Instruction: Sorry to hear about how much has happened to you in such quick progression  I can imagine it was and continues to be very jarringBased on your description and recollection of the events, you went into severe anaphylactic shock which likely would have been fatal had your husband/daughter/EMS not been around. Will reiterate what has been said already to keep an epipen on you at all times moving forwardOnly other thing Id add to whats been said is you likely may be a candidate for venom therapy. However, it sounds like theres still quite a few things going on so take it one day at a time. Once everything else has settled, you may want to consider connecting with an allergist to receive venom testing  in Canada the 5 main sting tests we do are on honeybees, wasps, yellow hornets, yellowjackets, and white faced hornets. If you test positive for a stinging insect, venom immunotherapy can be 98% effective for the rest of your lifetime. That being said, its not cheap, and it can take 3-5 years of injections at the very leastWishing you all the best in your recovery!

Output: In reference to your last sentence - your mast cells must work normally for you to get anaphylactic shock in the first place, the issue is that your immune system is sensitised to the venom in the sting. Given that there is no definite way that you can guarantee avoidance of the same allergen in the future you should be referred to an immunologist for consideration of a desensitisation program

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry to hear about how much has happened to you in such quick progression  I can imagine it was and continues to be very jarringBased on your description and recollection of the events, you went into severe anaphylactic shock which likely would have been fatal had your husband/daughter/EMS not been around. Will reiterate what has been said already to keep an epipen on you at all times moving forwardOnly other thing Id add to whats been said is you likely may be a candidate for venom therapy. However, it sounds like theres still quite a few things going on so take it one day at a time. Once everything else has settled, you may want to consider connecting with an allergist to receive venom testing  in Canada the 5 main sting tests we do are on honeybees, wasps, yellow hornets, yellowjackets, and white faced hornets. If you test positive for a stinging insect, venom immunotherapy can be 98% effective for the rest of your lifetime. That being said, its not cheap, and it can take 3-5 years of injections at the very leastWishing you all the best in your recovery!. ### Response: In reference to your last sentence - your mast cells must work normally for you to get anaphylactic shock in the first place, the issue is that your immune system is sensitised to the venom in the sting. Given that there is no definite way that you can guarantee avoidance of the same allergen in the future you should be referred to an immunologist for consideration of a desensitisation program.


Instruction: Could a Physician clarify as to why Cardiology have told GP to omit Ramipril until blood tests and ECG have taken place.34 year old male BP 160/110 (Schizophrenia/Meds Olanzapine/Valproic Acid/Citalopram)GP prescribed Ramipril 1.25mg, he started to take though 6 days later a call from the surgery saying omit Ramipril until above has been done. Booked for 2 weeks time, but has left (my son) with no BP moderation. Very worried as seems so high!

Output: Your doctor will likely be able to answer this question in much more detail, but often before starting an ACE inhibitor (which ramipril is one) it's important to make sure a patient has normal/stable kidney function and potassium. A blood pressure of 160/110 isn't imminently dangerous, no reason to make hasty decisions.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Could a Physician clarify as to why Cardiology have told GP to omit Ramipril until blood tests and ECG have taken place.34 year old male BP 160/110 (Schizophrenia/Meds Olanzapine/Valproic Acid/Citalopram)GP prescribed Ramipril 1.25mg, he started to take though 6 days later a call from the surgery saying omit Ramipril until above has been done. Booked for 2 weeks time, but has left (my son) with no BP moderation. Very worried as seems so high!. ### Response: Your doctor will likely be able to answer this question in much more detail, but often before starting an ACE inhibitor (which ramipril is one) it's important to make sure a patient has normal/stable kidney function and potassium. A blood pressure of 160/110 isn't imminently dangerous, no reason to make hasty decisions..


Instruction: Im a 40(F), 410 and 113 pounds. I was diagnosed with hypertension in 2018, its been u fee control with Lisinopril HCTZ 20-12.5 with no issues. I was diagnosed with ADHD in December 2019 and put on methylphenidate 20 mg(2 in the morning and 1 at 1:00 pm). I always checked my blood pressure around lunch to make sure it was t too high, I never had an issue. I was diagnosed with Hashimotos last October and started seeing a functional medicine doctor last December. I was put on NP Thyroid 30 mg, moved up to 60, then doubled to 120 by June. I have had labs drawn every 3 months since December. I felt really good until around the beginning of August. My TSH was <.02 but T3 and T4 were in range so she reduced my medication to 105 mg a day.Since I was checking my BP for it being to high, I didnt realize it was going down. I happened to miss my afternoon dose of the methylphenidate and my nephrologist commented is was a little low. This was the last week of August. I had some scans done by my cardiologist the next week. I mentioned my fatigue and she suggested I stop the methylphenidate for a few days to see if that helped and to follow up with her in 2 weeks. The next few days my BP just completely went down, I ended up in the ER twice because of it. The did CT scans the first time I went and I had kidney stones. The second time I went, they though it was a kidney infection. I went back in the methylphenidate because it kept my BP up. I followed up with my cardiologist. She said everything was fine cardiology wise and to continue to take the methylphenidate without the lisinopril until I could find out the cause for the drop.At this point a reached out to my thyroid doctor to see if anything thyroid related could cause this and she said no because usually signs of over medication is high blood pressure. She said to let her know what the urologist and nephrologist said.I made an appointment with my urologist and he did a cystoscopy and ureteroscopy based off the CT from the ER visit but he found nothing wrong and no stones. The nephrologist also found nothing wrong.So last Wednesday, I finally get her to run my TSH, Free T3 and Free T4. I got the results back yesterday. My T4 is in range. TSH is <.01. T3 is 5.3. I ask about T3 thyrotoxicosis and again she says that would cause high BP. She wants me to not take my thyroid meds for 2 days then go down to 90 mg.This has been going on for 2 months. The constant up and down with my BP has me struggling. My vision is getting blurry. Im exhausted. Do I wait it out to see if what she says or should I go to the ER?

Output: With hyperthyroidism, hypertension is definitely more common, but this is not always the case. In acute crises of hyperthyroidism, blood pressure can also be lowered, particularly diastolic. In general, I'm pretty sure the problem here is the interaction between the various medications you are taking. The thyroid medication is largely overdosed considering that TSH value, and has been increased quite randomly over the various months. Also, I am not a fan of NP thyroid, since adjusting the dosage is difficult with that medication. Until the TSH is in range, we can't be 100% sure thyroid is not responsible. Look for an endocrinologist.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im a 40(F), 410 and 113 pounds. I was diagnosed with hypertension in 2018, its been u fee control with Lisinopril HCTZ 20-12.5 with no issues. I was diagnosed with ADHD in December 2019 and put on methylphenidate 20 mg(2 in the morning and 1 at 1:00 pm). I always checked my blood pressure around lunch to make sure it was t too high, I never had an issue. I was diagnosed with Hashimotos last October and started seeing a functional medicine doctor last December. I was put on NP Thyroid 30 mg, moved up to 60, then doubled to 120 by June. I have had labs drawn every 3 months since December. I felt really good until around the beginning of August. My TSH was <.02 but T3 and T4 were in range so she reduced my medication to 105 mg a day.Since I was checking my BP for it being to high, I didnt realize it was going down. I happened to miss my afternoon dose of the methylphenidate and my nephrologist commented is was a little low. This was the last week of August. I had some scans done by my cardiologist the next week. I mentioned my fatigue and she suggested I stop the methylphenidate for a few days to see if that helped and to follow up with her in 2 weeks. The next few days my BP just completely went down, I ended up in the ER twice because of it. The did CT scans the first time I went and I had kidney stones. The second time I went, they though it was a kidney infection. I went back in the methylphenidate because it kept my BP up. I followed up with my cardiologist. She said everything was fine cardiology wise and to continue to take the methylphenidate without the lisinopril until I could find out the cause for the drop.At this point a reached out to my thyroid doctor to see if anything thyroid related could cause this and she said no because usually signs of over medication is high blood pressure. She said to let her know what the urologist and nephrologist said.I made an appointment with my urologist and he did a cystoscopy and ureteroscopy based off the CT from the ER visit but he found nothing wrong and no stones. The nephrologist also found nothing wrong.So last Wednesday, I finally get her to run my TSH, Free T3 and Free T4. I got the results back yesterday. My T4 is in range. TSH is <.01. T3 is 5.3. I ask about T3 thyrotoxicosis and again she says that would cause high BP. She wants me to not take my thyroid meds for 2 days then go down to 90 mg.This has been going on for 2 months. The constant up and down with my BP has me struggling. My vision is getting blurry. Im exhausted. Do I wait it out to see if what she says or should I go to the ER?. ### Response: With hyperthyroidism, hypertension is definitely more common, but this is not always the case. In acute crises of hyperthyroidism, blood pressure can also be lowered, particularly diastolic. In general, I'm pretty sure the problem here is the interaction between the various medications you are taking. The thyroid medication is largely overdosed considering that TSH value, and has been increased quite randomly over the various months. Also, I am not a fan of NP thyroid, since adjusting the dosage is difficult with that medication. Until the TSH is in range, we can't be 100% sure thyroid is not responsible. Look for an endocrinologist..


