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 first IVF cycle, have been administering 10 units of Lucrin since 6 Sep, 150units of Gonal since 29 Sep. Scan 2 days ago showed 15 follicles (6 - 11mm), todays scan showed 26 (7 - 15mm). Dr thinks I should be ready for ET next Wed. I found brown discharge today. Im also having sore back, sore knee and ankle for 3 nights.  Is this normal?  Is this OHSS?  During the consultation this morning, I was told i have higher risk of OHSS. What will happen if I have OHSS? Do i have to abort this cycle??? ### REPLY: Hi  user, your risk of HSS can be prevented with proper stimulation and dose of medications. nowadays antagonist protocol with GRH agonist trigger is a safer way to prevent HSS. Since you are already on agonist protocol you can try for embryo transfer but there is high risk for hyperstimulation. If there is hyperstimulation you will feel bloated, pain in abdomen heaviness, in sever cases their would breathe difficulties. If you conceive after transfer sometimes there are increased chances of hyperstimulation. Risk of abortion is low if managed properly. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My husband, age 60, diabetic, obese, amputee RBK, and partial left foot, has an enlarged scrotum. It started rapidly growing about 5 weeks ago. it is now bigger than a bowling ball! It is retaining fluid. Went to hospital ER 2 weeks ago. They did blood tests. Negative for infection. They did Ultra-sound. Male organs are fine, but It has fluid around them. Growing about 1/2 inch per day. On-call Urologist said he couldn t do anythings for him. Regular doctor gave more water pills, but had to back off due to leg cramps and blood test that showed kidneys were working hard. Is it related to Lymph Nodes? What causes this? What can we do about it? PLEASE HELP! ### REPLY: Hello, Thanks for posting in . From what history you are giving me it looks slike he has HY .  It is abnormal collection of fluid in scrotum due to various reasons. The only treatment for it is aspiration of fluid and surgery to reduce the size and depending on the reason for fluid accumulation it can be repaired. As you already have got done an ultrasound you need to consult a general surgeon for this problem. I hope I have answered your query well. 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: I am currently taking 1000mg of metformin twice daily along with 1200mg of gabapentin twice a day, 20mg of lisinopril once a day and 45 units of novolin 70/30 twice a day. Yet my blood sugar continues to rise. 4 months ago my average daily sugar level was 120, 3 months ago it went up to 140, last month it was around 170 and now I average 200. Whats going on? ### REPLY: Hello and thank you for asking! There are many factors that increase the blood sugar. One of them is weight gain, physical inactivity, uncontrolled diet, infection sect. You treating physician will evaluate them carefully and try to find a cause.Meanwhile, I would suggest increasing the dose of insulin (the dose of the morning if it is high during the day, or the dose of the evening if it is high fasting) until the blood glucose reaches normal levels. Hope the information will help. Kind 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: 8 weeks ago while lying out by pool I blacked out - started shaking all over (freezing) tingling in arms and legs and dizzy. The next few days was very weak. Went to ER said dehydrated and potassium low. Now, 8 weeks later, potassium is normal - but I get quick one second jolts of dizziness in my head at least 20 times per day. AGe 40, Height 5 6 Weight 122 - and I have CKD. ### REPLY: Hi, Your symptoms seem related to metabolic derangement such as low potassium. In some cases, it could be due to low sodium and low calcium too. High creatinine and urea, which are commonly seen in patients with CKD can also cause shivering and tremors, which is known as asterisks. This gets better with dialysis and other treatments of CKD. If metabolic causes are not there, then, a brain scan may be done. Hope I have answered your question. Let me know if I can assist you further.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have IBS and occasional bleeding from the rectum. Colonoscopy NAD. Today, I have had 4 large bleeds before 2pm. Just had another one, and the blood is leaking out as well as lots in the toilet. Could this be related to me ingesting crystal meth orally over the last 24 hrs? I dont want to present to ED under the influence, but Im worried about the amount of blood loss. ### REPLY: Hello and welcome to , The course of inflammatory bowel disease (IBD) is characterized by relapses and remissions. You can experience regular GI bleeds in the course of disease. The current episode can be due to ingestion of crystal meth. There are chances of development of fissures, ulcers, fistulas and ulcers in IBD. All these conditions can exacerbate the situation. The greatest risk factor in IBD is development of cancer of the bowel. You need to undergo a colonoscopy for development of these complications and their prompt management. Thanks and take care .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hii my husband 30 years discovered from 2 weeks that he has HBs Ag +ve,  but HBs Ab -ve, although he took vaccine from 4 years !!! PCR -ve thank GOD , HBe Ag -ve, HBe Ab +ve with normal liver function thank GOD, so doctor said no need for medication just follow up, please we need to travel for working and they refused cause HBs Ag +ve , even PCR -ve , so please how to remove HBs Ag or when it will be negative, please i need to know how to be negative... thank you ### REPLY: Hello! Thanks for putting your query in . I am a Gastroenterologist. I can understand your concerns. It is good that PCR is negative, and your doctor is right that he does not require any medicines at present and just follow up is required.However, the chances of Bag to become is very low that is around 5 %. And there are no medicines at present which can make it negative. I hope I have answered your query and this will help you. Wish you a good health ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hello doctor , I am married since 10 years and i have one child(7 years) and trying to second baby. i have consulted the gynaec, she advised me to take 10 placentrex injections every alternate days. hw much this will help in getting pregnant. all my report are normal only some cyst have found in my uterus. pls advise ### REPLY: Madam ...I have seen many ladies getting benefit after in placental ...you can take ...these are safe ...I hope all your other tests as RBS thyroid status FSH LH prolactin and body weight are in normal range .please also get tested for TORCH rest ....otherwise in placental is effective ...take multivitamins antioxidant combination...avoid papaya .and herbal products ...for mental stress do deep breathing and meditation ...you will benefit ### 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 a 23 year old female, fit, active, eat healthy, when i was little i did have a lump on my brain, but no further problems. Recently i have noticed a small hard lump about the size of a pea on my neck, its up towards my earlobe and jaw. It has been there for a few weeks now. I also have a few small ones on the back of my neck that have been there for about a year and tend to come and go... the one on my neck hurts a bit sometimes... any ideas? ### REPLY: Hi, Dear thanks for the query to  Virtual Clinic. I studied your query in all the details given by you. The lump you have seems to be chronic Lymph amenities. Cause of it could be scalp infection, or infestation with lice. Other causes of lymph node enlargement as TB Amenities need to be ruled out by consultation with your doctor. The one which hurts you needs attention, hence I would advise you to consult Er Surgeon. Hope this would help you to act fast and plan treatment with your doctor. Hope this reply would satisfy your query. Write excellent reviews if you like this reply and find it helpful to you, as your comments and reviews would improve my rating for the visitors of the  clinic. Welcome for any further query in this regard to Me. I would love you to help out of this intricate problem of lump. Wishing you fast recovery. Have a good day. . N. Senior Surgical Specialist. 