Instruction: What do these results mean?24F, 176cm 46kg. I have hypermobile ehlers danlos & likely gastroparesis, my stomach shut down just over a year ago & I rely solely on a nasojejunal tube for nutrition, hydration and medication. I've gained 8kg from my most unwell point, but my weight has been going on a bit slowly & my blood sugars are constantly low despite feeds. I've also had issues on & off with my liver and recurrent kidney and bladder infections.I had an ultrasound followed by an MRI last year, but I didn't see the results until I called the hospital & requested the results a few months ago. It seemed to suggest nutcracker syndrome, which I know can be related to SMAS. But I've also heard MALS? I don't understand the results, and no doctor has ever even told me them, let alone explained them to me.'Ultrasound: The left renal vein was not clearly visualised crossing anterior to the aorta, and the left gonadal vein appeared dilated with reversal of flow heading downwards into the pelvis. The appearances raise the possibility of nutcracker syndrome.MRI: The aortic-SMA angle is somewhat reduced, assessed at between 17 and 30 degrees on the low quality reformatted images (normal range 38 to 65 degrees).'What does this all mean?

Output: Basically there isnt enough fat between your superior mesenteric and aorta to prevent the SMA from crushing your left renal vein and duodenum (beginning portion of GI tract). I have attached a nice diagram below.Your BMI is 15 which is waaay underweight. I understand how hard it is for you to gain weight without a functioning GI tract but weight gain can help decompress structures through fat pad support. There are also surgical options but many will have you try to gain weight before offering surgery. Its often a multidisciplinary team approach in treatment. GI or vascular surgery would be most appropriate to consult about options.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What do these results mean?24F, 176cm 46kg. I have hypermobile ehlers danlos & likely gastroparesis, my stomach shut down just over a year ago & I rely solely on a nasojejunal tube for nutrition, hydration and medication. I've gained 8kg from my most unwell point, but my weight has been going on a bit slowly & my blood sugars are constantly low despite feeds. I've also had issues on & off with my liver and recurrent kidney and bladder infections.I had an ultrasound followed by an MRI last year, but I didn't see the results until I called the hospital & requested the results a few months ago. It seemed to suggest nutcracker syndrome, which I know can be related to SMAS. But I've also heard MALS? I don't understand the results, and no doctor has ever even told me them, let alone explained them to me.'Ultrasound: The left renal vein was not clearly visualised crossing anterior to the aorta, and the left gonadal vein appeared dilated with reversal of flow heading downwards into the pelvis. The appearances raise the possibility of nutcracker syndrome.MRI: The aortic-SMA angle is somewhat reduced, assessed at between 17 and 30 degrees on the low quality reformatted images (normal range 38 to 65 degrees).'What does this all mean?. ### Response: Basically there isnt enough fat between your superior mesenteric and aorta to prevent the SMA from crushing your left renal vein and duodenum (beginning portion of GI tract). I have attached a nice diagram below.Your BMI is 15 which is waaay underweight. I understand how hard it is for you to gain weight without a functioning GI tract but weight gain can help decompress structures through fat pad support. There are also surgical options but many will have you try to gain weight before offering surgery. Its often a multidisciplinary team approach in treatment. GI or vascular surgery would be most appropriate to consult about options..


Instruction: Thank you! Is it 'normal' given my weight & general health, or can this be a separate condition/issue entirely? Is it something I need to raise with my gastro even though they've ignored it?

Output: Its not normal. Just low weight worsens it. Whoever ordered the imaging should be the one to make the next referral.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you! Is it 'normal' given my weight & general health, or can this be a separate condition/issue entirely? Is it something I need to raise with my gastro even though they've ignored it?. ### Response: Its not normal. Just low weight worsens it. Whoever ordered the imaging should be the one to make the next referral..


Instruction: Pregnant with a pre-existing umbilical hernia. I don't know much yet, and I have questions.Age/sex: 29F | Height: 5ft 0in | Weight: 117 lbs (~105lbs before pregnancy) | Race: whiteI am 16 weeks pregnant with my first child. I live in the US.Yesterday, I had my 16wk OB appointment. We measured baby's HR at 140bpm, woo! But I have also been referred to a surgeon regarding my umbilical hernia, which, to my knowledge and limited understanding, I got in infancy (my mom watched my bellybutton "pop out" during a screaming fit). Yesterday, before the OB measured baby's HR, I told her about my "outtie" belly button and how it's already doubled in size since pregnancy; also about a day last week when I scraped a bathroom stall door against my bellybutton while opening it, which immediately caused sharp, downward shooting pains and overall abdominal discomfort that lasted for the rest of the day. She kind of wrote it off ("bellybuttons sometimes get sensitive during pregnancy"), until I laid down for her to get the heartbeat. She then looked closely at my bellybutton and asked me to do a sit up, then mentioned that she would be referring me to general surgery for an umbilical hernia. I asked her what the medical implications of an umbilical hernia with pregnancy would be, and she just said, "a lot of pain that we can't do anything about."So that was scary, and made me question why even see a surgeon now? Just to confirm it's a hernia? But then I did some googling, and have further confused and worried myself.My consultation with the surgeon isn't for another month, coincidentally the same day as my 20 week ultrasound._________________________________Here's some more info about my experience that might be relevant:-My bellybutton has always been sensitive, even as an adult. It was much bigger as a kid and got smaller as a I grew up, but definitely still an "outtie." When I was a kid, I remember it filling up and getting "hard" when I had gas. I would "pop" it and it would "deflate." That stopped happening by the time I was like 7 y/o.-I have struggled with constipation on and off throughout the years, but I wouldn't say it's generally "severe." I have had occasions when I'd go 4-6 days without a BM where it seemed like nothing helped, but overall, if I pay attention to lifestyle/proper nutrition, I don't go more than 1-2 days without a full BM.-Only today have I noticed a bulging under my bellybutton. And it's only when I lean back far enough so the rest of my belly/organs/fat go down so I can see it. I've never noticed this before, and I assume it's due to the pregnancy.-I've always had a pretty strong core with visible muscle tone and minimal stomach fat._________________________________I would really appreciate any comments/information about what to expect, what possible outcomes are, other experiences, etc. But some of my specific questions are:-Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)-Is it possible to not need surgery at all-- neither during pregnancy nor after?-Will a CT scan be necessary?-Will I inevitably be in a lot of pain?-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)-What, if anything, should I look out for before my consultation that would constitute an emergency?________________________________________I think that's all, I'll edit if I think of something else I should add.Thank you so much in advance!

