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 went through my blood test few days back. in 2006 i was advised to have gilberts syndrome and my normal billiburin level was between 2-3. however my recent blood test showed my billiburin level 7mg/dl, billiburin level (direct) 2 mg/dl, SGPT 35 and SGOT 25. I am feeling excess fatigue this days. please advice me am i having jaundice? what should i eat and what sholdn t i? ### REPLY: Hi, Bilirubin get conjugated in liver by the help of Glucoronyl transferase enzyme and thus make it water-soluble. Due to deficiency of this hormone(UGT) level of conjugated bilirubin increase in blood without any serious problem. There are some tips to manage this syn .  Avoid alcohol, fatty and sugary food. Take protein, turmeric, milk, carrot. Do exercise and take at least eight-hour sleep. Enjoy tension free life. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: my grand daughter is almost 13 and told me she has worms in her feces, she recently Wednesday went to her DR because she was having pain in her lower right abdomen, took blood and sent for ultra sound, nothing was detected right away and now has appt for Tuesday to go over results.  Would blood workd detect worms and how long they have been there, she is very frail and small in weight ### REPLY: Welcome to ChatDoctori appreciate your concern about your granddaughters health round or pin worms are very common parasites in the human intestines or tummy. They appear as white small thread like things in faces. They cause weight loss and sometimes itching at anal area at night. They can also cause decrease He level.don't worry your granddaughters just need to be deformed with a dose of albendazole. Give her healthy food. She will start gaining weight once deformed. The dose can be repeated every 6 months stay healthy ### 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 mother has been suffering from ILD for more than 10 years. She used to regularly take methyl prednisolon and Azathioprin tables in fixed doses as adjusted by specialists at Apollo Hospital in New Delhi. Also underwent an angioplasty of left coronaries in March 2012. Around 40 days ago she developed symptoms of sever respiratory infection and increased hypoxia, the medical doctors prescribed her braod spectrum anibiotic (ceftriaxon) to be taken with her routine drugs. However, her infection and hypoxia not treated and she found weakness in her lower part of her body and became unable to walk. Following this we transfered her from My country (Afghanistan) to Apollo Hospital in India on 20 Nov 2012. In the hospital she was admitted at ICU ward and received the treatment for infection, hypoxia and swelling in her legs and hands. she recovered after some five days and she was about to be shifted to general ward, but the medical doctors requested her further stay at ICR. Following this she got another sever infection (called Aseno Bacter). Then her health condition worsened, although she received new courses of antibiotics. Last night she got sever respiratory distress and then the doctors did intubation of her, now she is under intubation. Could you please kindly let me on the prognosis of this level of treatment and how long it may take that she may need intubation? ### REPLY: The condition of the patient is of course serious. About intubation which is life supportive measure that must have been done because of the life threatening hypoxia. As the patient is known case of OLD (interstitial lung disease) which itself reduces the diffusion capacity of lung with resultant hypoxia, & the super added infection which further deteriorates lung diffusion capacity worsens the situation. The decision of the extubation (removing the endotracheal intubation tube) can only be taken considering multiple parameters such as patients consciousness, her capacity of maintaining Oxygen saturation (SPO2), readings of the ABG (arterial blood gas reports), which is somewhat difficult & cumbersome process to make you understand. Considering the symptoms provided by you there are 50 - 50 % chances of recovery as well s deterioration. But let's hope for the better & expect improvement in her health in a day or two which will lead to extubation. But exact days can not be said at this moment. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi, I have a medium sized lump underneath my armpit. When I touch it there is a bigger lump,like a ball underneath the skin. The lump is raised and the skin is thinner on the lump . Its really sore and I was wondering what it was?. I am 59 and I weigh 230 pounds, Ive had these before..but smaller and less painful. ### REPLY: Hi, dairy have gone through your question. I can understand your concern. You may have enlarged lymph node. It can be due to reactive hyperplasia, tuberculosis, lymphoma or metastatic carcinoma. Or it can be due to some soft tissue tumor. You should go for fine needle aspiration cytology or biopsy of that lump. It will give you exact diagnosis. Then you should take treatment accordingly. Hope I have answered your question, if you have any doubts then contact me at bit.ly/ . 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 father was diagnosed with bone cancer today. He is 92 years old and has been in reasonably good health, but has lost some weight lately and generally doesnt feel as good. A body catscan and a bonescan was done and while the catscan was good the doctor said he has cancer in his bones. I nor my father knows anymore than that. The doctor told him he will start him on pills (?) and in a couple weeks will give him an injection. My Question is what should I be asking of the doctor? I live 700 miles away and just learned of this today. Info sketchy at this point and appreciate any info you may offer. Thank you ### REPLY: Hi. Thanks for using . As per the details given, you need to know where exactly the cancer is and what treatment he needs, actually. Pills as they told may mean chemotherapy which is given for cancer. You need to know about that in detail because your father is too old, and he should be in a condition to tolerate the effects of the .  Please try to inquire all this information as much as possible. 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 the other day my heart felt like it had stopped then started again very fast about 5 times staight after it went back to normal i went very dizzy and hot only lasted for seconds went straight to hospital who did an ecg and it was fine and got sent home since then havent been feeling to good what can be wrong ### REPLY: Hello! Welcome and thank you for asking on ! Regarding your concern I would explain that your symptoms seem to be related to anxiety or a panic attack. Did you feel other symptoms like difficulty breathing, shortness of breath, fainting, etc.? Anyway a cardiac arrhythmia can not be excluded even with a normal ECG. I recommend consulting with your attending physician for a careful physical examination and some tests : -a cardiac ultrasound to examine your cardiac function-an ambulatory 24-48 hours ECG monitoring to examine your heart rhythm trends during the day and exclude possible arrhythmia-blood lab tests (complete blood count, blood electrolytes, thyroid hormone levels, fasting glucose, kidney and liver function tests, etc.). I recommend you discussing with your doctor on the above tests. If all the above-mentioned tests result normal, the main cause of your symptoms would be just anxiety. Hope to have been helpful! Feel free to ask me directly at any time for any other uncertainties. 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 hit the top of my head yesterday on a concrete wall. It was a mild impact but hurt. About 5 hours later i got very nausea and vommited about 4-5 times. After that i felt fine. Could the vommiting just have been from yogurt I ate 30 minutes prior to vommiting?.... The head is still sore today but no other major bad signs ### REPLY: If it was a single episode of vomiting & there is no bleeding from nose, mouth or ear, no convulsions & more importantly, no loss of consciousness after trauma even for a minute, then nothing much to worry. Just observation for if there is any further deterioration is sufficient. Examination once for eye signs, vitals, reflexes is advisable. If there is vomiting again, see your doctor soon. Hope this information is useful for you. Thanks. 