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 was transferred from the ICU rehap hosp to the main hosp ER for hypoxia, hypercarbia, hypertension, suspecting from sepsis and chest pain with very slightly elevation of troponin, most likely related to demand ischemia due to sepsis, needing to evaluate for acute coronary artery syndrome & shock. What is the meaning for hypertension sepsis, troponin, demand ischemia due to sepsis and then leading to acute coronary artery syndrome & shock? ### REPLY: Hello! Thank you for asking on ! Regarding your concern I would like to explain that sepsis is only one step to a broad spectrum of body distress; ranging from high-energy consuming demands to multi-organs dysfunction and failure, and to the final high-lethal state of septic shock. So at the beginning is present a hyperdynamic dynamic state; and possibly hypertension. After that, as micro-circulatory and cellular dysfunction follow (as the result of the microbiological and toxins effects), appears tissue ischemia throughout the body, comprising even myocardial ischemia (even in the presence of insignificant coronary lesions, or in their absence). This mechanism explains demand ischemia. Metabolism turns highly to an anaerobic one, and tissue injury markers appear in the blood (one of them is troponin, etc.). When this vicious cycle is not interrupted during early stage, this is a lethal disorder. Frequently it is found septic shock heart pattern (with diffuse and patchy lesions in the absence of distinct coronary lesions). Hope to have answered your question. I wish a fast recovery to your husband! Greetings!  ### 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...Hi i want to ask about albumine in urine i have a little amount of albumine in my urine i want to know how much the amount of albumine is normal in urine if it is in traces then. ### REPLY: Hello and welcome to , Albumin should not be present in urine. The total amount of protein in urine should be less they 150 mg/24 hours. Presence of albumin between 30-300 mg.DL is called microalbuminuria. Levels above 300 mg/DL suggests increased permeability of glomerular membrane. Albumin excretion in urine is seen in diabetes mellitus and its presence is suggestive of diabetic nephropathy. Thus, get your blood glucose levels checked and consult your nephrologist. Thanks and take care .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello well to make along story short, I been just feeling odd lately.short of breath my face swelling. My right ear hurts.bad headacks for years mostly every thing on my right side hurts.I do have high bp.dizzy.and sometimes it feels like I ran a marathon feels like heart goin jump out.my dr dos lab work sees nothing had ekg last month dr said its good.then I was sick want back yesterday I told her (I don t feel good)then she tells me well your ekg is abnomal is shows a black spot.so now shes sending me to heart dr.what should I be a wear of here.what is a black spot and what causes it? ### REPLY: Thanks for your question on . In my opinion you should get done 2D Echo first. This will tell you about heart function. In hypertensive patients over a period of time heart function tends to deteriorate. And this causes poor circulation of blood and body fluids. This causes edema in face and legs. So go for 2D Echo. About black spot on ECG, one needs ECG strip for examination. So send me your ECG strip for further suggestions. ### 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 in the sixth month of pregnancy, and suffering from bad cough (started with sore throat and fever). My doctor has recommended Azibact 250 (Azithromycine salt) along with honey/gargles/steam etc, but nothing seems to help. I m also a bit worried about taking antibiotics at this stage. Please advice. ### REPLY: Hello and I hope I can help you today. Azithromycin is an antibiotic that is safe to use at all points in pregnancy. However, because your symptoms changed from a sore throat to a cough it is unlikely that your symptoms are due to a bacterial infection. However, certain types of pneumonia are treatable by azithromycin. So I suggest you take the medication as prescribed by your doctor because it is safe for your baby, and will not hurt if you only have a viral illness. Definitely continue conservative treatment like . It is also safe to take over-the-counter cough suppressants during pregnancy. I hope I was able to adequately answer your question today, and that my advice was helpful. Best wishes with the rest of the pregnancy, and I hope you feel better, ### 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: So if a guy says I need to have more self confidence a guy I like and I try to be less shy around him and have more confidence around him and try to talk to him with out being shy and when I totally make an effort to do so and he doesnt even notice or pay attention  what do I do? Is he testing me? He says he really likes me thinks Im nice and pretty. How can I have confidence and not be shy around him if he wont notice. Help me please ### REPLY: Degree understand your concerns went through your details. I can understand your feelings. I am certain you are simply thinking too much and being obsessive. The situation given by you is normal for any person feeling attracted towards opposite sex during adolescence. Both wants to show their love and affection positively, and ultimately it becomes possessive. Your friend is a little mature and has serious things to do than flirting, he opts for that. Understand the facts, and you too be attentive on your education or career related activities. If you require more of my help in this aspect, please use this URL. http://goo.gl/aYW2pR. Make sure that you include every minute details possible. Hope this answers your query. Available for further clarifications. Good luck. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have a history of gallbladder disease (which I can usually control with diet) and kidney stones. I have had moderate to severe lower back pain for a couple of weeks, mostly on the left side.  Not sure if this is related to that at all....Last night I had a gallbladder attack because of what I ate over the weekend.  I took a Percocet and slept.  When I woke the gallbladder pain was gone but I had vaginal bleeding which has continued all day.  (I had a normal period over 4th of July and never spot between cycles) and the lower back pain is intense today.  Ive taken Tylenol and rested all day but wondering if I should have gone to the ER or if I should call off work tomorrow to be seen. ### REPLY: Hello, Thanks for the query to . Forum. Gallbladder disease, not mentioned the name of disease, here, I would like to say one thing that don't take easy (gallbladder disease), as it may worsen in the future. As far as kidney stone, pain may (left side) be due to this stone, ID size of stone (calculus) less than 5-6 mm, it can be treated by .  Urine examination with blood (creatinine & urea) reports are very important. Consult a surgeon and get his opinion. Good luck.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello sir/madam, I have a breathing problem as soon as i started doing exercise to reduce my belly i think...its a simple exercise just raising my two legs to upward direction by normal lying position....i did breathing exercises also but it doesnt help...Is that due to air blockages in my chest?... ### REPLY: Hi thanks for contacting .... You have breathing difficulty on slight exertion.... So this should not be neglected..... First get your resp examination by auscultation.... If suggestive of bronchoconstriction by rhonchi heard then bronchodilator . . Second if fast breathing with sign and symptom suggestive bacterial infection like cough and fever then antibiotic need to be given.... For detail work up of resp causes chest x-ray and spirometry useful.... Here if you have hypertension history then cardiac failure also should be ruled out....ECG or echo done.... If you are obese, hyper cholesterol, smoking history and calf swelling then rule out pulmonary embolism by d dimer.... I have given you best diagnostic possibilities but remember physical examination utmost important and accordingly work up decided... 