Output: -Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)No, I don't believe so. I'm not ob/gyn but a general surgeon, so I could be wrong on the indications for a c section.-Is it possible to not need surgery at all-- neither during pregnancy nor after?Depends on if you want it fixed, if its causing you pain, etc. Not mandatory in all cases.-Will a CT scan be necessary?No, usually not unless the surgeon is unsure of something, and a CT is contra-indicated in pregnancy.-Will I inevitably be in a lot of pain?No. Some hernias cause pain, others do not.-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)Incarceration or strangulation.-What, if anything, should I look out for before my consultation that would constitute an emergency?hard, very painful lump at your belly button that you cannot push back it and it continues to become more and more painful.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pregnant with a pre-existing umbilical hernia. I don't know much yet, and I have questions.Age/sex: 29F | Height: 5ft 0in | Weight: 117 lbs (~105lbs before pregnancy) | Race: whiteI am 16 weeks pregnant with my first child. I live in the US.Yesterday, I had my 16wk OB appointment. We measured baby's HR at 140bpm, woo! But I have also been referred to a surgeon regarding my umbilical hernia, which, to my knowledge and limited understanding, I got in infancy (my mom watched my bellybutton "pop out" during a screaming fit). Yesterday, before the OB measured baby's HR, I told her about my "outtie" belly button and how it's already doubled in size since pregnancy; also about a day last week when I scraped a bathroom stall door against my bellybutton while opening it, which immediately caused sharp, downward shooting pains and overall abdominal discomfort that lasted for the rest of the day. She kind of wrote it off ("bellybuttons sometimes get sensitive during pregnancy"), until I laid down for her to get the heartbeat. She then looked closely at my bellybutton and asked me to do a sit up, then mentioned that she would be referring me to general surgery for an umbilical hernia. I asked her what the medical implications of an umbilical hernia with pregnancy would be, and she just said, "a lot of pain that we can't do anything about."So that was scary, and made me question why even see a surgeon now? Just to confirm it's a hernia? But then I did some googling, and have further confused and worried myself.My consultation with the surgeon isn't for another month, coincidentally the same day as my 20 week ultrasound._________________________________Here's some more info about my experience that might be relevant:-My bellybutton has always been sensitive, even as an adult. It was much bigger as a kid and got smaller as a I grew up, but definitely still an "outtie." When I was a kid, I remember it filling up and getting "hard" when I had gas. I would "pop" it and it would "deflate." That stopped happening by the time I was like 7 y/o.-I have struggled with constipation on and off throughout the years, but I wouldn't say it's generally "severe." I have had occasions when I'd go 4-6 days without a BM where it seemed like nothing helped, but overall, if I pay attention to lifestyle/proper nutrition, I don't go more than 1-2 days without a full BM.-Only today have I noticed a bulging under my bellybutton. And it's only when I lean back far enough so the rest of my belly/organs/fat go down so I can see it. I've never noticed this before, and I assume it's due to the pregnancy.-I've always had a pretty strong core with visible muscle tone and minimal stomach fat._________________________________I would really appreciate any comments/information about what to expect, what possible outcomes are, other experiences, etc. But some of my specific questions are:-Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)-Is it possible to not need surgery at all-- neither during pregnancy nor after?-Will a CT scan be necessary?-Will I inevitably be in a lot of pain?-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)-What, if anything, should I look out for before my consultation that would constitute an emergency?________________________________________I think that's all, I'll edit if I think of something else I should add.Thank you so much in advance!. ### Response: -Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)No, I don't believe so. I'm not ob/gyn but a general surgeon, so I could be wrong on the indications for a c section.-Is it possible to not need surgery at all-- neither during pregnancy nor after?Depends on if you want it fixed, if its causing you pain, etc. Not mandatory in all cases.-Will a CT scan be necessary?No, usually not unless the surgeon is unsure of something, and a CT is contra-indicated in pregnancy.-Will I inevitably be in a lot of pain?No. Some hernias cause pain, others do not.-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)Incarceration or strangulation.-What, if anything, should I look out for before my consultation that would constitute an emergency?hard, very painful lump at your belly button that you cannot push back it and it continues to become more and more painful..


Instruction: Scared about abnormal CBC results, history of anorexia25F, 5'0, ~105lbsHistory of anorexia and childhood asthma (used a nebulizer as a little kid, no need for inhaler/treatment now)Abnormal lab results: https://imgur.com/a/Mcg5s0kI see my PCP every couple of months at her request since I have struggled with a restrictive eating disorder since I was 13. As part of my semi-regular appointments she runs what I think are fairly comprehensive labs (I only included pics of abnormal results but she also runs thyroid, estrogen, etc.). My vitamin B12 is also slightly high (1,316 pg/mL).Im mostly concerned that my absolute lymphocyte count has been steadily declining since last year  when I first started seeing my doctor in March 2022 it was 1.26 L and in March 2023 it was 0.79 L. There are a few other results like hematocrit and mean corpuscular volume that are elevated, but those at least seem to be closer to the reference ranges. I know a small elevation/drop can be normal since were not robots, but the decrease in lymphocyte count seems pretty dramatic.My doctor didnt call/comment on my most recent labs, so I sent her a message online asking about the lymphocyte count. Her response was that a slightly lowered lymphocyte count isnt uncommon/could be due to nutrition and we could recheck at my next appointment. However, Ive actually been doing much better with nutrition since around December 2022 and am at a stable weight with normal thyroid/estrogen levels, so Im not sure that malnutrition would be a likely cause.Ive been waking up slightly sweaty/clammy in the middle of the night, usually a few nights per week. Ive experienced this before to a much greater extent in residential treatment for my eating disorder when I was going through refeeding and experiencing hypermetabolism, but that is definitely not the case now as my weight and food intake are adequate (confirmed by RD).I have a small lump on one side of my neck that my PCP ordered an ultrasound for in November 2022  result was normal enlarged lymph node, no biopsy recommended. It hasnt changed/grown, but I recently noticed another small lump on the other side of my neck. The lymph nodes just under my jawbone feel slightly swollen as of this weekend, but Im not sure whether to chalk that up to stress about this whole thing.Does my doctors suggestion to wait a few months until my next appointment to recheck the lymphocyte/other levels sound reasonable? Im worried that it will keep declining, or that it could signal a larger issue in connection with the other signs/symptoms. Thought about seeking a second opinion with a specialist, but Im having trouble figuring out how that will work with my insurance.Thank you for your time and advice.

Output: This isn't at all concerning. I agree with your doctor.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Scared about abnormal CBC results, history of anorexia25F, 5'0, ~105lbsHistory of anorexia and childhood asthma (used a nebulizer as a little kid, no need for inhaler/treatment now)Abnormal lab results: https://imgur.com/a/Mcg5s0kI see my PCP every couple of months at her request since I have struggled with a restrictive eating disorder since I was 13. As part of my semi-regular appointments she runs what I think are fairly comprehensive labs (I only included pics of abnormal results but she also runs thyroid, estrogen, etc.). My vitamin B12 is also slightly high (1,316 pg/mL).Im mostly concerned that my absolute lymphocyte count has been steadily declining since last year  when I first started seeing my doctor in March 2022 it was 1.26 L and in March 2023 it was 0.79 L. There are a few other results like hematocrit and mean corpuscular volume that are elevated, but those at least seem to be closer to the reference ranges. I know a small elevation/drop can be normal since were not robots, but the decrease in lymphocyte count seems pretty dramatic.My doctor didnt call/comment on my most recent labs, so I sent her a message online asking about the lymphocyte count. Her response was that a slightly lowered lymphocyte count isnt uncommon/could be due to nutrition and we could recheck at my next appointment. However, Ive actually been doing much better with nutrition since around December 2022 and am at a stable weight with normal thyroid/estrogen levels, so Im not sure that malnutrition would be a likely cause.Ive been waking up slightly sweaty/clammy in the middle of the night, usually a few nights per week. Ive experienced this before to a much greater extent in residential treatment for my eating disorder when I was going through refeeding and experiencing hypermetabolism, but that is definitely not the case now as my weight and food intake are adequate (confirmed by RD).I have a small lump on one side of my neck that my PCP ordered an ultrasound for in November 2022  result was normal enlarged lymph node, no biopsy recommended. It hasnt changed/grown, but I recently noticed another small lump on the other side of my neck. The lymph nodes just under my jawbone feel slightly swollen as of this weekend, but Im not sure whether to chalk that up to stress about this whole thing.Does my doctors suggestion to wait a few months until my next appointment to recheck the lymphocyte/other levels sound reasonable? Im worried that it will keep declining, or that it could signal a larger issue in connection with the other signs/symptoms. Thought about seeking a second opinion with a specialist, but Im having trouble figuring out how that will work with my insurance.Thank you for your time and advice.. ### Response: This isn't at all concerning. I agree with your doctor..


Instruction: Thank you so much, that helps me feel less worried about it. I know I'm a not a doctor and my current PCP has been great, but it's hard not to stress out sometimes.Really appreciate the time you and all the other doctors put into helping others out on here!

Output: I agree with your doctor's suggestion. This wouldn't concern me.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much, that helps me feel less worried about it. I know I'm a not a doctor and my current PCP has been great, but it's hard not to stress out sometimes.Really appreciate the time you and all the other doctors put into helping others out on here!. ### Response: I agree with your doctor's suggestion. This wouldn't concern me..