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, I am 18 years old and 4 11. I m 115 lbs and I have never had any major medical problems before, other than pleurisy and bronchitis. My entire life I have had an occasional pain in my right leg. It starts behind the knee and then goes all the way up and down my leg. The pain is like an intense cramp and it stays for hours and hours. A few times, I have woken in the middle of the night with a pain so intense I could hardly stand it. This pain was in my calf on the right leg and felt like someone tearing my leg apart from the inside. So I would stand up and put pressure on it and the pain would go away. What could be causing this? My parents have always said it was growing pains but I don t think that s the case. ### REPLY: Hello, I read carefully your query and understand your concern. Your symptoms seem to be related to a muscle cramp. I suggest using a muscle relaxant such as Baclofen three times a day. I also suggest using magnesium supplement for muscle relaxation. Warm compresses can also be helpful. Hope my answer was helpful. If you have further queries feel free to contact me again. 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: I m having sore throat and cough since 20 days , i also get blood in cough in the morning only every day, i hav used medicine such as antibiotics and some other medicines prescribed by docs but are of no use . so pls help me in this respect.my mail is  YYYY@YYYY  . ### REPLY: Thanks for your question on . I can understand your concern. You are having chronic cough (cough for more than 2 weeks) and hemoptysis (blood in sputum) which is not relieved by routine .  So we should definitely rule out lung infection (pneumonia or tuberculosis) 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 lung infection. PFT is must for the diagnosis of bronchitis. You will need higher antibiotics, inhaled bronchodilators and inhaled corticosteroid (ICS) based on the reports. 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, I have a couple questions is I have been having like a feeling in the morning to vomit but i dont and one day I did and this month I got my period for a full 7 days and it was very light and dark, also i vomited once the day after I had intercourse 3 days before my period. Do you think I could be pregnant ? ### REPLY: Hello dear, I understand your concern. In my opinion there is no chance of pregnancy in your case. Following are the factors which make the pregnancy unlikely :-1)The 3 days before the period comes under safe period where the chances of pregnancy are nil.2)You have got the periods already. Once the periods come the chance of pregnancy is ruled out.Also, other symptoms of pregnancy like nausea, vomitings, increased urination, sore breasts start 2 weeks after missed period. And the vomiting which you had a day after intercourse is not due to pregnancy but for some other reason. And stress regarding the thought of pregnancy also make one to feel the pregnancy symptoms. So relax. Avoid stress. There cannot be pregnancy in your case. Hope this helps. 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 am pregnant I am feeling pain in my in belly and my vagina feel numb I have been feel like this since 8:45 nine and no change if I lay down u feel worst And I amIn my last month the baby is movingBut it feelsTight someTime they to me to drink alotOf what andWalk but that dont seemsTo be helping at all ### REPLY: Hi ! Good morning. I am  answering your query. As you are in the last month of your pregnancy, I would advise you to report to your obstetrician as the vaginal numbness could be due to pressure exerted on various nerves by the fetus during uterine contractions causing pain in the abdomen, which could be an indication that you might progress to labor, and this could be a possibility. Therefore, I would advise you to contact him/her soon before taking any other self treatment. I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts. Thanks for choosing  to clear doubts on your health problems. I wish you an early recovery.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am a 19 year old female with Ehlers-Danlos Syndrome. At work I am standing up for several hours and I get bad foot pain. Today, when taking off my shoes, I noticed a dark, fresh bruise and a lot of swelling in a ring around the bone on the inside of my ankle. I didn t notice any acute injuries like a sprain or dislocation. Any ideas on what the bloody discoloration is from and how to treat it? ### REPLY: Hello, I have studied your case and I think that it is most probably ecchymosis. This is discoloration due to accumulation of blood around ankle joint. This can occur due to prolong standing and tight shoes. As you are saying that you did not notice any injury so most probably it was a trivial incident.  I would suggest you to follow these steps.1. Hot water fomentation.2. Antibiotics to prevent infection.3. Compression bandage I hope these steps will be helpful for you. Let me know if there is any other followup questions. 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: A  blood test reveals that I have an ESR of 37 and I am experiencing pain and stiffness in the fingers of my right hand.  I had high cholesterol and was taking 10mg Lipitor. The Lipitor was increased to 20mg. and it seemed soon after I started experiencing noises in my head.  However, I am wondering whether the noises in my head could also be attributed to the high ESR.. ### REPLY: Hello, THX to contact us. I understand your concern. If I am your doctor I advise you that ringing in the ear is not because of high ESR, but it is because of high cholesterol you have in your blood. So increase in Lipitor is in effort to decrease the cholesterol of your body. So continue the treatment with the .  I will be happy to answer more of your concerns, kindly know me, Wish you a very good health at . . Infectious Disease. ### 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 as been dealing with a low platelet and hemoglobin count for 2 years. He has been on danazol 200mg for most of the time which has brought is platelets up to 70,000 and hemoglobin up to 84. Dad was just in ICU because his right lung filled with bright red blood after coughing. Dad had no signs of fever or a cold. The ICU doctors think dad may have had an mild infection which caused this. Dad recovered and has been out of the hospital for 1 week. Today he coughed up about 50mls of bright red blood. He is staying in the hospital over night for observation. I am just wonder if dad need to be ASA especially if his platelet content is low.Dad had a stent July of this year and that is the first time he as been on 81mg of asa. Dad hx is myoplastic dysplasia, unstable angina, anemia, asbestos, asthma, esophageal reflux, high blood pressure and high cholesterol. He is on asa, bisoprolol, valsartan, amlodipine. fenomicro tamsulosin and nitropatch. ### REPLY: HIT hank for asking to ChatDoctorI can understand it, if your dad have had a history of frequent blood in cough then it has to be investigated because low platelet does not cause this thing the cough stain with blood comes very late in platelet crisis, there must be some other lung tissue issue and need to be investigated, long term hospitalization would require here take care of your father have nice day. ### 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, please tell me is it good to travel a patient with ventilated machine? This patient now in attached to the ventilated machine and we want to take her to another hospital? how we can do this? how long we can keep her after remove the machine till go to next hospital? please let me know what to do? ### REPLY: Hello dear, thanks for your question on . I can understand your situation and problem. It is extremely risky to shift patient with ventilatory support. So just make sure that patient is having genuine reason for transfer because during transfer patient can be critical and may expire.Nowadays, ventilators with battery back up are available.  In these ventilators, we can continue machine for 1 hour during travel. Another way is to start ABU bag ventilation in patient. So discuss all these in detail with your doctor and then take decision about transfer. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello, I am wondering if there is a legal way to possibly get something to help with pain. I have pain in my hip. I have seen a Dr and he did give me a prescription for hyrdocodone 10/325. However, I have recently lost my insurance and do not have a Dr. Can i do a chat online with a physician to possible get a prescription if he thinks I need it? ### REPLY: Dear patient Which hip is getting pain, and what is the duration of your complaints? Have you suffered from trauma?  If pin is on other sides and no trauma possibility of avascular necrosis of hip or arthritis should be considered. If pain is on single side then infective pathology or arthritis should be considered.  I would advise X-ray of pelvis with both hips anteroposterior and frog leg view to confirm diagnosis.  Visit radiology center nearby you and get it done. Meanwhile, start tab attract twice a day for pain relief. You need to consult expert orthopedic surgeon with report. 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: 35 female, 260 pounds, healthy. severe pain mid back, more on the right side, now radiating around to the front right ribs, takes my breath away. i seen my dr and said iw as sitting wrong in my work chair! pain has become consistantly worse the last 2 weeks, since i have a head and chest cold . today it is almost unbearable. i was gonna go to er, but figured the dr would tell me to take ibuprofen and relax. any idea. family history, kidney disease, galbladder and pancrease issues, heart disease, alzheimers and breast cancer , ia lso forgot to say i am on medication for high triglycerides, and syntroid for my thyroid . ### REPLY: Hi, Welcome to ChatDoctorYou have most likely developed back muscles spasm may be due to wrong posture and possibly precipitated by cold. A simple analgesic and local hot fomentation will help you to reduce pain. As if muscle relaxant . If condition is severe enough then visit to ER is advisable. As you are over weight and a spine disc problem may be there so an x-ray spine to see condition of spine if required an MRI may give valuable information. Please continue to take medication for thyroid and triglycerides. Take care 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: my age is 33 my height is 153cm and weight is 55kg i do not have any children i am under treatment now. while doing a scan small pepper size gall bladder stones were detected now i am planning to go for ivf for infertility my question is whether i should remove the gall bladder stones or can i conceive with it.  At present i do not have any stomachache or any other problem kindly advise. ### REPLY: Hi, dairy have gone through your question. I can understand your concern. You have small gall bladder stone. If you don't have any symptoms of gall stone then nothing to worry. No treatment is required for that. It has no relation with your pregnancy, and you can conceive with gall stone also so don't worry about that. Just be relaxed. Go for IVF treatment. Hope I have answered your question. If you have any doubts then feel free to ask me. 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: the top of my mouth on the back right there s a squishy area which has become a bit sore like a sore throat if i gently push the squishy area i feel a bony lump the size of a small tooth this is just past where the last tooth sits at the top and in a bit towards the center. If i push the other side of the roof off my mouth i cant feel no lump ### REPLY: HelloWelcome to ChatDoctorAll your symptoms give an indication towards impacted wisdom tooth. I would like to know:--what's your age?-since how long are you experiencing this lump? If its more than 15 days than better get an IOP AR done to confirm whether its erupting or impacted. If there is something ceasing its path then get operculumectomy done. But if that's not possible then get it removed because it doesn't help much in chewing. Consult your dentist for further query. Take Disregards .  ### 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 50 non diabetic, normal cholestrol, normal ECG, overweight and taking atacand 16mg for the last 4 years for hypertension. since the last 2 weeks i have been experiencing on and off tingling and pins and needles in my left arm. At night i am fine but the feeling seems to intensify when i am under stress. My doctor has advised adding 5mg norvasc but i have not started it yet. Any advise would be very helpful. ### REPLY: Hello, I would explain that your symptoms could be related to a pinched nerve. For this reason, I recommend consulting with a neurologist for a physical exam and performing nerve conduction studies. An exercise cardiac stress test would help exclude possible coronary artery disease, although your symptoms are not suggestive of this disorder. 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, I am currently have the copper coil fitted. I am 23 with no kids although want them when I am older. I have had the coil fitted for over 6 months now and my periods have been normal (albeit a lot heavier and painful!!) for the past 2 months or so, I have missed my period and have a tender abdominal and constant cramping. What could be wrong? I should also point out that I had a pregnancy test when I first missed my period and it was negative. I am engaged, only have 1 sexual partner for over 5 years and have no STD s (have been tested). ### REPLY: Hi, The copper coil is a very effective (more than 99%) contraceptive method. Moreover, your pregnancy test is negative. So it is extremely unlikely that you are pregnant. If you have had home pregnancy test then get blood pregnancy test done as it is more accurate as there is a very small chance of the contraceptive method failure Can you feel the threads of the coil. Do you have vaginal discharge? Do you have urinary complaints? If the pregnancy test is negative then see gynecologist to make sure that the coil is in place and to evaluate for vaginal and urinary infection. If no infection and the coil is in place take progesterone to start periods. Some women do get cramps just before periods, and it is normal. The symptoms subside with the period. I hope I have answered to your satisfaction. ### 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 experianced transient crushing pain in epigastric area radiating to right scapula.pain had subsided after 20 to 30 minutes I have a hx of cholicystectomy and Graves disease. My regular medications are Propanolol 10 mg BD and carbimazole 10 mg mane . Ialso take one Zyrtec tab every morning since i have developed rash and itchy skin after carbimazole administration. What could be the cause of pain ### REPLY: Hello! Welcome to . Pain in epigastric area suggests increased secretion of acid in your stomach. In my clinic, many such patients do come, to whom after examination of abdomen, I advise ultrasound of abdomen & pelvis, if necessary. You should avoid hot/spicy food, late night meals, alcohol, smoking. Also, try to reduce stress, if any, with yoga & meditation. Consult your doctor for medicines like omeprazole, spy. Sucralfate & upper GIs copy if needed. Wish you speedy recovery. Hope this information is useful for you. Thanks. 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 age is 40years, weight is 87 Kgs. I have undergone angioplasty in Jan 2011 due to acute MI . Two medicine eluted overlaping stents were placed in Right Coronary Artery. Due to some weakness of muscle or due to stenting, a small anurysm came into existence at the place of stent. Doctors advised to wait as to whether it remains static or grows. But I am worried and want to take some herbal medicine/s so that anurysm is cured / removed and artery comes to its normal shape. Advise some herbal medicine having no chances of any side effects. ### REPLY: Sorry but there is no herbal medicine to cure aneurysm, aneurysm means a defect in wall of artery arising out of wrong placement of stent or weak endothelial musculature around artery!you have to keep your blood pressure in normal range in order to prevent rupture of aneurysm! A angiogram repeat should be done to see the nature and extent of aneurysm. As off now there is no herbal medicine documented to cure aneurysm. 