Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Had medial branch denervation in October, felt great the first eight weeks or so however around about Christmas time my lower back pain returned. Ive been diagnosed with degeneration of the facet joints, l4 and l5. Does this mean the deneravation has been unsuccessful or am I still in recovery. My usual painkillers dont seem to help at all now, cocodomal.  Also have tailbone pain, seems to be some debate between doctors as to where this is referred pain or a difficult issue and subsequently is ignored completely. ### REPLY: The only solution which is a basic principle in such lumbosacral vertebral degeneration/ spondylosis/ arthritis or for that matter whole of the inter vertebral joints is to maintain intervertebral gap. If that gap is reduced by whatever disease or causes as explained above, the nerves originating/ emanating from those sites get compressed. Whole nerve or part thereof - medial or lateral filaments - where ever they supply, pain is bound to take place. Enervation is only removal of feeling of pain and not the real treatment. Surgeons have done their best and may do again. To my own patients I would have suggested getting the support of Ayurveda medicine at some good Ayurveda hospital. There are no painkillers in Ayurveda, but cause may be tried to be managed by Panchakarma techniques. May also make use of International Day of Yoga on 21 June where you can learn 35 minute package free if cost. This will be all over world. Hope it helps you well. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have a spinal tumor on my L5-- now I have horrible pain under my shoulder blade making it hard to breath. I have 2 mris next week but until then I want to know what this could be.. I haven t done anything strenuous what so ever so I am completely confused.L la ### REPLY: Hi, I am .  I have read your question and understand your concerns. Let me try to help you Question : Is shoulder pain and breathing difficulty normal with spinal tumor? Answer : No. L5 Spinal Tumor Will NOT cause Shoulder Pain and Breathing Difficulty Shoulder Pain and Breathing Difficulty are due to some other problem, most likely a problem in Cervical Spine would suggest you to consult a Neurosurgeon at the earliest Hope you found the answer helpful. If you need any clarification / have doubts / have additional questions / have follow-up questions, then please do not hesitate in asking again. I will be happy to answer your questions. Let me know if I can assist you further. Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: few days back my large finger on the left leg, had hit the table egde and the area near the nail has been wounded. a few days before that a thorne hit there and i removed it. Now all around the wound is filled with pus and the finger is swollen than its counterpart on right leg. ### REPLY: Hello, Welcome to , As you had hit your left toe against the table edge and the area near the nail and has been wounded. S the wound is filled with the pus it suggests me that your wound is infected which should be managed vigorously and completely. You require a physical examination to know the extent of the injury and the amount of tissue lost. I would suggest you to follow1. Wound should be cleaned and . X-Ray of the left toe finger should be taken3. A course of broad spectrum antibiotics like Tab Augmenting, twice daily for 5 days should be taken.4. Oral AnalgesicsThank 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 have a knot on the inside of my right cheek in my mouth , in which I have had it removed once already and it came right back. The actual knot starts back at the back of my mouth at the space between the teeth at the very back on the right side, now on my left side there is no such place it is smooth. And this feels kind of bumpy and it hurts when I touch it, or try to eat or yarn and sometimes when I talk. Now I do have some bad teeth and was wondering if it could be coming from that. ### REPLY: Hello, the lesion u had is most probably a dento-alveolar lesion: most common is abscess from infected tooth esp third molar, any cyst or jaw tumor. The jaw bone is this region is very prone for ameloblastoma, dentigerous cyst, traumatic bone cyst, etc. For correct diagnosis one need to go under following examination- clinical, radiographs- IOWA of infected teeth, OPG, lat oblique, occlusal, then FNAC /incisional biopsy then as per pathologic examination treatment can be decided. If its infected tooth abscess origin- ACT/ extraction of involved tooth if it is cyst or any tumor then surgical intervention is required along with involved tooth Cenote for any abnormal sensations/paresthesia as it will be critical factor to decide neural involvement in region.don't delay treatment as long-standing abscess can convert to cystic lesion.most probably your problem will resolve by RCT of infected tooth. Consul your dentist soon meanwhile maintain oral hygiene by use of antiseptic mouthwashes and interdental aids. 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, lately Ive noticed that my urine is very, very dark, and my discharge of seamen is unregularily thick. Also, when I wake in the mornings, Im very queezy n have been vomiting. And Ive also noticed that the whited of my eyes have a yellow cast to them. This has all happened within the last three weeks. I am 36, 180 pounds with no past medical history. ### REPLY: Hello, Welcome to . I can certainly understand your concern. I have worked through your query in detail. As per your symptoms the possibility of significant urinary tract infection is very high. This can cause significant change in seminal parameters causing thick or foul smelling semen with or without urinary disturbances.It's important to get few tests to determine further course of action-urine examination, scrotal ultrasound Doppler to look for any infection of the testicles or epididymis. A short course of antibacterial antibiotics will help to clear the infection and improve the seminal parameters. Repeat testing after 2 weeks will help to assess the outcome. Please check with your physician if he shares my view and if you can prescribe these medications to you. Post your further queries if any. 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: Hello,  I was in a car accident on 4/13/11.  About a week after when I eat it sometimes causes extreme pain in my upper stomach area and shoots thru the ribs either on just one rib or both, then about 30 - 45 mins later it moves to below the belly button above the pelvic bone (sometimes feels like ovary pain) some days it involves gas and lately it has been followed w/ diarrehea that is dark black in color.  Curious if I should be concerned w/ it being after the accident.  The ER did an upper right ultra sound and ct scan of the upper stomach and everything looked good.  Just curious, tysm :) ### REPLY: Welcome to  .1. The May or may not be related to the accident which happened in 2011.2. It could be a fresh pathology. Similar symptoms are seen in acute gastroenteritis / gallbladder pathologies / renal problems / gastritis.3. To narrow down the diagnosis if you are my patient I would ask for an ultrasound scan - and start treatment accordingly. 4. I would recommend you to get an appointment with your GP and get the needful investigations done.5. At the same time the doctor will look o the related issues with your accident. Hope it helps you. Wish you a good health. Anything to ask ? Do not hesitate. Thank you. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My mom s MRi report shows degenrative changes in the spine . Transitional vertebra at lumarosacral junction with sacralisation of L5 vertebral body. Also its mentions posterocentral and paracentral disc protusion at L5-l4 with minimal cranial migration causing identation of thecal sac and narrowing of bilateral lateral recess / foramen compressing exiting nerve roots. Doctors in India have adviced undergoing an back surgery with 50 -50 percent chances but we are a little concern about undergoing a back surgery. We are not sure about the chances and also recovery time needed. Your advise will be greatly apprciated. ### REPLY: Hi, Thank you for posting your query and MRI spine findings of your mother. The decision to operate would depend not only on the MRI findings, but also on the clinical symptoms and examination findings of the patient. In general, only about 10-20% of patients with these findings would require surgery and the rest can be managed with medications and physiotherapy. In operated cases, the success rate is more than 95% cases, if the case selection is correct. I would request you to get back with patients symptoms and examination findings. Best wishes, .