Instruction: How long can formula milk be run through an IV without spoiling?6 months old male Continuous feedI asked in r/nursing when milk goes bad and they immediately closed it and said ask a doctor for medical advice so here I am.Our son was in hospital for 5 months on continuous feed 20 hours a day in 4 hour chunks. We've continued that cadence now he's home and he's currently getting 180ml every 4 hours for 20 hours with a 4 hour break, but we now have a student nurse who watches him during the night while she studies. She's feeding him 360ml in 8 hour chunks which we were under the impression would be a bad idea as formula at room temperature for this long would spoil - is that correct?When I Google it it says formula can't be at room temp for longer than 2 hours which would mean he's been fed incorrectly since birth so just looking for a bit of clarity on how long you would run a continuous feed for in hospital before swapping the bags out so that we're not feeding him bad milk.

Output: What is the actual material you are feeding? Is it formula, tube feeds or other types of nutrition?Is it going to his stomach via a tube? Or in an IV?Lots of inconsistencies in the post. Regardless best person to ask is the manufacturer of the feeds.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How long can formula milk be run through an IV without spoiling?6 months old male Continuous feedI asked in r/nursing when milk goes bad and they immediately closed it and said ask a doctor for medical advice so here I am.Our son was in hospital for 5 months on continuous feed 20 hours a day in 4 hour chunks. We've continued that cadence now he's home and he's currently getting 180ml every 4 hours for 20 hours with a 4 hour break, but we now have a student nurse who watches him during the night while she studies. She's feeding him 360ml in 8 hour chunks which we were under the impression would be a bad idea as formula at room temperature for this long would spoil - is that correct?When I Google it it says formula can't be at room temp for longer than 2 hours which would mean he's been fed incorrectly since birth so just looking for a bit of clarity on how long you would run a continuous feed for in hospital before swapping the bags out so that we're not feeding him bad milk.. ### Response: What is the actual material you are feeding? Is it formula, tube feeds or other types of nutrition?Is it going to his stomach via a tube? Or in an IV?Lots of inconsistencies in the post. Regardless best person to ask is the manufacturer of the feeds..


Instruction: Please forgive my ignorance, this is genuine confusion and not sarcasm or anything like that but I'm really not understanding how anything is relevant behind the time at which formula milk goes bad at room temperature. Whether he's fed 10ml an hour or 1 liter an hour into his stomach or his bowel, the fact would remain that the rate at which milk would spoil at room temperature would be a constant - I'm having difficulty understanding why the answer is not straightforward that 'formula cannot sit unused at room temperature for xyz hours' as an example. Nothing unique to him or his situation would make milk sat at room temperature last longer - at least that I can think of - but if I am being ignorant to something that changes everything then please tell me so I can learn.Right now in my head I'm having trouble getting away from the concept of whether I eat chicken in 2 bites or 17 or whether I put it in a blender or I eat it fried, it would still be unfit for consumption if it were first left out for a period of time. And given that we believe the nurse is doing something we've been told is bad, it wouldn't make sense to ask her because she wouldn't contradict herself. It makes more sense to me to look for a consensus from different professionals.For his feed, that's my bad referring to it as an IV, it's in a bag that hangs up on a pole and is administered slowly over 4 hours at 45ml per hour. We give him 180ml and change the bag every 4 hours. The line runs through a kangaroo thing that pumps it into his bowel through a J port in a button on his chest. Instead of 180ml at 45 per hour for 4 hours the night nurse is feeding him 360ml in the bag over 8 hours at the same rate so just doubling the contents of the bag and leaving the bag at room temperature for 8 hours while it is administered into him

Output: It's not milk though is it? It's some type of tube feeding. Look at the bottle, and then look on the company website.For example, Vital AF, a common tube feed formulation used in my hospital can hang unrefrigerated for 48 hours per the company website.https://www.abbottnutrition.com/our-products/vital-af-1_2-cal

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Please forgive my ignorance, this is genuine confusion and not sarcasm or anything like that but I'm really not understanding how anything is relevant behind the time at which formula milk goes bad at room temperature. Whether he's fed 10ml an hour or 1 liter an hour into his stomach or his bowel, the fact would remain that the rate at which milk would spoil at room temperature would be a constant - I'm having difficulty understanding why the answer is not straightforward that 'formula cannot sit unused at room temperature for xyz hours' as an example. Nothing unique to him or his situation would make milk sat at room temperature last longer - at least that I can think of - but if I am being ignorant to something that changes everything then please tell me so I can learn.Right now in my head I'm having trouble getting away from the concept of whether I eat chicken in 2 bites or 17 or whether I put it in a blender or I eat it fried, it would still be unfit for consumption if it were first left out for a period of time. And given that we believe the nurse is doing something we've been told is bad, it wouldn't make sense to ask her because she wouldn't contradict herself. It makes more sense to me to look for a consensus from different professionals.For his feed, that's my bad referring to it as an IV, it's in a bag that hangs up on a pole and is administered slowly over 4 hours at 45ml per hour. We give him 180ml and change the bag every 4 hours. The line runs through a kangaroo thing that pumps it into his bowel through a J port in a button on his chest. Instead of 180ml at 45 per hour for 4 hours the night nurse is feeding him 360ml in the bag over 8 hours at the same rate so just doubling the contents of the bag and leaving the bag at room temperature for 8 hours while it is administered into him. ### Response: It's not milk though is it? It's some type of tube feeding. Look at the bottle, and then look on the company website.For example, Vital AF, a common tube feed formulation used in my hospital can hang unrefrigerated for 48 hours per the company website.https://www.abbottnutrition.com/our-products/vital-af-1_2-cal.


Instruction: How do you know if you're nutritionally deficient in some way?Male. Late 20s. Non smoker. Non drug user. Non drinker.So I have a fairly basic diet. I eat a reasonably healthy mix of meat veg and fruit every day. But it is basically the same things every day. So unless there is a major health issue as a symptom is there a way to know if there's something else I need to be eating?For example I can't eat fish/ seafood. Is there a symptom that I should mindful of that means I'm missing something from my diet that fish/ seafood would normally provide?

Output: Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.True nutritional deficiencies are almost unheard of in modern first-world countries. They are either the result of very restrictive diets, or of medical conditions that cause problems with the absorption of nutrients, such as inflammatory bowel disease or celiac disease, or surgery of the gastrointestinal system, such as bariatric surgery (weight-loss surgery) or removal of parts of the small intestine (usually due to injuries like getting stabbed or shot in the abdomen).As an aside, there is an "epidemic" of vitamin D deficiency currently. I use the quotation marks, as this is a controversial issue. By some measures, up to 60% of people in the United States are "deficient" in vitamin D. However, it is possible that the values that are considered to be sufficient are just wrong. For an interesting discussion of how this came to be you can read this interesting article about the physician who more-or-less singlehandedly creates the modern idea of vitamin D deficiency.https://www.nytimes.com/2018/08/18/business/vitamin-d-michael-holick.htmlIt should be noted that there are studies that associate vitamin D deficiency with worse outcomes of various illnesses, including COVID-19, but that large studies of vitamin D supplementation have never shown any benefits whatsoever.Finally, and to me mysteriously, despite the "epidemic" of vitamin D deficiency, children are oddly spared the effects: vitamin D deficiency in children produces a specific syndrome called rickets, which is very nasty, but somehow, there is essentially no rickets in the United States. The only case I ever saw was a well-meaning but utterly misguided family feeding their newborn infant home-made vegan formula.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How do you know if you're nutritionally deficient in some way?Male. Late 20s. Non smoker. Non drug user. Non drinker.So I have a fairly basic diet. I eat a reasonably healthy mix of meat veg and fruit every day. But it is basically the same things every day. So unless there is a major health issue as a symptom is there a way to know if there's something else I need to be eating?For example I can't eat fish/ seafood. Is there a symptom that I should mindful of that means I'm missing something from my diet that fish/ seafood would normally provide?. ### Response: Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.True nutritional deficiencies are almost unheard of in modern first-world countries. They are either the result of very restrictive diets, or of medical conditions that cause problems with the absorption of nutrients, such as inflammatory bowel disease or celiac disease, or surgery of the gastrointestinal system, such as bariatric surgery (weight-loss surgery) or removal of parts of the small intestine (usually due to injuries like getting stabbed or shot in the abdomen).As an aside, there is an "epidemic" of vitamin D deficiency currently. I use the quotation marks, as this is a controversial issue. By some measures, up to 60% of people in the United States are "deficient" in vitamin D. However, it is possible that the values that are considered to be sufficient are just wrong. For an interesting discussion of how this came to be you can read this interesting article about the physician who more-or-less singlehandedly creates the modern idea of vitamin D deficiency.https://www.nytimes.com/2018/08/18/business/vitamin-d-michael-holick.htmlIt should be noted that there are studies that associate vitamin D deficiency with worse outcomes of various illnesses, including COVID-19, but that large studies of vitamin D supplementation have never shown any benefits whatsoever.Finally, and to me mysteriously, despite the "epidemic" of vitamin D deficiency, children are oddly spared the effects: vitamin D deficiency in children produces a specific syndrome called rickets, which is very nasty, but somehow, there is essentially no rickets in the United States. The only case I ever saw was a well-meaning but utterly misguided family feeding their newborn infant home-made vegan formula..