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 a 42 yrs old female that was diagnosed with polymalagia rheumatica ...i am taking 50 mg of prednisone daily what else can i do ... i also feel like the muscles in my legs strain today i pulled the leg muscle and it really hurts is this a symptom of the diseases ? YYYY@YYYY ### REPLY: Hi Hope this message finds you in good health. I have gone through your complaints and understand your concern. You seem to have strained your calf muscles which generally take around 3-4 weeks time to heel, if given adequate rest, The treatment you are taking is absolutely right, but I guess you are not taking sufficient rest. But still, it will eventually heal. Take analgesics, anti-inflammatory tablets, crepe bandage, rest. Nothing to worry about. I hope your question has been answered. If you have any follow-up queries, feel free to consult me anytime. Thanks, Take care, God bless. ### 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 some unusual pain in lower back. I think from kidney. Recently I took cholesterol medicine after years of break. I remember that a few years ago I had same problem , same discomfort. I thought is something not right about my kidney. I felt that I am allergic to statin Recently, My urin test showed some blood Shall I be very concern ? Please advice. Thank you very much ### REPLY: Dear patient statins are known to cause muscle damage in few patients. That may lead to increase protein levels in blood which in turn goes to kidney for excretion and hence may affect your kidney. Chances are few but since your urine test showed blood this needs to be ruled out. I would advise visit to your physician for further examination and investigation like Ultrasound of PUB. Meanwhile stop taking statin if it is possible. ### 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 s upper right arm started to feel achy earlier this evening, a few hours later, complaining that it was hurting, I saw his arm,. It s swollen and black and blue in one spot. He doesn t recall doing anything to it. I gave him 2 Aleves at 4:00. ### REPLY: Hello, I read carefully your query and understand your concern. The symptoms of your husband seem to be related to an n injury. It can be a microtrauma which he did not notice. I suggest using anti-inflammatory medications such as Acetaminophen to relieve the pain. I also suggest using cold compresses for local application. Hope my answer was helpful. If you have further queries feel free to contact me again. 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: yes, my duaghter, 16 years of age. bloodwork was done at my request becuase i saw symptons of anemia , which i myself have suffered since the age of 12. she is of african american race her dads side,he once told me he had sickle cell traits but it never affected him.myself not knowing my whole side becuase my mother did not put my dad on the birth certificate leaves a half side- kinda unknowen.reason why im stateing this is the doctors office said they couldnt give me a proper diagnosis becuase my duaghter blood level was so extremly low her red blood cells ..ect.. very low.they gave her a month worth of strong iron pills @ laxatives to help her with the iron pills. they said they will have to retest becuase they couldnt determind proper lab results has to why or what it maybe?.the doctor asked if maybe it was thalassemia her dad may have had? but i know he said sickle cell traits.(we are no longer together & cant find him at this time.)when i looked up thalassemia very scary. but im white catch.. 22 my mother refuses to tell anyone whom my birth father is, well in concultion i cant be mediterrranean or asian haritage.. maybe itailain?or greek? problem is to norrow this down,.....maybe?.. cant sickle cell traits disguise as maybe as thalassemia? ### REPLY: Your description of your daughters' problem shows that she has anemia which you think might be sickle cell trait or Thalassemia. First test which can be performed is a reticulocyte count. If this is high it is a hemolytic anemia. A peripheral smear should be done which will make the picture clearer. A bone marrow biopsy can be done to rule out plastic anemia or other bone marrow abnormalities. All these tests will help you to narrow down the diagnosis ### 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 m 15 weeks pregnant with a really bad nose blockage.Its been a month that i m suffering from severe nose bloackage.I had been to the hospital and took some medicines which is of no use.I m drinking warm water always and taking care of myself by taking vapours in hot water.This problem is making me restless.Please i request you to suggest some remedies atleast which help me to take rest for a while in a day. ### REPLY: HAI, nasal blockage without any infection or allergy kindly rule out any nasal polyp.(growth in nasal pathway)if you are free from any nasal polyp kindly administer NAIL solution two . No harm in taking it. Avoid cold temperature as well as Air conditioner in your living room. Stay in normal atmospheric temperature. Above advise will help in temporary basis. Kindly rule out the cause for your nasal block with the help of ENT specialist to get rid of the condition. Thank you hope I answered your query ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello doctor ! my age is 43, height 177cm and weight is 83 kgs. All the CBC, sugar and LFT parameters are normal. HDL is 37 and LDL is 122.3... ultrsound report says that i have grade 1 fatty liver. Is this is cause of concern? how to get the liver normal. i walk for one hour almost 4 times a week. drink and smoke socially. Any medicine to cure fatty liver ?? ### REPLY: Hi and Welcome to . I appreciate your concern for the fatty liver. You need to have some lifestyle modifications in order to get rid of fatty liver:1. Since you are overweight (BMI is 26.49), your maximum healthy weight based on a BMI of 25 is 78.32 kg. So, continue regular physical activities in addition to walking2. Avoid fatty meals (both vegan and non-vegan), fast and junk foods, salted snacks, .  ### 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 31yrs old, 5.5ft tall, 83kgs, & married for 4 yrs. I have 9yr old daughter with another man & my husband has a 18yr old daughter with his former wife. I have been trying to conceive for 3 yrs.  I have a regular menstrual cycle of 28 days, hsg test shows that my uterus is normal and the tubes are fine. My husband has a sperm count of 48m/ml with 70% mortility rate.  What is causing our infertility?  I am really desperate and need a child badly. ### REPLY: Hi welcome to . I have gone through your question. You both have kids with past relationship that rules out major abnormality. And you also have done SG for you and semen analysis for your husband which also normal then it suggests" unexplained infertility". As nowadays 10-20% infertile couple has this type of infertility. I would recommend consulting a gynecologist for GUI intrauterine insemination or IVF invited fertilization. Hope I answered your question. Would be happy to help 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: keep getting these electric shock sensations in my upper back more to the left side, sometimes it can be really painful and it literally jerks my entire body when it happens. When it happens it happens so randomly. It might not happen for weeks and sometimes it happen multiple times a day for days. It doesn t matter if I m waking, standing, laying ect.. it just comes out of nowhere. I haven t always had it, it only started roughly about ago. The only thing I can put it down to is after a I moved I hurt my back and ever since I ve been getting the electric shock sensations. I haven t really worried about seeing a doctor because it goes away but always comes back. ### REPLY: Dear friend, thanks for your consultation.it seems that the upper back pain is really bothering you, and it is really painful and electric shock like .as far as you have given your trauma history, you have hurt your back. From my clinical experience I am telling you that you might either have injured your lower back muscle or vertebral bone of that region. An injured muscle or a group of muscles always give rise to this kind of pain. Also see there is a sponge like thing in between our vertebral bones.it is called vertebral disc. If you have injured this disc or the disc is displaced then the nerve in between two vertebrae is getting irritated causing pain. So to know for sure you should go for an X-Ray and MRI of that region to know if there is any structural problem in that region like fracture of any vertebra or displaced disc or any muscle tear.my best wishes for 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: okay i have had my gallbladder removed and a yr ago i had 20 % of my right kidney removed to cancer and i keep getting this really pad pain in my liver area and it will move into the chest and into my shoulder and then my kidney will start to hurt i will get the urge to get sick and when i lay down or ant kind of movement and the pain will become very bad.. it will go away for a little while but here the last few months it has been bothering me alot and the last two weeks it has been almost every day ### REPLY: Hello Dear. Welcome here on  Dot Com.I am very much concern of your problem. I think I will certainly able to help you out of this condition. In my viewpoint is a defensive symptom of the body to alert you be cautious and take care of yourself in time. So I will suggest youth visit your GP sand get evaluated this problem until a diagnosis is formed, and you are given correct treatment. Good luck. 