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi,I have liver disease and had a grave prognosis about a month ago. Am doing everything right now and slowly getting so much better! But I forgot to ask my nurse this am if i can take aspirin or anything for a bad headache?? Thank you!! P.S.Please respond here as my email is down thank you! ### REPLY: If I were your treating doctor I would advise acetaminophen less than 1-2gm/day if pain relief is inadequate then tramadol tablets starting with low dose with monitoring instead of using aspirin or other NSAIDs for pain relief as they can precipitate liver dysfunction. I have given satisfactory answer to your questions. You can like it if its satisfactory and can ask any other offer your queries and I will be pleased to answer them. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: In the middle of 2010 I got HSV-1 on my genitals from my bf going down on me. I think like two days later i realized because we were about to have sex but when he went to go in it hurt me a little and then i had to stop because it hurt. Moving on i went to the dr. Asap n they gave me medication and it healed fine and i haven t had an outbreak since. But my problem is i have no sex drive at all. We went from having sex at least once a day to maybe twice a year now. I feel like im not a woman anymore. Is this something mental? ### REPLY: Hello, Welcome to www.ChatDoctor .com! I really appreciate your concern. From your description of the situation I suspect you are having fear or phobia of intercourse. I understand that in 2010 you suffered a lot. But that thing happens rarely. So don't feel that you will have herpes every time you have sexual intercourse with your partner. Transmission of STI is simply prevented by use of condom during intercourse. Avoid having unprotected intercourse with multiple partner. Sexual intercourse is itself an exercise beneficial to your body. So there is nothing wrong in it. Enjoy your sexual life without any fear. Hope my answer has solved your query. Take Care. Thank you. Best Regards. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello, a few weeks ago i sprained my back in a boating incident, 4 days after the sprain i began getting stomach pains and then i started to pee blood it is painful too, i dont know what to do or what it is i would like you to help me i am of female gander. ### REPLY: Hi. Thanks for your query. Read the history and understood your problem. The history of an injury to the back in a boat and starting of hematuria (blood in urine) after 4 days is indicative of trauma to the kidney. I would advise you the following :- Admission to the hospital.-Urgent ultrasonography of the while abdomen.-Tests of blood: Blood group as you may need blood anytime, CBC, kidney function tests.-Urine: routine, microscopy, culture and sensitivity.-CT Scan and intravenous Paleography to see the status of the kidney.-Rest of the treatment under the guidance of the Urologist. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi doctor my husband is 34 years old ,he doesnot get the urge of having sex on his own... may be the arousal is ok but every time i ve to help him in his arousal , every time he gets angry if i want from my end.. we get physical at an interval of 1 and a half month and so.. i get irritated at times .What i want to know is is it a physical disorder do i need to take him to a doctor for this ### REPLY: Hi welcome to the  Low libido means decease desire for sexual activity For low libido physical as well as psychological issue are related So by careful history cause, needs to be evaluated Causes for low libido are as follows.... _chronic medical illness _low testosterone _stress, depression, anxiety _certain . . Check diabetes, thyroid issues as well According to cause specific treatment given If depression or stress associated then medication for that given So with keeping all this in mind consult nearby physician for examination Take care ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I was diagnosed with pcos when I was 17 but was pregnant 3x. 1 miscarriage, 1 birth and 1 abortion. I am 24 years old and have been trying to concieve with my husband for the past 2 and a half years but cannot. I am 30 lbs overweight but could not concieve when I was thin. I have been on 2 rounds of clomid, the last round I did ovulate but no pregnancy. I do get my periods every month but they are always a week late. Any suggestions? ### REPLY: Hi, Hormonal imbalances associated with POD make it difficult for pregnancy to happen and if it happens, to retain. I would suggest a complete evaluation before any more induction. Treatment should be based on the hormone levels, tubal patency and glucose tolerance tests. Addition of Metformin has been shown to enhance conception chances. Maintenance of a normal body weight also plays its part by regulating the demand for hormones. Monitoring of an induced cycle to identify the exact time of ovulation and timed intercourse is the mainstay of success. Hope this helps. Good luck. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi, may I answer your health queries right now ?  Please type your query here...I am 55 year old and my Echoo +ve,TMT-moderality +ve.Dr. advice me for angio due to some problem I am anable to get it done. Dr. advice me to take Ecosprin 100mg, Imdur 30mg, Crestor 10mg, Xm Beta 50mg. you are requested to suggested me can it be cure by exercise, yoga or medicen or what I should do ### REPLY: Welcome and thank you for asking on ! I have gone through your question. Yoga, exercise and dietary changes(lifestyle changes) constitute only a part of the treatment. You definitely need to be on medicines (compliant). Angiogram will answer many questions like . The presence of and severity of the coronary artery disease (blocks) and the treatment needed subsequently for optimal outcome. Undergoing an angiogram is not a bad idea (recommended)Hope to have been helpful! Wishing good health, .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have had intermittent right sided abdominal pain for around 6 months but not particularly worried as it comes and goes, rarely lasting for more than a few hours. This weekend the pain has lasted much longer and I am wondering what it might be. It is in a very specific place and is worse to the touch. It also seems worse when I have a full bladder.I am a 52 year old woman and my only other symptom is a number of lumps in my neck, the longest of which has been there for a year. Over the last 6 months these have increased to at least 5 lumps that I can identify. I have been to my GP twice but she does not seem concerned as all blood tests seem normal. ### REPLY: Hi. This is very specific but an atypical presentation. Let us consider a diagnosis of something in abdomen which is pressed upon by a full bladder that too on right side in a specific place. I would consider this lump which can be a mass from lymph nodes or ovaries or the area of ileocaecal junction with an appendix. I would do a thorough clinical examination and may be per-vaginal palpation to see the lump. Furthermore, I would also advise going for sonography per-abdomen and per vaginal. Maybe a CT scan with a marking on that specific point. I would do FNAC of the lumps in neck too. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, 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 my name is rohail and i am 19 years old weight 75 i have one question is there any side effect of masturbation for muscle because my bodybuilder trainer said that masturbation is an energy sucide is it true one more question is how many time i do this in a month when i feel uncomfortable. ### REPLY: Hi, Do not here this nonsense tip given by this type of person. If this is the case then every married man should have lost energy and handicapped ! Masturbation does not have any side effect either less of energy or muscle weakness or not having any bed effect in sex life. This is just like other feelings like thirst, hunger, joy etc. At young age this is common habit where male hormone is its maximum level. So there is no harm doing masturbation. I always advice that keep this habit in control as excess in every thing should be avoided. If one person does not do masturbation, excess amount of semen is going into blood stream, metabolized in the body and will be thrown by kidneys. Ok and take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: my root canal procedure is going on since from 12 days. at first stage doctor has given me anesthecia and performrd the procedure of root canal. the after that same procedure is carried out on same tooth 3 times without anesthecia. and every time my tooth is filled with cotton. but the problem is my tooth has pain while I take my meal and chew the food ( food taken is not very hard ). the tooth starts paining a lot and after 3 to 4 hours pain stops automatically. what might be the reason??? is there still infection in my tooth???? because my doctor said that next time he will permamantly fill my tooth. hence i am hesitated. ### REPLY: Hello! Read your query. This pain arising from the tissues around the tooth apex and not from the tooth itself. You need to give some time to the inflamed tissues to settle down. I suggest you not to use this side for chewing for at least a week. The infection(pus) is given a way to escape in a root canal therapy. Call your dentist and inform about this, he will grind your tooth little so that it is out of occlusion. Take antibiotics and analgesics as prescribed. It is ideal to permanently fill the tooth when the pain is completely absent. Hope this helps. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have had a bad upper respiratory thing going on for a week. It started w a sore throat and moved into sinuses then nose and chest. Very deep chest congestion. Now having mild ear pain that alternates between ears and when I blow my nose, left ear squeaks. Is this normal? Should I just ride it out? Thank you. Dana ### REPLY: Thanks for your question it seems you have upper / lower resp tract infection which has tracked up your Eustachian tube in the ear. You need to consult a pulmonologist who can prescribe you some antibiotics like lifetime for a week or two .he may request for a sputum culture and sensitivity to know the exact organism causing the disease and will prescribe the exact antibiotic this will solve your problemthanksfeel free to ask more questions may god bless you with 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: Me and my boyfriend are trying to have a baby. Today is July 29th 2:29pm, and I always get my period on the 28th of the month. I haven t had cramps or anything, but my breasts are pretty tender. Could I be pregnant? Will a home pregnancy test accurately tell me if I am pregnant this early? ### REPLY: Hello dear, I understand your concern. In my opinion when there is missed period in a regularly menstruating woman the pregnancy should be ruled out first. I suggest you to go for a urine pregnancy test a week after missed period for accurate results. The pregnancy symptoms like nausea, vomitings, increased urination, sore breasts usually start 2 weeks after missed period in pregnancy. So wait and check for the test. 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, my mother is suffering from severebavk pain and she also sufferinf from pain in her right shoulder and right portion of her body.As per MRI report following points were highlighted:diffuse disc bulge from L2-3 toL4-5causing narrowing of bilateral neural foramina.Ligamentum flavum hypertrophy is seen at L3-4 and L4-5 levels.Facet joint arthropathy is seen in leftL3-4 facet joint.please advise the remedy measures in this case. ### REPLY: Hello, I have studied your case. Your MRI says foraminal protrusion causes bilateral foraminal stenosis which leads to compression of exiting nerve root which later on supply lower limb [leg]. Due to compression of this nerve root there is tingling numbness in your leg and pain associated with it. Medication like methylcobalamine with muscle relaxant and analgesic will reduce pain; you can take them consulting your treating doctor. You may consult physiotherapist for further guidance. He may start TENS, or ultrasound which is helpful in your case. I will advise checking your it B12 and it D3 level. As MRI shows disc compressing on nerve root then surgical decompression is permanent solution. Hope this answers your query. If you have additional questions or follow-up queries then please do not hesitate in writing to us. I will be happy to answer your queries. 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 is confused, is tired, normal BP, elevated pulse rate (112) and pulse is erratic.  Has been diagnosed in the past with COPD - does not have difficulty breathing.  Over the past several months , he has experienced several of these episodes where his speech is slurred and has difficulty walking.  He is 64 years old today.  We got ready to go for a bicycle ride and he is apparently having another episode.  I can always anticipate that he will be okay the next morning after 10-12 hours of sleeping. ### REPLY: Hello ! I read your question and understand your concern. In my opinion the problems of your husband may be related to a low blood flow to the brain, causing Transient Ischemic Attacks. These events may be related to the heart, as you refer that he has elevated pulse rate, erratic, which may be atrial fibrillation. Repeated TIA lead to high risk of stroke if not treated. I would recommend consulting a cardiologist, and have an ECG and an ECG 24 hours monitoring and a cardiac ultrasound to see the heart output. He may need anticoagulation if FA, due to high risk stroke. A brain MRI and a neurologic examination would be helpful. I would also recommend and EEG, as these signs may be also caused by epilepsy. Hope to have been helpful! Best wishes,  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am 40 yr old, my semen test shows: Physical exam- milky white,translucent,self liquifaction occurred in 20 min,normal viscosity, vol-0.5 ml. Chemical- fructose positive PH-7.5 Microscopic: Sperm count-no of spermatozoa per ml- 62 millions  Viability -70% alive at the end of 1/2 hr Active sperms in ejaculate at the end of half hr is 15.5 millions Epithelial cells-squamous type, macrophage cells- present++, pus cells 1-3/hpf candida nil RBC nill, trichomonads-nill Sperm morphology (Kruger) Head abnormalities -58% Midpiece abn-09% Tail abnormalities-13% Total number of abnormal spermatozoa are 80% ### REPLY: Hi, I have gone through your question. Your semen examination is all normal except that the 80% sperms are abnormal in morphology. Abnormalities in the morphology of the sperm can be due to infection, or any abnormality in the testes or the ejaculatory duct. Apart from it, the sperm count and motility are normal. Increased number of macrophages are suggestive of infection. I would suggest you to consult a urologist and get properly examined, investigated and treated accordingly. Hope you found the answer helpful. Wishing you good health. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My 15 year old son was diagnosed with thyroid cancer in October. He had a bilateral neck dissection. The cancer metastasized to his lymph nodes and lungs. He is now complaining of left lung pain when he takes a deep breath with profuse sweating. Can it be related? ### REPLY: Thanks for your question on . Since you are saying that he is having thyroid cancer (operated) with lung and lymph nodes metastases, his chest pain can be due to1. Pleural effusion2. Pneumonia3. Lung metastases Malignant pleural effusion is very common in thyroid cancers and if present can cause pain on inhalation. Pneumonia is another possibility. And if worsening of lung metastases is there than this can also cause pain. So better to get done chest x-ray and if needed CT THORAX to rule out 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 autoimmune hepatitus and i have been reading medical articals to try to find a different treatment.  i seen one that talked about low dosses of THC were proven to suppress immune system and act as a antinflametory.  is this true and something i should discuss with my doctor? ### REPLY: Hi, I had gone through your question and understand your concerns. THC is still controversial as a treatment method for many disorders and there are supporters of these medications but also, many doctors refuse THC as an inefficient and harmful. For this type of disease, autoimmune hepatitis, there is no clinical or scientific evidence that it may be beneficial and cure the disease or act as anti-inflammatory substance It may only reduce pain and make you feel more relaxed. So this is not good choice and official anti-inflammatory agents should be used including steroids. I hope I have answered your query. Wish you good health. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: age 27 year, height 51 ,weight 42.5 kg no medical history... i am trying to conceive for last 10 months. but did not.. my husband has some time erection problem.. and some time after intercourse he do not have ejaculation.. i want to conceive but how?? ### REPLY: HelloThanks for writing to ChatDoctorTrue erectile dysfunction is unlikely in your husbands age. His problem may be due to stress or psychological causes. He should try to be calm and before penetration spend sufficient time in foreplay. This is very important in intercourse. He should avoid stressful situation.Don't take alcohol or cigarettes if he takes these things. Last but not the least, he needs your support and confidence. He should take nutritious food and do exercise. If symptoms persists then he needs proper evaluation and investigations. Investigation includes routine hologram, RBS,lipid profile, urine RE/ME, semen examination, penile Doppler, hormone estimation, ultrasound of scrotum etc. Hope I have answered your query. 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 a quarter size bump on my back. It s hard and red...similar to a pimple. I squeezed it and a smelly puss and some blood came out. After touching it for a while it starts to hurt. How can I treat this? I thought it was a pimple but I don t think it is anymore ### REPLY: Hi, Thanks for your query. After going through your query I came to know that you may be having infected sebaceous cyst. Treatment of it is analgesic such as diclofenac and antibiotics. Vitamin B and C will help in promoting healing. If it is not healed by it then excisional biopsy of it can be carried out which will exclude other affections. You can discuss with your treating Doctor about it. I do hope that you have found something helpful. If you have additional questions or follow-up queries then please do not hesitate in writing to us. I will be happy to answer your queries. 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: I got circumcised last week on the 11 January . . I have ripped a stitch out my penis now I have a hole I left the hole and now it seems as if it is getting bigger . . I took out some stitches where it was sore on my penis but now not sore after stitches came out . . But now I have yelllow stuff coming out of the stitch holes ? ? Is that normal ? ? IV been cleaning it with salt water every day . . Hole still hasnt closed . . And the yellow stuff is still coming out . . I went to a doc they said they cant stitch it again . . I should just leave it . . It would grow closed . . What should I do ? ? ? Pls help ### REPLY: Hello dear, Thank you for your contact to . I read and understand your concern. I am  answering your concern. Usually stitch mark will start healing in two to three day. So discharge after a week is abnormal and should require a treatment. I suggest you to visit nearby surgeon, they can examine the site and will give you appropriate opinion. If the site is infected then proper antibiotics followed by restitching can cute the lesion. I suggest you to maintain good cleaning and hygiene locally. Avoid any injury to the open site.  . I will be happy to answer your further concern on bit.ly/ ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: my daughter she is having nodules in her neck for the past 3 weeks consulted doctor gave her antibiotic but still not reduced but meanwhile another one appeared near the earlier one today we are going for the blood test will it be cured with medicine or i should go for a surgery ### REPLY: Hi, Whether these nodules will require surgery or will go off with medical treatment depends on the diagnosis. Lymph nodes enlargement may be primary (with the disease involving the nodes itself) or secondary (reactive in response to disease somewhere else). Symptoms you mentioned here points towards reactive cause, though your description is very insufficient. Hope I have answered your question. Let me know if I can assist you further.  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: hi i think i have varicocele but i dont have any enlarged veins neither right or left only my left vein is small not enlarged or swollen but its thicker than the right one is this ok i saw pictures on the wikipedia http://en.wikipedia.org/wiki/File:Gray1144.png shows that the right vein is thinner than the left i want to get sure is i am normal or i have varicocele ### REPLY: Hello, i have gone through your query and saw the reference picture you have attached. The picture shows the dissected spermatic cord with it contents on right side of the picture. Without examination, it is difficult to identify the varicocele. But if you have varicocele, it may feel like" Bag of Worms" on examination. If it is very big, it may cause . The main problem in varicocele is infertility. Due to engorged blood vessels and blood stasis, the temperature in veins in varicocele is high. As the testis is nearby organ and connected, this high temperature affect the sperm production. Thus better consult your primary care physician and rule out the varicocele. If you have varicocele, it is best to get operated. Hope this helps. Please write back for further queries. Wishing you good health. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi Doctor, I am suffering from acidity. If I take medicine (Omiprazole) it subsidies and coming again after 1 or days. I also have burnging paid on my back. I was tested H phylori positive, took antibiotic now in the stool test it is negative. But the acidity and pain are still continuing ### REPLY: Hi, I have read your query. You should always consult doctor before taking any medicine. Acidity can not go away with single dos of omeprazole, you have to limit spice and fried food, and you have to take antacids for some time by discussing it with your doctor. For back pain get your x-ray of lumbosacral spine done in AP and Lateral view done send us report or discuss it with your doctor. Till then take painkillers+muscle relaxants by discussing tit with your doctor. I hope you have got your 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: Hi,I am a 34 y/o female with a personal history of kidney stones. I am having lower back pain in waves, but no where near as severe as it was when I had kidney stones the past two times; both required surgery to remove them. I am also urinating more frequently than normal and am nauseous. I typically consume 90 oz of water a day. I got a urine test to check for leukocytes and nitrates. Nitrates have come back negative, leukocytes positive (not trace, but a pretty dark color in the positive range). My question is should I go see my doctor? Urgent care? ER? Are these early symptoms of kidney stones? ### REPLY: Dear patient, Classical symptoms of kidney stones are: severe flank and groin pain, blood in urine, nausea/vomiting and restlessness. Sometimes it can be without symptoms, because depends on the size of the stone. Presence of leukocytes in urine, your mild lower back pain, frequent urinating and nausea, together they indicate you have urinary tract infection. For this I would recommend to . Hope my answer was helpful for you. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My mom was bending the freezer this afternoon, when she experienced a loud snap in her lower back. Now she has a localized pain in the middle and lower portion of her back. She is very sensitive to pain, therefore it is a little hard for me to gage how server it is . Can you advise as to what are the possible causes. ### REPLY: Hi, I am .  I have read your question and understand your concerns. Let me try to help you Question : Can you advise as to what are the possible causes. Your Answer: The probable causes can be a slipped disc, slipped facet, (rare) Muscle Sprain, Strain (common)The Treatment should be bed rest for 48 hours. If the pain does not improve, consult a Neurosurgeon In Most Cases, the pain will settle by 48 hours Hope you found the answer helpful. If you need any clarification / have doubts / have additional questions / have follow-up questions, then please do not hesitate in asking again. I will be happy to answer your questions. Let me know if I can assist you further. Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, 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,please find my semen report and advicesperm count 31ml active motile 13%sluggish motile 29%non motile 58%double tail 2%double head 1%amorphous form 3%pus cells 10-12/hpfrbcs 1-3/hpfepi cells nilvolume 2.8mlliquification time 28minreaction alkaline ### REPLY: HelloThanks for query. Thanks for query. Your semen analysis report suggests Oligoasthenoterratospermia meaning the by that all the important parameters of your semen like sperm count, motility of sperms and morphology of the sperms are abnormal and below the range of normal values compared to WHO standards. Presence of 10-12 pus cells suggest infection of either seminal Vesicle or Prostate. Take antibiotics like Doxycycline twice daily for one month and repeat semen analysis after completion of course of antibiotic. .