Instruction: Thank you. I was taking Jaimiess birth control until mid-July. The functional medicine doctor kept suggesting I get off of it to help get my hormone levels up since I was only on it to lighten my periods. From what I read, the estrogen acts as an inhibitor for the thyroid medicine, which would explain why the dosage needed to be increased so much before it started working. Then I went off the birth control and the thyroid meds just went wild. I asked her if that could possibly be a factor but she said no. I am now also wondering if my hypertension was caused by the birth control. Hypertension runs in my family so I just assumed that was the reason. I had no idea birth control could cause that. Im looking for an endocrinologist but the 6 Ive called, with good reviews, are at least 3 months out. Im debating if I should go back on the pill so I can get my BP back up for now, then come off of it under the supervision of an endocrinologist. My cardiologist said, shed rather it be high(obviously not too high) that can brought down with meds, than it be too low. I just know I cannot continue with the methylphenidate like I have. Again, thank you for your response.

Output: Estrogen has an effect on thyroid function by altering the hormone-binding protein, but generally the problem is when you stop therapy or go through menopause. It is also true that the pill can increase blood pressure, but not so much that you go from hypertension to hypotension. The effect of the pill is modest. I think if therapies are the culprits, it depends more on the triad thyroid hormone-antihypertensive - ADHD meds . I don't think it's a good idea to start hormone therapy again just to control blood pressure, honestly.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you. I was taking Jaimiess birth control until mid-July. The functional medicine doctor kept suggesting I get off of it to help get my hormone levels up since I was only on it to lighten my periods. From what I read, the estrogen acts as an inhibitor for the thyroid medicine, which would explain why the dosage needed to be increased so much before it started working. Then I went off the birth control and the thyroid meds just went wild. I asked her if that could possibly be a factor but she said no. I am now also wondering if my hypertension was caused by the birth control. Hypertension runs in my family so I just assumed that was the reason. I had no idea birth control could cause that. Im looking for an endocrinologist but the 6 Ive called, with good reviews, are at least 3 months out. Im debating if I should go back on the pill so I can get my BP back up for now, then come off of it under the supervision of an endocrinologist. My cardiologist said, shed rather it be high(obviously not too high) that can brought down with meds, than it be too low. I just know I cannot continue with the methylphenidate like I have. Again, thank you for your response.. ### Response: Estrogen has an effect on thyroid function by altering the hormone-binding protein, but generally the problem is when you stop therapy or go through menopause. It is also true that the pill can increase blood pressure, but not so much that you go from hypertension to hypotension. The effect of the pill is modest. I think if therapies are the culprits, it depends more on the triad thyroid hormone-antihypertensive - ADHD meds . I don't think it's a good idea to start hormone therapy again just to control blood pressure, honestly..


Instruction: My son 3 years old recently diagnosed with autism. He was sitting near me suddenly he started to cry but with very low energy. I looked at him and his face was blue. I quickly grabbed him and he fainted I put some cold water on his face and ran to the balcony to get some fresh air. Then his face turned to very white and he started to open his eyes then he fainted again, on my way out of the building he woke up and slowly got some energy back. I arrived at the ER Almost 30 minutes after this happened, they did blood gases tests and blood counts then after an hour they said all is good but I need to see a cardiology to make sure nothing is wrong with his heart. I took a look at the test results and I think there is something wrong and the tests were not ok. I uploaded a screenshot of the tests. TAM KAN SAYIMI = FULL BLOOD COUNT (Count or percentage) KAN GAZLERI = BLOOD GASES. What should I do now? TestsEdit: Now (after 7 hours in the ER) they gave him the 3rd "fever shot" in his serum. The heartbeat is now stable in 160s after being stable at 180s but it sky rocketed twice to 241 and 250 bpm and when he cries it goes to 200s until he comes doen. They say it may be a flu infection.

Output: I believe one of those is chloride. It's a hair above reference range and is fine.The other two are oxygenated vs. deoxygenated hemoglobin. They appear to be applying arterial reference range values to a venous sample, making them look very aberrant. These are also fine.Lactate being slightly elevated is super common in kids also. Nursing often struggle to get good samples with limited tourniquet use, and the lactate is frequently a tad elevated.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My son 3 years old recently diagnosed with autism. He was sitting near me suddenly he started to cry but with very low energy. I looked at him and his face was blue. I quickly grabbed him and he fainted I put some cold water on his face and ran to the balcony to get some fresh air. Then his face turned to very white and he started to open his eyes then he fainted again, on my way out of the building he woke up and slowly got some energy back. I arrived at the ER Almost 30 minutes after this happened, they did blood gases tests and blood counts then after an hour they said all is good but I need to see a cardiology to make sure nothing is wrong with his heart. I took a look at the test results and I think there is something wrong and the tests were not ok. I uploaded a screenshot of the tests. TAM KAN SAYIMI = FULL BLOOD COUNT (Count or percentage) KAN GAZLERI = BLOOD GASES. What should I do now? TestsEdit: Now (after 7 hours in the ER) they gave him the 3rd "fever shot" in his serum. The heartbeat is now stable in 160s after being stable at 180s but it sky rocketed twice to 241 and 250 bpm and when he cries it goes to 200s until he comes doen. They say it may be a flu infection.. ### Response: I believe one of those is chloride. It's a hair above reference range and is fine.The other two are oxygenated vs. deoxygenated hemoglobin. They appear to be applying arterial reference range values to a venous sample, making them look very aberrant. These are also fine.Lactate being slightly elevated is super common in kids also. Nursing often struggle to get good samples with limited tourniquet use, and the lactate is frequently a tad elevated..


Instruction: Looking for clarification, are you recommending a tighter tourniquet to ensure a more accurate lactate level? I am a nurse...

Output: No. Limiting tourniquet use as much a possible is best for lactate.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Looking for clarification, are you recommending a tighter tourniquet to ensure a more accurate lactate level? I am a nurse.... ### Response: No. Limiting tourniquet use as much a possible is best for lactate..


Instruction: Okay thats traditionally been my understanding. I just wanted to make sure there wasnt some other thought process. Thank you.

Output: No. Nothing in these labs is spooky.Has he had any gastrointestinal symptoms?"Toddler doing weird shit and passing out" is sometimes from intussusception, and we have a low threshold to do US looking for this.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Okay thats traditionally been my understanding. I just wanted to make sure there wasnt some other thought process. Thank you.. ### Response: No. Nothing in these labs is spooky.Has he had any gastrointestinal symptoms?"Toddler doing weird shit and passing out" is sometimes from intussusception, and we have a low threshold to do US looking for this..


Instruction: 37F, 5'7, 128lbs, Caucasian. Primary complaint is increased resting heart rate, palpitations at night that wake me as I'm trying to fall asleep and fatigue.Symptoms started 06/15/2022 with one severe episode of diarrhea. After that I was feeling very fatigued. On 06/22/2022 I was very dizzy and almost fainted, my heart rate was elevated (120-140) and I had tingling/numbness in my hands and feet. Went to the ED. Only thing they found was a Potassium of 2.6, they said my ECG was "inline with my low Potassium". They gave me IV Potassium, Magnesium and saline. Got my Potassium up to 3.8 and sent me home.Three days later I had a similar episode and went back to the ER (I thought maybe my Potassium was low again or that maybe it was my heart). They did another ECG and said my heart was fine. Potassium was fine. No other abnormalities. ER doc said maybe viral or Thyroid.In the weeks after my ER visit I was still feeling very weak and my heart rate was still elevated (80's laying, 90's sitting, 110 standing). I was still dizzy. My stomach was destroyed, I couldn't eat without getting severe reflux and I just wasn't hungry. I thought it could be POTS. My symptoms were worse in the morning and in the evenings I felt almost normal.Symptoms slowly started to improve as I started breathing/meditation exercises and started getting back into training and eating. (I lost almost 10 pounds during this because I just couldn't eat).I then started to experience adrenaline surges where my heart would race, I would feel very jittery, nauseous and I would have to pee many times. At first the surges happened only in the morning, but later started happening at night. Only one a day. The surges would leave me very tired. I had very poor exercise tolerance.I saw my PCP and we ran many tests, CBC, BMP, Full Thyroid Panel, T3 and antibodies, H.Pylori, AM cortisol, Catecholamines, PTH, Heavy metals, MTHFR, DHEA serum, ACTH plasma, celiac panel, Homocysteine, CRP, 25 hour Urine Catecholamines and Metanephrines, Folate RBC and serum and B12. The only "abnormal" tests are below:Alkaline Phosphatase low 32 (this has always been low for me).High epinephrine 67 (I was having a "surge" that morning, I am not afraid of blood draws).Heterozygous C665C MTHFRHigh am Cortisol 21.2 (I was having a "surge" that morning, I am not afraid of blood draws).DHEA 686 (she said it was normal but it seems high for me based on my age).24 hour urine Normetanephrine 122 lowFolate RBC 1248 (for context)Folate serum >20 (for context)B12 852 (for context)Background information: When this all started, my husband and I were trying to conceive and I had been taking 800mcg of Methylfolate to prevent neural tube defects since May. The day I ended up in the ER was the day I got my period. I thought that maybe, based on my MTHFR mutation, I had a bad reaction/poor tolerance to the Methylfolate so I stopped taking it 2 weeks ago. My symptoms seemed to align with too much Methylfolate, based on other peoples reports.My biggest complaint now is the palpitations at night. I keep getting jolted awake several times as I am falling asleep. This lasts an hour until I fall asleep until morning. Palpitations are felt when I am lying on my side and sometimes when I lie flat on my back. I have headaches off and on and still feel like something isn't right, like my body cannot relax. I also get this feeling of pressure in my head. I don't have any shortness of breath except for when I am jolted awake at night.I am not an anxious person thought I am certain these issues have caused worries. I am active (strength training three times a week, assault bike workouts and lots of walking/hiking/paddleboarding). I do Olympic lifting for fun but haven't gotten back to that yet. I eat paleo-ish, low carb, Weston A. Price though I am trying to incorporate more carbs into my diet. I take Magnesium Glycinate at night, probiotics, Vitamin D and Cod Liver Oil. I practice good sleep hygiene. I don't lead a stressful life. I have a cardiology appointment at the end of August.Any input would be greatly appreciated as I have already spent so much money on all this, I need to be efficient with my resources.Im thinking that something really messed me up, maybe the Methylfolate combined with a stomach bug? I had COVID in January, maybe that has something to do with it. Will this likely resolve on its own?Thanks in advance!