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 m having a sharp pain about an inch from my left hip bone It hurts really bad when I lay on my side or try to get up and move And it s nearly unbearable when I pee It s not too bad when I lay on my back but it s kind of swollen and and hot where the pain is Any clues as to what it could be? ### REPLY: Dear patient You have got infection around your hip area.  Localized tender area that is hot to touch indicates infection.  Are you having fever?  If yes it also adds to Infection. I would advise for local ultrasound to assess collection. Also blood investigation with total and differential leukocyte counts needs to be done. Start tab augmenting 625 mg thrice a day with tab Aeroflot 500 mg once a day for 7 days. This will relieve you of pain and inflammation.  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: its a day or so to my menses and i cant concentrate completely. i failed my aptitude test yesterday, couldn t even figure out what the questions were asking. its very disturbing especially with my kind of job, i develop software. how should i handle these times to ensure i can get the possible maximum productivity? ### REPLY: Degree understand your concerns went through your details. I suggest you not to worry much. Instead of trying to find a solution for a problem just before the problem has been presented, you need to find a permanent solution. Possibly you have menstruation anxiety, which is quite common. The best option to you is to ask your female colleagues who do your type of work. They will be able to help you better. Practice meditation and yoga. Understand menstrual cycle and process. If you require more of my help in this aspect, Please post a direct question to me in this website. 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: Hi ,I have a dry and sensitive skin, none of the market available mosturising cream suites me.Sometimes wrong use of cream leads to dry patches and many small small pimples on my face.I am fed up of trying new creams  suggested by someone or other every time. Currently I am using Curatio fash face wash , Evion mosturising cream and suncros aquagel sunscreen which is again not having a good result still I can sometimes see dry patches on my face and my skin getting darker slowly. Please help me as for my marriage 3 months is left and I want to look best on my day. ### REPLY: Hi Ankita Welcome to the forum. You should not be worried about the simple problem of your skin. What you are suffering from is quite common condition in people with sensitive skin condition which sometimes behave both as . The very first thing you should do is avoiding direct sunlight exposure to the skin. Even if you are avoiding the same then also there is exposure of UV radiations from computers and other artificial light sources, so should also take care of the same. The best avoidance is never at all by sunscreen but is by personal protection by clothes and umbrellas. Contact with Cell phone on facial skin (because of radiation and heat)also make the skin sensitive. Secondly you should start up your day  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My son is 1.5 month old. Weight 3.3 KG, Height 54 cm.He got blood infection (Septicemia) on 2nd day of his birth and became hypoglycemic and got convulsion on 3rd day. His level of Calcium in blood was also low 6.9 mg/dl Treatment he got: 1. Meropenem for 12 days 2. Phenobarbital for 2 days Doctor withdrew phenobarbital on 5th day and convulsion stopped. Doctor released Nuhayed on 15th day. He was cured then. From 28th day very little jerking was seen in his left leg. It was approx 5-6 times per day. Then gradually it increased day by day. Now both hands and legs and also head jerk several times in a day. It seems less when he is in deep sleep and fully awaken. In time of breast feeding and before going to sleep he jerks more and strongly. Treatment he is getting: 1. Phenobarbital 30mg (1/4+0+1/4) 2. Folic acid (1/4+0+0) from 32nd day till today. His EEG report is notrmal.His USG report says, The appearances of the Cerebral Hemispheres & Sulci s, areas of basal ganglia & Moderate interhemispheric fissure collection are suggestive of possible changes due to (?) on going intra-carnial infection. No considerable improvement yet. Would you please advise. ### REPLY: The important thing to know is doing he had a documented intracranial infection ? Meaning : did they do Lumber puncture ? And what was the results of the analysis and culture of the cerebrospinal fluid? Early convulsions in meningitis usually suggest a good prognosis unless it was a devastating bacterial meningitis which can affect the vision, hearing and can cause mental retardation as well, and sometimes is associated with convulsions .EEG can be normal in 30 % of patients who has convulsions, and it doesn't exclude it .the most important next step is doing MRI scan of the brain, to exclude congenital malformation, inflammatory changes following meningitis. A video showing these Jerks is very important in diagnosis, because some infants can exhibit Benin myoclonus Jerks during sleep and is considered normal. So the following is needed : - brain MRI - video documenting the Jerks. - if a documented meningitis was there, then should do hearing test (aquatic emission) I hope this was helpful ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi, may I answer your health queries right now ?  Please type your query here... I went to the doctor because of skipped heart beats, only lasting a second, which causes me to cough.  Just didnt feel right. At the office my blood pressure was 169/92 which is 50 pts up for me, ekg turned out ok.  He did chest xray and blood work.  Waiting for results and appt. for echocardiogram.  Heart feels like it beats a lot stronger. ### REPLY: Hello! Welcome and thank you for asking on ! I understand your concern and would explain that these skipped heart beats could be related to a cardiac arrhythmia. For this reason, I would recommend performing further tests: - a cardiac ultrasound- an ambulatory 24-48 hours ECG monitoring to examine your heart rhythm trends for a prolonged period of time-complete blood count for anemia-thyroid hormone levels for thyroid dysfunction - blood electrolytes for possible imbalance. You should discuss with your doctor on the above issues. Hope you will find this answer helpful! 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: Suffering from headache at the back of left head for 5 days , some diarrahea and am feeling alot of anxiety. had bloods tests and chest x-ray done 2 days ago, but headache is still there and am getting more anxious, also I have a CTscan appt.for the morning. Could this be a Brain Tumour..? ### REPLY: Hello. I am . I have read your message. I think I can help you. First, I don't think this is brain tumor. The brain tumor patients do have headache and vomiting. But it is for a long time, not for 5 days. So try to relax. That itself may reduce your headache. The way you have described the headache, one-sided, probably pulsatile is suggestive of a migraine. This may be associated with a feeling of apprehension or anxiety. And loose stools do occur with migraine. However, a CT scan is still needed. It would be prudent to talk about therapy after scan especially since you have it soon. Meanwhile, take some painkillers and antiemetic. A simple Pantoprazole with paracetamol may help you for the time being. I have tried to make it as simple as possible. Feel free to contact me for further clarification on any point. Best of 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 have developed a very sore gum,on my left lower jaw on the place where my wisdom tooth is to come.I m 20 and never had this much swelling before.There have been days when i developed swelling there but it was not too painful.But this time it is too much and i cant eat anything,even swallowing pains and the left side o my throat has started to pain now.I smoked weed the previous night an when i woke up i had this sore gum.Are these two things related?How can i get well asap? ### REPLY: Thanks for your query, I have gone through your query. The soreness in the gums could be because of the peritonitis or periodontal abscess secondary to infection of the gums around the wisdom tooth. Consult your oral physician and get radiograph done. If the space is sufficient for the tooth to erupt then we can remove the flap around the tooth. If space is not there for the tooth to erupt then you have to get it removed. You can take a course of antibiotics. Do saline gargling. I hope my answer will help you. Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am married for about 4 months.i am getting periods in 45 days 50 days by last one year.i had a problem of PCOS.i dont know its still present or not.On march 19 i got my periods after that i didnt.i consulted a gynec.she gave me dupahsaton 2 tablets 3 times for 5 days.after finishing tat on 4th day i got periods.what is my chance of ovulation this month?.am i get pregnant? ### REPLY: Hi, I think you should go for evaluation first.  Do a thyroid profile and prolactin levels and an ultrasound for your uterus and ovaries to find out the cause of irregular periods.  It can be due to some thyroid disorder or may be polycystic ovaries.  If anything is abnormal, it can be treated. You can track your ovulation by repeated ultrasound. It will tell you if ovulation is happening or not.  If ovulation is not happening, you can take some medicines like camphene for ovulation.  Talk to your doctor regarding 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: respected doctor, my kid is suffering from cold, cough and fever from 14.1.2011 on wards. from that time onwards we are giving cetirizine suryp, indclave-bid syrup. from 2 days onwards red rashes are raised on the face and body. kid was suffering from continuous cough also. yesterday blood test was done. ESR 1st hour 40 recorded. remaining tests are normal. today doctor suggested to give 4ml azithromycin oral suspension 40mg and 2ml and 2ml will give remaining days. please suggest me what are the steps we will take to relief my kid from this adverse illhealth. awaiting yours reply ### REPLY: Hello, Cough and cold are viral 95% of the times in child .  For cold, you can use anti-allergics like cetirizine and for nose block, saline nasal decongestants will do. Paracetamol can be given, that too only if fever is more than 100F. I suggest not using combination medicines for fever, especially with Paracetamol. For cold, you can use Cetirizine. For nasal block, plain saline nasal  ### 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 undergoing ovolution study and on 14th day lt ovary the follicule mesaures 22 mm and ?CH and on 19th day 21X35 CH. my doctor told egg ruptured. and gave T Meprate for 13 days.Why Meprate was given will i get preganant this cycle. i tried durinf 14-19 th day. ### REPLY: Hi, I will suggest you the best possible treatment options. If sonography reports show rupture of follicle and egg release then egg is available for next 24 to 36 hours. Chances of getting pregnant are high in this period if you have sex activity or GUI in this period. Usually, progesterone hormone is prescribed as support for the expected pregnancy for 10 to 15 days after your ovulation. Your doctor must have given you tablets Me prate for the same. Me prate does not help to get pregnant. It might be given to you to support the pregnancy or if there is no confirmed ovulation then to get with .  I usually suggest micronized natural progesterone tablets to my patients after ovulation. I hope this answer helps you. Let me know if I can assist you further. Thanks, ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi I am sana I have baby girl abt 5 and half year old last january I have expell of almost 3 months becoz fetal iz too weak.this month I consult dr she gave me conceving medicne named prolifen and call me ony my ovulation day that iz 29 of may she ultrasound but mature fallopin iz not seen. Now she inject me iui c5000 gave me myfol for one month and vitamin E too. I would like to know that it is possible after ovulation conceiving iz happen? Why dr give me myfol. Ans me urgent waiting for ur reply. ### REPLY: Hi Sana, Thanks for your question. Ovulation is necessary for a conception to occur. I donor know exact findings on your ultrasound, so it is difficult for me to comment on your management. My fol is folic acid which is a necessary vitamin & it is recommended that all pregnant women & those who are trying to conceive must take it. This approach is very helpful in reducing the incidence of some birth defects. Best of 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: When I am sitting I get chest pains. When I am standing and doing work, there is No chest pains. I have to drive alot and every time I drive I get terrible chest pains. I saw a cardiologist and my angioplastic and my echo cardiogram were fine. The chest x ray was good also. Why is my chest hurting me when I sit down only and not when standing or moving around? Tighting pain. ### REPLY: Thanks for your question on . In my opinion I think you are having muscular pain mostly, as cardiac cause has been ruled out. Another thing which supports the muscular pain is positional pain (only in sitting posture). So your sitting posture causes some muscle s to pull or work more. This causes pain in your case. So try to follow these things.1. Proper sitting position is required.2. Seat in back support chair only. Avoid too much bending on either side .3. Take good painkiller and muscle relaxant.4. Apply warm water pad on affected site. You will be alright. No need to worry much. ### 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 left chest pain only when i cough or breath deeply. I do have asthma, sinus and hay fever. I have no fever but when i walk i do run out of breath. This morning when i woke up i felt pain in left side and i could feel the pain when i cough or breath deeply. i can also feel the pain when i touch. ### REPLY: Thanks for your question on . I can understand your concern. Chest pain on coughing and deep breathing is mostly seen with pleurisy (inflammation of pleura). Common cause for pleurisy is lung infection. So first get done chest x-ray. If chest x-ray is normal then no need to worry about lung infection. Sometimes simple musculoskeletal pain can also cause similar kind of pain. So avoid movements causing pain. Apply warm water pad on affected areas. Take simple painkiller like paracetamol or ibuprofen.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, I am an hemophiliac type A , factor 8 , with percentage around the 5% less or more of +/-1% ... I found that Dicynone, might be helping to recover my small capilars to recover, in case i have some sensitive area with small capilars impacted by some pressure or force, that caused longtime ago some small hemorragy of the kind of ankle ... but now, no blood, just i feel sometimes some pain in those small capilars, and because of pressure of the body weight over my ankle, i feel those small capilars might pass small hemorragy, as being week ones, so that i thought of using the Dicynone, and i am not sure if this might help, and it was a fully subjective decision, after i discover this medicament with my wife, and read its data-sheet i felt it might help me (as hemophilia Factor 8) to save my small injured capillars within my ankle area... Thanks to explain to me, what might such medicament impact on my case, and i know it is not the proper way, but just some hope in my mind to avoid one day totally (the factor 8, injection, as treatement of precaution in such small doubtfull cases, where no clear hemorragy is showing).Best Regards,O. Dahan YYYY@YYYY ### REPLY: Hiyou have the factor level around 5% and that's good. You are not having severe hemophilia thus an unprovoked bleeding is less likely. I will suggest you not to take any treatment as you are quite asymptomatic and level is not bad. You will definitely need treatment [tranxenemic acid for local and small bleed and replacement of factor for accident, significant bleed or planned surgery]is limited conditions. For your Angel, its possible to feel tingling sensation and pressure due to old injury. Do good and gentle physiotherapy. It will help. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My MRI shows Diffuse posterior buldge with posterior protrusion of L5-S1 disc, indenting thecal sac. Sir, Can I walk about 15 minutes per day. How can I do yoga. Is this is a SIATICIA. My problen is in back but I cant bend my knees. Why sir. Please answer my questions sir ### REPLY: Hello, This MRI finding is not indicative of sciatica. Sciatica usually causes back pain irradiating in one or both legs, which is triggered by walking or sitting position. For this reason, I would recommend performing regular physiotherapy and checking your knees too (an X-ray study of both knee joints, coupled with inflammation tests). 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: 3 weeks ago someone ran into my left calf very hard pushing a wheelchair. The area was swollen for 2 weeks in my leg and foot. There is still bruising covering an area the size of my palm, and a have a goose egg under the bruise. How long will it take to heal? Should I get it checked by a doctor? ### REPLY: Hello, I think you should meet up a physician and get it checked as its almost 3 weeks now and no signs of healing mentioned in the history. It must be surely just a muscular injury and will heal with hot water fermentation and use of stocking for the leg.  But to keep yourself safer a physical examination and x-ray will be good to be done. Hope I have answered your query. Let me know if I can assist you further. Jay In .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My husband had a round rash type area on his neck.  No itching.  Roundness was red but lighter inside.  It has spread down his neck, all over his back and one spot on his leg.  On a side note...he is also having blood work and an MRI to diagnose a possibility of gout in his left ankle that started almost a month ago. Not sure if these are connected or not.  What could the rash be? ### REPLY: Hi, thanks for writing to us. From the description provided it could be liturgies rose, Tina corporal or psoriasis etc. P rose presents as red round rash with scales at margin of the lesion. Initially a single rash appears and later on multiple rashes appear over trunk along the ribs. It is a self resolving condition. Tinea or ring worm is fungal infection characterized by ring shaped itchy lesions. Treatment is antifungal medicinesPsoriasis - red raised lesions with overlying thick scales. Treatment is steroid cream emollients etc. I would recommend a visit to dermatologist for diagnosis and Treatment. Hope that helped. 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 n law has endocervical stage four cancer she has been to Mayo clinic where she was told it is incurable . They will treat her with Chemo and radiation . She had a complete hysterectomy and they took nogels and lyphnodes which were also cancereous Her cancer spread to her cervix ovaries kidneys bladder uterus at Mayo they checked there are still cancer cells present and spreading can this be cured in your opinion ### REPLY: Thanks for your question on . I can understand your situation and problem. But stage 4 endocervical cancer is incurable. It is very notorious for local recurrence and distal metastases. So after debunking hysterectomy, if local recurrence is there, then brachytherapy is needed. It is having small pellets of radioactive material.  Which can be put locally. So desired site can be targeted without harm to other tissue. To prevent distal spread chemotherapy is needed. She can also have other palliative treatment like nutritional support in the form of multivitamins and protein powder, Painkiller .  ### 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: Doc im suffered from typhoid im in medication for past 4days now im thinking that im free of temp and bodypains not completely bt some betterment is there bt nw in my 5th day i hv severe headache especially at the back side.in some position it disappears please help me ### REPLY: Hi Welcome to  . I have gone through your query and can understand your concern. Typhoid fever is treated with antibiotics that kill the Salmonella bacteria, responsible for typhoid fever. Oral Antibiotic like definite, ciprofloxacin, ofloxacin, Augmenting are used, sometimes injectable antibiotics like cefuroxime may be required in severe cases too. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days. For fever, body-ache, headache are treated with anti-inflammatory medicines like acetaminophen, naproxen, 2-3 times a day. Hoping your query is solved. 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: I got in an accident on thursday i didnt black out or hit my head that i know of but felt dizzy after geting out the er didnt adress the dizzyness or the sudden tyredness i felt n i noticed over the last couple days theres clear fluid in my ears i use qtips to free it every few hrs . Do i need to go to the hospital or is it normal. Ive also had a slight headache on my right front side ### REPLY: Welcome to ! I can say from my clinical experience that you need to see a doctor and may also require MRI brain as- there is dizziness, tiredness, headache post trauma, which is localized; then there is clear fluid discharge from eyes, which is not having any other apparent reason. It is ok that you didn't hit your head directly, but dizziness, headache, watering from eye (without redness Or any other eye complain) needs to be looked into. Getting it checked will not harm you in any way, even when everything comes out to be normal! Hope the reply is useful. Further management can be advised only after examination and scan. Feel free to ask more queries .  ### 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 premolar seems to be slightly loose. whenever i jump or hit my head or run, that tooth hurts. I feel an upward pain. i cant chew on the side where my affected tooth is because theres a little pain. i already had my teeth deep- scaled today. how long will this problem end? what seems to be the problem? ### REPLY: Thanks for your query, I have gone through your query. The pain could be because of the gum infection or tooth infection. Since you have got your teeth cleaned today wait for 3-5days, the pain should come down. You can also take a course of antibiotics like doxycycline 100 mg twice daily for first day and once daily for next four days and take analgesic for the pain. Do saline gargling. I hope my answer will help you. Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am in college and about an hour ago, I masturbated then shaved my pubic hair. It was burning a little while i masturbated then kind of had a cool burning after. When I got out of the shower I realized that the foreskin was all swelled up and was really thick. The bottom was the same and so was the head. I am circumcised and have not been sexually active in around six months. ### REPLY: Thanks for asking in  forum In short: If you are circumcised then how can you get swelling of foreskinExplanation: Slight bruise/cut/insect bite and injury caused by shaved hair can cause swelling of foreskin as it is very sensitive. So, for time being you can take antihistamines or can apply point clobetasol locally for relief.  If it does not subside then visit a doctor for examination. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Last year In December I had total gastrectomy done because of stage 3 cancer and completed six cycle of chemo. Now every report is normal.but one problem I am worried of that after eating food sometime I feel ing coughing then some kind of whitish liquid coming out.and sometime disturbance in stomach.i am taking lesuride still sometime this prob is there.why it is so? ### REPLY: Hello. Your complaint appear to be developed after the surgery. It appears that since the stomach is removed the food reservoir function is lost.n it is expected is gastrectomy patients. Usually it is manageable with change in dietary pattern such as shift to small frequent meals. Lesuride three times a day will help. Prefer easily digestible food with less gas producing food. Example most people feel better with avoidance of pulses and legume. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: sir , i am 35 years old and i have been diagnosed with kidney stone of 3.4mm in january 2014, and i have tested fot UTI but it was negative, i have burning sensation after urinating and its like again i feel urinating but it continues, it sometimes severe or mild, i took urilizer sometimes but whether there is some permanent cure? ### REPLY: Hi, Thanks for writing in. A stone measuring 3.4 mm is too small and if found in the kidney, it is usually non-obstructive. This will not cause any urinary obstruction in most patients. If this stone is on its way out then it can cause symptoms like burning sensation after urination and feeling of urge. This can also happen if there are any other small stones in the urinary tract which can be held up anywhere along the lower urinary tract. I suggest you .  Please pass urine frequently. This can be done for about 15 days and if there is persistent burning and pain then please report to the urologist. You might require a CT scan and cystoscopy to evaluate other causes of burning urination and urge. ### 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 sick to my stomach and my head feels full like I want to throw up for a couple of weeks now. It started when i started having pain between my shoulder blades. I do have high blood pressure but it is controlled by medication. And this past weekend, i went to sneeze and i had a jarring pain through my shoulder blades and into my neck. I went to the doctor and he said i pulled a muscle. But I am still nauseated and my head feels heavier than it should. ### REPLY: Hello! I understand your concern. In my opinion this may be something more serious than a muscular contraction. The pain you are having, and the gradual increase mean that something is happening in this region. It may be a cervical or thoracic disc bulge, a spinal tumor or an infection located in your column or UN the surrounding tissues. The headache and nausea may be signs of an infection. Have had fever during these days? I would recommend you to go to the doctor, have a physical examination, a routine blood test for infection, a service- thoracic x-ray, followed by a service- thoracic CT scan.Finally, if this diagnosis ate ruled out further exams may be needed for gastrointestinal or heart problems. Hope to have been helpful! Thank you for using ! Best wishes .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i have lower right stomack pain mood swings and really bad acne my flow is ushely heavy but this time it was 4 days early and extemly light i have for 4 dYs its been 7 days and to top that out of the blue ive gone up one cup size and crave cheese and hav gained weight ### REPLY: HI. Thanks for your query and an elucidated history. The symptoms of right lower abdominal pain, changed uterine flow, acne, increase in size of breasts as you have explained all are suggestive of the following:Ovarian Dysfunction causing hormonal changes causing all the symptoms you have.-I would advise you to consult a Gynecologist for clinical examination;-Hormonal assays;Ultrasonography for ovarian evaluation to see for PCs and other related problems of uterus and so on. To get started with treatment as per the investigations. ### 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 do kick boxing and took a hard blow to the left side of my upper chest just below the clavicle bone 3 weeks ago, it hurts when i take a deep breath in the left side of my chest or if i apply pressure on the area. Please can you advise me on what to do. Thanks ### REPLY: Thanks for your question on . I can understand your situation and problem. You are having blunt chest trauma 3 weeks back. Musculoskeletal pain is common after blunt chest trauma. So better to avoid movements causing pain. Avoid bad postures in sleep. Avoid strenuous exercise and heavyweight lifting. Avoid pressing chest. Start painkiller and muscle relaxant .  Apply warm water pad on affected areas. All these will give you symptomatic relief. If after 1-2 weeks, you still have pain than get done chest x-ray to rule out internal damage. Don't worry, you will mostly improve with above-mentioned things. Hope I have solved your query. Wish you good health. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My 5 month has had a cough for over a month now. We have taken him to the doctor and they say his lungs are clear. No one is sleeping because of his cough that is not getting better. We have a humidifier running in his room and have tilted his mattress. Any other suggestions? ### REPLY: Hi, Cough persisting for one month evaluation to find out the cause and treatment accordingly. Is there any fever associated? Cough throughout the day or only at night? What kind of sounds do you hear while coughing, like sputum is there inside? These details will help us to narrow down possible causes. Probabilities are allergy, sinusitis with postnasal .  In such cases, I used to order a blood count, ESR, chest X-ray and sometimes a manitou test for tuberculosis. Depending on the result, he may need a course of antibiotics and other  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been unwell over. A period of time ,symptoms include severe pain in lower back muscle spasms and sciatica like symptoms over a period of months , headaches especially on left side and eye very tired lack of power now I have tingling and pain in left arm indigestion and heartburn symptoms ### REPLY: Dear I read your scenario you should go for investigation like MRI of lumber region of spinal cord for Confirming Sciatica. You should do Nerve conduction study for Trigeminal nerve. You should take tablet Omeprazole once daily before breakfast as our clinical practice. Furthermore, you should take paracetamol for pain and take Multivitamin. Avoid loading work. Take rest for few days. If you have any problem regarding this issue you can ask me otherwise you should go near doctor thanks for asking. ### 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 ve had kidney stones three times in six years. All stones were 2mm or smaller and caused severe pain . I use the va and had the surgery two of the three times. The last surgery was jul 2011. Starting march I started getting severe pain again. I am told its probably not the stones that hurt cause 2 mm stones don t hurt. What else could it be? Every time I have had pain I ve had small stones. Surgery relieves the pain for awhile but i still have never passed a stone. They stay in my kindness. Any suggestions as to what is causing this? ### REPLY: Hi, kidney stones are a recurrent problem. If you have a kidney stone, chances of your having another stone in next 8-10 years is around 50%. So cause of your repeated pain attacks may be that you are forming new stones which while passing down the kidney tubes cause you pain. Surgery does not prevent new stone formation. Each episode has to be treated as a separate disease, some will require medicines only, some will require surgery. Go see your urologist for further evaluation and 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: My sister has recently been diagnosed with ESLD, stage 4 autoimmune cirrhosis. Her first meld score was 26 and, after two months medication, is 8. She is going through the process to get listed for transplant. She is having severe hand cramps and her finger hands (and sometime toes) cramp and cross over, looking deformed. She says its a pain level 20. Her first GI Doctor said he had no idea what it is, but I suspect it s due to related and/or new renal deficiencies. Do you know what could be causing this and if it could be severe or indicative of an emergency requiring attention? ### REPLY: Thanks for your question on . I can understand your sisters situation and problem. ESL (end stage liver disease) patients tend to have nutritional deficiencies. Vitamin b12, vitamin d3, hemoglobin, folic acid, vitamin B 6 etc. are at lower side in such patients. And these can lead to severe musculoskeletal pain. So her cramps are mostly due to nutritional deficiency of these vitamins. Another possibility of autoimmune arthritis of small joints. She is having autoimmune Hepatitis, so this can be the reason for hand cramps. So discuss all these with her doctor and plan treatment accordingly. Hope I have solved your query. Wishing good health to your sister. Thanks. ### END