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: 33yrs 6ft 185lbs when sleep have seizure only when sleep, now have sinus problem heart beats at 43 b.p. Per minute I am active cardio four days a week, no super athelete mild weight training last two years dizzy spells and black outs been to cardio an have neuro dr. loop recorder was implanted for two years results read once. The dr found a lot of problems then turned it down said it was two sensitive. What should I do? ### REPLY: Hi, Regarding your concern, I would explain that a cardiac arrhythmia could be related to seizures. But, it is important correlating the presence of seizures and cardiac arrhythmia at the same time. Coming to this point, I would recommend consulting with your neurologist and performing a prolonged EEG with ECG incorporated. It will help determine if there is any relation between your heart rate and seizures. If this correlation is confirmed, you should try to treat cardiac arrhythmia. Otherwise, an optimization of anti-epileptic therapy would be necessary. Hope I have answered your query. Let me know if I can assist you further. Kind 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 dr. Told me to take 1,000 mcg of B12 eight months ago. My blood level went from 212 to  906 . She never asked to check it and three weeks ago I stopped for two days and then had heart palpitations. Since then my heart is racing, I cant sleep both at that dosage. I cant seem to stabilize or get off it. ### REPLY: Firstly your B12 level of 906 is in the normal range, and you have been cured of microcytic anemia, which is a good thing. Stopping B12 is very unlikely to cause any change in the heart rate as B12 does not have any direct effects on the cardiovascular system. I suspect there could be some other cause for your palpitations. Are you sure you are not having any other reason for the anxiety as such? What is the pulse rate like? I suggest you get examined by your GP if it is bothering you too much to cause loss of sleep even after 1 week. ### 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: age 23 years female married respected mam 6 months have been passed being married .still im not pragnant.my menstrual cycle from april is below. 27 april 6 june 19 july 7 sep 12 oct am i suffering through irregular cycles? plz help me how can i be pragnant ### REPLY: Hello dear, I understand your concern. In my opinion after seeing your dates of your cycles they seem to be irregular. The causes for irregular cycles like thyroid abnormalities, PCOD, overweight or obesity or stress need to be ruled out. Ultrasound and thyroid profile are helpful to diagnose the above conditions. Weight reduction in case of overweight or obesity is helpful. Avoid stress. 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 had got chicken pox around 14 yrs ago...n now i m 22yrs old..there r few scars left on my nose and other parts of the face ..i have also tried laser treatment,were in the Doc had promised it would go away but nothing like that happened and rather money of Rs30000/- got wasted.. but nothing seemed 2 work..its d same..i want to know that do these old chicken pox scars go away? Is there any particular laser treatment??can u suggest me any nice clinic? and also let me know that how much it shall cost me because i have already spent a lot on it..??i stay in mumbai(India) ### REPLY: Dear Patient, Yes chicken pox scars can be reduced substantially (70-80%). Normally it requires multiple (3-4) sittings of fractional Laser by an expert. Each sitting for will cost you 4000 Rs. Microderma will not help for chicken pox scars. If you wish you can send your photographs on our clinic mail(citylightskinclinic@gmail.com) & there after you can consult to me over phone (0261-6458426). .  ### 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 is an 82 year old, asian male, w/ history of cardiomyopathy, hypertention and borderline diabetes. He has ICD implanted on October 2006.He was seen recently for his complaint of bilateral edema and pain on his feet. Though the swelling does not occur at the same time. He s been experiencing the pain and swelling since August of 2010. The swelling and pain is alternating on each feet. He shows elevation on his uric acid level and responds on Naproxen. Due to his other medical condition, the provider has concern on putting him on Naproxen for a long period of time. His most recent lab results performed on 12/21/10 shows the following: Glucose: 114, Bun : 30, Creatinine 2.0, eGFR- other : 34, eGFR African American : 41, Calcium : 9.4, Total Protein : 8.6, Albumin : 3.7, Bilirubin, Total : 0.7 Alakaline Phosphatase : 121, AST : 23, ALT : 42, Sodium : 140, Potassium : 3.9, Chloride : 104, CO2: 28, Cholesterol : 137, Triglyceride : 214, HDL : 34, LDL (Calculated) :60, Cholesterol: HDL Ratio: 4.0, LDL:HdL Ratio: 1.76, VLDL (Calculate) 43, Abs. Monocyte: 0.6, Abs. Eosinophil : 0.2, Abs. Basophil : 0.0, PSA, Free: 0.29, PSA Total : 0.63, PSA, Free% Calc : 46, Free T4 : 1.56, TSH : 1.27, WBC Count: 7.4, RBC Count : 4.59, Hemoglobin : 14.2, Hematocrit : 41.5, MCV : 90, MCH : 90, MCHC : 34.2, RDW: 13.2, Platelet Count: 210, Diff Type : automated, Neutrophil: 60, Lymphocytes: 28, Monocyte: 9, Eosinophil: 3, Basophil: 0, aba. Neutrophil : 4.4, Aba. Lymphocite: 2.1. An X-ray of his bilateral ankle taken on 12/21/10 shows moderate degenerative change. Three views of each ankle were obtained for a total of six views. Bony mineralization is normal. No fracture or acute osseous abnormality is evident. The joint spaces are well maintained with minor osteophyte formation. He is presently scheduled for his ICD battery replacement on February 4, 2011. Today, I ll take him for the following lab works: Renal Panel, 24-hr Urine Protein and Creatine and Hba1c. The patient is currently taking the following medication: Micardis 40mg once a day, Coreg 6.25 Twice a day, Furosemide 80mg Twice a day, Theragran-M once a day, Zocor 40mg once daily, Singulair 10mg once daily. I am his daughter and I am the one responsible for his health care. Thank you very much for your time. I need your guidance. I have concern about his stability prior to his scheduled procedure. I know that it is a n out-patient procedure. However, I cannot afford to overlook any other possible medical condition. I look forward to your reply. ### REPLY: Hi, Swelling in the foot in a patient with cardiomyopathy and low heart function is generally because of fluid overload which gets accumulated in the dependent part of the body.  I can see that she has an abnormal and deranged kidney test (creatinine). She might be having low urine output causing deranged kidney tests and swelling in the foot. You should increase the dose of Furosemide in her. She can 80 mg thrice a day is urine output is low. She also needs to restrict the total fluid intake to around 1 liter/day. Get her ICD battery replaced as planned as it is important for her to prevent sudden cardiac arrest. Hope I have answered your query. Let me know if I can assist you further. Take care .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My wife is in carrying 9th month, since 3 days she is suffering from high allergy- she is not able to control the allergy, she is scratching allover her body.Due to which rashes appeared on her skin, we have consulted over regular Gyn. she has prescribed the some ointments but those ointments are not at all working. Could you please suggest how get rid of allergy? ### REPLY: HI, thanks for using  It may be an allergic reaction or one of the rashes that occur specifically in pregnancy. There are some skin conditions that occur only in pregnancy and can be associated with severe itching. In addition to the topical ointments, she can use an oral anti histamine. It will not harm the baby. These anti histamines are given both in pregnant women with allergic reactions and in some specific pregnant related rashes. Examples are Ben . Should be available over the counter. 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 Im a 27 yr old circumcised male from birth, my problem is that in the last few days I have noticed a tingling and burning sensation at the tip of my penis. when I urinate my penis is sealed by a white plaster almost like a spot which I have to peel away to urinate if not my urine goes everywhere.  