Instruction: Can I survive only on smoothies and fruit bowls if I make them nutritionally complete?Alright so heres the deal. Im 20, female, 119 lbs and 54. I was diagnosed with gastroparesis and IBS when I was 16 and Ive been trying to keep my symptoms at bay. However lately Ive struggled a lot with very intense pain after eating and a lot of bloating, especially when I eat at night. Whenever I eat after like 4 I have trouble sleeping because of the pain, that is if I dont throw up immediately afterwards. I started to realize that the problem goes away if I consume smoothies or smoothie bowls instead of my normal meals. I always have oatmeal for breakfast and I usually dont have an issue with it, I do become full super quickly though. I decided to replace my lunch and dinner with one big smoothie. The smoothie contains: -Spinach or kale -About 1.5 cups of fruit -Coconut oil or sugar free peanut butter -Vegan protein powder -Fortified Almond milk -Cauliflower, Celery or other miscellaneous vegetables.The smoothie is either liquid or thick and topped with more fruit, some light granola and extra nut butter. It would be my one meal aside from my daily bowl of oatmeal which is also topped with berries, nut butter and a little bit of honey. Although sometimes I have eggs for breakfast instead.In addition I take a B complex vitamin, omega 3, vitamin D and Iron supplements. I want to know if this is sustainable and something I can do long term, I honestly cannot stand the pain food causes me anymore and I figure liquid food is better than no food. Im treatment resistant and Ive been on medication for both of my conditions, somehow after I started treatment my symptoms got worse so I had to stop. I appreciate any advice you can provide.

Output: sure. You can survive on a blended up vegan diet if you want.Just be sure you're hitting reasonable amounts of fat and protein, and supplement B12. Pay attention to your iron intake, may need supplementation too.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can I survive only on smoothies and fruit bowls if I make them nutritionally complete?Alright so heres the deal. Im 20, female, 119 lbs and 54. I was diagnosed with gastroparesis and IBS when I was 16 and Ive been trying to keep my symptoms at bay. However lately Ive struggled a lot with very intense pain after eating and a lot of bloating, especially when I eat at night. Whenever I eat after like 4 I have trouble sleeping because of the pain, that is if I dont throw up immediately afterwards. I started to realize that the problem goes away if I consume smoothies or smoothie bowls instead of my normal meals. I always have oatmeal for breakfast and I usually dont have an issue with it, I do become full super quickly though. I decided to replace my lunch and dinner with one big smoothie. The smoothie contains: -Spinach or kale -About 1.5 cups of fruit -Coconut oil or sugar free peanut butter -Vegan protein powder -Fortified Almond milk -Cauliflower, Celery or other miscellaneous vegetables.The smoothie is either liquid or thick and topped with more fruit, some light granola and extra nut butter. It would be my one meal aside from my daily bowl of oatmeal which is also topped with berries, nut butter and a little bit of honey. Although sometimes I have eggs for breakfast instead.In addition I take a B complex vitamin, omega 3, vitamin D and Iron supplements. I want to know if this is sustainable and something I can do long term, I honestly cannot stand the pain food causes me anymore and I figure liquid food is better than no food. Im treatment resistant and Ive been on medication for both of my conditions, somehow after I started treatment my symptoms got worse so I had to stop. I appreciate any advice you can provide.. ### Response: sure. You can survive on a blended up vegan diet if you want.Just be sure you're hitting reasonable amounts of fat and protein, and supplement B12. Pay attention to your iron intake, may need supplementation too..


Instruction: Wouldnt talking to a dietitian help or even be a good idea for anyone considering something like this? Or is that not in line with what a dietician would normally advise on?

Output: She can if she wants. If she's not familiar with vegan diets, it could be a good idea.The intake of protein, fats and other micros could become a problem. Remember a healthy diet is first, balanced and second, a diet you can stick to.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Wouldnt talking to a dietitian help or even be a good idea for anyone considering something like this? Or is that not in line with what a dietician would normally advise on?. ### Response: She can if she wants. If she's not familiar with vegan diets, it could be a good idea.The intake of protein, fats and other micros could become a problem. Remember a healthy diet is first, balanced and second, a diet you can stick to..


Instruction: What does a toddler really need nutritionally?My husband and I have 3 children. We have always had good eaters but my youngest (2 years) is becoming rather picky. I personally believe she is still eating enough and realize this is just a pretty common childhood thing. My poor poor husband is worried sick. I think this man legit thinks she will starve if he doesn't just get her to eat something and often results in caving to more snack foods, making this whole thing worse.To give you an idea of what she is currently eatingBreakfast - a full bowl of Oatmeal, banana, cup of milk. Lunch - about a quarter (plus a few bites more) of a peanut butter and jelly sandwich, bowl of applesauce, cup of water She will snack on some plain animal crackers or cheerios throughout the day Dinner - usually a small bowl of noodles and a cup of milk. Definitely her smallest meal of the day. I usually will still give her a small bowl of ice cream or a slice of pie if we have it. And I'm talking age appropriate portions. All within reason.I realize she's heavy on carbs and in an ideal world we could get more fresh foods in. I think it will all happen in time but this man really is scared for his daughter. Please help me calm him down and let me know if she will survive to adulthood on this pretty standard kids diet?

Output: She'll be just fine. Toddlers are often snackers, and they get in a lot more calories than you'd think through this. As long as she's growing, I wouldn't be too concerned. You can always bring her in and discuss further with her pediatrician if you think your husband needs to hear it directly from them.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What does a toddler really need nutritionally?My husband and I have 3 children. We have always had good eaters but my youngest (2 years) is becoming rather picky. I personally believe she is still eating enough and realize this is just a pretty common childhood thing. My poor poor husband is worried sick. I think this man legit thinks she will starve if he doesn't just get her to eat something and often results in caving to more snack foods, making this whole thing worse.To give you an idea of what she is currently eatingBreakfast - a full bowl of Oatmeal, banana, cup of milk. Lunch - about a quarter (plus a few bites more) of a peanut butter and jelly sandwich, bowl of applesauce, cup of water She will snack on some plain animal crackers or cheerios throughout the day Dinner - usually a small bowl of noodles and a cup of milk. Definitely her smallest meal of the day. I usually will still give her a small bowl of ice cream or a slice of pie if we have it. And I'm talking age appropriate portions. All within reason.I realize she's heavy on carbs and in an ideal world we could get more fresh foods in. I think it will all happen in time but this man really is scared for his daughter. Please help me calm him down and let me know if she will survive to adulthood on this pretty standard kids diet?. ### Response: She'll be just fine. Toddlers are often snackers, and they get in a lot more calories than you'd think through this. As long as she's growing, I wouldn't be too concerned. You can always bring her in and discuss further with her pediatrician if you think your husband needs to hear it directly from them..