Output: I dont think methyl folate has anything to do with your symptoms. My hypothesis is that the first occurrence sensitised you and made you more introspective. Fear of something can cause tachycardia and introspection can make you notice your heart beat, where you previously wouldnt have noticed it.Relaxation exercises, especially breathing exercises and a distraction from your own thoughts via audio book or podcast might be helpful. 24h ECG could objectify your symptoms, but Im not sure thats a good idea. Maybe try it for a week or so and get back to me, if it doesnt help? Cant promise Ill immediately respond, but I check up on Reddit regularly :)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 37F, 5'7, 128lbs, Caucasian. Primary complaint is increased resting heart rate, palpitations at night that wake me as I'm trying to fall asleep and fatigue.Symptoms started 06/15/2022 with one severe episode of diarrhea. After that I was feeling very fatigued. On 06/22/2022 I was very dizzy and almost fainted, my heart rate was elevated (120-140) and I had tingling/numbness in my hands and feet. Went to the ED. Only thing they found was a Potassium of 2.6, they said my ECG was "inline with my low Potassium". They gave me IV Potassium, Magnesium and saline. Got my Potassium up to 3.8 and sent me home.Three days later I had a similar episode and went back to the ER (I thought maybe my Potassium was low again or that maybe it was my heart). They did another ECG and said my heart was fine. Potassium was fine. No other abnormalities. ER doc said maybe viral or Thyroid.In the weeks after my ER visit I was still feeling very weak and my heart rate was still elevated (80's laying, 90's sitting, 110 standing). I was still dizzy. My stomach was destroyed, I couldn't eat without getting severe reflux and I just wasn't hungry. I thought it could be POTS. My symptoms were worse in the morning and in the evenings I felt almost normal.Symptoms slowly started to improve as I started breathing/meditation exercises and started getting back into training and eating. (I lost almost 10 pounds during this because I just couldn't eat).I then started to experience adrenaline surges where my heart would race, I would feel very jittery, nauseous and I would have to pee many times. At first the surges happened only in the morning, but later started happening at night. Only one a day. The surges would leave me very tired. I had very poor exercise tolerance.I saw my PCP and we ran many tests, CBC, BMP, Full Thyroid Panel, T3 and antibodies, H.Pylori, AM cortisol, Catecholamines, PTH, Heavy metals, MTHFR, DHEA serum, ACTH plasma, celiac panel, Homocysteine, CRP, 25 hour Urine Catecholamines and Metanephrines, Folate RBC and serum and B12. The only "abnormal" tests are below:Alkaline Phosphatase low 32 (this has always been low for me).High epinephrine 67 (I was having a "surge" that morning, I am not afraid of blood draws).Heterozygous C665C MTHFRHigh am Cortisol 21.2 (I was having a "surge" that morning, I am not afraid of blood draws).DHEA 686 (she said it was normal but it seems high for me based on my age).24 hour urine Normetanephrine 122 lowFolate RBC 1248 (for context)Folate serum >20 (for context)B12 852 (for context)Background information: When this all started, my husband and I were trying to conceive and I had been taking 800mcg of Methylfolate to prevent neural tube defects since May. The day I ended up in the ER was the day I got my period. I thought that maybe, based on my MTHFR mutation, I had a bad reaction/poor tolerance to the Methylfolate so I stopped taking it 2 weeks ago. My symptoms seemed to align with too much Methylfolate, based on other peoples reports.My biggest complaint now is the palpitations at night. I keep getting jolted awake several times as I am falling asleep. This lasts an hour until I fall asleep until morning. Palpitations are felt when I am lying on my side and sometimes when I lie flat on my back. I have headaches off and on and still feel like something isn't right, like my body cannot relax. I also get this feeling of pressure in my head. I don't have any shortness of breath except for when I am jolted awake at night.I am not an anxious person thought I am certain these issues have caused worries. I am active (strength training three times a week, assault bike workouts and lots of walking/hiking/paddleboarding). I do Olympic lifting for fun but haven't gotten back to that yet. I eat paleo-ish, low carb, Weston A. Price though I am trying to incorporate more carbs into my diet. I take Magnesium Glycinate at night, probiotics, Vitamin D and Cod Liver Oil. I practice good sleep hygiene. I don't lead a stressful life. I have a cardiology appointment at the end of August.Any input would be greatly appreciated as I have already spent so much money on all this, I need to be efficient with my resources.Im thinking that something really messed me up, maybe the Methylfolate combined with a stomach bug? I had COVID in January, maybe that has something to do with it. Will this likely resolve on its own?Thanks in advance!. ### Response: I dont think methyl folate has anything to do with your symptoms. My hypothesis is that the first occurrence sensitised you and made you more introspective. Fear of something can cause tachycardia and introspection can make you notice your heart beat, where you previously wouldnt have noticed it.Relaxation exercises, especially breathing exercises and a distraction from your own thoughts via audio book or podcast might be helpful. 24h ECG could objectify your symptoms, but Im not sure thats a good idea. Maybe try it for a week or so and get back to me, if it doesnt help? Cant promise Ill immediately respond, but I check up on Reddit regularly :).


Instruction: Fair enough. I am and have been meditating and doing breathwork. I will continue. Any hypothesis on why the first occurrence happened in the first place?

Output: Hm, maybe its not really anything about your body changing, but your perception of it having changed. Concentrate on your belly button, for example. Normally, we dont really consciously feel the pulse there, but if you concentrate on it long enough, it will feel really strong. Its there all the time, but we only notice it, if we actively look for it.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Fair enough. I am and have been meditating and doing breathwork. I will continue. Any hypothesis on why the first occurrence happened in the first place?. ### Response: Hm, maybe its not really anything about your body changing, but your perception of it having changed. Concentrate on your belly button, for example. Normally, we dont really consciously feel the pulse there, but if you concentrate on it long enough, it will feel really strong. Its there all the time, but we only notice it, if we actively look for it..


Instruction: I understand what you are saying, I just don't know that it's true. But, I will go with that theory and see what happens. Thank you for taking the time to reply to my post.

Output: Neither of us know if its true. I only have your explanation of everything happening to you, there is no blood work, no images, no test results available to me here. Im trying to give you a direction to work in and my opinion based on the information given. There is a reason this isnt designed as an actual treatment or doctors visit, here :) That said, I hope you get well soon!

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I understand what you are saying, I just don't know that it's true. But, I will go with that theory and see what happens. Thank you for taking the time to reply to my post.. ### Response: Neither of us know if its true. I only have your explanation of everything happening to you, there is no blood work, no images, no test results available to me here. Im trying to give you a direction to work in and my opinion based on the information given. There is a reason this isnt designed as an actual treatment or doctors visit, here :) That said, I hope you get well soon!.


