then please do not hesitate in asking again. I will be happy to answer your questions. Let me know if I can assist you further. Take care. ### END