Instruction: I (f21) have been losing my hair and I think its a nutritional issueMy hair used to be super thick when I was younger. As I got older, I would shed like crazy. Id be in the shower and pull out chunks of hair. My part is getting wider and it has mini parts so my big part is shaped like a stitch or spine. What kind of foods could help me grow my hair back, if possible?

Output: This post is missing much of the helpful required information for this subreddit and contains no medically-precise information about the distribution of hair loss and medically-precise description of the findings of the scalp examination. Providing an opinion is not possible. Seek dermatology care.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I (f21) have been losing my hair and I think its a nutritional issueMy hair used to be super thick when I was younger. As I got older, I would shed like crazy. Id be in the shower and pull out chunks of hair. My part is getting wider and it has mini parts so my big part is shaped like a stitch or spine. What kind of foods could help me grow my hair back, if possible?. ### Response: This post is missing much of the helpful required information for this subreddit and contains no medically-precise information about the distribution of hair loss and medically-precise description of the findings of the scalp examination. Providing an opinion is not possible. Seek dermatology care..


Instruction: Where to start for a good nutrition deficiency and gastro health testing29 6'1" 200 lbs white male Fatigue last couple of yearsHey everyone. Thanks in advance for any help! I have maxed out my deductible this year for unrelated arm surgery and am looking to make sure I get the most of medical assistance that I have kinda been putting off. For the last couple of years I have felt fairly fatigued and cloudy from day to day and generally held a bit of a fog. I am in great shape physically but my diet is not the best due to very little fruits and vegetables. I was wondering about a good place to start to get a nutrition deficiency test? I would like to do a comprehensive one if possible. This has been something that I have been meaning to check off regardless of if it is the best place to start for concerns around fatigue. I have also noticed frequent black specs that look like coffee grinds in my stool. I got a take home test done with a general physician with negative results. Does this mean I simply do not need to worry about this concern anymore? I was picturing a situation where I might be able to combine the concerns and see a gastro health doctor and have a general look at my overall nutritional picture?On a side note hangovers have been getting really bad for me recently and usually lasting two days.In addition to this, I am open to suggestions on any general medical checkups that would be advised to get an idea of my health prior to the end of the year and having to pay out of pocket next year. Thanks for any help. It is appreciated!

Output: Why get a nutrition test when you know the problem already: you need to eat more fruits and vegetables.Why are you still getting hangovers? You're 29 dude. Drink a glass of water between every drink and stop drinking so much that you get hungover. Alcohol is a literal poison. It's fun in moderation, but if you're getting hangovers for days, you aren't drinking in moderation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Where to start for a good nutrition deficiency and gastro health testing29 6'1" 200 lbs white male Fatigue last couple of yearsHey everyone. Thanks in advance for any help! I have maxed out my deductible this year for unrelated arm surgery and am looking to make sure I get the most of medical assistance that I have kinda been putting off. For the last couple of years I have felt fairly fatigued and cloudy from day to day and generally held a bit of a fog. I am in great shape physically but my diet is not the best due to very little fruits and vegetables. I was wondering about a good place to start to get a nutrition deficiency test? I would like to do a comprehensive one if possible. This has been something that I have been meaning to check off regardless of if it is the best place to start for concerns around fatigue. I have also noticed frequent black specs that look like coffee grinds in my stool. I got a take home test done with a general physician with negative results. Does this mean I simply do not need to worry about this concern anymore? I was picturing a situation where I might be able to combine the concerns and see a gastro health doctor and have a general look at my overall nutritional picture?On a side note hangovers have been getting really bad for me recently and usually lasting two days.In addition to this, I am open to suggestions on any general medical checkups that would be advised to get an idea of my health prior to the end of the year and having to pay out of pocket next year. Thanks for any help. It is appreciated!. ### Response: Why get a nutrition test when you know the problem already: you need to eat more fruits and vegetables.Why are you still getting hangovers? You're 29 dude. Drink a glass of water between every drink and stop drinking so much that you get hungover. Alcohol is a literal poison. It's fun in moderation, but if you're getting hangovers for days, you aren't drinking in moderation..


Instruction: Nutrition Response Testing21M 165lbs 5'10 I think this is not scientific or accurate but am looking for other opinions. The idea that the body responds differently depending what bottled supplement or substance someone is holding doesn't make sense to me at all. I haven't been able to find any detailed explanation online about the rationale behind this. Still, nutrition response testing is quite widespread and used by many doctors, which is difficult to understand. Do they legitimately believe it works or are they just trying to appeal to more clients/make more money? The fact that Freddie Ulan(founder of nutrition response testing) is a known scientologist is also a red flag to me. My mom is convinced that this works and wants to take me. What are your thoughts?

Output: Removed under rule 7. Please do not post pseudoscience/pseudomedicine or other non-medical interventions in this subreddit.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nutrition Response Testing21M 165lbs 5'10 I think this is not scientific or accurate but am looking for other opinions. The idea that the body responds differently depending what bottled supplement or substance someone is holding doesn't make sense to me at all. I haven't been able to find any detailed explanation online about the rationale behind this. Still, nutrition response testing is quite widespread and used by many doctors, which is difficult to understand. Do they legitimately believe it works or are they just trying to appeal to more clients/make more money? The fact that Freddie Ulan(founder of nutrition response testing) is a known scientologist is also a red flag to me. My mom is convinced that this works and wants to take me. What are your thoughts?. ### Response: Removed under rule 7. Please do not post pseudoscience/pseudomedicine or other non-medical interventions in this subreddit..


Instruction: Pediatric: Cannabis vs Opiods for pain management?My step-son (13M, 238lbs, 6'3) fractured the growth plate on the back of his ankle today. We were given hydrocodone but he has gotten very agitated/rage-y on painkillers before.Also, there is a history of opioid abuse/addiction on one parent's side and general substance abuse/addiction on the other so we're all very skeptical to give him anything. Two of us parents have used medical marijuana as a replacement for pain medication effectively.Which would be considered the lesser of two evils here? Either way we would mostly be giving it to him once a day to help him sleep.

Output: Besides hydrocodone. Is he on any nsaids? (Ibuprofen,naproxen,etc) I assume the hydrocodone is in combo with acetaminophen. Cannabis has and is used for some pain control but it really depends on the legality in your state/country.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric: Cannabis vs Opiods for pain management?My step-son (13M, 238lbs, 6'3) fractured the growth plate on the back of his ankle today. We were given hydrocodone but he has gotten very agitated/rage-y on painkillers before.Also, there is a history of opioid abuse/addiction on one parent's side and general substance abuse/addiction on the other so we're all very skeptical to give him anything. Two of us parents have used medical marijuana as a replacement for pain medication effectively.Which would be considered the lesser of two evils here? Either way we would mostly be giving it to him once a day to help him sleep.. ### Response: Besides hydrocodone. Is he on any nsaids? (Ibuprofen,naproxen,etc) I assume the hydrocodone is in combo with acetaminophen. Cannabis has and is used for some pain control but it really depends on the legality in your state/country..


Instruction: Yes, we are alternating ibuprofen and Tylenol every few hours throughout the day which is why the main concern is him getting some rest at night. Delta 8 and 9 are legal in our state. I'm mainly worried about the whole brain still developing at his age thing.