Instruction: Well, here's my week update. I am definitely continuing to feel better. I told myself that whatever seems to be happening to me is not something that I need to worry about. I am continuing to do my breathing/meditation exercises 1-3 times a day. I am exercising daily (strength training, pushing the sled and riding the assault bike, usually 10 minute TABATA). I drink water with liquid IV daily, am eating well and sleeping well. I sauna every other day. My resting heart rate is still consistently elevated, about 100 - 110 standing. I used to be around the 70 range standing. I've only had one adrenaline surge in the last week. I do think that changing my state of mind has helped me avoid any extra stress but I do still feel like im not my usual energetic self. Like my body is working harder.

Output: First of all,thats great to hear. In addition to that, a physical stress response, where your body constantly readies for fight or flight will sap energy from you. Are your palpitations still there?Your cardiology appointment isnt far now, that will hopefully help with stress, too, or maybe allow for more specific advice.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Well, here's my week update. I am definitely continuing to feel better. I told myself that whatever seems to be happening to me is not something that I need to worry about. I am continuing to do my breathing/meditation exercises 1-3 times a day. I am exercising daily (strength training, pushing the sled and riding the assault bike, usually 10 minute TABATA). I drink water with liquid IV daily, am eating well and sleeping well. I sauna every other day. My resting heart rate is still consistently elevated, about 100 - 110 standing. I used to be around the 70 range standing. I've only had one adrenaline surge in the last week. I do think that changing my state of mind has helped me avoid any extra stress but I do still feel like im not my usual energetic self. Like my body is working harder.. ### Response: First of all,thats great to hear. In addition to that, a physical stress response, where your body constantly readies for fight or flight will sap energy from you. Are your palpitations still there?Your cardiology appointment isnt far now, that will hopefully help with stress, too, or maybe allow for more specific advice..


Instruction: I'm(M17) 176cm(5'9) and 48kg(105 lb), my BMI is 15.5 and I'm REALLY skinny, everytime somebody sees me they get either scared or concerned, and at the beginning i said i was fine but now I really feel like I need help. We contacted many different doctors in my city(I live in Italy) and nobody knows what my problem is.. we(my family and I) did many exams looking for problems with metabolism and we got nothing, we were thinking to get my self hospitalized (as you know, it's free in Italy xD) but they asked us a kind of "hint" of what medical department(like "cardiology" i don't know if it's correct in English) i should go in, and our doctor told us he'd inform himself but didn't tell us anything.So my questions are, what could be my problem, what department should I get hospitalized in and in general what should I do?Any answer is appreciated and I'll try to answer every question

Output: "You're not eating enough food" is the answer about 98% of the time.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm(M17) 176cm(5'9) and 48kg(105 lb), my BMI is 15.5 and I'm REALLY skinny, everytime somebody sees me they get either scared or concerned, and at the beginning i said i was fine but now I really feel like I need help. We contacted many different doctors in my city(I live in Italy) and nobody knows what my problem is.. we(my family and I) did many exams looking for problems with metabolism and we got nothing, we were thinking to get my self hospitalized (as you know, it's free in Italy xD) but they asked us a kind of "hint" of what medical department(like "cardiology" i don't know if it's correct in English) i should go in, and our doctor told us he'd inform himself but didn't tell us anything.So my questions are, what could be my problem, what department should I get hospitalized in and in general what should I do?Any answer is appreciated and I'll try to answer every question. ### Response: "You're not eating enough food" is the answer about 98% of the time..


Instruction: Add a couple of glasses of sustagen/ensure and a few spoonfuls of peanut butter to your daily intake (in addition to everything you already eat), if you still havent gained any weight after a few months then I would see a gastroenterologist to check for malabsorption.Well, I'm not the 98% I eat enought I'm quantity and i get all the nutrients i would need, yet i can't gain any weight nor muscle. We've been struggling with his problem for a while and it's getting always worse.. i grew 10cm in about 1 year and a half while not gaining any weight, i actually lost weight. I get it that many people jump to that conclusion, but I'm 100% sure it's not that

Output: How many calories per day are you eating?What brand of food scale are you using?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Add a couple of glasses of sustagen/ensure and a few spoonfuls of peanut butter to your daily intake (in addition to everything you already eat), if you still havent gained any weight after a few months then I would see a gastroenterologist to check for malabsorption.Well, I'm not the 98% I eat enought I'm quantity and i get all the nutrients i would need, yet i can't gain any weight nor muscle. We've been struggling with his problem for a while and it's getting always worse.. i grew 10cm in about 1 year and a half while not gaining any weight, i actually lost weight. I get it that many people jump to that conclusion, but I'm 100% sure it's not that. ### Response: How many calories per day are you eating?What brand of food scale are you using?.


Instruction: Don't know exactly, but I can estimate about 2.6k calories a day, altough some days it may be Less and some a lot more

Output: Also, you can't say it's "100% not that" when you haven't ever measured your calorie intake.It's like saying your checking account is getting lower and lower and you don't know why, but you've also not looked at the math for your income vs. expenditures."You're not earning enough money for how much you spend."Nah, can't be that! I'm certain."Have you actually looked at you budget?"Nope.Unless you have some malabsorption disorder where you can't absorb nutrients (these people have constant diarrhea, gas, belly pain, and even oil in their stool), you just aren't eating enough calories.That's not enough.Young men, especially active young men, typically need 3,000-4,000 kcal to gain weight.Anything in the low or mid 2,000s isn't going to cause weight gain.This isn't a medical mystery. Eat more food and workout. You need r/gainit, not an inpatient stay (assuming no eating disorder).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Don't know exactly, but I can estimate about 2.6k calories a day, altough some days it may be Less and some a lot more. ### Response: Also, you can't say it's "100% not that" when you haven't ever measured your calorie intake.It's like saying your checking account is getting lower and lower and you don't know why, but you've also not looked at the math for your income vs. expenditures."You're not earning enough money for how much you spend."Nah, can't be that! I'm certain."Have you actually looked at you budget?"Nope.Unless you have some malabsorption disorder where you can't absorb nutrients (these people have constant diarrhea, gas, belly pain, and even oil in their stool), you just aren't eating enough calories.That's not enough.Young men, especially active young men, typically need 3,000-4,000 kcal to gain weight.Anything in the low or mid 2,000s isn't going to cause weight gain.This isn't a medical mystery. Eat more food and workout. You need r/gainit, not an inpatient stay (assuming no eating disorder)..


Instruction: Yes, but I don't think it should cause this much weight loss either, as well as the fast loss of muscle.I'll try eating even more as you told me.. even tho I'm still skeptical about it, as me and my brother eat pretty much the same things yet he's alright(skinny but not on the same level as me)

Output: That's literally the only answer. If you've been evaluated for metabolic disorders, malignancy, etc, the only thing that will make you gain weight is eating more calories.Even moreTo clarify, mid 2,000s is not a lot of food for a teenage boy. If that's an accurate estimate at all, is not surprising you're not gaining weight. You're not eating a lot to start with.Eating the same amount of food won't make you gain weightEating less food won't make you gain weight.You must eat more food.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes, but I don't think it should cause this much weight loss either, as well as the fast loss of muscle.I'll try eating even more as you told me.. even tho I'm still skeptical about it, as me and my brother eat pretty much the same things yet he's alright(skinny but not on the same level as me). ### Response: That's literally the only answer. If you've been evaluated for metabolic disorders, malignancy, etc, the only thing that will make you gain weight is eating more calories.Even moreTo clarify, mid 2,000s is not a lot of food for a teenage boy. If that's an accurate estimate at all, is not surprising you're not gaining weight. You're not eating a lot to start with.Eating the same amount of food won't make you gain weightEating less food won't make you gain weight.You must eat more food..


Instruction: If I feel heart flutters about once a day, and cardiology tests come back normal, at what point do I need a medicine to prevent strokes? In other words, when, if ever, would it be time to go on Plavix or Eliquis?(Female, 55, no drugs, overweight, normal blood pressure, normal cholesterol)

Output: The sensation of flutters versus having atrial flutter / fibrillation is different. Unless you actually were diagnosed with it, you do not need medicine for stroke prevention.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: If I feel heart flutters about once a day, and cardiology tests come back normal, at what point do I need a medicine to prevent strokes? In other words, when, if ever, would it be time to go on Plavix or Eliquis?(Female, 55, no drugs, overweight, normal blood pressure, normal cholesterol). ### Response: The sensation of flutters versus having atrial flutter / fibrillation is different. Unless you actually were diagnosed with it, you do not need medicine for stroke prevention..