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: Sir/Madam, I want to know whether i am pregnant. I had my periods at the correct time when i had had sex 2 weeks before my periods. Then a month and a half later i had sex again on the day when my period was due. It s 7 days since then and i have yet not had my periods. I used protection both the times and it wasn t broken or anything. Is there any chance that i am pregnant? Will home pregnancy test help me to determine accurately? ### REPLY: Hello dairy understand your concerned have done sex when period was due, means around the period date. It is very safe period, and again you used protection without failure. So chance of the pregnancy is nil. Now your period is delayed by the 7 days. I would suggest going for pregnancy test in next 2-3 days. You can use area news, or I can pregnancy kit. But I think it will come negative as you have done sex in safe period with protection. Your period could be delayed due to hormonal imbalance, ovarian dysfunction. If period will not come then meet the gynecologist to find out the cause. Period can be induced by the Progesterone pill in absence of the pregnancy. Avoid stress, take healthy diet, . Hope this may help noncontact  for further health query 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: Sir I came from Pakistan to Oman my weather totally changed I infected by cough I tried alot of tablets but from last month I am not being fit what to do doctor says after xray and cbc test that it is because of balgham in Urdu it is called balgham I don t know its English so please help me I ate madicines of ammaxivilline+clavilanic acid but not feeling full well but I feel a little bit better ### REPLY: Thanks for your question on . I can understand your situation and problem. I advise you to consult pulmonologist and get done1. Chest x ray2. PUT (pulmonary function test)Chest x-ray is needed to rule out infection.PFT is needed to rule out bronchitis. Many times due to change in environment, possibility of bronchitis are high. So we need to rule out this first. So PFT is must for you. It will also tell you about severity of the disease. And treatment is based on severity only. You may need inhaled bronchodilators too. So better to consult pulmonologist and discuss all these. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been experiencing lower back pain, light headedness, abdominal cramping. Always tired. I have taken numerous pregnancy tests. Not pregnant. I have a history of ectopic pregnancy. Still have one tube left. In the last 4 months many changes to my body as I have been watching what I eat and exercising. Have lost 52 pounds. ### REPLY: Hello, Welcome at . I have read your question. It looks from your details that you had ectopic pregnancy & at present you are feeling lightheaded, lower back pain & abdomen pain. These symptoms can be there due to following reasons--Anemia-Adhesion formation after surgery for ectopic pregnancy-Low or high blood pressure should consult to your doctor & should have following investigations--Routine blood examination.-ULTRA SONOGRAPHY Abdomen.-Serum electrolyte estimation. You should also ask for routine blood pressure examination. Till then, you may have relief by following--Take an antispasmodic medicine like dicyclomine on prescription from your doctor.-Avoid deny .  ### 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 17. It sounds crazy, but I have been concerned about the shape of his skull lately. The top(more toward the back) part of his head is not flat/round feeling. It has a good size bump there. He also has a lump at the base of his skull by his neck. No head injuries. Any thoughts? Should I have him looked at? And if so, would he be better off seeing a neurologist or GP? ### REPLY: Hi, dairy have gone through your question. I can understand your concern. He may have some occipital or posterior cervical lymph node enlargement or some benign tumor. You should consult general surgeon. If needed go for fine needle aspiration cytology. Then 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: I got kicked hard in my lower leg on the inner side it at the time bruised bad then my foot pooled blood.. this was two years ago and i still have  a bruise .. why would it still be there.. Now i got into an accident in November hit my eye hard on the windshield and still bruised i am worried it will do the same .. why would a bruise stay and is there something i can do or take to help with this... ### REPLY: Hi welcome to  forum.  It appears that you have some problem with the coagulation factors of blood. You may be tested for the bleeding and clotting time, and if something wrong is found, you have to be tested for hematology.  I advise you to consult a hematologist for diagnosis and treatment.  Take more of green leafy vegetables, pulses, sprouts, and protein rich foods to develop good blood.  Wishing for a quick and complete recovery. 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 had an operation last june 2007 because i had a soft lump in my scalp and according to the biopsy, it was a fibrolipoma.. i had it removed and the doctor said if there.is a recurrence i should not be bothered because it is just a benign tumor. However today it is getting larger in size-the lump. What should i do? IT is bothering me because it is causing deformity in my head. ### REPLY: Hi, Thank you for posting your query. Benign tumors could also grow in size, especially if they were incompletely removed. It your scalp is looking ugly, you can go for another surgery, and get it removed. In rare cases, a benign tumor can also turn malignant, however, the chances of that happening is low. Biopsy of the tumor after surgery would exclude that. I hope my answer helps. Please get back if you have any follow-up queries or if you require any additional information. Wishing you good health, . Ly/ ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi Doctor, I am a overian cancer patient and having chemotherapy. I finished the 3rd courses of chemo 15 days ago my next course is on 2nd May 2014. I have ulcer in my tongue and having pain. my doctor suggest me FOLVITE tab 5mg (1-0-1) what is your opinion doctor ? ### REPLY: Mouth ulcers are because of many causes of which authors ulcers are most common. Stress can precipitate oral ulcers. They are no identified cause for authors ulcers. Vitamin deficiency and Chemotherapy can cause mouth ulcers. Since you said ca ovary, you must be given paclitaxel and carbonation, both of which do not cause mouth ulcers commonly. Since vitamin deficiency is only treatable, you were given vitamin tablets ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I fell on my left knee...right away there was a dark bruise like circular shape. It doesn t hurt while walking or bending, just to the touch...tonight it looks like almost my whole knee cap turning black and blue. I fell on twice before..just wondering if I should have an x ray done to make sure ### REPLY: Hi. Turning of the knee black and blue after injury is due to bruising and it is due to trauma to superficial Blood vessels leading to spillage of blood into the soft tissue leading to bruising. If there is no pain AMD discomfort on walking then you need not worry. You should do cool compresses over it and apply Thrombophob gel. Avoid exertion to let it heal soon. Elevate your leg while lying down by keeping pillow under the feet. In case if there is worsening consult a Physician and get evaluated. Hope I have answered your query. Please let me know if I can assist you further. 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 just tested my blood pressure at the grocery store and it was 142the over 69. I am very physically fit working out 6the days a week and doing intensive cardiovascular an hour a day 5 days a week. I have issues in my wrists due to a burn injury and am going in for joan nerve surgery , sorry ulna nerve surgery on Tuesday. I normally take 800 mg ibuprofen for the pain,  but was asked to discontinue it until after the surgery. Could this be a side effect of the pain and anxiety about the surgery?Also because of the size of my arms, I had to really work to get it in the cuff of the machine. Could this cause an inaccurate reading too? ### REPLY: Hey, BP of 142/69 mm Hg is slightly high, but a single reading of high BP is not that important. You can get HGH BP during exercise, anxiety or exertion. Inaccurate sized cuff also causes inaccuracy in BP measurement. Small sized cuff overestimates the BP (like in your case) & large sized cuff underestimates the BP. So do remember to measure your BP with an appropriate sized cuff (which covers 2/3rd of your arm circumference).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 Sanv was patient of GBS-CIDP & need to discuss that-1)at initial statge IVUG was given to me but that treatment was failed i n my case so ther after i have beeen given steriod and i am still taking Medrol teblate as advised by doc.