Output: if his pain is bad enough he could get a nerve block with a catheter. would make the pain basically gone and he could keep it pretty numb for 3-5 days till a lot of the inflammation is down.You could try paracetamol and ibuprofen first. If his pain is uncontrolled with that then chat to his doctor about your concerns. Opiates can be entirely appropriate for acute pain. Im not sure of the evidence for cannabis for acute pain, especially in children.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes, we are alternating ibuprofen and Tylenol every few hours throughout the day which is why the main concern is him getting some rest at night. Delta 8 and 9 are legal in our state. I'm mainly worried about the whole brain still developing at his age thing.. ### Response: if his pain is bad enough he could get a nerve block with a catheter. would make the pain basically gone and he could keep it pretty numb for 3-5 days till a lot of the inflammation is down.You could try paracetamol and ibuprofen first. If his pain is uncontrolled with that then chat to his doctor about your concerns. Opiates can be entirely appropriate for acute pain. Im not sure of the evidence for cannabis for acute pain, especially in children..


Instruction: My pediatric urologist wants to put my child under general anasthetics at 6 monthsI am worried about negative impacts this might have on brain development is it possible to have a successful surgery done at 3 years old instead?

Output: 3 year old kids get extremely stressed about surgery and will remember both the period before and the pain afterwards. It can be very traumatizing for them.A 6 month old will have no clue what's happening and won't remember.The available evidence suggests that a one off exposure to a general anaesthetic will not have long term implications for neurodevelopment. However your concerns are very valid and you should discuss it further with your paediatrician.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My pediatric urologist wants to put my child under general anasthetics at 6 monthsI am worried about negative impacts this might have on brain development is it possible to have a successful surgery done at 3 years old instead?. ### Response: 3 year old kids get extremely stressed about surgery and will remember both the period before and the pain afterwards. It can be very traumatizing for them.A 6 month old will have no clue what's happening and won't remember.The available evidence suggests that a one off exposure to a general anaesthetic will not have long term implications for neurodevelopment. However your concerns are very valid and you should discuss it further with your paediatrician..


Instruction: This! When my kid was 6 months old all he needed to feel better was to nurse. At 3 nothing worked!

Output: It depends on what surgery your child is having on whether it can be delayed that much. What is it?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This! When my kid was 6 months old all he needed to feel better was to nurse. At 3 nothing worked!. ### Response: It depends on what surgery your child is having on whether it can be delayed that much. What is it?.


Instruction: Chordee

Output: He'll be more uncomfortable after surgery at age 3 than at age 6 mo, but there's really not a solid indication to fix that early. For things like undescended testicles, those should be done sooner.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Chordee. ### Response: He'll be more uncomfortable after surgery at age 3 than at age 6 mo, but there's really not a solid indication to fix that early. For things like undescended testicles, those should be done sooner..


Instruction: Was this inappropriate?26M. I recently had a flashback to when I was 15.5 y/o and had regular visits with my pediatric endo. I only have TID, no other autoimmune disorders but my pediatric endo always checked my testicle size during every 3-6 month checkup. Is this appropriate? I'm trying to figure out if this is the norm

Output: Most pediatric endocrinologists check the testicles to see the volume and stage sexuality maturity.Endocrinologists also are heavily focused on hormones, so its well within their training to make sure youre testicles were growing appropriately.What's TID? What were you seeing an endocrinologist for?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Was this inappropriate?26M. I recently had a flashback to when I was 15.5 y/o and had regular visits with my pediatric endo. I only have TID, no other autoimmune disorders but my pediatric endo always checked my testicle size during every 3-6 month checkup. Is this appropriate? I'm trying to figure out if this is the norm. ### Response: Most pediatric endocrinologists check the testicles to see the volume and stage sexuality maturity.Endocrinologists also are heavily focused on hormones, so its well within their training to make sure youre testicles were growing appropriately.What's TID? What were you seeing an endocrinologist for?.


Instruction: Sorry, type 1 diabetes

Output: Well apparently high sugar levels can damage your testes, so perhaps? Hard to say

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry, type 1 diabetes. ### Response: Well apparently high sugar levels can damage your testes, so perhaps? Hard to say.


Instruction: Possible seborrheic dermatitis?Pediatric patient 10M, height 4ft, 80lbs, white/black, healthy and has no medical issues, no meds, etc. I was thinking it was just a serious case of dry scalp as it was starting to peel. He's been itching it quite a bit while at school. I mentioned this to the pediatrician and was told to use selenium sulfide (Head & Shoulders), so that is why the scab appears that greenish/blue color. It is raised pretty high. My concern is if he keeps scratching it could lead to an infection. Does this appear to be seborrheic dermatitis? if not what else could it be? Thank you.

Output: 1 marginal quality image. Seborrheic dermatitis could appear this way as could psoriasis, tinea capitis and many other conditions.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Possible seborrheic dermatitis?Pediatric patient 10M, height 4ft, 80lbs, white/black, healthy and has no medical issues, no meds, etc. I was thinking it was just a serious case of dry scalp as it was starting to peel. He's been itching it quite a bit while at school. I mentioned this to the pediatrician and was told to use selenium sulfide (Head & Shoulders), so that is why the scab appears that greenish/blue color. It is raised pretty high. My concern is if he keeps scratching it could lead to an infection. Does this appear to be seborrheic dermatitis? if not what else could it be? Thank you.. ### Response: 1 marginal quality image. Seborrheic dermatitis could appear this way as could psoriasis, tinea capitis and many other conditions..


Instruction: Thanks, Doc. It definitely could be tinea capitis. I'll keep treating it with selenium sulfide until my appt with the pediatrician next week.

Output: You might consider dampening the scalp, using a salicylic acid shampoo and let it stay in place 5-10 minutes, then rinse it off. This may loosen the scale.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks, Doc. It definitely could be tinea capitis. I'll keep treating it with selenium sulfide until my appt with the pediatrician next week.. ### Response: You might consider dampening the scalp, using a salicylic acid shampoo and let it stay in place 5-10 minutes, then rinse it off. This may loosen the scale..


Instruction: Thank you, Doc. So salicylic acid should work better than selenium sulfide? Selsun Blue and Head and Shoulders have both.Correct, I have been rubbing it in gently and washing it out after 10 minutes.

Output: There is no evidence that one active ingredient in these shampoos works better than another for seborrheic dermatitis. I was making a suggestion to help remove the adherent scale.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you, Doc. So salicylic acid should work better than selenium sulfide? Selsun Blue and Head and Shoulders have both.Correct, I have been rubbing it in gently and washing it out after 10 minutes.. ### Response: There is no evidence that one active ingredient in these shampoos works better than another for seborrheic dermatitis. I was making a suggestion to help remove the adherent scale..


Instruction: Pediatric neurology help. Sudden onset Anisocoria (1.3mm) in 3 siblingsMy 4.5, 2.5, and 6 week old all have Anisocoria. The first 2 measure 1.3mm difference, the third has not been seen.My 4.5 year old was referred after he didnt pass the vision screen at pediatrician (they turn off lights and the kids look in the box with birds chirping.) My 2.5 year old failed same test and was referred. It is noticeable by naked eye with the 6 week old. The older two have previously passed the eye test in years prior. This is the first appointment for both that they failed.My 4.5 year old went to a pediatric eye doctor and he said he couldnt find any other issues. He said he has seen it come and go in kids and even switch eyes. I cant find anything like that on Google. Nothing about it being genetic. He said 1 in 10,000 chance that its a neurological issue because no other symptoms present. My 2.5 year old will go on 10/20. My 4.5 year old will go for follow up on 10/31.I dont know what other actions to take. It is unsettling this popped up in all of them with no answers.