Instruction: 35F, 145lbs, 511 dont smoke, drink rarely. Generally consider myself healthy, however mid last year I underwent double jaw surgery and have since not taken part in any form of exercise and feel very unfit, but I still eat a well balance diet for the most part!After surgery however I lost over 20lbs in around 2 months and then gained it all back in the following 4 I had a hard time psychologically during recovery for a plethora of varied reasons and also unexpectedly became a carer for a relative who developed dementia whilst I was still recovering, this took a toll on mental health and I fell into a bit of a depression, I was prescribed Sertraline 50mg in late September 2022 however my mental health has VASTLY improved, it is my physical health that is bothersome.I also have a history of IBS and GERD (diagnosed over 10 years ago so is my normal but has slowly gotten a little worse over time).I reached out with no urgency to doctors for a health check as my generally sense of physical health felt at an all time low. I wanted to reassess IBS and GERD with focus on regular urgent diarrhoea (occasionally up to 6x a day), and regular nausea. Additionally I find myself easily very short of breath, dizzy and nauseous, and ultimately I feel weak. The disconcerting feeling this brings means I avoid any physical activity (historically I have enjoyed being more active). I noted that my heart rate has been falling lower and lower in the last 8 months since surgery and I am not physically fit at the moment. I feel slow. Maybe I am just getting old I was given a battery of tests and most of my bloods are generally fine, I have some deficiencies eg. Folate (which I queried as I dont drink and enjoy my greens) but was advised that some people are built different and need more vits or nutrients than others and I just need to take supplements  I assume this may cause some of my symptoms such as diarrhoea?I also had a 24hr Holter monitor and results came through yesterday. I havent seen them but doc noted 357 counts of bradycardia with lows of 37bpm. Coupled with my nausea and dizziness, I have an urgent referral to cardiology (although that still means in 3 months).However when I read up on Bradycardia, it doesnt seem to be a concerning issue? I dont have the full results but is it only the coupling of my nausea etc that makes it more concerning. Unsure if relevant, but despite low heart rate I often have slightly high blood pressure.Tldr: is bradycardia with nausea and dizziness worthy of urgent cardiology referral? Can heart issues cause additional symptoms such as regular diarrhoea?Also not sure if relevant, but I had a persistent rash and redness and deep itch in left breast for last 2 months, ultrasound shows I have lots of benign cysts and a fibroadenoma, they (radiologist and consultant) seemed unconcerned but did biopsy due to my age and I will get results soon, the lack of concern from consultant means I have little concern also (my mother has fibroadenomas that have never caused any issues), but thought I would add everything that ails me! Ha! In case there is some magical connection to it all.Thanks!

Output: What is your normal heart rate? Was it sinus bradycardia? How long were these episodes in duration?. Also would be helpful to know any medications other than the SSRI and whether you have sleep apnea, have had Lyme or chagas disease or are hypothyroid.To he honest I would also be surprised if it is sinus bradycardia that it is causing your symptoms rather than vice versa. Nausea and bowel movements are an excellent way to temporarily lower your heart rate. Most often it is just a normal variant, and if it is sinus bradycardia almost never requires a pacemaker. Wouldnt get too overwrought.The downside is i there is no magical connection here to any issue other than maybe being a symptom of nausea, which isnt that magical.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 35F, 145lbs, 511 dont smoke, drink rarely. Generally consider myself healthy, however mid last year I underwent double jaw surgery and have since not taken part in any form of exercise and feel very unfit, but I still eat a well balance diet for the most part!After surgery however I lost over 20lbs in around 2 months and then gained it all back in the following 4 I had a hard time psychologically during recovery for a plethora of varied reasons and also unexpectedly became a carer for a relative who developed dementia whilst I was still recovering, this took a toll on mental health and I fell into a bit of a depression, I was prescribed Sertraline 50mg in late September 2022 however my mental health has VASTLY improved, it is my physical health that is bothersome.I also have a history of IBS and GERD (diagnosed over 10 years ago so is my normal but has slowly gotten a little worse over time).I reached out with no urgency to doctors for a health check as my generally sense of physical health felt at an all time low. I wanted to reassess IBS and GERD with focus on regular urgent diarrhoea (occasionally up to 6x a day), and regular nausea. Additionally I find myself easily very short of breath, dizzy and nauseous, and ultimately I feel weak. The disconcerting feeling this brings means I avoid any physical activity (historically I have enjoyed being more active). I noted that my heart rate has been falling lower and lower in the last 8 months since surgery and I am not physically fit at the moment. I feel slow. Maybe I am just getting old I was given a battery of tests and most of my bloods are generally fine, I have some deficiencies eg. Folate (which I queried as I dont drink and enjoy my greens) but was advised that some people are built different and need more vits or nutrients than others and I just need to take supplements  I assume this may cause some of my symptoms such as diarrhoea?I also had a 24hr Holter monitor and results came through yesterday. I havent seen them but doc noted 357 counts of bradycardia with lows of 37bpm. Coupled with my nausea and dizziness, I have an urgent referral to cardiology (although that still means in 3 months).However when I read up on Bradycardia, it doesnt seem to be a concerning issue? I dont have the full results but is it only the coupling of my nausea etc that makes it more concerning. Unsure if relevant, but despite low heart rate I often have slightly high blood pressure.Tldr: is bradycardia with nausea and dizziness worthy of urgent cardiology referral? Can heart issues cause additional symptoms such as regular diarrhoea?Also not sure if relevant, but I had a persistent rash and redness and deep itch in left breast for last 2 months, ultrasound shows I have lots of benign cysts and a fibroadenoma, they (radiologist and consultant) seemed unconcerned but did biopsy due to my age and I will get results soon, the lack of concern from consultant means I have little concern also (my mother has fibroadenomas that have never caused any issues), but thought I would add everything that ails me! Ha! In case there is some magical connection to it all.Thanks!. ### Response: What is your normal heart rate? Was it sinus bradycardia? How long were these episodes in duration?. Also would be helpful to know any medications other than the SSRI and whether you have sleep apnea, have had Lyme or chagas disease or are hypothyroid.To he honest I would also be surprised if it is sinus bradycardia that it is causing your symptoms rather than vice versa. Nausea and bowel movements are an excellent way to temporarily lower your heart rate. Most often it is just a normal variant, and if it is sinus bradycardia almost never requires a pacemaker. Wouldnt get too overwrought.The downside is i there is no magical connection here to any issue other than maybe being a symptom of nausea, which isnt that magical..


Instruction: Thanks for response! I take no other medication, however I did take antibiotics and omeprazole briefly post surgery last year. I cannot see the detailed results,

Output: okay then what i said above i guess.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks for response! I take no other medication, however I did take antibiotics and omeprazole briefly post surgery last year. I cannot see the detailed results,. ### Response: okay then what i said above i guess..


Instruction: I have zero other health issue than those noted in my post, when I was very young I had migraines and I have always had dodgy joints (again Im getting older and runs in the family) and that is about it.I have never had any ailments you noted. When first diagnosed with IBS I was given lansoprazole in case I had an ulcer. But generally I have been in good health most of my life and taken little medication. Its just a bit cloudy all at once now I have reached my mid 30s  Blood tests historically are fine only regular things to note: I consistently have high bilirubin in liver blood tests but as the rest are fine this is usually noted as Gilberts syndrome? And again, not an issue. Cholesterol is teetering on high side but still currently in normal range. High but normal MCV in last few blood tests (~100)Im more concerned that I am not in need of an urgent referral and wasting time? But secondarily would like to know why I feel so rotten, and if it could relate to heart at all? It would be great if I could actually see the results and notes - I should call and ask for them and see if they will share!

Output: I suspect that this is not cardiac related and it is incidental. But with your symptom of dizziness and bradycardia and your GP's concern followup is prudent and not a waste of time. "urgent" and "three months" don't seem to belong together.You certainly have symptomatic gastrointestinal disease, diagnosed IBS but some of the symptoms sounds like gastroparesis. I would continue to followup with gastroenterology for workup and treatment.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have zero other health issue than those noted in my post, when I was very young I had migraines and I have always had dodgy joints (again Im getting older and runs in the family) and that is about it.I have never had any ailments you noted. When first diagnosed with IBS I was given lansoprazole in case I had an ulcer. But generally I have been in good health most of my life and taken little medication. Its just a bit cloudy all at once now I have reached my mid 30s  Blood tests historically are fine only regular things to note: I consistently have high bilirubin in liver blood tests but as the rest are fine this is usually noted as Gilberts syndrome? And again, not an issue. Cholesterol is teetering on high side but still currently in normal range. High but normal MCV in last few blood tests (~100)Im more concerned that I am not in need of an urgent referral and wasting time? But secondarily would like to know why I feel so rotten, and if it could relate to heart at all? It would be great if I could actually see the results and notes - I should call and ask for them and see if they will share!. ### Response: I suspect that this is not cardiac related and it is incidental. But with your symptom of dizziness and bradycardia and your GP's concern followup is prudent and not a waste of time. "urgent" and "three months" don't seem to belong together.You certainly have symptomatic gastrointestinal disease, diagnosed IBS but some of the symptoms sounds like gastroparesis. I would continue to followup with gastroenterology for workup and treatment..