--is it harmful for me to take for long time..?2) due to less immunity cos of steriod i am suffering some kind of infaction like in throat & toes infaction-what is your views..?3)I am 95% revovered from GBS but i am very afraied of as this deciease might come again so what precaution should we take after full recovery from GBS i.e what should we avoid in food or in travelling out door.4)when i was admitted into hospital coupls of months back,my blood got tested thru HIV as well but it was negative.is there any link between HIV & GBS..? should i get checked my Blood again for satisfaction or it is fine..?5) I was habitual of smoking but During GBS period i dint skmoke but now i again started to smoke,kindly advise me how it is harmfull for this kind of patients.i am very scared of this kind of deciease and i want to  save by life for better living.pls help me...i am waiting for your respoce...kindly repy point wise. ### REPLY: Hi San.GBS is an autoimmune disorder, in which body produces antibodies against our own neural tissue cells, triggerd by some infections(like campylobacter, cytomegalo virus. Mycoplasma, )causing progressive muscle weakness, starting legs migrating up involving hands resp. Muscles, sometimes neck muscles cranial nerves.the condition may last from 4 was to 6 months usually....the main treatment modality is supportive, immunoglobulins and plasmapheresis if red........GBS recurrences can occur but rare.......more than 90% of pts recover significantly or totally by 6 months without long term problems....but pts have to continue rehabilitation physiotherapy, muscle and breathing exercises...usually steroids donor help much in GBS, but in CDP which is a variant of GBS steroids have a significant role,recurrences can occur .with varying securities and are unpredictable.your doctor might have put based on your clinical condition.long term steroids should not be used as can cause some problems like infections, reduce immunity bone and joint problems.as stated HIV -ve do not worry.,,consult your doctor(as he is the best person knowing your health status, response to treatment and side effects) regarding slowly tapering steroids and adding mild immunosuppressants which are helpful in your condition, avoid infections, stay healthy eat healthy, continue physiotherapy and breathing exercises.,,,as GBS can affect breathing system better you totally stop smoking take care of infections use antibiotics as required.best wishes, take care ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi my fallopian tube are blocked so that we finish the operation .operation is fail what to do next my fallopian tube was blocked so that i was done the operation .that operation is fail what to do next ### REPLY: Hello, welcome to  thanks for the query cases, laparoscopic surgery can open blocked tubes or remove scar tissue that is causing problems. Unfortunately, this treatment doesn't always work. The chance of success depends on how old you are (the younger, the better), how bad and where the blockage is, and the cause of blockage.  So you can go for options like IVF procedure.  Consult your gynecologist about it take care ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hello. i have been suffering from fissure post delivery and i was told that i have a fissure and was advised of a surgery. regularly i face problems like dryness, itchiness and slight pain in my anus region.my bowel movement is normal but post my stolls i have these problems.i took antibiotics too. right now i am undergoing treatment from reputed homeopathy which gave me relief..but still at times i face all the above problem. surgeon detected as sentinile pile which pops out at times..please suggest. ### REPLY: 1. due to push and straining during childbirth, increased pressure is put on the muscles, which sometimes causes the lining of anus to tear, resulting in fissure.2. Any pain/bleeding associated with fissure?3. You haven't mentioned the duration, since how long has been this problem after post delivery?4. Has your general surgeon looked into the pathology, whether acute or chronic fissure??5. Any complaint of constipation, depression, hypothyroidism, physical inactivity??6. High fiber diet (fruits, legumes,vegetables, whole grains) and adequate fluid intake with regular site bath.7. Don't suppress the natural urge, as it will only add up to the problem.8. Consult with your gynecologist for further evaluation and management. ### 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 done my normal checkup and found some thing new1) ECG report-- low normal average cardic rate2) LFT ---69 SGPT3) lipid profile---hdl cholestrol---26,cholestrol---187,triglyceride--118,LDL--1424)uric acid--8.995) TSH ---5.6PLEASE ADIVCE  WHAT SHOULD I DO?Thanks in advance ### REPLY: Hello 1) ECG is normal if you are an active and have athletic built, however heart rate between 50-60 is considered healthy, second is if your thyroid is on lower side (TSH here is just borderline) 2) lipid profile can be better, your HDL should be more than 45-50, LDL less than 130 at least.  Diet, exercise and supplement like omega 3 fatty acid, krill oil, flax seeds may help 3) uric acid is high, diet modification or starting on medication recommended 4) Sept is also high (borderline), considering other tests I would presume you are obese and do have the most healthy lifestyle.  Subtle change in life will help in long run.  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: A couple of days ago I got a weird sickness/pain in my lower stomach and went to the bathroom and thought it was better and thought nothing of it, well today about mid morning I started having pain in my lower right back almost under my ribs and thought it was a pinched nerve well its moved into the front right side of my stomach and I cannot find a position that doesnt cause pain. What could be the problem? ### REPLY: Hello and thanks for the query have read your query with diligence. Your pain is most likely to be a Renal stone pain you need to be investigated for that. Get your urine routine examination done with sonography of abdomen. X-ray PUB also helps in detecting the stone is done empty stomach. Consult your doctor and get your investigation done as per the advice. Meanwhile, take plenty of water. Urinary alkalizer if burning maturation is present. Take anti-spasmodic .  Other disease which can cause pain are muscular spasm. Gall blabber stone. But these are associated with nausea and vomiting. So consult your doctor and get to a diagnosis. Hope this will help you out. 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: Took a fall and landed on ground with my right arm tucked against my right rib cage. after the initial pain subsided somewhat i kept working. As the day went on my right side became more sore to the touch and any torquing movement got more severe. If I lay on my left side and press on my right upper ribs there is little pain. If I lay on my right side and press on my upper ribs the pain is about an 8 on 1 to 10 scale, 10 being most severe. I m thinking I may have bruised my liver . Any thoughts? ### REPLY: Hi and welcome to , thank you for your query. I think this is just contusion of abdominal wall and ribs. Much harder hit is necessary to cause liver injury, so I don't think you should be concerned. Of course, be cautious and watch for any new signs. Pain may persist for 7-14 days and just take painkillers and rest. If pain persists you should do rib X-ray and liver ultrasound. Wish you good health. Regards. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi there, I have a question in regards to a small lump that is right next to my collar bone. It moves a lot when I touch it, it does not hurt, it s oval shape and has been there for several months now. I have talked to my regular doctor about it and she dismissed it by saying that it was a fatty pocket?? Can you please tell me what it sounds to you and if I should be concern about it?? Thank you ### REPLY: Hi, dairy have gone through your question. I can understand your concern. You may have soft tissue tumor like lipoma or enlarged cervical lymph node due to reactive hyperplasia or tuberculosis. You should go for ultrasound test and fine needle aspiration cytology study of that mass. 