Output: I'm not an opthalmologist, but if three children in the same household developed this as a sudden onset issue in the same time period it seems reasonable to consider an environmental trigger or exposure. New medicines in the house?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric neurology help. Sudden onset Anisocoria (1.3mm) in 3 siblingsMy 4.5, 2.5, and 6 week old all have Anisocoria. The first 2 measure 1.3mm difference, the third has not been seen.My 4.5 year old was referred after he didnt pass the vision screen at pediatrician (they turn off lights and the kids look in the box with birds chirping.) My 2.5 year old failed same test and was referred. It is noticeable by naked eye with the 6 week old. The older two have previously passed the eye test in years prior. This is the first appointment for both that they failed.My 4.5 year old went to a pediatric eye doctor and he said he couldnt find any other issues. He said he has seen it come and go in kids and even switch eyes. I cant find anything like that on Google. Nothing about it being genetic. He said 1 in 10,000 chance that its a neurological issue because no other symptoms present. My 2.5 year old will go on 10/20. My 4.5 year old will go for follow up on 10/31.I dont know what other actions to take. It is unsettling this popped up in all of them with no answers.. ### Response: I'm not an opthalmologist, but if three children in the same household developed this as a sudden onset issue in the same time period it seems reasonable to consider an environmental trigger or exposure. New medicines in the house?.


Instruction: My 10 year old had an allergic reaction Sunday night and still has welts. Is it normal for his body to heal like this?My 10 year old son had an allergic reaction while asleep Sunday night and woke up with his trunk covered in welts. He was taken to his pediatrician and prescribed 4mg Dexamethasone, 2 tabs first day and 2 two days after.His only known allergy are peanuts (severe).He is still getting new welt outbreaks and does not seem to be getting better, but physically feels fine minus the itching.Thanks for your help.

Output: The most common causes of hives in a pediatric population is actually a viral illness. If you don't think he's having other allergic symptoms, this could be the culprit.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My 10 year old had an allergic reaction Sunday night and still has welts. Is it normal for his body to heal like this?My 10 year old son had an allergic reaction while asleep Sunday night and woke up with his trunk covered in welts. He was taken to his pediatrician and prescribed 4mg Dexamethasone, 2 tabs first day and 2 two days after.His only known allergy are peanuts (severe).He is still getting new welt outbreaks and does not seem to be getting better, but physically feels fine minus the itching.Thanks for your help.. ### Response: The most common causes of hives in a pediatric population is actually a viral illness. If you don't think he's having other allergic symptoms, this could be the culprit..


Instruction: 5.5 Year Old Severe ConstipationTLDR: 5.5 year old is severely constipated, complaining of major stomach pain, trouble swallowing, and nausea. Shes waking up through the night coughing and crying in pain. Doctors are suggesting 5 cap fulls of miralax and 2 ex-lax a day - Im concerned this is not good for her. Thoughts?Hello! I feel like Im new to the constipation world, but weve honestly dealt with it for awhile now without me knowing how bad this is. My daughter is now 5.5 and we are about 5 months into a severe constipation epsiode. Its taken doctors awhile to help figure out how bad this is, but here we are. Shes struggled with constipation on and off ever since she was born (at 4 months old she would pass stool the size of hard boiled eggs), but I didnt know how bad it truly is. She has always pooped once or twice a day for most of her life, its just the consistency and size of the stool that I was ill-informed about. Here is where we are at now: Since November, she has been complaining that as soon as she eats or drinks, her throat feels tight, feels that shes going to throw up, and her stomach hurts so bad. Ive taken her to the ER twice, doctors at least once a week, and have had multiple X-rays. The X-rays consistently show tons of stool. We officially started doing a clean out method about 2.5 weeks ago doing mirilax, milk of magnesia, and ex-lax. Shes been pooping 5 or more times a day, passing lots of ribbon size or huge logs. But her complaints are continuing and shes eating less and less. She is not afraid of pooping and has no problem making it to the bathroom which is good. Weve missed a lot of school (kindergarten) for this and shes only 35 poundsI cant imagine what this is doing to her long term. The X-ray 2 days ago showed that shes still completely backed up right at the exit of her stomach, her stomach isnt digesting her food well, and her stomach is extended. The pediatric GI suggested to do 5 mirilax cap fulls a day and 2 ex-lax still, for up to 3 months. I just dont feel like this is safe for her, how little she is, how little shes eating, and how much pain this is causing her. Im no doctor, which is why Im turning here. Of course the stomach aches are now worse and shes in tears on and off all day. I, personally, have IBS with diarrhea so I have no experience on how to deal with this and asking for all the tips. We have been dairy free for a month, and Im not yet going to try gluten free because I do want her tested. We have only been talking to a pediatric GI on the phone through our regular doctor because her appointment is still a month and a half away (we had to wait almost 2.5 months to get in), so further testing hasnt started yet as to why we are in this mess.

Output: I would agree 100% with the pediatric GI given what you say here. Long-term constipation like this causes her bowels to dilate (become larger) at baseline. That distension causes her to have less sensation of when she needs to go. Those nerves in her gut can retrain themselves, but it takes months, so it's important that she get fully cleaned out and stay that way while the retraining happens.If the dairy-free diet is helping, you can continue, but if you don't see a huge difference, it's fine to re-introduce dairy. Most pediatric constipation isn't due to a food intolerance.https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Constipation.aspx

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 5.5 Year Old Severe ConstipationTLDR: 5.5 year old is severely constipated, complaining of major stomach pain, trouble swallowing, and nausea. Shes waking up through the night coughing and crying in pain. Doctors are suggesting 5 cap fulls of miralax and 2 ex-lax a day - Im concerned this is not good for her. Thoughts?Hello! I feel like Im new to the constipation world, but weve honestly dealt with it for awhile now without me knowing how bad this is. My daughter is now 5.5 and we are about 5 months into a severe constipation epsiode. Its taken doctors awhile to help figure out how bad this is, but here we are. Shes struggled with constipation on and off ever since she was born (at 4 months old she would pass stool the size of hard boiled eggs), but I didnt know how bad it truly is. She has always pooped once or twice a day for most of her life, its just the consistency and size of the stool that I was ill-informed about. Here is where we are at now: Since November, she has been complaining that as soon as she eats or drinks, her throat feels tight, feels that shes going to throw up, and her stomach hurts so bad. Ive taken her to the ER twice, doctors at least once a week, and have had multiple X-rays. The X-rays consistently show tons of stool. We officially started doing a clean out method about 2.5 weeks ago doing mirilax, milk of magnesia, and ex-lax. Shes been pooping 5 or more times a day, passing lots of ribbon size or huge logs. But her complaints are continuing and shes eating less and less. She is not afraid of pooping and has no problem making it to the bathroom which is good. Weve missed a lot of school (kindergarten) for this and shes only 35 poundsI cant imagine what this is doing to her long term. The X-ray 2 days ago showed that shes still completely backed up right at the exit of her stomach, her stomach isnt digesting her food well, and her stomach is extended. The pediatric GI suggested to do 5 mirilax cap fulls a day and 2 ex-lax still, for up to 3 months. I just dont feel like this is safe for her, how little she is, how little shes eating, and how much pain this is causing her. Im no doctor, which is why Im turning here. Of course the stomach aches are now worse and shes in tears on and off all day. I, personally, have IBS with diarrhea so I have no experience on how to deal with this and asking for all the tips. We have been dairy free for a month, and Im not yet going to try gluten free because I do want her tested. We have only been talking to a pediatric GI on the phone through our regular doctor because her appointment is still a month and a half away (we had to wait almost 2.5 months to get in), so further testing hasnt started yet as to why we are in this mess.. ### Response: I would agree 100% with the pediatric GI given what you say here. Long-term constipation like this causes her bowels to dilate (become larger) at baseline. That distension causes her to have less sensation of when she needs to go. Those nerves in her gut can retrain themselves, but it takes months, so it's important that she get fully cleaned out and stay that way while the retraining happens.If the dairy-free diet is helping, you can continue, but if you don't see a huge difference, it's fine to re-introduce dairy. Most pediatric constipation isn't due to a food intolerance.https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Constipation.aspx.