Im worried I might have a STD ### REPLY: Hi, Sometimes either due to sexual activity or due to rubbing of the genitals to the inner wear, foreskin sustains minute abrasions. These abrasions when exposed to secretions or urine can produce mild tingling sensation. These abrasions can be seen in all and heal themselves without any intervention. Need not worry, unless you see evident lesions on the foreskin or anywhere on the penis. Hope I have answered your query. Let me know if I can assist you further. Wishing you all the best.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My brother in law went to emergency with extreme pain on his lower back  leftside.  He  was told he  has two kidneystones. He also has a cyst on his kidney that has been present for many years.  He is still experiencing symptoms of chills, low grade fever and back pain.  Today he was sent for a cat scan.  He was called  right away by his phycisian to book him for an appointment . Can it  be serious??? ### REPLY: Hello, Thanks for the query to . Forum. There are two stones in left kidney, low grade fever, chills, cyst, backache. May be, 1 Kidney disease as due to stones in the kidney, usually there develop shy .  Diagnosis can be confirmed by C T scan (as already done).2 Due to cyst or stone kidney got infection and developed glomerulonephritis or pyelonephritis (depending upon the location of cyst or stone). In my opinion get in serum creatinine level to evaluate the diagnosis and kidney damage. 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 felt a pop in the front left part of my temple then felt a warm waves run down the side of my face like warm water. Slight dizziness, but I think it may have been due to a slight panic feeling. What could this be? this happened earlier in the day and I feel fine now ### REPLY: Hello read your questionCertain problems are possible1) low sugar level following a panic attacker 2) a panic attack following a low sugar level3) very low level of anxiety with depression which has just started. Please 1) do your fasting sugar level2) post lunch after 2 hours sugar level3)measure your sugar level at a clinic when you have this attack.4) get your blood pressure measured at that time asap. Note down the timings if you get this regularly.5) Get a general checkup from your family Doc. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Yes. I am a 56 year old female. I have had my blood reports which indicate my bilirubin levels are high at 1.6. My white blood count is borderline at 4.0 where the norm is 4.0 to 11.0 I am feeling very tired and was wondering if iron (floradix) would help with that. Thank you ### REPLY: Hi, dairy have gone through your question. I can understand your concern. You may have some viral infection.  It leads to low WBC count.  Moreover, your bilirubin level is high.  You should go for complete liver function test. Like GOT, SEPT, Alkaline phosphatase and ultrasound abdomen if needed.  It will give you exact diagnosis.  Then you should take treatment accordingly.  Once your treatment start four WBC count will increase automatically.  Florid (iron) doesn't increase your total WBC count. If you have iron deficiency then you should take it according to advise. 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: hi doctor, i am detected with mild typhoid 1 week back and i am given 3 days medicine course and saline with antibiotic injection.now doc said i am recoverd but still i am getting lite headache. i need the food i need to take and precautions inorder to not to lead to liver prblms as in my childhood i m affectd with jaundice ### REPLY: Hello, Welcome to , Typhoid has a direct effect on the digestive system and requires special dietary care even after the symptoms subsides. You need to consume easy to digest foods that would give rest to the system. First thing is to maintain the fluid and electrolyte balance. To do so, you must take plenty of plain water, tender coconut water and .  Maintaining small and frequent meals. Taking light foods and avoiding peel or seeds of the fruits/vegetables, wherever possible. A protein rich diet would help. 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: My child is 4 years old .He frequently gets cold , sneezing with some less or more mucus.what is reason for it?He is taking bresol syrup now,iron,calcium and magnovit syrup.The problem gets severe in winter.Please tell the solution.Age:4 year,Height :38"  ,Weight:13.8 kg,Medical History;good,           takes antibiotics treatment when the problem is severe, sometimes becomes healthy with some  normal treatment and light medicine.He is healthy , active and has sharp brain. ### REPLY: Welcome to the ChatDoctorI understand your concerns but don't worry. Your son seems to be suffering from allergic tendency. I would recommend you to start him on montelukast once daily for 2-3 months. This will improve his allergic tendency. Hold the calcium, iron and magnolia syrups if your child is not having deficiency. A healthy diet and lifestyle is the best long-term health secret. Hopefully it will be of help. Take care ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I had a total hip replacement 2.12.13 and am still getting excrutiating pain when getting in and out of bed and when sitting in a chair at work. I m a young 57 year old low bmi right weight for height and my surgeon has said the operation went well and there s no infection what could be wrong? ### REPLY: Hi, thank you for providing the brief history of you. A thorough neuromuscular assessment is guided. As the THR was successful, and no infection is there, than the pain is due to muscle weakness. Also, you need to perform physical therapy post THR not only up to the mobility but up to the state where your body is out of pain and aches. For which, exercises included are - core stability, pelvic floor strengthening, back strengthening, hip strengthening and lower limb as a whole. Since all these exercises will strengthen the muscle groups in and around the hip joint which needs an attention to give full support to the hip joint. In my clinical experience, I prefer physical therapy for my patients anywhere between 6-8 weeks post which after a musculoskeletal assessment the discharge from physical therapy is advised. Patient recover to 99% of optimum muscle strength and no pains. RegardsJay 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: just received a call 1 hr ago. my 63yr old brother went to hospital with severe kidney pain. after test they found 7cm tumor on top of rt kidney pressing onto his liver and a couple nodules on lung. they are doing further testing and i m very scared. he is in great physical condition with no prior med problems and pain was sudden and unexpected ### REPLY: Thanks for your question on . In my opinion your brother is having tumor spread in lungs and the nodules seen in lung are nothing but metastatic lesion from primary site (renal). So this categorises your brother in stage 4 cancer. And in stage 4 disease surgery is contraindicated. Only chemotherapy and radiotherapy is indicated. In rare cases if renal tumor mass is too big and compressing vital organs like aorta and ureter than debunking surgery is done. Better to consult oncosurgeon and discuss all these. ### 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 and have a soft lump/swelling on the middle joint  of my ring finger. It gets bigger when my hand is downward or when my hands swell. If I put my hand up in the air the lump gets smaller. It does not hurt (it is not a ganglion cyst). Waiting on specialist appointment. Have had it for about 3 months. ### REPLY: Hi, dairy have gone through your question. I can understand your concern. You may have hematoma or other soft tissue tumor or some cyst.  You should go for examination and if needed go for biopsy. It gives 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 creatine level in February 2013 was o.53 with eEGFR Rate of 99. All other baseline tests were normal except for microscopic hematuria. I am 68 now with pseudomonas bacterial UTI that hasn t gone away even with ciprofloxasin. June 2014 creatine level was 0.9. Using same formula as used in 2013, the eEGFR rate is now 66!!! Same lab says Less than 60 indicates chronic renal disease. I know of NO risk factors (drugs, lifestyle, toxins, hospital care) that would make this happen. I look and feel very good.But the UTI isn t going away. Just saw my doctor, cystoscopy scheduled. He was not concerned.Any reason eEFGR could go down so fast??? (I am doing heavy contructioin work in my house.) ### REPLY: Hi, dairy have gone through your question. I can understand your concern. You should not worry about that.  