Instruction: Hey guys,Today I had a pulmonary function test performed and results are mostly normal, which I expected. The only abnormal result is my FEF25-75%. The final value was 2.04, 64% of the expected reference value.I didn't have a bronchio dilator test performed due to palpitations, which I take beta-blockers for. Still being studied in cardiology.I didn't expect much to come out of this, because my GP suspects it might be exercise induced asthma. I wasn't feeling particularly bad when I had the test performed either.I experience chest tightness, wheezing, sob, air-way burning feeling and it hurts when I try to take a deep breathe. If I talk too much or laugh, I also get chest pain and cough.I have been prescribed Atrovent/Ipratropium bromide and it's so far the only thing that has helped me. It has taken me from barely being able to walk 40-50min, to walking 40-90min (usually 40-60) depending on the day without collapsing.

Output: The FEF25-75 is the forced expiratory flow throughout the middle of your expiration. When we fully exhale our lungs are left with some air leftover (called residual volume, or RV on your PFT). This RV is there because as we exhale our small airways close down as the intrathoracic pressure rises above the intra-bronchiolar pressure -- it's a normal part of expiration. A lower FEF25-75 is thought to reflect early small airway closure, which could be a component of asthma (as asthma affects small airways).You'll notice I use a bunch of hedgy language (lots of "could" and "thought to"). PFT guidelines recommend against using FEF25-75 to diagnose or treat anything. The data just isn't very strong. The American Thoracic Society recommends not even putting the FEF25-75 on the PFT report. All that said, the FEF25-75 isn't entirely worthless, it just has to be interpreted with caution. If you have the right symptoms, a reduced FEF25-75, and a positive clinical response to bronchodilators it can be very reasonable to suspect asthma.If you have a great response to the inhaler, great, there's your answer. If not, it would be a reasonable time to seek an evaluation by a pulmonologist. Your goal should be feeling normal. All-too-often asthmatics will talk about having daily symptoms, which is a real shame. They either need more aggressive treatment or a different diagnosis altogether.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hey guys,Today I had a pulmonary function test performed and results are mostly normal, which I expected. The only abnormal result is my FEF25-75%. The final value was 2.04, 64% of the expected reference value.I didn't have a bronchio dilator test performed due to palpitations, which I take beta-blockers for. Still being studied in cardiology.I didn't expect much to come out of this, because my GP suspects it might be exercise induced asthma. I wasn't feeling particularly bad when I had the test performed either.I experience chest tightness, wheezing, sob, air-way burning feeling and it hurts when I try to take a deep breathe. If I talk too much or laugh, I also get chest pain and cough.I have been prescribed Atrovent/Ipratropium bromide and it's so far the only thing that has helped me. It has taken me from barely being able to walk 40-50min, to walking 40-90min (usually 40-60) depending on the day without collapsing.. ### Response: The FEF25-75 is the forced expiratory flow throughout the middle of your expiration. When we fully exhale our lungs are left with some air leftover (called residual volume, or RV on your PFT). This RV is there because as we exhale our small airways close down as the intrathoracic pressure rises above the intra-bronchiolar pressure -- it's a normal part of expiration. A lower FEF25-75 is thought to reflect early small airway closure, which could be a component of asthma (as asthma affects small airways).You'll notice I use a bunch of hedgy language (lots of "could" and "thought to"). PFT guidelines recommend against using FEF25-75 to diagnose or treat anything. The data just isn't very strong. The American Thoracic Society recommends not even putting the FEF25-75 on the PFT report. All that said, the FEF25-75 isn't entirely worthless, it just has to be interpreted with caution. If you have the right symptoms, a reduced FEF25-75, and a positive clinical response to bronchodilators it can be very reasonable to suspect asthma.If you have a great response to the inhaler, great, there's your answer. If not, it would be a reasonable time to seek an evaluation by a pulmonologist. Your goal should be feeling normal. All-too-often asthmatics will talk about having daily symptoms, which is a real shame. They either need more aggressive treatment or a different diagnosis altogether..


Instruction: 23F, 51 and 115 pounds, Asian. depression, anxiety, ptsd, adhd, taking 20mg adderall, 57.5mg paroxetine, 50mg welbutrin. i drank weekly in college but since ive left, i barely have. no weed either.I crashed my car a while back into a pole, but I have no idea how it happened - my memory is blank from me just driving on the road to me being in front of a pole, where i tried to break before i crashed. i dont know why theres a gap in the memory, but my pcp is suggesting i may have passed out or have had absence seizures, but she feels its neurological and not cardiological which is why Im seeing a neurologist in a week. i am just wondering if there are any ideas of what it could be / if i have any disorder. i know i didnt fall asleep as i have a pretty routine sleep schedule, but i just want any ideas of what could have happened to soothe my nerves. the car crash left me with a broken ankle and a friction burn, but nothing else. thank you in advance.

Output: You need to be evaluated for potential seizures - that's why you're scheduled to see a neurologist. If nothing found there, probably worth getting some kind of cardiac workup.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 23F, 51 and 115 pounds, Asian. depression, anxiety, ptsd, adhd, taking 20mg adderall, 57.5mg paroxetine, 50mg welbutrin. i drank weekly in college but since ive left, i barely have. no weed either.I crashed my car a while back into a pole, but I have no idea how it happened - my memory is blank from me just driving on the road to me being in front of a pole, where i tried to break before i crashed. i dont know why theres a gap in the memory, but my pcp is suggesting i may have passed out or have had absence seizures, but she feels its neurological and not cardiological which is why Im seeing a neurologist in a week. i am just wondering if there are any ideas of what it could be / if i have any disorder. i know i didnt fall asleep as i have a pretty routine sleep schedule, but i just want any ideas of what could have happened to soothe my nerves. the car crash left me with a broken ankle and a friction burn, but nothing else. thank you in advance.. ### Response: You need to be evaluated for potential seizures - that's why you're scheduled to see a neurologist. If nothing found there, probably worth getting some kind of cardiac workup..


Instruction: Age: 28Sex: Non-binary/Female (she/they with a uterus)Height: 59Weight: 145Race: White/EuropeanDuration of complaint: N/A, 3-weeksLocation: New England USAAny existing relevant medical issues: Depression and anxietyCurrent medications: Wellbutrin (daily 150mg), Xanax (as needed, usually ~0.25mg/month)Hi Docs,This is a question about my spouse (she/they) in their late 20s and physically healthy. She has a panic disorder thats especially bad in medical settingse.g., took 0.5mg Xanax before their recent echocardiogram, but was still hyperventilating and crying throughout.Three weeks ago she was having some chest tightness, which we thought was from a workout we did the prior day, but wanted to go to urgent care just in case. Urgent care gave her an EKG (her first one), which had an inverted T wave in one lead (EditI think it was actually in two leads, EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.). Along with the tachycardia (which always happens in medical offices, but goes back down to ~70bpm after) and they sent us (in our car, not ambulance) to the ER.ER did blood panel CBC/diff, some hormones, D-dimer in case clot, etc, all looked normal except for neutrophils at 82% (reference 48-76), then checked for fluid in the heart cavity with an ultrasound. ER wasnt concerned and sent us home with a cardiology f/u.Cardiology NP was worried about potential inflammation (e.g. myocarditis, as Ive heard has been a more common than usual in young women lately from covid, which we dont think weve had yet) so did an echo and a few more blood tests, including a sediment test, all of which looked normal.No chest pain or tightness or swelling other complaints since the ER incident.I dont have the full EKG, but herere the values they released to us from one lead:PR interval: 123ms QRS: 78ms QT: 318ms QTC: 443ms P Axis: 65 degrees R Axis: 69 degrees T Axis: -4 axis (was -36 at previous visit)Cardiology NP is concerned about the inverted T wave and wanted a cardiac MRI after the echocardiogram, but to me the T wave seems like an unconcerning variation in the absence of other symptoms. If I was the patient Id be fine with the MRI but, given how psychologically difficult an MRI would be for my spouse, Im not sure its necessary and want to encourage her to talk to her primary care doctor about her options.Based on the (of course incomplete) picture Im giving here, does my interpretation sound reasonable, or am I missing something?Thank you!