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: Hi how effective is ozone Therapy for heart Patients. Where does it happen in Bangalore. Are there any side effects. How much does it cost. How often are we supposed to go for therapy. My friend is turning 75, male, would you recommend Ozone Therapy, instead of bypass. Regards Rajesh ### REPLY: Hey, These types of therapy like ozone therapy to treat blockage in heart vessels are not approved, and their efficacy is not yet proved by any study. Still peoples are conducting this. I being a cardiologist do not recommend this and recommend you to take a decision for CABG(by pass surgery) which is a very good surgery and has excellent long term prognosis. It might sound little fearful for the patient as it is a major surgery but believe me it has very good results if the patient is fit for surgery. So you have to think over again & make a decision which is good for your 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: GETTING 2ND OPIONION ON COLOSOMY DR SAYS NEEDS TO OPERATER AND REMOVE DUE TO ITS TO CLOSE TO BONE AND HARD TO REACH AND SEE AND TOUCH- SO IM GETTING SCANS AND WITH 3D IMAGING - MY T-CELLS ARE 230 - AIDS FOR 20 YEARS T-CELL WEREW JUST COMING UP AFTER2 YEARS - FROM 0 ZERO - IS THERE A T-CELL#  OR ABOVE  NUMBER THAT I SHOULD HAVE TO HELP ME THREW THE SURGERY-? ### REPLY: T cell count above 500 is suggestive of good immunity. This shows you will recover fast and chances of infection is very less. Chances that this cell number will improve are very less specially since you have AIDS since 20 year, I would suggest you to go for this surgery if your doctor allows. Any way with low T cell count you are prone to infection so avoid contacting with infection like wear mask, take clean and homemade food. Avoid going to public places where you can catch infection through .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been having back pain for the past couple of days. It hurts most when I try to stand up from a seated position. Once I stand, the pain gradually goes away as I start waling. I only feel the pain again when I step (walk). If I stand without moving the pain goes away. I don t feel that much when pain I remain seated also. ### REPLY: Hi, In my opinion that sort of neuropathic pain is common with sciatica whicChatDoctormonly happens due to neurovascular bundle compression. From your history I don't think you should be worried yet but early diagnosis and treatment is very suggestive in such cases. I recommend some topical gels, physiotherapy and muscle relaxants and even massages are very effective and try to avoid sitting on hard objects for a long time and avoid compression on your muscle to prevent that kind of compression. Please consider some positive feedback if the information was helpful. Hope the above information helps you. Any further clarifications feel free to ask. ### 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: Monday I had a root canal done by an orthodontist. He prescribed me 800 mg Motrin and hydrocodone. I took the Motrin as prescribed. The side of my cheek where the RC was done began swelling Wednesday night. He called in penicillin go 500mg and I began taking it it is Friday night. Should he have prescribed a stronger antibiotic.? I dont have anymore pain  but should I still take the Motrin? If I go to the emergency room would they be able to help? Will taking the antibiotic reduce the swelling alone ### REPLY: Thanks for your query, I have gone through your query. The swelling could be because of the endodontic flare up pr it can be because of the remnant infection. Consult an oral physician and get a radiograph to rule out whether all the canals have been filled properly and to rule out any infection. If there is defect in RCT and infection you have to get it retreated. If it is because of the remnant infection then take a course of antibiotics like amoxicillin 500 mg and metronidazole 400 mg TID for 5 days(if you are not allergic). Along with these you can continue Motrin. 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: Hai, I am 30 age ,I have a question about mucus that in my lungs,I wants to clear mucus from lungs permanently,I want that come again ,it is about5,6 years mucus their ,please advice me ,what to do ,and what to eat ,and avoid food ,I said to doctor he said me that I have allergy and in my lungs some place airways are filled with mucus plz and soon ### REPLY: Thanks for your question on . Mucus production is normal physiological response to any injury to the lung. Injury can be due to anything like1. Organism (infection)2. Inflammation3. Allergy4. Foreign body etc. So we have to identify the cause first. If allergy is the cause for this than complete avoidance of allergen is needed. Anti-allergic .  So I vice you to first consult pulmonologist and discuss these. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: From last two weeks,I have body full itching and swelling on face and legs especially during night times. the symptoms slowly develop from evening and severe at night.i am taking medicine for allergy everyday night . this itching lead to rashes on whole body and it disappears by morning.why this allegy came and why it is persisting??? please help ### REPLY: Can you think of changing any soap oil cream or shampooHave you introduced any medicine for fever cold pain or multivitamin these can cause thylakoid Using mustard coconut walnut groundnut almonds soda oilcan apply olive and can use olive for cooking the housekeep temperature between 25 to 35 degree of room temperature can take Basting 10 MGM plus Atari 10 mg at night for 3 week can apply fluticasone and histocalaminedo for 3 weeks till you find answer l ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi ,i m doing masturbation since 15 year old age ......in middle i suffer from nightfall and weakness but i consults the doctor now i m normal but my present age is 24 year and i have less beard like a girls.or infirtility......i worried plz give guidence.... thanks ### REPLY: HelloMasturbation is not related to fertility. It is also not related to weakness. Night fall is a common phenomenon, and it is not concerning. You should try to get rid of masturbation because its obsession is bad. You should avoid provocative literature and videos. Try to concentrate in your job. If you find any problem in coping the situation then you may consult psychologist also. Get well soon. Take Care .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My husband has been with Drs. every day last week. - Dermatologist - General hand surgeon & Internist. 1. He stated with a large infected abscess on his hand and the Drs. thought it may be MRSA - prescribed medication for MRSA along with Keflex. A few days later they found out he didn t have MRSA and the abscess was not draining. 2. His mouth and lips were starting to get sensitive and very irritated and the Drs decided he may be having a slight reaction to the meds. They took him off the Meds and sent him for surgery to remove the infected Abscess. 3. He is now on Prednisone for his hand but I think he has thrush from the antibiotics? 4. Will Benadryl help with the white lesions that are now on his lips and mouth also a scalloped tongue? 5. What can you mix that with the Prednisone? ### REPLY: Hifacial swelling and irritation is one of the major side effects of steroids due to water retention in the body. Prolonged use of prednisone also lowers the normal immune responsiveness of the patient. The oral thrush is the result of this. See a dental surgeon and let him decide how to deal with the present situation. Indiscriminate use of broad spectrum antibiotics can aggravate the oral thrush. Wish your husband a quick recovery. Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i have been chewing Manikchand gutkha for the last 16 years now i have minimized it to one packet per day from four to five.  i am comcerned i have oral cancer because my chins are so tight when i open my mouth.  it is not bulging enough when i blow up.  i have been getting frequent sores on my tongue if i eat too spicy foods.  i do not know to what speciality doctor to approach to get the diagnosis right. ### REPLY: Hi, dairy have gone through your question. I can understand your concern.  You have history of tobacco chewing for long time.  You may have subbed mucosal fibrosis or squamous cell carcinoma or just hyperkeratosis.  Furthermore, you should go for biopsy diagnosis.  It will give you exact idea regarding cause. Then you should take treatment accordingly.  For biopsy, you should consult general surgeon.  Consult your doctor and take treatment accordingly. Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using . Wish you a very good health. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My Dauter is 4 years. She was suffering with fever for 3 days. so we took a Blood test. WBC count - 2.7 Platelet Count - 142 So we took another test . After that results was.... WBC count - 5.4 Platelet Count - 142 Do I have worry on this doctor.... ### REPLY: Hi, Welcome To . I had gone through your query and can understand it. The normal range of WBC and Platelets are 4000 to 10,000 and 1.5 lack to 4.5 lack accordingly. And in this query, the counts are not properly specified accordingly. So better you will go for consultation of pediatrician. Till the time of consultation, give her liquid Retain (if no allergy), 5 ml, 3 times in a day at the interval of 7 to 8 hours for a day or two. Apply cold sponges on forehead, on both palms and soles if fever is too high. Give her maximum liquid intake. Hope this information will be helpful to resolve your query and further queries are always welcome. I would like to answer them. Wish your daughter good health. Take Care, Thank You. From:-  ### 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 a 25 year old female and for the past year i have been experiencing big dizzy spells that always occur around the 15th day(when im ovulating).it is accompanied by nausea as well but it hink its due to the diziness i feel.sometiems it comes in waves.i use tobe on the pill but i have stopped them for this month because i feel the are too strong for me.althought on it or not,these dizzy spells still happen.my blood pressure is normal and i feel ok on a daily basis so im wondering what this could be from.if you can please just give me some advice it would help alot!thank you!! ### REPLY: Hello, Ovulation period is coupled with some physical phenomena that can cause transient fall in blood pressure leading to the dizzy spells. It may also be associated with spells of nausea or vomiting, abdominal pain and sometimes spotting. The reason for all this is hormonal and nothing to worry. You should be able to manage with some symptomatic treatment. I advise you to have an appointment with your gynecologist since you are experiencing these symptoms only from one year and not prior. 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: Im 37 yrs old with normal hormonal profile.Married for 1yr & 3 month.My husband has no issues.I did Ivf that was unsuccessful after producing 5 oocysts,& 4 embryos were produced,3 of them were excellent.And all 4 embryos were transferred.3 wks after my failed ivf i did HSG,That to my shock it came with bilateral distal tubal block with silght swelling on both sides after exerting pressure!!!Would this result be conclusive??Or there may be other confirmatory test?Is this also might be hydrosalpinx??Given that i never had PID.May be only at marriage when in the beggining I had painful intercourse,and I had UTI at that time & took medication for it.But if it was untreated PID isnt it too short time to have blocked tubes within one yr?? Otherwise it could be endometriosis that blocked them?? But I dont have any family History of endometriosis.If they are really blocked what do you advice to try to concieve naturally inbetween ivf cycles ### REPLY: Hi, You may have a laparoscopic chromotubation to check for tubal patency and if the consultant is experienced enough may perform any operative interventions needed to relieve tubal block. Considering your age, it would be better if you do not waste precious time trying for natural conception. Tubal patency as well as tubal motility together have an impact on the tubal function. For endometriosis to affect the tubes, it would be rare. The impact of any pelvic inflammation varies with the severity of the infection and the individual predisposition. You should try ART under the guidance of an expert. Wish you success. ### 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 been told i have moderate stenosis 31 gradient,but it would be too risky to replace mechanical aortic valve which i recieved back in 1991. they said it would be 5 times riskier to repeat open heart surgery at this time. I,m 48 years old right now, had the first surgerywhen i was29. They said my stenosis would have to get worse before they would even consider surgery. Is this good advice? ### REPLY: Hello thanks for posting here. I have gone through your description. The severity of your aortic valve stenosis is mild to moderate with a pressure gradient of only 31. Hence, surgery is not an option at this stage. You have to be on medications for the time being. However, you have to follow up repeatedly every year with 2 D echo to assess the severity and progression of aortic valve disease. Wishing you good healthRegards. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I fell off kitchen counter one week ago. I apparently landed on my foot funny. I have lots of pain in the arch of my foot and along the outside edge of my foot. It s still swollen & blue. Also swollen at base of toes on top of my foot & I can t move my three small toes. I had x-ray the day it happened. They said there were no fractures but hve me crutches. I ve been using them, keeping elevated as much as I can & using Ice & ib profen. I am mom to 2 small children one a baby. And am really having a hard time.Shows no improvement. Any thoughts on what I ve done to it & what I should do next?? Need to heal asap. Thanks ### REPLY: Hello, I have gone through your question and understand your concern. In my view, you are doing everything required to help your foot heal already. It will take a few days to show improvement, despite all the measure taken. Soft tissue injuries are painful to deal with, and you may take 2 to 4 weeks to recover fully. In addition, if you bear weight on the injured foot it may take even longer to heal. However, you can ask your treating doctor, or a pharmacist to provide you with an ankle brace which will provide support and may help you heal better.  Hope I have answered your query. Let me know if I can assist you further.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am married for 6 mnths now.I am 27 yrs old. I did not have much menstrual issues in the past years. But last month i had my 10 days delay in my period and again now it is 16 days now but my period has not yet started. Please help me on this. Is this my pregnancy or any hormonal issues. If this is not pregnancy then will it call cause any problems for my pregnancy later. Currently i m feeling very tired and low in energy. Feeling very pale and drousy all the time. please suggest. ### REPLY: Hello dear, I understand your concern. In my opinion there are different causes for irregular periods like:-1)Thyroid abnormalities.2)Polycystic ovarian disease (POD).3)Overweight or obesity.4)Stress.5)Anemia.etc. So all the above causes should be evaluated by getting done physical examination and necessary investigations. Ultrasound helps to rule out POD, thyroid profile helps to rule out thyroid abnormalities and HE to rule out anemia. If overweight or obesity weight reduction helps in regularization of cycles. Weakness, tiredness and paleness symptoms are suggestive of anemia.HE helps to rule out anemia. Avoid stress if any. Nothing to worry. Once the cause is treated the cycles become regular. Relax. 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: dear sir,My husband is suffering from Psoriasis for the past 1 year. He initialy had itching in his little toe later started spreading. He consultated a Doctor & is under medication. Presently he is using Vunusia max moisturizing cream, Sorvate ointment & Propysallic NF ointment. Internally he is taking Folic Acid tablets.  Kindly suggest me which is the best cure for Posriasis. Hw can it be kept under control. Wht r the food items to be consumed.  Is Homeopathy a best way to treat Psoriasis. Plllll help me & give me proper giudance so that I can take care of him. ### REPLY: Hi. As you said your husband suffers from psoriasis since last one year. Psoriasis is a chronic relapsing and autoimmune disease. He may be having scaly plaques on various parts of the body, scaly lesions on the scalp. Exact cause is not known. Genetic tendency, autoimmunity, stress, . .etc. may be responsible for precipitation and exacerbation of the disease. You consult dermatologist for firm diagnosis and treatment. I usually recommend cap accretion 10 mg twice a day along with methotrexate 15 mg weekly in three decided doses 12 hourly. Folic acid may be taken if there are oral ulcers. All this may be taken for long time till good response. Blood tests may be done to monitor the treatment. He may apply mild steroid cream as he used proposal or calcitriol point as he used solvate on the lesions. He may apply moisturizer as he used Venusian to improve the skin texture. Tell him to avoid soap bath for few weeks. He should avoid stress and worries as that might worsen psoriasis. Homeopathy response for psoriasis may be unpredictable, so, I do not know about its role. Your husband might get good result after few months' treatment. I hope you got my answer. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been going through parmenopause Sp? my lower back is constantly hurting, my right lower abdomen is hurting. it is sometimes hard to breath when standing and sitting. the abdominal pain is getting worse. I put a call into my dr. my lower back pack is the worst. ### REPLY: Thanks for your question on . I can understand your concern. Para menopausal women are at increased risk of osteoporosis due to low estrogen and progesterone. This osteoporosis is the most likely cause for your lower backache. So consult orthopedic doctor and get done clinical examination of your back and x-ray of lumber spine. If it is osteoporosis then you have to start supplements of calcium and vitamin D3. Right lower abdominal pain is mostly due to ovaries. So get done ultrasound examination of abdomen for this. Also consult gynecologist and get done hormone levels to rule out hormonal imbalance. You may need hormone replacement therapy (HRT). 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: MRI shows flattening of the ventral sac and ventral cord as well as severe foraminal stenosis, but currently not in pain. I just do not have full range of motion in my neck. Surgery is not required if I am not in pain. Correct? I am an active runner/cyclist and go to the gym. I am hoping I can continue with gym with no heavy lifting and thinking I am ok to run. I am assuming probably should lay off the bike. My appt with Neurosurgeon is Feb 14th. c5-c6-there is a broad based central & right posterior disc herniation with endplate ostephyte formation. There is flattenting of the thecal sac & ventral cord. There os mild to moderate central canal stenosis and moderate to severe right foraminal stenosis. ### REPLY: Hello, Your MRI findings suggest that you have a lot of spinal stenoses that compresses the medulla and the nerve. Even though now you do not have much pain, but you have stiffness. Sooner or later the disease will progress. I would suggest you not to neglect these signs but discuss with the neurosurgeon or spine surgeon for surgery the pros and cons of surgery. Hope I have answered your query. Let me know if I can assist you further. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been on diclofenac sodium for a week now as I have been diagnosed with pericarditis. I had a chest x ray which showed nothing as well as a echo-cardiogram. I wanted a second opinion to see if this is correct. I am still in pain after being on these tablets for 10 days. 19 years, 178 cm, 68kg, no previous heart condition or ailments. ### REPLY: Do u have fever, weight loss, appetite loss, joints pain, rashes over face or body, recurrent oral ulcer, contact with case of tuberculosis, any family history of major diseases. If any of these is present then you need to be evaluated further. If not, you can try tab Ibuprofen 600 mg three times a day along tab pantoprazole 40 mg before breakfast once a day for 2 days and diclofenac should be stopped. If still not responding then needs to be evaluated further for other diseases. Then you may require test like chest x-ray, Manitou, ANA, repeat Echo may be needed. ### 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 SGPT levels deceased from 68 to 53 but my bilrubin levels are elevated from 2.34 to 3.10,should I be worried,AST & ALT are all normal & m not feeling nauseous, fever or headache it s just from 4 days m also suffering from loose motion but it s only for 1 time in a day. ### REPLY: Hello, The bilirubin level can fluctuate in case of liver hepatitis.  You need to investigate with a viral profile for hepatitis and ultrasonography abdomen to guide you further.  Kindly revert with that two reports.  Meanwhile, avoid high fatty foods and take more fruit juice. The sugar cane juice, apple juice, lemon water etc. beneficial in reducing your jaundice.  Hope I have answered your query. Let me know if I can assist you further.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My friend has a been experiencing pains in his chest... he says that his heart hurts when hes running or excersising...It just started and im worried. He is 15 years old at 6 foot even, and he has been a very active person all his life. He plays basketball football and baseball. Any suggestions on what might be going on with him? ### REPLY: Thanks for your question on . I can understand your friends situation and problem. Possibility of musculoskeletal pain is more but better to rule out heart related diseases because he is having left sided chest pain. So first get done ECG and 2d echo to rule out cardiac diseases. If both these are normal then no need to worry about heart diseases. Musculoskeletal pain is more likely in his case. So ask him to follow these steps for better symptomatic relief. 1. Avoid heavyweight lifting and strenuous exercise. 2. Avoid bad postures in sleep. 3. Avoid movements causing pain. 4. Apply warm water pad on affected areas. 5. Start painkiller and muscle relaxant .  He will mostly improve in 1-2 weeks. Hope I have solved your query. Wishing good health to your friend. Thanks. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have what the doctor believes is a sebaceous cyst, and have scheduled its removal in 3 weeks. It has been bothering me and I have used some ointment that the dr prescribed for it. It burst today. Do I need to be concerned or move up the appt to have it removed? ### REPLY: Hello, Welcome to , Sebaceous cysts are common noncancerous cysts of the skin which contains liquid or semi-liquid material. They grow slowly and are not life-threatening, but they may become uncomfortable if they go unchecked. Sebaceous cysts develop if the gland or its duct become damaged or blocked. It can be managed by1. Sebaceous cysts are treated by .  Normally cysts should be removed.2. Antibiotic ointment to prevent infection in the affected area. 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 had a skin biopsy and it was demined that I have Vacuities. Although I ve only gotten the rash about 4 times I recently had 3 urine tests that are showing trace amounts of blood and protein in the past 2 months. I have now been referred to a nephrologist that I cant see for about 3-4 weeks and no one really seems too concerned except for me. I do have Celiacs as well and that caused a rash as well. Been gluten free since Oct 2013. I can see white floaties in my urine and try to drink plenty of water. Ive read that the kidneys can be involved so Im scared. They say I don t have to avoid anything (eating, drinking and so on) but again Im concerned. What will be the next logical step for my new doctor so I can be prepared? ### REPLY: Dear Patient, do you have more details on your skin biopsy? Was I T IGA positive? Your kidneys may be affected by Schooling Enoch purpura, ANNA vasculitis or a so-called monoclonal gammopathy of renal significance. Do a complete immunological test including C3, C4, ANA, EN ZA, Egg, IGA, IGM, Kappa and Lambda free light chains (serum) and total light chains in purines, STEP, PEP, total 24h proteinuria and luminaria, HBO, CV. This is a basic screening that gives us lots of information of what is going on. Then, if your renal function is good, and you have only mild urinary signs of activity, you can delay a renal biopsy, that otherwise is mandatory. Let me know, ### 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 experiencing pain and weakness in my arms from my elbow to about halfway down my forearm. The pain is particularly noticeable when I try to pick and lift something up. I initially believed I over did It doing yard work but the pain is not improving and it s been at least a month. Taking Advil dulls the paid Someone mentioned to me that this may be carpal tunnel related? I am sick of chalking it up to old age. Any ideas? ### REPLY: Welcome to  I have gone through your query and understand your concern. It is more likely to be overwork related and conditions such as tennis elbow. I do not think it to be carpal tunnel related. In carpal tunnel syn .  But I advise you to consult your Orthopedic and get treatment accordingly.  So you can treat it after consulting your Orthopedic. You can discuss with your treating Doctor about it. Hope I have answered your query. If you have any further questions then don't hesitate to writing to us. I will be happy to help you. Wishing you good health. Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: doc if the baby had a blood enfection after he admit in 1 week in the hospital then now the blood infection is clear but now the doctor said the baby nid to put in incubator because of the yellow color of the skin i dont know if its true i nid a second opinion. its that posible? ### REPLY: Hi thanks for the question. I assume that your baby is more than a week old. Most of the babies have yellow discoloration of skin and sclera during the first few days of life. This is called physiological jaundice, and it subsides on its own without any intervention. This is a normal phenomenon as a result of transition from fetal to extrauterine life. You should be aware when jaundice is a cause of concern: 1. If jaundice appears on first day of life2. If the level of bilirubin is more than 12 mg/DL. Bilirubin is the substance that causes the yellow coloration of skin. Its level can be checked with a blood test .3. If the rise in bilirubin level is more than 5 mg/DL/hr. For this your doctor my prescribe repeated test and then plot the levels on a graph to predict the expected rise in bilirubin.4. If direct bilirubin is more the 2 mg/DL or 20% of the total. Bilirubin is of two types physiological jaundice is due to the water insoluble indirect bilirubin so if direct component is high it means it's not physiological and should be a cause for concern. The direct and indirect breakage is given in the blood test. 5. If your baby is otherwise unwell e.g. is lethargic, is not feeding well, has fever or difficulty breathing then its not physiological jaundice because in that case your baby will be otherwise totally ok. You have asked if your baby needs incubator care. Incubators are for premature babies who can not maintain their body temperatures as they have arrived earlier, and temperature control mechanisms have not yet been established. The incubator provides specific temperature. Incubators are not used for the treatment of any type of jaundice. Phototherapy is used for that. These are specially lights that convert the indirect water insoluble bilirubin into water soluble forms that can then be excreted out through urine. As I have told high levels of direct bilirubin are a cause of concern and these need treatment with a phototherapy unit. Your doctor may prescribe phototherapy if your child has any of the criteria I have mentioned earlier, but incubator care is not needed as your baby is not premature and is at least older than a week. If you have any other questions I will be happy to answer. ### 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...sir im 21 yrs of age, my penis is 14cm recently i had sex with my gf but i was not able to penetrate, as my penis doesnt get hard enough, it was the first time i had sex . i dont smoke but drink but just occational drinker, sir is this a serious problem for my future life ### REPLY: Hi, Your erectile dysfunction could be due to psychological issues or performance anxiety for the first time. The erectile dysfunction problem is very rare at such a young age.  However still you can investigate with serum testosterone estimation and get checked your sugar level and measure blood pressure.  You can practice more foreplay for getting a hard penis and then only try to insert it in vagina. You can Consult sexologist for counseling.  Hope I have answered your query. Let me know if I can assist you further. Take care .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi sir .i m 29 years old.i have problem in my ankel.now white pus comes out from a small hole in my ankel.sometime swelling is there.some time nothing is there.no hole no pus.but after 10 days hole becomes and pus comes out.sir i have gone to many doctor but nobody came yo know about this desease.one time i have got small opperated.9 month it was ok but again same problem.plz give me suggession wht should i do ### REPLY: Hi, I have gone through your query and I can understand your concerns. If I were your treating physician, Based on your description I would come up with following possibilities.1- Osteomyelitis, The first and most probable differential diagnosis would be osteomyelitis.It's a kind of chronic infection of the bone. Your symptoms (pus and discharging sinuses)perfectly fits for osteomyelitis. We have to do an X-ray and biopsy to confirm the diagnosis.2-Actinomycosis-Its kind of fungal/bacterial infection. Less likely differential, multiple investigations are needed to confirm the diagnosis.3-There are other conditions also present with similar symptoms including some bone tumors, But those are rarest among the differentials and no need to worry that much. I suggest you to consult an orthopedic for detailed evaluation and proper treatment. You may require an X-ray or MRI scan for evaluation. You have to do a biopsy to confirm diagnosis. If the diagnosis of osteomyelitis is confirmed you require long course of IV antibiotics and surgical debridement. I hope this helps. Please feel free to contact us if you have any further queries. 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 suffering from tail bone pain i took local depamedral injection as suggested by doctor that go infected ultimately abcess formation was there inside suddely one day that bruested as per advice of the Doctor in Forties hospital  i under went coccyx excision as well aspilonidal sinus excision after a gap of two month again pus formation started and i landed to simillar situation. now i doesnt want next surgery. Pus is coming from 7cm deep wound just near to coccyx muscles . pls suggest me some treatment? ### REPLY: Welcome to , I appreciate your concern for the infected wound near coccyx. Features are suggestive of recurrent infected colonial sinus. As many as 50% of the surgically removed colonial sinus recurs. Early recurrence is usually due to failure to identify one or more sinuses at the time of incision and .  Later recurrence (more than six months after surgery) is usually due to tension in the mid-line cleft and a secondary infection caused by further build-up of hair or other debris. Recurrences have been reported as late as 20 years after the surgery. You are advised to visit your treating surgeon for further evaluation and incision and  ### 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 H1N1.  My cough has changed from a dry bark to being a more productive cough. Actually, it is still kind of a bark but more productive than when this began.   I now have pain in my back and around my rib cage in front. I am presently on Tamiflu.  It has been years since Ive had the flu so just want to make sure this pain is not associated with bronchitis or pneumonia.  I did have bronchitis in May and had this same feeling.Thank you ### REPLY: Thanks for your question on . I can understand your situation and problem. By your history and description, possibility of bronchitis and pneumonia are high. Both these conditions are common after viral (flu) upper respiratory tract infection. So better to consult pulmonologist and get done 1. Clinical examination of respiratory system. 2. Chest x-ray 3. PUT (Pulmonary Function Test). Chest x-ray is needed to rule out lung infection (pneumonia). PFT is needed to rule out bronchitis. You may need antibiotics, inhaled bronchodilators and antihistamines .  So better to consult pulmonologist, first diagnose yourself and then start appropriate 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: At the base of my spine and like above the anal opening, but still in the butt crack there is something hard right at the ending of the spine and it has been hurting for a while now. When I squeezed it tonight a light yello mucous like substance shot out and now there is just clear fluid. Is this a cause for concern? Could the clearish fluid be spinal fluid? ### REPLY: Hi, Dear,Thanks for your query to . Dear I read your query and reviewed it with context to your query facts. Based on the facts of your query, you seem to suffer from-Pilonidal Cyst with abscess, which ruptured and formed Colonial Sinus. Treatment-USG / CT study of the Colonial sinus and Second expert Opinion from Surgeon would help plan further treatment for you. As the recurrence is more with this sinus-I would suggest following options-Debridement of the Colonial Sinus with Excision of the Sinus or Marsupilisation of the Colloidal Sinus. Coccygectomy-Removal of SacroCoccygeal / or tail bone would end the possibility of the recurrence of such colonial sinus with recurrent abscess. Hope this would help you to plan further treatment with your family and specialist doctors there. Welcome for any further query in this regard. Good Day!! . N. Senior Surgical Specialist. S. Genl-CVTS ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi im 15 years old and i have been having shortness of breath. When i try to breath, each breath feels incomplete and as I inhale my chest area near my heart hurts. High cholestrol is hereditary in my family and everyone thinks i have clogged arteries and/or high cholestrol. What do these signs tell you? Do I have either or? ### REPLY: Thanks for your question on . I can understand your concern. Yes, high cholesterol can block coronary arteries and this can cause chest pain and breathing difficulty. Since you are having strong positive family history of high cholesterol, you should definitely consult cardiologist and get done 1. Serum cholesterol levels 2. ECG 3.  