You may have urinary tract infection. Repeated urinary tract infection may be due to diabetes.  You should check your blood sugar level. Heavy exercise can also cause this.  So don't worry about that.  Repeat your creatinine level and EFR level after a month. 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: Hi Doctor,My mom is suffering from cardiac problem. The referred doctors are saying that there more than 3 blocks hence she has to undergo bypass operations. Would like to know is there any treatment without operation to recover from this problem. She is almost 68 yrs old lady. could u reply ### REPLY: Hello dear, welcome to .come have evaluated your query thoroughly.* The best option to avoid bypass surgery if to look into matter for possibility of balloon angioplasty in her case to open up the blocked vessels.* Along with that - necessary blood thinners.  - lifestyle modifications.  - control of blood sugar, cholesterol, body weight.  - avoidance of stress, anxiety.  - regular walking, exercises, YOGA.  - sound sleep of 8 hours.  - balanced nutritious diet.  - avoidance of alcohol, smoking if doing. Hope this will help you for sure. Wishing her fine health ahead. 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 loose stools and sharp abdominal pains for the last few days. I suspect food poisoning but in 2012 I had a bCT scan of my stomach. There were a few gall bladder stones and a Terra Tumour on my R ovary. I am getting a new refrigerator to prevent possible food poisoning. What are the symptoms for each condition? ### REPLY: Hello, Pain abdomen, nausea, fever are generally seen in patients with gallstones. Sometimes it's not symptomatic. As you said there are gall stones that were noted when you did CT scan.  Have you taken any treatment for the same? If not I would advise you to talk to your doctor. Ovarian teratomas are generally benign and symptoms are not specific as the painless lump. Its treatment is surgery most of the time depending on the nature of the ovarian teratoma.  I would advise you to consult a gynecologist for the same and follow her advice for its management. Hope I have answered your query. Let me know if I can assist you further. Take care .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My daughter is three years old she was vomiting last weekend and then had diarrhea throughout the week now she has been running a fever around 101- 102. I was planning on taking her to the doctor tomorrow but I am worried. when fever goes down she plays and acts as she feels fine, I have been alternating motrin and tylenol every 4 hours. ### REPLY: Hi, It seems that she might be having gastroenteritis giving vomiting and loose motions. Go for stool test to type of infection like bacterial or protozoal. After report she might require ofloxacilin, Flagyl combination medicine course. Consult your doctor and get examined. Give her plenty of water and ORS liquid for fever and to prevent deny . Give Motrin or Tylenol as and when required. Ok and take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi Doctor,I want to speak to a gynaecologist I had my last period on 24th May 2014, and lasted till 29th. Me and my husband had sex on 30th and every alternate day we do have sex.I felt like vomitting a week later. I was tired all day. So took a pregnancy test but it was negative.We are planning to have a child.We have tried for 2 months but the result is negative Please suggest ### REPLY: Hi, You are unsuccessful in normal process of conceiving. Infertility is defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. So try to regular unprotected sex in fertile period of cycle. But be sure that you have normal menstrual period and completely healthy. If failed in future then both of you need to consult an infertility specialist and undergo reproductive and thyroid hormone analysis, USG scan, ovarian follicle study to find any cause. Semen analysis, USG pelvis, routine blood test and complete health check up for your husband. Meanwhile, avoid stress, take healthy diet rich in protein, green leafy vegetables and fresh fruits, do regular exercise, and . Hope this may help you. Contact further if follow up needed. 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: Hello My name is nikia barber I am 27 I have 6yr old daughter ever since I was a younger child I been through a lot stress til this day I been having these shakes ith everything I do and it embarrassing and I have told my doc and I as ignored I want to knw my reason pluse I cant sleep at nite I find myself waking up at least 5 time in the middle of the night what can I do im shaking kn like a old lady ### REPLY: Hi, Thanks for using . I have gone through your available history. You might have Performance anxiety with social phobia or depression, but physical causes like thyroid dysfunction, neurological deficit must be ruled out. You should consult your doctor preferably psychiatrist. Doctor may advise you some investigations including CAT scan to rule out physical causes. Doctor may advise you to take antianxiety or antidepressant .  You should also do stress management and relaxation exercise like yoga, meditation etc. 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: Is it still possible to be pregnant even if you "think" you have your period?  Im 25 and My breast are really sore and seem like they are bigger but my breats have NEVER been sore throuhgout my cycle in my life.  I got my expected period on wednesday nov 8th and its light.  When can I take an accurate home pregnancy test? ### REPLY: Hello, and I hope I can help you today. A pregnancy test will be accurate at this point if your period came on time, but many things can affect the amount of breast tenderness you have during your menses, like weight changes, salt intake, and irregular hormones for other reasons (like a missed ovulation) which can also give you a light period. So you may accurately do a pregnancy test if you are at risk for conception. However, the greatest likelihood is that you are not pregnant. I hope I was able to answer your question today and that 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: my face have pimples with pus ,thes is seen to be approximately 1 year.Now i consult a doctor and he prescribes clindamycin phospate gel.so by using this wheather i can recover my problem. if u can give me any more suggestions for this plz give me as soon as possible. ### REPLY: Hi...dear ksgopika., thanks for choosing ., Pimple with pus on face....common problem in Your age..., It is due to hyperactivity of hormones., So good treatment is there.1) Frequent washes with Low pH soaps... Triclosan(CNIL, Fast bar).,2) Tab Isotretinoin 20 mg daily for 2 months.,3) Tab Azithromycin 250 mg daily nighttimes for 1 week.,4) Plenty of vegetables and fresh fruits...,5) Avoid fried items., Oily food and Genk foods., ok....than ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i have been having major pain in both legs and the pain goes to the bone lastnight i went to stand up and couldn t everytime i tried my legs would buckle they were like jello this lasted for about 3 to 5 min i am 34 year old female wife and mother of two children what is wrong with me i m scared please help ### REPLY: Hello, It looks from your details that you may have nerve compression at your back or nerve compression at your peripheral part of leg due to compression from exterior source due to abnormal posture. Please correct your posture during sleep if it is abnormal. You should also take some multivitamin supplements to relieve any weakness of nerves. Take care. Hope I have answered your question. 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: hi my grandson has a g6pd deficiency. we want to change his milk from promil. what milk is suitable for him?he is 3 1/2 years olad already. right now, he ate only a little food. what vitamins can we give to him? thank you and i will appreciate your soonest reply. ### REPLY: Hi, I am glad that your grandson is already 3 years and 6 months. Milk as such is no problem. You can give him fresh cows milk pasteurized because one has to avoid infections with bacteria like salmonella which causes diarrhea. In this case you can also give Pedicure. Regarding foods to be avoided, some homework has to be done because main management is to avoid lava beans, sometimes touching may also precipitate some hemolysis. My advice to look at all food labels and compare with a list which you can download from internet and hang it on the fridge for ready reference ------alternatives are always available. Also check out how severely deficient your grandson is with a pediatric hematologist. Good news is as they get older and have at least 50% of total enzyme not many hemolytic episodes reported. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: HELLO, my follical size on day 14 (for 30 day periods cycle) is 19mm. What is the optimum size required for egg repture? Also do i need to take injections to ensure that the egg is released? Can i go for IUI or IVF considering this follicular report. ### REPLY: Hiwelcome to . A follicle size of 19 mm is good. It can rupture today or in a day. You must first have a cycle of just monitoring your cycle by an infertility specialist then you can be advised appropriate medication. Ivf /GUI is not the first step in treatment and is not required for all the people who are unable to conceive. You must go step by step in the treatment. It is best you visit a 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: For the past 2 days I have been having pain on my left side of the chest. A constant urge to take deep breaths and I am also having trouble yawning. I workout 5 times a week, so I think that might be the cause. Last time I showed it to a doctor he said it was just muscle tightness. It is back and I do not know what is causing it. Please Help? I m 15 years old ### REPLY: Thanks for your question on . I can understand your concern. Yes, possibility of musculoskeletal pain due to work out is more. At your age of 15 years, heart diseases related pain is not possible. So don't worry about it. Musculoskeletal pain is more likely. So follow these steps for better symptomatic relief. 1. Avoid heavyweight lifting and strenuous exercise. Avoid heavy work out for few days. 2. Avoid movements causing pain. 3. Avoid bad postures in sleep. 4. Take painkiller like ibuprofen. 5. Apply warm water pad on affected areas. Don't worry, you will be alright with all these. Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have a bump on the back of my leg. on my thigh. and im not sure if its ring worm or a bug bite? My boyfriend right now has ring worm and its not covered up and i think i go it from him but im not sure. could you help me too try to see what it is. thank you. ### REPLY: Hi, Dear,Welcome with your query to . Studied your query in full depth of its details. Reviewed it in context of your health concerns. Based On the facts, Dear, you need to consult Surgeon and dermatologist-if need be. It could be Varicose vein lump or could be ringworm transferred from your boyfriend.USG would rule out the MB Cyst of the knee. Dual Image Doppler study and physical examination from Surgeon would fix the cause of the lump on the back of the leg. This reply would help you to plan further treatment soon with your treating doctors. Best of Luck and early recovery. Welcome any further query in this regard, which would be replied in next session. Good Day!! . N. Senior Surgical Specialist. 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 a fever and recently Ive experienced wheezing coughs and chest sounds. After some research on the internet I found causes of this such as pneumonia, lung disorders, or asthma. All of this worries me, can you tell me what I might be experiencing? ### REPLY: Thanks for your question on . I can understand your concern. Fever, wheezing (whistling sound from chest) and chest congestion are commonly seen with pneumonia and bronchitis. So better to consult pulmonologist and get done clinical examination of respiratory system, chest x-ray and PFT (Pulmonary Function Test). Chest x-ray is needed to rule out pneumonia. PFT is must for the diagnosis of bronchitis. You may need antibiotics, inhaled bronchodilators (formoterol or albuterol) and other supportive treatment. Please quit smoking as soon as possible if you are smoker. Don't worry, you will be alright with all these. 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: Hi, myname is christina. ihave had a tooth ,rootcanel done several years ago, A year ago it broke, i couldnt afford the dentist ( the check up cost 197 dollars..for 10 minutes make another appointment.. ) two days ago my right ear started to go numb and now my ride side of my face is numb/tingly. i HAVE made an appointment with the dentis ( i been saving up) andmy apponintment is in TWO days . This morning my face was o.k but ,now its numb again.my Question is. should i wait till thursday ( today is tuesday - adelaide time). also have i done some premanent damage?...... the numb ness has spread .slow ly across my face.... and my ear feels od best wishes worried christina S.A Adelaide ### REPLY: Hello Christina, Greetings from India, As I understand you got a root canal done several years ago and the tooth fractured a year ago, and now you are having some indifferent sensation on the right side of face. Well whether this is related to your tooth is very difficult to say without a proper examination. You have not mentioned whether this tooth is present on the right side or not? So can not correlate. But numbness isn't a good sign, and it requires immediate attention, so you are advised to immediately see a dentist. 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: Hello specialists. I am Jay. I m 19 years old now. Turning 20 next year. I have a space in between my teeth . Around 3.3mm wide. I bought teeth effect bands from WWW.WWWW.WW For 5 nights of wearing the bands, I found out that my teeth gap is getting smaller. My concern now is that after using Orthofill and my teeth gap is totally closed, is their a possibility that it will reopen? And, is there something that I have to do so that my teeth gap will be close permanently? ### REPLY: Hello and welcome to  forum, I would like to inform you that using bands for closing gaps between teeth is one of the option but not a permanent solution.I advise you to visit an orthodontist who will plan a treatment for you, and the results will be permanent. These bands will move your teeth temporarily but after sometime, teeth revert to their normal position, therefore to avoid sucChatDoctorplications it is better to see a specialist.I hope I answered your query, i wish you good health. Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi im a very high patient of trycleceride its even reaches upto 1200 ,ive now been advised to take storva ez20 ,rt nw ive contolled the cholestol n tryclrds ,but it is tryclds r always in 400 /500 range but i just wanted to know how effective is this tab ,n what r the side effects of it ,would really like a reply coz worried a lot ### REPLY: Welcome to . I am . My pleasure to help you. Atorvastatin is effective medicine and used together with diet, weight loss, and exercise to patient who are at risk of developing heart disease. Common side effect - No need to worry about these-diarrhea and heartburn Stop taking atorvastatin and call your doctor-Muscle pain, tenderness, unusual tiredness, weakness and dark-colored urine. Thanx. Keep in touch. Always welcome for further 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: For the past 3 weeks Ive been suffering with ongoing severe derealization and I cant shake it. I wanted to know if their are any medicines that can help with this and how long does it take for them to work? I had a severe attack like this 2 1/2 years ago and was put on wellbutrin for it and the derealization went away after about 5 to 6 weeks. I went to the doctor this past tuesday and she put me on citalopram and metoporol and she said it should work much faster than wellbutrin but it hasnt worked so far and its been 4 days. ### REPLY: Degree understand your concerns went through your details. I suggest you not to worry much. Derealization disorder is not a stand-alone disorder but dissociative symptoms of many conditions, in psychiatry and neurotic spectrum. It is also called Depersonalization-derealization disorder. Psychological counseling helps you understand why depersonalization and derealization occur, and helps you gain control over the symptoms so that they go away. Two such techniques include cognitive behavioral therapy and psychodynamic therapy. Depersonalization-derealization disorder may also improve when counseling helps with other mental health conditions, such as depression. If you require more of my help in this aspect, Please post a direct question to me in this URL. http://goo.gl/aYW2pR. Make sure that you include every minute details possible. I shall prescribe the needed psychotherapy techniques. 