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hi Doctor, My brother is facing some issues now a days, he feels like fainting and puke after sometime. it has happend twice in this week, but never before that. once he was in Gym and had not taken proper intake. and sec. time he was in office in morning when he encountered it. he is only 22. well physic, hgt.- 5.10, wt.- 64, i consulted a doc. and he said his body is completely fine but  there can be a problem with the brain and suggested to took MRI and EEG tests to know it better.  please suggest which is the best center in PUNE to perform these tests along with the approx cost, and are these symptoms dangerous. we dont have any heriditry problem. ### REPLY: His had gone through your question and understand your concern. First, let me assure you that these symptoms are NOT dangerous or serious. A person can suffer these symptoms due to various reason, and deny .  If I were your physician, then I would have gone for rather smaller tests like He, CBC, etc. Also get your brothers blood pressure checked. Anyway, an MRI scan can you around Rs 7000/- and EEG around Rs 700-1200/-. I hope this information was of help. Thank you. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My daughter is 9 yrs old is developing her breasts early. Friday she noticed a bump on her areola and said that the area around her breast was itchy and then the bump started to burn . After her shower last night, she dried her body and the skin fell off the bump (like a scab I suppose). It now looks deep red like an open soar and it burns she says. What could this be? ### REPLY: Hi, Dear,Thanks for your query to . Studied your query in full depth of its details. Reviewed it in context of your health concerns. Based On the facts, Your daughter seem to suffer from-Cracked / Scored Nipple / or Pimple /acne / or Boil of the Montgomery lump with Sub-areolar Abscess -as the lump is painful and itchy. Duct papilloma with adenoid or adenocarcinoma need to be ruled out due to its situation. But is remote possibility as it painful and the age negates its possibility. Mammography / USG with / CT study of the breast with FNAC Biopsy would fix the cause of the lump on the areola of the daughter. Welcome any further query in this regard, which would be replied in next session. Good Day!! . N. Senior Surgical Specialist. S. Genl-CVTS ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i am trying to find a birth control pill that suits me. At first i was on lindynette, but my face was breaking out a bit and i had pre menstrual symptoms everyday. My doctor recommended yaz, but this made my face break out even more and i had continuous break through bleeding . I have been on minigynon for the past three days and i just want to find how how i can stop my face from breaking out cause i never had an acne problem before and how to stop the break through bleeding. Is there a pill that is right for me? ### REPLY: Hello, Since you have been having persistent problems with the combined oral contraceptives, you can see if you are able to tolerate only progesterone pills. These may be in the form of a demo shot, implant, IUD or oral medication. For acne, you would need specific treatment from a dermatologist. The triggering factors should be avoided. Intake of oily foods, fats, sweets and baked items should be avoided. Dan .  Local applications and oral medication are used for treatment of acne. Hope this helps. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Have right foot pain for approximately two weeks, on 2/28 my foot pain woke me in the middle of the night. My foot was very swollen and tender to the touch. Went to the ER, doctor diagnosed me as having Gout, took my blood and wrote me a prescription for indomethacin. At my follow up visit with my regular doctor, she said no way gout , blood is below the range and u don t fall in usual gout criteria. Took X-rays of the foot, no broken bones. Now is sending me to podiatrist, what is wrong with it? ### REPLY: Hello, Did you have a history of trauma, fall, or long walking or running lately? From the information you gave, the first diagnosis that comes in my mind is arthritis of the foot bones, could be mid-foot, forefoot or hind foot. Normally, in the x-ray that you did arthritis should have been visible. The second option is stress fracture of foot bones, but only if you had prolonged walking or running recently. This cannot be seen on x-ray, but only on bone CT scan or scenography. There is even more rare disease such as infection or tumors that need to be distinguished. Maybe the podiatrist will order these examinations and blood work for you to diagnose and treat your condition. 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 got my wisdom teeth pulled about a week or 2 ago and just now I tasted something weird in my mouth almost like blood but not exactly like it so I look in my mouth and were my wisdom tooth got pulled there is a tiny hole that everytime I push near it alot of puss/blood comes out I manage to drain it out I guess you can say but u just want to know should I be worried and what s gonna happen to me? And if I go to the oral surgeon what are they gonna do to me ### REPLY: Hello, Thanks for writing in. I read your problem. First I would like to tell you that pain up to some extant after wisdom tooth removal is normal. But as you gave the detail, bleeding and pus . It shows that there is infection in that area. So I will suggest you please visit to your oral surgeon as soon as possible and get the complete examination done. Nothing to get worried, your oral surgeon will provide you the proper treatment which will include irrigation of that area followed by placement of antiseptic  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: my brother in law has lung disorder   doctors say  it is leakage in lungs due to this he cannt breath properly, for the last 15 days he is under medical supervision in hospital bereilly  but so far  has no relief...so please tell me the best lung care hospitals and specialists in delhi and the phone no. my id is  YYYY@YYYY ### REPLY: Thanks for your question on . I can understand your concern. Leak in the lungs is mostly due to Bronchopleural Fistula (BPF). And best treatment for this is VATS (Video Assisted Thoracoscopic Surgery). In Delhi, you can go to Vedanta, AIMS, Maulana Azad hospital for VATS surgery. Usually Cardio thoracic surgeons are doing VATS Hope I have solved your query. I will be happy to help you further. Wishing good health to your brother-in-law. 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 am having herniation in my L4-S1 disc, this i came to know approx 1 year back when i started feeling back ache.(may due to my long sitting job or my wrong sitting posture ) I am 28 years old with 5.7 height and 58 kg weight. My MRI report shows that it is minor, i gone through several medications , approx 3 months bed rest and approx 15-20 days physiotherapy . But till date I am not recovered completely. When ever i feel severe pain it spread upto thighs, else mild pain persist all the time in my lower back. Along with this, i am having pain in my upper back also, some time it become very severe and it become hard for me even to laid down on bed on any position. Is this problem is also related to my disc herniation? Please suggest what to do next. I avoid any pain killers, i improve my diet with milk, non-veg, dry-fuits, not sure if this all help me out in heeling my problem. ### REPLY: Hi, Treatment for disc herniation depends on many factors and based on all that the treatment strategy in made. Important factors considered are symptoms, age, activity and presence of worsening symptoms of the patient. Now treatment modality available for this condition are many and most of the time it is started with the conservative step. Most of the time if it is not very complicated and impairing than rest and activity modification, application of ice and heat, physiotherapy, using of painkillers are done in the initial stage to control the condition. But this is not going to permanently cure this condition. After all this if it is not working than steroid is also used first in the form of oral dosage and then epidural steroidal injections. After this only the role of surgery is there which is the last resort to control and cure the condition. Taking you age in consideration and activity level I think you can avoid surgery and can control your condition with the more conservative treatment. But if it is not working than you can think for the surgery also. Hanks and take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I ve been diagnosed with fibromyalgia and I also have muscle and skeletal issues and I do on occasion have spasms but this past week I have had some extreme fatigue and spasms