Output: Inverted T-waves in V1 and V2 are normal.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Age: 28Sex: Non-binary/Female (she/they with a uterus)Height: 59Weight: 145Race: White/EuropeanDuration of complaint: N/A, 3-weeksLocation: New England USAAny existing relevant medical issues: Depression and anxietyCurrent medications: Wellbutrin (daily 150mg), Xanax (as needed, usually ~0.25mg/month)Hi Docs,This is a question about my spouse (she/they) in their late 20s and physically healthy. She has a panic disorder thats especially bad in medical settingse.g., took 0.5mg Xanax before their recent echocardiogram, but was still hyperventilating and crying throughout.Three weeks ago she was having some chest tightness, which we thought was from a workout we did the prior day, but wanted to go to urgent care just in case. Urgent care gave her an EKG (her first one), which had an inverted T wave in one lead (EditI think it was actually in two leads, EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.). Along with the tachycardia (which always happens in medical offices, but goes back down to ~70bpm after) and they sent us (in our car, not ambulance) to the ER.ER did blood panel CBC/diff, some hormones, D-dimer in case clot, etc, all looked normal except for neutrophils at 82% (reference 48-76), then checked for fluid in the heart cavity with an ultrasound. ER wasnt concerned and sent us home with a cardiology f/u.Cardiology NP was worried about potential inflammation (e.g. myocarditis, as Ive heard has been a more common than usual in young women lately from covid, which we dont think weve had yet) so did an echo and a few more blood tests, including a sediment test, all of which looked normal.No chest pain or tightness or swelling other complaints since the ER incident.I dont have the full EKG, but herere the values they released to us from one lead:PR interval: 123ms QRS: 78ms QT: 318ms QTC: 443ms P Axis: 65 degrees R Axis: 69 degrees T Axis: -4 axis (was -36 at previous visit)Cardiology NP is concerned about the inverted T wave and wanted a cardiac MRI after the echocardiogram, but to me the T wave seems like an unconcerning variation in the absence of other symptoms. If I was the patient Id be fine with the MRI but, given how psychologically difficult an MRI would be for my spouse, Im not sure its necessary and want to encourage her to talk to her primary care doctor about her options.Based on the (of course incomplete) picture Im giving here, does my interpretation sound reasonable, or am I missing something?Thank you!. ### Response: Inverted T-waves in V1 and V2 are normal..


Instruction: Thank you! Yeah I just went back into the ER notes to check. It looks like it was two leads, not sure which ones (Thinking back, I think they circled the top right cornerlead 4?)From the ER Chart: EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.

Output: Would need to be able to see the EKG to tell more info.Are they still having symptoms?Could provide more info with: Troponin lab value D dimer lab Echo report

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you! Yeah I just went back into the ER notes to check. It looks like it was two leads, not sure which ones (Thinking back, I think they circled the top right cornerlead 4?)From the ER Chart: EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.. ### Response: Would need to be able to see the EKG to tell more info.Are they still having symptoms?Could provide more info with: Troponin lab value D dimer lab Echo report.


Instruction: Thanks for the responseAh, that makes sensebummer that they dont provide the full EKG, I shouldve taken a picture. Ill update this post if I somehow get it.Theyre not having any symptoms anymore, aside from the anxiety.Troponin is <6 ng/L. D-dimer is <270 ng/mL.Echo summary: The left ventricular cavity size and wall thickness are normal. Left ventricular systolic function is normal. There are no segmental left ventricular wall motion abnormalities noted. The estimated ejection fraction is 60% The right ventricular size is normal. The right ventricular systolic function is normal. Normal valve structure and function.Reason for exam: eval in ED with CP x 4 days, EKG showed TWI inferolateral leads, trop <6, Dimer wnl, no history of Covid. Persistent tachycardia. Abnormal EKG Palpitations

Output: Thank you. So labs and the echo are normal. TWI is not an indication for cardiac MRI. TWI in inferolateral leads can even be due to things like lead misplacement.I think it would be in your partners best interest to ask the ordering NP how the cardiac MRI would impact their care. If it's positive for myocarditis, what will they do to treat it? (The answer is probably nothing). If it is negative for myocarditis, what will they do to treat it? (Also nothing) Secondly, it could be in their best interest to discuss this test and their care with a physician.Gotta give you a disclaimer: My assessment and recommendations are based on the information provided and I have not seen the EKG, taken a history from the patient, or performed a physical exam. I don't want to sow mistrust and am not attempting to disagree with other medical personnel, since the ordering NP has performed all of these assessments.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks for the responseAh, that makes sensebummer that they dont provide the full EKG, I shouldve taken a picture. Ill update this post if I somehow get it.Theyre not having any symptoms anymore, aside from the anxiety.Troponin is <6 ng/L. D-dimer is <270 ng/mL.Echo summary: The left ventricular cavity size and wall thickness are normal. Left ventricular systolic function is normal. There are no segmental left ventricular wall motion abnormalities noted. The estimated ejection fraction is 60% The right ventricular size is normal. The right ventricular systolic function is normal. Normal valve structure and function.Reason for exam: eval in ED with CP x 4 days, EKG showed TWI inferolateral leads, trop <6, Dimer wnl, no history of Covid. Persistent tachycardia. Abnormal EKG Palpitations. ### Response: Thank you. So labs and the echo are normal. TWI is not an indication for cardiac MRI. TWI in inferolateral leads can even be due to things like lead misplacement.I think it would be in your partners best interest to ask the ordering NP how the cardiac MRI would impact their care. If it's positive for myocarditis, what will they do to treat it? (The answer is probably nothing). If it is negative for myocarditis, what will they do to treat it? (Also nothing) Secondly, it could be in their best interest to discuss this test and their care with a physician.Gotta give you a disclaimer: My assessment and recommendations are based on the information provided and I have not seen the EKG, taken a history from the patient, or performed a physical exam. I don't want to sow mistrust and am not attempting to disagree with other medical personnel, since the ordering NP has performed all of these assessments..


Instruction: 40M, 5'10", 210 lbs, Caucasian, California.5mg Bisoprolol for arrhythmia, 160mg fenofibrate for high trigs, 300mg gapapentin for chronic thoracic spinal painHello. I'll try to keep this as short as possible as I know you're all busy.TL:DR - https://imgur.com/a/m5lprmBWondering if anyone can offer an opinion on this ECG from my implanted loop recorder. The loop recorder was inserted 1.5 years ago to investigate a an episode of sustained arrhythmia + syncope. I have a history of AVRT (ablated in 2006, possibly WPW, but that wasn't made fully clear to me). It seems something didn't go quite right during the ablation and the AVRT was eliminated but I developed frequent PVCs that were not present before the procedure. I have some documented NSVT from holter monitors and 30 day loop recorders over the past 10 years.My loop recorder seems to not be programmed to detect much of anything on its own. I think I would have to literally be in v-fib for it to automatically flag an event for review. After about a year of it literally capturing nothing despite having symptoms, I requested a patient trigger device that I can use to force the device to record and upload an event. Since I have started using the trigger, I have been able to capture several episodes such as this: https://imgur.com/a/m5lprmBWhen I look at this, my untrained sees a salvo of PVCs, which I guess technically defines NSVT. I have asked my doctor for an opinion on these events and every time his response is basically "Doesn't look like anything to me".What he doesn't seem to understand or appreciate is I find these episodes to be physically very uncomfortable and honestly, highly distressing, like hand over heart, feeling like I'm going to die sort of vibes. I admit that's probably a bit dramatic and an overreaction, but my cardiac history and long road to a diagnosis has trained me to think this way. Additionally, I am dealing with Kaiser Permanente in California and unfortunately, they have a rather abysmal reputation for cardiology and electrophysiology is basically non-existent.I realize there's people out there that have PVCs and other palpitations and barely notice them, but for some reason when I experience them, its like I'm getting punched in the chest.My hope is that someone out there can give me a reason why I should NOT be worried about these events. My doctor seems to be very, very, unconcerned by them, and maybe he's right to think that, but an explanation would be nice and if there's a way to be less frightened by these episodes, I think that should be considered therapeutic and part of the plan for care in this situation.Thanks for reading.

Output: So first things first I dont see clear P waves and you seem to be slightly irregular. Do you have a history of AFib? Secondly the beats that you point out are wide but also irregular. This makes it less likely that they are PVCs/NSVT and more likely to be AFib with aberrant conduction if you have AFib to begin with. Since you have AVRT and have had ablation, its not unusual to have some aberrancy when the rate changes since you have an abnormal electrical conduction system thats also been burned. While this isnt life threatening in any way, increasing your bisoprolol dose would probably help keep the rates better controlled and decrease your symptoms. You can also get a cardioversion/ablation if you are actually in AFib