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: Yesterday I just discovered a lump on my left armpit but I m not sure if it is a lump? And this morning my breasts were itchy and it was hurting but the pain was not so much. Since last week my underarms have been itching and I m really worried if it s some type of breast cancer. I told my mom about it but she said I was just overreacting. ### REPLY: Hi, dairy have gone through your question. I can understand your concern. You may have enlarged axillary lymph node due to reactive hyperplasia or soft tissue tumor like lipoma or some axillary tail of breast.  You should go for examination of axillary region and breast.  If needed go for biopsy or fine needle aspiration cytology. 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: Hi, for the past six months I have been waking up with head aces, body aces, tiredness and lethargic. I have all of this all day everyday. I also have a white discharge that smells ready bad and is itchy and if I wipe is breaks the skin. Can you please help me? I have in the past week also been experiencing some pains in my kidneys to. ### REPLY: Hi, Two possibilities come to my mind here. One is an under functioning of the thyroid or Hypothyroidism. The other possibility could be Chronic Fatigue Syn . Initially, I would suggest you to get the thyroid profile checked and then proceed further. Also, get your basic blood investigation done to check your hemoglobin levels. You should proceed further on these lines. Hope this helps you to an extent. Get well soon. ### 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 had my kidney transplant a month ago. Kidney funtion is doing good but after 1 week there was a oozing from one of stich. on investigation it seemed to be lymphosite  but there was a doubt of urine leakage for which nephrotosmy is advised by doctor. i would like to know that is it the only solution to confirm the leakage in my case and secondly is it safe for grafted kidney ### REPLY: Hi and welcome to . As a Urologist and kidney transplant surgeon, i understand your concern. Lymphoceles do form around the graft and need to be . If there's urine leak, it can be treated by a nephrology and stenting. At the same time, the origin of leak can be confirmed, with a contrast study. This is a standard procedure and will save the graft. Once the origin of leak is localized, it can be corrected accordingly. Wish you well.  ### 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 spleen was removed about two yeas ago and there are things that have happened. I have to take daily medication. My body is not taken or absorbing my medication there are other medication as well. What else is happening because I do not have my spleen ### REPLY: Thank you for posting query at . Spleen is a very important organ and plays a vital role in defense against microorganisms (bacteria) and regulation of lymph. A person without spleen is very prone to get infected from bacteria especially encapsulated bacteria. Therefore, usually all patients undergoing splenectomy receive vaccination against "encapsulated bacteria" (hemophilia influenza and streptococcus).if your not vaccinated, get a vaccine shot asap against these bacteria. Wish you good health. Further queries are welcomed. Health professionals aim to diagnose properly and manage patients according to their limited knowledge. Cure is blessed by the ONE who Created us, whose power and knowledge is unlimited .wish you good health. Regards, .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i had a heart attack two years ago following a stroke.Ever since iv e had on going problems.I started haveing seizures very difficult to control.Before haveing a seizure I would start shacking and my blood pressure would go out of control 140 over 172.I would have to take a tab of clonodine.as of now.I have other problems that I can t fiquore out,All of a sudden i feeldraind and mu musceld tightend up i feel dizzy and sick and my heart starts beating fast.It scares the hell out of me i feel that i m going to die it gets so bad.I have three stents.I don t know what to do any more.please help me.George Troncoza. ### REPLY: Hi Welcome to . I understand your query and concern. Rapid heart rate and Dizziness can be a definite feature of heart rhythm disturbances. Irregular heartbeat is known to alter the blood supply to the brain leading to impaired function in a transient way. Few . I advise you to have a complete 24 hr holder ECG which can accurately determine the cardiac conduction abnormalities. Monitor your blood pressure and heart rate. ### 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 surgery to remove a plate that had come loose from my upper jaw, right above my canine tooth . I also told the surgeon that I had noticed a hole that had been there since my initial double jaw surgery. The surgeon said he didn t notice any hole. Now, one week after surgery, the stitches that are right over the spot the hole was have popped loose and now there is a huge painful hole in my upper gum and lip, right above my canine tooth. My canine tooth has started hurting and my nose keeps running on the side of the hole. What could this possibly be? ### REPLY: Hello and welcome to  forum, according to the dental history provided by you, it seems, that you have had a congenital jaw problem, for which you have undergone a surgery. I am not able to make out through your dental history that what kind of hole it is. until I check clinically, but as you said post surgery you have been suffering from running nose and pain, it clearly signifies sinusitis(maxillary sinus). It is a condition, wherein, the maxillary sinus associated with upper teeth(canine to first molar) gets infected following surgeries, extractions and trauma. Therefore I advise you to visit your concerned dentist, he/she will prescribe you antibiotics and anti-inflammatory medication to resolve infection.I advise you to start warm saline rinses(3-4 times/day). And see your dentist soon.I wish you good health, take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I had a TDaP injection in left shoulder. 10 days later shoulder around injection site is still very sore, difficult to raise arm above head, feels like a muscle tear around injection site. No visible swelling or redness. But very sharp pain when trying to use the arm, especially when raising it. Suggestions? ### REPLY: Hi, Soreness around the injection site is due to allergic reaction to the vaccination you received. Since there is no visible sign of swelling or redness you need not worry. Take pain relievers like Ibuprofen/Coquitlam when pained. You should get comfortable. Try to keep moving your arm, if you keep it still it will hurt. If you get fever you should contact your doctor. Hope I have answered your query. Let me know if I can assist you further.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I had pain in my right jaw when I was trying to open it to eat supper.  This has just started and even though I chewed on my left side, it still hurts but not as bad as when I was initially trying to open it.  This is brand new, it was not hurting earlier today,  Yesterday, my right molar was tender once, when I tried to bit down on it, but it went away and has not returned. ### REPLY: You may be having a dental decay in your right molar which would have persisted long to cause such a pain. Usually such pain arises when the infection spreads below the roots and thus in that case pain can be manifested both while biting and also on opening of the jaw. Instead of trying to chew from the other side I would suggest you to get the problem on the right side corrected by visiting a dentist because ignorance in case even if your pain subsides would only lead to further problems such as gum infections, bad breath etc. ### 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: Ive been under stress recently and am now back on antidepressents 20miligrams. I tried to recite the alphabet and all the letters came jumbled up leaving me with the feeling that it wasnt quite right, but not really sure about it. I cant think ahead or make plans. Little things like what do i like to eat, I couldnt answer. I feel light headed, dull, fog like state. Cant keep track of what anyone is saying. what can this be? ### REPLY: Hello, Thanks for choosing  for posting your query. I have gone through your question in detail and I can understand what you are going through. From what you have stated it is quite clear that you are having a depressive episode. Depression can occur with regular stress, and it can also occur biologically without any stress as well. You need proper treatment for the same. There are various effective therapies for depression like fluoxetine, venlafaxine, bupropion, mirtazapine or Escitalopram, and they are all very effective and mostly safe. You may also require some benzodiazepines like clonazepam or lorazepam for a short period like 2-3 weeks to reduce the anxiety and help with your sleep.  