to the point Im afraid to move around because I m cramping up so bad.I take zanaflex but truthfully this seems to make them worse.Could I be having an adverse affect to the medication? ### REPLY: Hi, thank-you for providing the brief history of you. A thorough clinical assessment is advised. As you have been diagnosed with fibromyalgia, this condition has the pain up and down due to the inflammation of the fibers of the muscle. A muscle contains numerous fibers and inflammation in the fibers lead to pain. Also, the fatigue is the early occurrence due to rapid metabolism and also the spasm and cramp is the end result.in my clinical practice such cases are recommended with physical therapy, meditation and breathing exercises. Physical therapy - Therapeutic ultrasound therapy and TENS therapy will help reduce pain and inflammation. Also exercises will help regain the strength and improve the metabolism and endurance of the muscle. Meditation will help reduce the anxiety and also help in Performing well during exercises. Breathing exercises will help improve the oxygen carry blood capacity by tissues and there by helps reduce the inflammation. As the metabolism is slower in patients with fibromyalgia, having breathing exercises, meditation and exercise does play a big role in overall help of the condition. RegardsJay In .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: My son is 9 years old now at age 5 and 1/2 he was dignosed with Pertheses Disease at his last appointment they said it was gone. Now he has muscle weakness all over still has alot of pain in his legs sometimes he walks with a limp. He runs alittle funny too. Teachers have also noticed this too but his doctor doesnt seem to know what is wrong. So do you have any suggestions? ### REPLY: Hello have gone through your query. A child with Perches disease may tend to walk with a limp due to a stiff hip. To help restore hip joint range of motion, the child may be encouraged to walk with crutches and participate in physical therapy. Bed rest in traction may be needed in some cases. With physical therapy, the child will be shown some simple exercises to do until the final stage of healing has occurred.~Hip abduction:The child will lie on his or her back, keeping knees bent and feet flat. With the parents hands on the children knees, assist the child as he or she pushes the knees out and as squeezes the knees together.~Hip rotation:With the child on his or her back and with the legs out straight, roll the entire leg inward and outward.I would advise you to visit your doctor to know more about that. Regards ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Hello, My neurologist put me on Propranolol . I have pressure in my brain for two weeks. I feel every day . Some times gets very bad. I had CT scan done. It was normal. My blood pressure is normal 115/75 and pulse is 65 . I m afraid to take the drug because I could get low blood pressure and heart rate. ### REPLY: Hi, Thanks for writing in. Pressure in the brain is called intracranial pressure. This pressure is different from blood pressure but complications due to high blood pressure can cause raised intracranial pressure. The intracranial pressure depends on the flow of cerebrospinal fluid which is surrounding the brain and spinal cord from every side. Increase in intracranial pressure can be due to brain swelling, bleeding within the brain, tumors inside the head and infections causing block of cerebrospinal fluid flow. Propranolol need not necessarily cause increased intracranial pressure. Please discuss with your neurologist. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, 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 chronic obssessed patient since 6years..and i am taking SSRIS since 6years like fluvoxamine(100mg) and clomipramine (25mg)..but still i dont find much effective in controlling my obssessions...only 50% is effective..s can you tell me which medicine is bes to control chronic obscessions.. ### REPLY: Hi... thanks for writing.I have understood your concerns.so you were diagnosed as an OCD patient before 6 years.what I feel here is the dosage of fluoxetine and clomipramine is very low and ineffective...so you shut consult your psychiatrist and ask for increasing the dose of both these medications.with increase in dosage you will find further improvement.clomipramine can be increased to 225 to 300 mg in a day and fluoxetine to 200 to 300 mg a day...another option is to continue fluoxetine and add fluoxetine, which is very effective in OCD. Fluoxetine also shut be taken in higher dosage like 80 mg in a day.in my opinion, tell your concerns to your treating psychiatrist and ask for increase in the dosage.I hope this advice will be helpful to you.best 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 had pain in my right shoulder and down my right side muscles for five years. My movement of my arm and strength are normal, but my side muscles are always tender with the epicenter of the tenderness and pain being in a muscle about 2-3 inches below the armpit. My shoulder around the scapula has pain low to high at times and sometimes numbness. It sometimes tickles and makes me want to pop my shoulder. ### REPLY: Hello, I have studied your case. It can be shoulder rotator cuff injury which may need MRI for confirmation. Medication like methylcobalamine with muscle relaxant and analgesic will reduce pain, you can take them consulting your treating doctor. You may consult physiotherapist for further guidance. He may start TENS, or ultrasound which is helpful in your case. You may need to take rest for early healing. Also check your it B12 and it D3 in your blood. Hope this answers your query. If you have additional questions or follow-up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health. Take disregards .  ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have a lump in my lower back on the left side. it causes pain down my leg when I walk, sit and laydown. My hip hurts aswell.. My doctor said that the xrays of my back were fine and that my back is perfectly aligned (because she thought my pelvis what shifted). help. ### REPLY: Hi. Thanks for your query. Noted your history of a lump in the low back on the left side and there is pain down your leg when you walk, sit down and lay down. There is pain in the hip too. Your Doctor says X-ray is normal. I would advise you in such a condition the following:- First remember that X-ray has not much of a diagnostic value in such conditions. - MRI of the lump, spine and the hips would help you to get an appropriate diagnosis and a plan for proper treatment. - Clinical evaluation by an Orthopedic Surgeon would add on the diagnosis and get you proper prescription of medications. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Good Evening Doctors! . Mild multilevel cerivcal discogenic/degerative changes, superimposed on congenital cervical spinal canal narrowing. 2. At C3-4 there is a 1mm central disk protrusion, with mild central canal stenosis. Mild facet arthropathy is present. 3. At C6-7 there is a broad disk/osteophyte with mild to moderate central canal stenosis. 4. Mild bilateral foraminal narrowing at C7-T1.Relative straightening of cervical lordosis. What does all this mean please? And would surgery be an option? ### REPLY: Hi, Thanks for writing in.1. Mild multilevel cervical isogenic/decorative changes, superimposed on congenital cervical spinal canal narrowing.There are degenerative changes in the discs between bones of the neck spine. This is probably due to age related changes. There is also a narrow spinal canal in you since birth and the degenerative changes makes it more narrow.2. At C3-4 there is a 1 mm central disk protrusion, with mild central canal stenosis. Mild facet arthropathy is present. There is backwards displacement of disc at level C 3 - C 4 and this is causing a slight pressure effect on the spinal canal. This leads to pressure on the covering of spinal cord and pain symptoms. The joint between bones is also showing degenerative changes.3. At C6-7 there is a broad disk/osteophyte with mild to moderate central canal stenosis. There is also a broad disc displacement at C 6 - C 7 level and extra bone formation. The spinal canal is narrowed at this level.4. Mild bilateral foraminal narrowing at C7-T1. There is pressure on the nerve roots at level C 7 - T 1 and this can cause pain.5. Relative straightening of cervical lordosis. This shows that there is muscle spasm of the neck. In conclusion, medications and physiotherapy should be given for 6 to 12 months. There are new medicines which reduce nerve related pain. Also avoid making sudden neck movements. Surgery is indicated if the symptoms persist and worsen even after months of treatment with medications and physiotherapy. Please do not worry. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Well, occasionally I have a dizzy spell. Nothing major but concerning. I am 5 9 , 175 lbs,, 62 years old and fairly fit and active. It occurs out of the blue and not necessarily from quickly getting up. I do suffer from high blood pressure but take Coversyl (8 mg daily). ### REPLY: First thing I need to know since when you are taking that medicine for your high BP. Because with covers initially you may get sudden dizziness on getting up, but it will subsequently get corrected on long term use. Another explanation of your symptoms may be due to some underlying heart block, for which you need to undergo at least an ECG and if required detail cardiac investigations.  If I were your treating physician I would have suggested you to consult a cardiologist for further work up. Hope I have answered your queries. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: for about the last 3 days i have experienced NUMBNESS AND TINGLING in the left index finger esp the tip. and today both my hands are dark red in discoloration and when i touch my left hand it feels esp. soft and slightly tingles wherever on the left hand i touch it. ### REPLY: Hello, I have studied your case. Due to compression of cervical nerve root there can be tingling numbness in your finger and pain.  I will advise you to MRI cervical spine for better diagnosis. You can take neurotrophic like pregabalin consulting your doctor. Till time, avoid lifting weights, Sit with support to back. You can consult physiotherapist for help. Physiotherapy like ultrasound and inferential therapy will give quick relief. I will advise you vitamin B12 supplement. Hope this answers your query. If you have additional questions or follow-up queries then please do not hesitate in writing to us. I will be happy to answer your queries. 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: my mother in law 63 years of age about 5ft 5in 190lbs on pd dialisis for the past six months had a history of high blood pressure, has recently been admitted to the ICU. She went to the ER with severe radial and throbbing pain in her head neck and upper back. she was also within the week put on Adavan to help her sleep. the nurse in the ER gave her IV medications of benedryl and something for pain. immidently after the color in her eyes were gone and she was twitching, speaking loud, and kept saying her shaken leg syndrome was the reason for it. at this time i left the ER being told that i will get a phone call around three in the morning to pick her up. I call the Hospital at three and they tell me she has been admitted to the ICU due to a medication reaction. Now five days later she is still in ICU on venelation and low blood pressure. they say she is making slow progress and they are lessening BP meds and weaning her off sedation. they guarentee me she will be on ventelation untill at least friday morning. ### REPLY: Robbing pain in upper back could be because she is on bed from long time, and have not moved around, as well she also has other issue as per your explanation that she is on dialysis, BP, and in its care due to medication reaction.  Now when I see her all issues as a whole I understand her body has become week due to age and on top of this her existing medical problem.  I suggest to advice the hospital staff to do some good physical therapy treatment also to mobilize her as well as to move her body at least in bed itself.  This should be done frequently when ever she is awake and need to push her little since she is week she will feel tired.  Better to perform under some nursing staff observation or physical therapist observation.  And don't worry along with her existing medical issue this back pain will also go away and if not do post it here again I will be happy to help you.  Take care. . ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I have been on Anastrozole since late 2012 for breast cancer. Last summer a nodule formed on top of my toe. It was surgically removed. 2 months ago a nodule,causing trigger finger formed at the base of my inner left thumb. I m in hand therapy for and had a cortisone shot.Yesterday I noticed a nodule at the 2nd joint of my right index finger. Could these nodules be a side effect of my medication? It seems suspicious that 3 have developed in such a short time. ### REPLY: HIT hank for asking to ChatDoctorI really appreciate your concern, the nodules that you have on your fingers are not because of the breast lesion or the medicine that you are taking for the breast malignancy, when you have first removed the nodules then this should have sent for histopathology, the finger lesion could be something else and that need to be examined properly keeping in mind the history of malignancy, take care and have nice day. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i have eczema from my child hood with breathing problem also I am a 22 years old student.i have eczema from my child hood.with that i have some breathing problem also. frequently i get cold and that results in bronchitis. other time i dont have much problems in breathing.usually i dont consult any doctors for that. 2 years before i consulted a doctor due to acute bronchitis. after treatment for bronchitis he suggest me to use a dry powder inhaler(rota haler, 3 tablets per day).but i didnt continue it. from last week i have the problem and i had visited a doctor. she gave me some tablets(deriphyllin,levocetrizine,levofloxacine)and an inhaler Aerocort( beclomethasone+salbutamol). i have a doubt about that inhale. should i use it daily or is it for when i feel problem in breathing? what should i do as a prevention against bronchitis?should i continue the inhaler after the problem is over? ### REPLY: According to Ayurveda this problem is related with Rasta(blood), rasa(lymph-?) & also with TRI dos has. From childhood, you are suffering from skin & bronchial problems, these 2 are well related with each other, as per the pathogenesis is considered. Any skin problem is due to deformity in blood+skin+mama(muscle)+tri-doshas. In asthmatic cases blood & vat ta(Vāyu) are the major dishes i.e. basic causes. A special treatment is required for all these mentioned, if you are thinking to take an ayurvedic medicine. The medicines which you are currently taking are only symptomatic. I think for complete recovery ayurvedic medicines are the best path-way for 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 have sle. For the last two days I have been running a fever in excess of 101 F. Im having shortness of breath and making rattling/wheezing noises when I breath. My doc did chest X-ray and WBC which were normal. She said well I hope you feel better. My allergist said I should go to er. What do you think ### REPLY: Hi, thank you for posting. Your symptoms make me think you suffer from Diffuse Bronchiolitis(lung inflammation). This is a hypersensitive disease, and it is appeared when the immune system is low. Diffuse Panbroncholitis is caused by bacterial or viral infections.However, to be sure for the diagnosis I recommend you: 1- Pulmonary Ct-scan.2- Complete blood count.3- Urine test.4- Lung function test. To treat this disease, I recommend Caroline antibiotics, expectorant medicines, anti-allergic medicines and painkillers. You should consult your pulmonologist. I hope you find this helpful. All the best. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: my mother had a cysotosopy of her kidney, the 2nd one.  After the stent was removed she had pain, pressure, then started having burning after urinating too.  She was tested and treated for a UTI, had a fever of 101.But now after a week on Cipro, she is having episodes of extreme pain, cant urinate for 2-3 hrs. , then when it finally lets loose, there are white particles in the urine.  Some fairly large.  It is like these are clogging up the uretha or uterer.  The dr. wants to put her on penicilin now, but 30 yrs ago she had a reaction to  a shot with a swollen arm.  She is prone to hives.  She has been diagnosed with renal pelvis kidney cancer, small amt. that is contained to the kidney. ### REPLY: Dear Ma'am, Sorry to hear about your mothers' problem. It appears that she has developed urinary tract infection following the cystoscopy. This is a common problem after cystoscopy and requires antibiotics. Her antibiotic should be changed according to the culture report. You can give her crisps to relieve the spasm and pain she is having. If she has had a penicillin reaction in the past, it should be avoided and some other .  Hoping for the best. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: I am experiencing pain in the lower part of my left leg. It aches like a toothache suddenly. I sometimes walk with a limp because of the pain. There are times that I have to take Tylenol or Advil for relief. I am concerned it could be a blood clot. ### REPLY: Hi, Causes of your difficulties may be neuropathy or ischemic issues. Neuropathic are seen in diabetics or injury of spine nerves.  If this is not your case then these symptoms are indicating circulatory problems in legs which are common in this age and there may be present atherosclerosis that obstructs blood vessels and causes pain and blisters to form.  You should do Doppler ultrasound of the leg or CT angiography to rule out such obstructive changes, and then it can be treated properly by medications or by surgical and radiological procedures. Also, you should have Aspirin and have elastic stockings applied, and should avoid cold environment and long walks. In most cases, it can be managed with medications, but sometimes surgery may be required in severe cases. 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 fiance and i have been trying to get pregnant for the past year now. Ever since my mirena slipped out since then i have had irregular periods. On 3/29 my.period lasted for 7 days n i just recently started again on 4/21 it lasted for 4 days last night we had unprotected sex so later on today i wipe there was a small pinkish amount of blood and a very small blood clot.now iam having mild cramps on my right side. What is going on ? Please help ### REPLY: Hi, Thanks for your query.  The chances of pregnancy have always been there because you are not using any type of contraception, and you had unprotected sex (on the 4th day of a cycle but no period is safe period).  Bleeding and cramps may be because of hormonal changes or because of pregnancy.  Consult a gynecologist to rule out pregnancy with urine, blood and ultrasonography.  GOOD LUCK.  Take care. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i had my breakfast this a.m. with yoghurt, pineapples and dragonfruit.  within minutes i  sense the itch around the arches of my palms and around my upper neck and inside of my ears. Whats wrong?  I ate the same stuff for breakfast yesterday a.m. but with no problem ### REPLY: HI, thanks for using  The allergic response can sometimes occur after the initial sensitization period. The body is initially exposed to the allergen and the reaction occurs at the other time it is used. You may not be allergic to all the components of this meal. You can either consider not using any of them or having allergy testing to determine which one would have caused your response. I hope this helps ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: Ive been having abdominal pain thats just recently sprung up. I have pain in my left shoulder and forearm, right in the middle of the upper quadrants of the abdomen, and what appears to be an indent in the upper right quadrant. I have also been having muscle pain in my legs but that is slight. Ive been through many tests and a pulmonologist is leaning towards asthma being my diagnosis, but Im not sure if thats the cause of the pain. ### REPLY: HI, Asthma can not cause pain in abdomen or leg. The pain in the upper abdomen can be due to pancreatitis, cholecystitis, gastric ulcer, colitis of transverse colon, The pain in the left shoulder and the forearm can be due to cervical spine problem. And You need the investigations of MRI cervical spine, CT scan of the abdomen as it will show the lower chest too. Consult your Physician as he would coordinate all the varied symptoms and findings and help you to come to a diagnosis and then may refer you accordingly. ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: i dont have insurance and my wisdom teeth are killing me. i have tried orajel, tylenol and baby teeth tablets. they work for a little bit but then the pain returns and its starting to affect my sleep. what can i do to help ease the pain until i can afford to get them removed? ### REPLY: Hello, Thanks for consulting ChatDoctorRead your query, as you have pain in wisdom tooth this pain can be due to carious tooth, decayed tooth, or impacted tooth. Don't worry I will suggest you to do warm saline rinses 2 -3 times a day, and you can take medicine like Cap. Amoxicillin and analgesic like Diclofenac sodium or Petrol DT by consulting with your local doctor. Consult your dentist and go for its treatment. Hope this will help you ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: How can I share my feelings? I dont know how to share/express how i feel. Usually its not a problem i dont have many things that bother me. I have a very very long fuse and i hardly get upset. I tend to keep things to myself if that makes sence. In this case i want to share my feelings with my fiance. We have been togeather for about 6years, and he knows when somethings wrong... he usually stats with whats the matter? Whats wrong? ect My problem is i cant really answer the question. Its like i dont know whats wrong. For example he will say something and it bothers me, but im not sure why. I used to just ignore it, lately ill sit there for a while and say i dont know how i feel about that. I feel like i have reasons to be upset but i dont know how to verbalise them. I know its a problem, i want to fix it. But i dont know how to start. How to share without feeling stupid? Or sound like im complaining. ### REPLY: Hello......... Thanks for your query. The lack of ability to articulate ones thoughts/feelings is a delicate issue. I would suggest you to seek help from a trained clinical psychologist who can train you in better social skills, assertiveness training and undertake a behavioral analysis to suggest you remedies. This issue can lead to anxiety disorders/depression. Hope you found the information useful. 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: HiI am a type 2 diabetic and on Diamin 500mg. I try my best to keep a low carb intake and I am generally successful in keeping my blood sugar levels below 180 mg/dl (10 mmol/L) however I have dawn phenomenon and I have it bad. I wake up in the mornings with an average level of 280 mg/dl or above, and then struggle the rest of the day to get it down to acceptable levels. Is there anything I can do? ### REPLY: Welcome to . Certainly your sugars are very high in the morning, and you already know about the dawn phenomenon. I hope you got your endocrinologist on board to help you. Stress is the biggest cause for this along with poorly controlled diabetes. Try to take your evening meal early between 5-6 pm and have a snack prior to going to bed. Take insulin per carb count. This will certainly avoid hypoglycemia at night and hyperglycemia during the morning. Other thing you should do is to keep you sugar levels little high before going to sleep that means decreasing the dose of meal time insulin during the supper time. Do regular exercise after eating to prevent post prodigal high sugars. Good luck ### END


Below is an instruction that describes a task, paired with a human input that provides further context. The task is to simulate a doctor-patient consultation. The human input will be a description of symptoms or health concerns from the patient's perspective. Write a response (reply) that appropriately completes the request, providing an accurate, thoughtful, and empathetic response that a real doctor might give based on the information provided. Never use the words 'Chat Doctor' in your response ### HUMAN: my wife fall on ice and pain start two days after she fell,pain starts in right upper leg ,after that is increasing in pain and burning sensation,she had already steroides shots and some therapy ,also she had x rays and mri done ,what i can do to relief her burning and pain in her right knee? she is taken now norco and using some burning cream that happen in two weeks all ### REPLY: Hi, thank you for providing the brief history of your wife. Since you mentioned MRI & X-ray are done you haven't mentioned which region and what was the conclusion given by the radiologist. You didn't mention either where the steroid was given. let's assume that your wife had injury in the knee and the treatment was directed towards the knee. So now as you say she is having burning sensation that may be due to the steroid dose which is at times common. The effect of burning sensation stays for 72 hours +/-. Post that the burning sensation comes down, and the pain is lowered. Since you are at home you can help her by giving icing around the knee joint, and it will help her to an extent by desensitizing the skin texture. Hope this helps with the grace of God I wish your wife a speedy recovery ### END