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 40M, 5'10", 210 lbs, Caucasian, California.5mg Bisoprolol for arrhythmia, 160mg fenofibrate for high trigs, 300mg gapapentin for chronic thoracic spinal painHello. I'll try to keep this as short as possible as I know you're all busy.TL:DR - https://imgur.com/a/m5lprmBWondering if anyone can offer an opinion on this ECG from my implanted loop recorder. The loop recorder was inserted 1.5 years ago to investigate a an episode of sustained arrhythmia + syncope. I have a history of AVRT (ablated in 2006, possibly WPW, but that wasn't made fully clear to me). It seems something didn't go quite right during the ablation and the AVRT was eliminated but I developed frequent PVCs that were not present before the procedure. I have some documented NSVT from holter monitors and 30 day loop recorders over the past 10 years.My loop recorder seems to not be programmed to detect much of anything on its own. I think I would have to literally be in v-fib for it to automatically flag an event for review. After about a year of it literally capturing nothing despite having symptoms, I requested a patient trigger device that I can use to force the device to record and upload an event. Since I have started using the trigger, I have been able to capture several episodes such as this: https://imgur.com/a/m5lprmBWhen I look at this, my untrained sees a salvo of PVCs, which I guess technically defines NSVT. I have asked my doctor for an opinion on these events and every time his response is basically "Doesn't look like anything to me".What he doesn't seem to understand or appreciate is I find these episodes to be physically very uncomfortable and honestly, highly distressing, like hand over heart, feeling like I'm going to die sort of vibes. I admit that's probably a bit dramatic and an overreaction, but my cardiac history and long road to a diagnosis has trained me to think this way. Additionally, I am dealing with Kaiser Permanente in California and unfortunately, they have a rather abysmal reputation for cardiology and electrophysiology is basically non-existent.I realize there's people out there that have PVCs and other palpitations and barely notice them, but for some reason when I experience them, its like I'm getting punched in the chest.My hope is that someone out there can give me a reason why I should NOT be worried about these events. My doctor seems to be very, very, unconcerned by them, and maybe he's right to think that, but an explanation would be nice and if there's a way to be less frightened by these episodes, I think that should be considered therapeutic and part of the plan for care in this situation.Thanks for reading.. ### Response: So first things first I dont see clear P waves and you seem to be slightly irregular. Do you have a history of AFib? Secondly the beats that you point out are wide but also irregular. This makes it less likely that they are PVCs/NSVT and more likely to be AFib with aberrant conduction if you have AFib to begin with. Since you have AVRT and have had ablation, its not unusual to have some aberrancy when the rate changes since you have an abnormal electrical conduction system thats also been burned. While this isnt life threatening in any way, increasing your bisoprolol dose would probably help keep the rates better controlled and decrease your symptoms. You can also get a cardioversion/ablation if you are actually in AFib.


Instruction: No history of AFib.I think the lack of visible p waves may have more to do with how the ecg is rendered with this recorder (very small), plus this is a screenshot of the report's summary, so maybe the actual report renders the morphology with better detail (I don't ever have access to that). For comparison, I have a 6 lead Kardia ecg device that is much clearer and shows clear p waves.This isn't the first time I've gotten a recommendation to increase the bisoprolol dosage but im a bit concerned about the long term side effects of that. I've already been on it for over a decade and I'm 40 now. However, after this recent episode, I think it's probably best for my sanity.Follow-up question. Does your opinion change knowing that I have never been diagnosed with afib, despite several doctors reviewing my strips in the past?

Output: I think the answer no matter what is to increase bisoprolol.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: No history of AFib.I think the lack of visible p waves may have more to do with how the ecg is rendered with this recorder (very small), plus this is a screenshot of the report's summary, so maybe the actual report renders the morphology with better detail (I don't ever have access to that). For comparison, I have a 6 lead Kardia ecg device that is much clearer and shows clear p waves.This isn't the first time I've gotten a recommendation to increase the bisoprolol dosage but im a bit concerned about the long term side effects of that. I've already been on it for over a decade and I'm 40 now. However, after this recent episode, I think it's probably best for my sanity.Follow-up question. Does your opinion change knowing that I have never been diagnosed with afib, despite several doctors reviewing my strips in the past?. ### Response: I think the answer no matter what is to increase bisoprolol..


Instruction: Now I am off them in the past few weeks I have noticed mild chest pain and fluid retention in my legs. I have always carried weight in my legs but recently I have been needing to pee quickly after lying down at night. I can speed the process up by lying on the ground and putting my legs up against the wall to let it drain down them. I always get a lot of fluid when I pee when I do this, lots more that I should do. I know fluid retention can be dangerous with heart problems and Im getting quite concerned. I have a GP phone appointment next Friday but Im concerned Im not pushing for the right things fast enough.I also suffer from what I have always assumed was IBSI have been tested for Celiac, thyroid problems, absorption levels and all the standard things you would be tested for on the NHSI know that the heart problems could be caused by the low levels in my blood, but what is causing my levels to be low in the first place. Im really worried and really at a loss. Thanks

Output: The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Now I am off them in the past few weeks I have noticed mild chest pain and fluid retention in my legs. I have always carried weight in my legs but recently I have been needing to pee quickly after lying down at night. I can speed the process up by lying on the ground and putting my legs up against the wall to let it drain down them. I always get a lot of fluid when I pee when I do this, lots more that I should do. I know fluid retention can be dangerous with heart problems and Im getting quite concerned. I have a GP phone appointment next Friday but Im concerned Im not pushing for the right things fast enough.I also suffer from what I have always assumed was IBSI have been tested for Celiac, thyroid problems, absorption levels and all the standard things you would be tested for on the NHSI know that the heart problems could be caused by the low levels in my blood, but what is causing my levels to be low in the first place. Im really worried and really at a loss. Thanks. ### Response: The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication..


Instruction: The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication.

Output: Often, but not always. Your physiology changes over time so sometimes you may start to see side effects that you previously didnt.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication.. ### Response: Often, but not always. Your physiology changes over time so sometimes you may start to see side effects that you previously didnt..


Instruction: Cross from /AskCardiologyDetails to previously deleted post, dad had heart attack but refuses medical adviceI previously posted and deleted due to lack of details. My dad (56M) had a cardiac event two weeks ago that he refused to explain. Yesterday he invited me to dinner to explain his situation. He looks TERRIBLE, he is gray with the blackest bags under his eyes. He explained he was working out and suddenly had SVT bad enough to where he lost feeling in his body, his left arm turned blue and he collapsed (didnt lose consciousness) and couldnt get up for a couple hours. As a nurse, he 100% believes he had a heart attack. He stated he has been feeling ill for 6 months, had this event, and has not felt normal since. His cholesterol and triglycerides are insanely high and he knows he has hereditary atherosclerosis. He is very anti-doctor/pharmaceutical and is relying on a diet of nitrous oxide-rich foods and Willow bark to clear is arteries of plaque. He looks like a corpse and Im afraid he will die soon without medical attention. If he did have a heart attack, whats his outlook without treatment?Edit: he is not on any medications, works out twice a day, his father had triple bypass at 70.

Output: Ok man, I'll be pretty straightforward - lack of attention to this could kill your father.The thing you worry about after a heart attack is that part of the heart muscle doesn't work well. You can get heart failure pretty easily when one wall of the heart isn't contracting. If he looks bad to you, keep gently encouraging him to get checked out. Use words like "I'm worried about you" and "I don't want to lose you." Don't push. Encourage and focus on your concern for him.It isn't clear it was a heart attack, but something bad happened. An arrhythmia, exacerbation of undiagnosed heart failure, a heart attack, some other vascular event are all on the table and need proper testing to sort out.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Cross from /AskCardiologyDetails to previously deleted post, dad had heart attack but refuses medical adviceI previously posted and deleted due to lack of details. My dad (56M) had a cardiac event two weeks ago that he refused to explain. Yesterday he invited me to dinner to explain his situation. He looks TERRIBLE, he is gray with the blackest bags under his eyes. He explained he was working out and suddenly had SVT bad enough to where he lost feeling in his body, his left arm turned blue and he collapsed (didnt lose consciousness) and couldnt get up for a couple hours. As a nurse, he 100% believes he had a heart attack. He stated he has been feeling ill for 6 months, had this event, and has not felt normal since. His cholesterol and triglycerides are insanely high and he knows he has hereditary atherosclerosis. He is very anti-doctor/pharmaceutical and is relying on a diet of nitrous oxide-rich foods and Willow bark to clear is arteries of plaque. He looks like a corpse and Im afraid he will die soon without medical attention. If he did have a heart attack, whats his outlook without treatment?Edit: he is not on any medications, works out twice a day, his father had triple bypass at 70.. ### Response: Ok man, I'll be pretty straightforward - lack of attention to this could kill your father.The thing you worry about after a heart attack is that part of the heart muscle doesn't work well. You can get heart failure pretty easily when one wall of the heart isn't contracting. If he looks bad to you, keep gently encouraging him to get checked out. Use words like "I'm worried about you" and "I don't want to lose you." Don't push. Encourage and focus on your concern for him.It isn't clear it was a heart attack, but something bad happened. An arrhythmia, exacerbation of undiagnosed heart failure, a heart attack, some other vascular event are all on the table and need proper testing to sort out..


Instruction: hanks for your response, I did ask that he see a doctor but he is very stubborn and just accepts if its my time then oh well. So Im not expecting much here unfortunately.

Output: Ugh. Im sorry. So hard to watch a parent do that. Be persistent. Enlist other family members. Avoidant behavior is very common. Especially for healthcare workers.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: hanks for your response, I did ask that he see a doctor but he is very stubborn and just accepts if its my time then oh well. So Im not expecting much here unfortunately.. ### Response: Ugh. Im sorry. So hard to watch a parent do that. Be persistent. Enlist other family members. Avoidant behavior is very common. Especially for healthcare workers..