The other possibility is you having an ADHD which will improve with methylphenidate or bupropion etc. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. In future if you wish to contact me directly, you can use the below-mentioned link:bit.ly/ .  ### 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 small lumps around my anus and a couple on my viginia that ich now and again they have been they a few weeks on and i seem to be getting more around my anus and have quite alot now they did bleed a little. but havent for a while now. am really worried. ### REPLY: Welcome to . 1. The possible cause of multiple lumps around the anus with pus / bleed - hair follicle infection, subcutaneous infection, Infective diseases can not be ruled out regarding the vaginal surrounding lumps.2. In this case needs to examine and a course of antibiotics will help to treat the infection.3. In case of localized skin infection or inflammation a local application of the anti-inflammatory cream will be necessary.4. A remedy - do not interfere any of the lumps, lesions - in that way if they will heal better, apply some antiseptic liquid in that are that will help as disinfectant and healing process.5. Suggest you to see your GP and get examined and treated according to the findings. Good luck. Hope I have answered your query,anything to ask do not hesitate to ask.http://doctor.ChatDoctor .com/doctors/ .  ### 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: to the inside of my tight just next to my scrotum I get little bump like swellings very small like a botton size and they pain. I observed them and I noticed they come about when I wear tight fitted under pants and sweat in that area. how do u get rid of them and is this normal? ### REPLY: Dear sir thanks for posting your query to . As I understand it could be an infection of hair follicle or sebaceous cyst. Cyst are usually painless whereas infected follicle produces pain, tenderness, pus collection, or fever. Infection can be treated using antibiotics or sometimes require surgical intervention to evacuate pus. Cyst can only be treated by surgical removal .  I suggest you consult a general surgeon for complete treatment . ### 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 there, my bf has a nocturnal seizure for few years now currently taking keppra 2000mg a day..lately he is been seizure free..he just seen his neurologist last week and was hoping to lower his dose but according to his neaurologist wait in 6mos..just need a second a opinion if there s any cure for nocturnal seizure..appreciate your help...thank you ### REPLY: HelloWelcome to  He has nocturnal seizure for few years and is non Levetricetam 2000 mg per day. He is seizure free for some time. Usually in any seizure or epilepsy Neurologists advocate that medicines should be taken for at least 3 years after last episode of seizure. 3 year seizure free period is duration as per guidelines. As you visited his neurologist, and you were told to wait for 6 months more. I will advise waiting and then discontinue medicines with advise of doctor only. Nocturnal seizures can be cured with medicines if taken properly. Also follow proper precautions of seizure as Proper nutrition fix the time of dinner no late night awakening avoiding bright lights avoiding loud music never miss a dose of .  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: About a month ago my wrist right below my right thumb randomly became severely itchy and a few small bumps appeared, overnight it stopped and I woke up the next day with one slightly bigger bump on my wrist. It hasn t gone away, It gets itchy maybe once a week not even but it s red and dry almost like a tiny wart. I also just found out that I m pregnant. Does anyone know what it may be? ### REPLY: Hi, If I were your treating Doctor for this case of an itchy wrist lump, I would come up with only one and one possibility that is folliculitis arising from an allergic reaction! Nothing to worry about this and try not to get infected there again! I suggest you to go for an FNAC test of the lump for confirmation if you feel necessary, and to relieve your concerns! Hope this answers your question. If you have additional questions or follow-up questions then please do not hesitate in writing to us. I will be happy to answer your questions. Wishing you good health. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have a hard lump where my lower wisdom tooth used to be. It was taken out about 5 months ago. This bump developed about a month after the initial extraction and my oral surgeon removed it because he said it was granular tissue. Now this bump has returned in the same area. ### REPLY: Hello, thank you for consulting with . Yes granulation tissue sometimes remains after extraction, but once after clearing that it should not appear again and if it had then, it can not be just a granulation tissue. It can be a cyst or tumor which was associated with this wisdom tooth, but it will be cleared only after an OPG (full mouth x-ray) so you should visit a good dentist and get it confirmed. Hope it will help 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, my name is Baljit, I m 54yrs female n I hv very very bad melasma since 5yrs on my cheeks n nose. I hv seen doctors who did IPL,LASER n CREAMS but it looks worst darker.I feel so ashamed to leave my house n am very very depressed seeing my face everyday. Pls Pls I beg, I need real help. ### REPLY: Hello Balaji. Welcome to . Your plasma is becoming darker with all cosmetic treatments you mentioned right? So I would opine to stop all that stuff.  I think that is not going to help u anymore.  You haven't send your picture. This is an internal problem needs to be treated by internal medicine only. Have u tried homoeopatChatDoctoredicine? It has excellent result in skin problems if u know. You can consult some good .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i went to exercise class for heart people and i had good bp reading 112/70 however my pulse rate was at first before exercise 112 after 121. i find also i have lost weight and got back my smell and taste. this has been transitory gone gor months then back.however i believe the senses may be tied to stress or sinus. this electric anxiety i have in dealing with problems may trigger senses. is there a connection. now i can taste and smell lately. i do however have anxiety tonight. thanks from cape breton ### REPLY: His had gone through your query. I understand your concerns. Anxiety is unconcerned fear with physical symptoms like heart beating sweating etc. It can be controlled by nature way improper sleep and diet.Stress-free activity pleasurable activity, music and hobbies. I have treat so many patients with mild dose of benzodiazepine and mild dose of SSRI, in SSRI mild dose of Escitalopram and paroxetine like . Still have a query then feel free to ask. Thank 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 my belly button pierced and I noticed that I have a hardish lump thats red and a little blue beside it. Im not sure if its a reaction to the piercing or an absess. its kinda tender and it just makes me nervous not knowing how to treat it. ### REPLY: Welcome to  .1. It seems like an infection post piercing.2. Needs to be evaluated as it could complicate if its infection.3. Get an appointment and request for an ultrasound scan done, which will evaluate how deep it is and what it is coming from / contents of the lump.4. Hernia are also expected there, but your symptoms don't sites here. 5. Hope it helps you. Anything to ask ? Do not hesitate. 