2d echo. 4. Stress test (trade mill test). If all these are normal then no need to worry about heart diseases or high cholesterol. Sometimes stress and anxiety can also cause similar symptoms. So avoid stress and tension, be relaxed and calm. Don't worry, you will be alright but first consult doctor and discuss 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: Hello doc my 2 year 3 month old daughter got Uti followed by fever an cough.after consulting pedia we started her antibiotic course and she is relived from UTI and fever but the cough still persists and she is facing difficulty in eating is very cranky she has severe congestion I m giving her steam and also use humidifier in her room but the cough is still troubling her please suggest ### REPLY: Hi, your child needs a good bronchodilator. Start by giving her Syrup Absolute S 4 ml thrice a day for 5 days. Continue giving her nebulizations with Stalin solution. Start a course of antibiotic in form of Syrup Augmenting if she runs fever or her condition deteriorates. Give her a course of Syrup Kindred(5 mg/5ml) 5 mg twice a day for 3-5 days. This should reduce her congestion. Continue to put position nasal . Thanks and regards. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi, I am a25 year old married women..for the last one week, I have severe itching on my waist line. Also the color of my small finger on the toe gradually changed into a reddish brown color. I have noticed it around 1 month ago. Last year I had urinal infection due to the kidney stone ...for the last few months, after I pee, I feel to pee again...but at that time urine will go as drops.... Can u pls help me in diagnosing what these symptoms says...? ### REPLY: Hi, You have 3 problems.1) kidney Stone along with Urinary Tract Infection - needs investigation & treatment. Investigations like USG of Urinary Tract, complete urinalysis, Urine culture & sensitivity are important. Treatment according to the results of investigation2) Waist line itching may be due to infection - commonly Fungus - Anti-fungal is available as OTC.3) Your little toe - Probably injured without your notice one month back EQ., while cutting of nail or by a scratch - producing ? Inflammatory swelling. Consult a surgeon & get treatment. Best Wishes ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi, im a 24 year old female, 5 foot 11 and 84 pounds. I was watching a show on TV and my heart started racing. i checked my pulse and it was almost to 250. i felt woozy and passed out on my bed. when i woke up i couldnt fell my heart beat anymore. i checked my heart beat again and it was at 25. i went to my doctor and he said i was fine but i dont believe him. help....... ### REPLY: Hi, This could be episodic tachycardia, like PSV or atrial fibrillation. So I guess your ECG was normal. In this condition, heart rate suddenly goes up and BP falls. You will need evaluation like ECG, thyroid test and holder monitoring. You should also get one hemoglobin levels done. So visit a nearby cardiologist for this investigation. Also, to abort such episodes you should try to cough hard. Hope I have answered your query. Let me know if I can assist you further.   ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi my name is jennifer my boyfriend is getting poping sounds in his chest and he said it really hurts. his first poping sound was wen he was runing his heart was hurting and then he had the poping sound but now the poping sound comes randomly. can you please tell me what that poping sound is and he should do to stop having it ### REPLY: Thanks for your question on . I can understand your concern. Popping sound from chest is mostly due to gas in the stomach. But better to first rule out heart diseases. So get done ECG, 2d echo. If they are normal then no need to worry about heart diseases. Give him pantoprazole and risperidone combination twice daily on empty stomach. Tell him to avoid hot and spicy food.Don't worry, he will be alright with these . Hope I have solved your query. I will be happy to help you further. Wishing good health to your boyfriend. 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: Bilirubin elevated to 2.7, I m 57 y/o have high blood pressure, mostly controlled with medicine, high cholesterol, & hypothyroidism. 40 lbs overweight. Do occasionally enjoy mixed drink. This is first time with lab work this was found. Recommend things to do/ concerns? ### REPLY: Hi, Thanks for asking. Based on your query, my opinion is as follows.1. Get a liver function test along with direct and indirect bilirubin.2. Need to control cholesterol, possibly fatty liver disease. However, diagnosis is based on direct or indirect bilirubin which is elevated. Hypothyroidism can also cause elevated bilirubin due to reduced metabolism, repeat of bilirubin to be done after treatment with thyroxine.3. Advise stopping alcohol, weight reduction, control of lipid profile and regular medication for all including hypothyroidism. Hope it helps. Any further queries, happy to help again. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have a lump larger about the size of a dime on the top back of my head slightly toward right (if one where to put their hair in a pony tail), it s very tender to the touch but does NOT move when I press on it & from what I understand if it were a pilar cyst it would move. I also have had a headache all day (not severe but enough to be annoying). Also have facial numbness, major vision issues past 24 hours (but also have keratoconus). I have significant history of multiple issues as follows that may or may not be pertinent & just want to know if it is something that can wait until I see either my Neuro Doc next week or my Dermatologist the following week for schedule appointments OR if I should take action sooner: I also have had scalp tenderness off & on as well as other strange neurological symptoms (numbness in buttocks that goes down both legs especially after sitting & diminished memory & concentration etc.) ever since I broke my neck roller blading (Genetic Defect: Reverse Curvature of C-Spine at C-4-5 and have had two cervical spine surgeries - first C3-C5 in 2007 then C5-C7 in 2010). Continued to have falls even after second surgery (most of falls occurred while carrying things with my arms). Six months ago w/o having had any falls in previous 90 days woke up one day and couldn t bare to stand or walk more than about five minutes. I have neuropathy in both of my hands plus arm weakness which worsened significantly since and at this point I can barely lift a half gallon due to pain that shoots down into my low back. Was diagnosed with Facet Joint Osteoarthritis in Lumbar Spine and was referred to NeuroSurgeon/Pain Mgmt Specialist to sever nerves that send pain signals to the brain because physical therapy and all other treatment options have failed plus steroid injections have been tried multiple times and each time produced extreme roid rage. NeuroSurgeon/Pain Mgmt Specialist believes I have Failed Back Surgery Syndrome (FBSS) has already done an MRI of my cervical spine as he feels that everything is the result of an issue in that areas and is trying to get to the bottom of ACTUAL cause of symptoms such as Numbness & falling down for what appears to be no reason BEFORE he just treats lumbar symptoms. Also have significant issues with my jaws (both top & bottom jaws out of alignment) and tried wearing customized mouth piece over the past year but was just told by my cosmetic dentistry specialist that he highly suspects Mandibular Condylar breakdown for sure and need to assess the severity to properly treat (& currently awaiting insurance approval for MRI or Cat Scan). ### REPLY: Hi, Regarding the current issue of facial numbness and mild headache, I think it is safe to say that you can wait till your appointment with your neurologist next week, in order to discuss the issue with.  However, if you develop acute deterioration of your symptoms like loss of vision, one-sided body and/or facial paralysis, speech problems you have to visit the nearest emergency room.  Hope I have answered your query. Let me know if I can assist you further. Take care  ### END