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: 1st of im sixteen & im sexually active, i have gotten a blood test & a urine test for STD STIs & I dont have anything, every now & then i get a small lump on my anus , its tender & stings when i touch it.  Im not sure if its hermorroids because they do run in my family or if its a tear because i strain when i poop , it causes little discomphort & goesWha away after a few days , do i need to see a doctor or is it harmless ? ### REPLY: Hi. This is a classical finding of a fissure-in-ano, you have described. Occurs due to strain at pooh as you have rightly mentioned. The simple treatment which you do at home is ::High fiber diet mild laxative at bedtimeHave a Site bath (in a tub with warm water) to sooth the area. If you maintain this suggestion, you may get cured and there may not be a recurrence unless there is constipation. But if you have symptoms of more than 6 months or more than 3 attacks till now, it would be wise to consult a Castro surgeon, He would advise conservative treatment as I have already directed and may add an antibiotic and metro if he thinks of an infection too. Some patients may require a simple dilatation under general anesthesia if medical management fails to heal this. ### 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: A close family friend traveled to either Liberia or Nigeria and then soon came back to America with her two 5 year old twins who she had gone with to Africa. The boy twin now has large noticeable bumps on the top of his head and staying with him for about a half hour did not show any pain why is this happening, what is the diagnosis, and cure ### REPLY: Welcome to  Hi I am  and I will help with your Query I have gone through your question. It appears to be Desmond cyst keeping in view the site and age. However, it needs further clinical examination, which will help us in assessing features of lump like consistency, mobility/fixity with underlying structures, skin mobility over the swelling. CT scan and MRI are usually performed to know about its extension into the skull bone as it is known for intracranial extensions. Other possibilities are Polar Cyst and Pilomatrixoma. The treatment is surgical excision. You need to see a general surgeon in your area who after evaluation of the lump, will give you a plan for its treatment. I hope this will help you. Do rate my answer if like it. 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: well thank you Sir. I am from Chennai. The thing is i am addicted to porn beyond my limit. I am scared that i may mislead my way in my life. Now i really wanna get rid of that. I am getting depressed. I couldn t focus in my career. Could you please help me sir? ### REPLY: Degree understand your concerns went through your details. I suggest you not to worry much. It is the other way around. You are addicted to porn because you are not interested in your career. Once you become serious about your career, once you have no time and energy to spent on porn because of your career and life commitments, the addictions slews and gradually stops. You did not mention your age. If you are young and below 25, your addiction shall stop when you marry and start behaving as a family person. If you are above 25 and married, then life compulsions should stop you from this habit. Otherwise, you shall post a direct question to me in this website. Make sure that you include every minute details possible. I shall prescribe some sexology related psychotherapy techniques which should help you cure your condition further. 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: Hello Doctor, Hope you are keeping well, I am based in Dar es Salaam , Tanzania. I have a brother of age 24 years, who is suffering from Diabetes, for the past 16 years and he is under mixtard Insulin, He is injecting himself 2 times a day, morning 24 units and evening 18 units, he has been injecting as mentioned above for the past 16 years. He has gone into comma 3 times, and has recovered successfully. Recently 3 months back he has been suffering from neuropathy infection and his kidneys have started producing protein, we have consultated 4-5 doctors here in Dar es Salaam, but it has not worked out. He has pain in his left leg and the leg is getting thinner and thinner, he is unable to walk as well. He has been controlling his sugar as well but doesnt seem to work out as well. We are now planning to visit India, for his further treatment, we got your contact through the website, Can you assist us in this and give us ur estimated cost. Looking forward for your kind assistance regarding this matter. Incase you need any further information please do not hesitate to contace me on this number +0000. Thanking you in advance. ### REPLY: Dear friend, greetings from . I understand your concern . The whole problem is that . The sugar levels are poorly controlled . Hence, due to high glucose levels he is all end organ impact at the early age itself . You also told that he was admitted because of coma . That too three times . That is really not good sign of diabetic management... You need to evaluate him thoroughly first. Get his fasting glucose, HbA1c, lipid profile, 24 hour urinary proteins and thyroid profile.,.that gives an idea what could be the problem . And what should be done . Kindly take care of his diet and exercise. Ask him to take more of green leafy vegetables, oats, miles, and whole grains . Divide the meals into 3/4 small parts when ever he is hungry ... He can take little of fish . Avoid carboy . . He needs to have some physical activities. Even at home no problem . Take care and do contact us with the report .... ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello. I have been prescribed to 10 mg of adderall twice a day for about a year and a half now, about 6 months after beginning the adderall, I began experiencing muscle tightness all over but mostly in between my shoulder blades. I have tender points in my thighs, and buttock area, and calves. I never thought until now after some research on side effects that my pain could be coming from the adderall. During my research that is when I learned about Rhabdomyolysis.. however I always have take my medication as prescribed. Recently I have felt as if my medication is not working for me anymore. My body feels as if I have the flu but I am not ill. The tender points feel like big bruises but are not visible to the skin. I have been to physical therapy after clear xrays from a local Orthopedic, that suggested poor posture.. this is not the case for me. My pain is to severe. I do no know where else to turn because I do not feel comfortable seeking help from any more doctors after several attempts, only leaving me with the blank stare and being treated as if I m only trying to score narcotics. My question is; 1. Are my symptoms something someone would experience with Rhabdomyolysis? 2. What steps should I take if so? ### REPLY: Hi I did review your concern. Adderall on long term use can cause rhabdomyolysis. However, we need to do some tests that indicate presence of myoglobin in blood and urine. You should consult a physician who can get this test done and also examine your kidneys if they are under any damage. Meanwhile I must advise you to take adequate water for proper urination to remove if there is excess of myoglobin body.I hope this helps. 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: On 2nd May 2010 i started with vertigo and a cconstant feeling i was going to pass out. Since then my symptoms are : dizziness, lightheaded, short of breath, chest feels tight, heart palpatations, pain in my left arm, feeling weak, tired all the time, and generally unwell. Usually my blood pressure is 120/60 today it is 107/79. Ive been unwell with this for 4 months now - should i be concerned? Im a 25 year old female. ### REPLY: Thanks for your question on . I can understand your concern. Since you are young (25 years old) with normal blood pressure, possibility of stress and anxiety related symptoms is more likely. But better to rule out heart diseases first. So get done ECG, 2d echo and Holder monitoring (24 hours continuous recording of ECG). If all these are normal then no need to worry about heart diseases. Consult psychiatrist and get done counselling sessions. Try to identify stressor in your life and start working on its solution. You may need anxiolytic . Don't worry, you will be alright with all these. Avoid stress and tension, be relaxed and calm. Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks. ### END