Instruction: Pediatrics, please!Hello! Worried Mom here.Patient is 5 years old (almost 6). He weighs 35ish pounds and is in the 90th percentile for height. He is a picky eater, but there has been no loss of appetite.His symptoms are diarrhea. I believe this is from lactose intolerance (his dad has the same issue) because the worst episodes are after he consumes anything that could contain lactose.What I am concerned about are the dark circles beneath his eyes that have developed lately. These two symptoms (diarrhea and the dark circles) pull up neuroblastoma when I Google (I know, no Googling). I had a friend whose child had this so it hits a little closer to home, but I know its rare.He has an appointment Monday. Should I push for tests? Or is it probably just lactose intolerance and allergies/lack of sleep and I am just freaking out as a Mom?I do have health anxiety that is being dealt with by a professional- counselor and medication - but every time my children are sick I always jump to cancer.Thanks for any advice!

Output: More concerning that he's not hydrated well, or very tired. Neuroblastoma, just...no. Not up high on the differential at all.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatrics, please!Hello! Worried Mom here.Patient is 5 years old (almost 6). He weighs 35ish pounds and is in the 90th percentile for height. He is a picky eater, but there has been no loss of appetite.His symptoms are diarrhea. I believe this is from lactose intolerance (his dad has the same issue) because the worst episodes are after he consumes anything that could contain lactose.What I am concerned about are the dark circles beneath his eyes that have developed lately. These two symptoms (diarrhea and the dark circles) pull up neuroblastoma when I Google (I know, no Googling). I had a friend whose child had this so it hits a little closer to home, but I know its rare.He has an appointment Monday. Should I push for tests? Or is it probably just lactose intolerance and allergies/lack of sleep and I am just freaking out as a Mom?I do have health anxiety that is being dealt with by a professional- counselor and medication - but every time my children are sick I always jump to cancer.Thanks for any advice!. ### Response: More concerning that he's not hydrated well, or very tired. Neuroblastoma, just...no. Not up high on the differential at all..


Instruction: What to expect from a pediatric UTI examFemale Age 5 Weight 42 lbs Symptoms started this morning Occasional burning sensation when urinating Frequent urge to urinate No current medications Exam scheduled for tomorrow morningJust wondering what to expect by the exam. Mostly which areas will be examined and the manner in which it is done. I want to be able to protect my daughter and be able to spot any predatory behaviors.

Output: I'm assuming you're asking whether a genital exam will happen. May depend on the physician. Some girls that age will complain of "burning" with urination and not have a UTI, but instead have a yeast infection or vaginal irritation that is causing the symptoms, so I do often do a genital exam unless they have symptoms like fever that make me more certain about a UTI.Genital exam in a prepubescent female would consist of often getting into a frog-leg or "butterfly" position while lying down or sitting back. The doctor may spread the labia majora slightly to get a view of the urethra and assess for redness or discharge. There should be no touching of other structures.If you don't feel safe with your pediatrician, time to find a new doctor. A good doctor should always welcome you asking questions and asking for an explanation before they do an exam.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What to expect from a pediatric UTI examFemale Age 5 Weight 42 lbs Symptoms started this morning Occasional burning sensation when urinating Frequent urge to urinate No current medications Exam scheduled for tomorrow morningJust wondering what to expect by the exam. Mostly which areas will be examined and the manner in which it is done. I want to be able to protect my daughter and be able to spot any predatory behaviors.. ### Response: I'm assuming you're asking whether a genital exam will happen. May depend on the physician. Some girls that age will complain of "burning" with urination and not have a UTI, but instead have a yeast infection or vaginal irritation that is causing the symptoms, so I do often do a genital exam unless they have symptoms like fever that make me more certain about a UTI.Genital exam in a prepubescent female would consist of often getting into a frog-leg or "butterfly" position while lying down or sitting back. The doctor may spread the labia majora slightly to get a view of the urethra and assess for redness or discharge. There should be no touching of other structures.If you don't feel safe with your pediatrician, time to find a new doctor. A good doctor should always welcome you asking questions and asking for an explanation before they do an exam..


Instruction: Thank you for the very helpful reply! Im glad you specified what the exam would consist of that was exactly the response I was looking for.Its not so much that I dont feel hes safe or a good doctor, more that I want to be aware. I feel that asking someone involved in the situation with more knowledge than I puts them in a position of power where they could just claim what theyre doing is normal.But again its less the doctor and more about me being suspicious, paranoid, and protective.

Output: No problem!

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for the very helpful reply! Im glad you specified what the exam would consist of that was exactly the response I was looking for.Its not so much that I dont feel hes safe or a good doctor, more that I want to be aware. I feel that asking someone involved in the situation with more knowledge than I puts them in a position of power where they could just claim what theyre doing is normal.But again its less the doctor and more about me being suspicious, paranoid, and protective.. ### Response: No problem!.


Instruction: Pediatric impetigo or something else?Age: 5Weight: 43 lbsRelevant health background: Hes very picky with eating due to some sensory aversions, so he ends up eating a bit of a lopsided diet and barely eats any proteins. He takes multivitamins with iron and no other regular medications. We are in the US, and he is up to date on his vaccines.Maybe relevant maybe not: We live in an area that has brown recluse and black widow spiders. I havent personally seen any. This also began his very first week of Kindergarten. A cough accompanied it, but to be honest my son has a cough 80% of his life.TIMELINESept 2 - My son comes home from Kindergarten and tells me he has a bug bite and his leg hurts. I dont think anything of it, were driving when he tells me this so I dont immediately look.That evening, I see it when giving him a bath. It looks like a bug bite. I put a bandaid on it.Sept 3 - The bug bite is irritating him. Hes scratching at it, I replace the bandaid and give him neosporin.Sept 4 - When I remove the bandaid, the wound has grown considerably. This is the first time I take a photo. Now Im wondering if this was a spider bite. I put some neosporin on and leave it without a bandage Photo: https://imgur.com/a/rB1KJ7BSept 5 - The next day, it looks a bit larger, and with some dots surrounding it. https://imgur.com/a/QdcVImZSept 6 - No change, didnt photographSept 7 - We go to the zoo and he immediately begins complaining about his legs being soooo tired. He was excited to go to the zoo so this was unusual. He whined the whole time and insisted on being carried (hes 5, this is not typical). When we get in the car, he immediately falls asleep. This is important because he had not napped in THREE YEARS. He dropped his naps when he was 2 and never napped since. When we get home, his legs look a lot worse. Not only that, the little bumps around the area have begun popping up all down his back, shoulders, everywhere. https://imgur.com/a/bbCGtFVSept 8 - We visit his pediatrician. He takes one look and diagnosis impetigo. Hes very confident in this. Prescribes topical antibiotic and oral antibiotic for a week. Said he was fine to return to school as long as the wounds werent weeping.Sept 9-16 - The rapid progression stops almost immediately and it begins to heal after about 48 hours on antibiotics. Things are looking good! All my fears of flesh eating bacteria and so on start to go awaySept 21 - Another small sore pops up on the same leg, near his hip. Im immediately suspicious of it, and dont want it to progress, so we go back to the pediatrician the same day.She says it doesnt look anything like the others, and to just keep using the antibiotic ointment, but to add a daily bleach bath (1/4 cup bleach in a tub of water) to help ward off the bacteria living on the skin. She says impetigo is just staph or strep that found its way into a wound and is irritating it, so we just need to keep his skin clean. So we start that.MAYBE RELEVANT - She notes his tonsils are large and does a rapid swab for strep, which is negativeSept 28ish - He has a scrape. Its on the OTHER leg. Hes adamant that he fell and scratched it. We believe him and leave it alone.Oct 1 - Its considerably larger but he also keeps scratching it so were not sure what to think.Oct 2 - We took a walk today and he began complaining that his legs are sooo tired (I cannot stress enough what a hyper boy he is his legs are NOT tired). We go home and that other leg looks IDENTICAL to how the original looked. I go to the urgent care and insist on a skin swab, which they do but since theres no pus, they cannot guarantee accurate results. They prescribe 10 days of Cephalexin but say theyre just not convinced its bacterial. They said it just doesnt look like anything they can readily name.https://imgur.com/a/cObh69dI am worried because it seems to be jumping around his body, made worse by walking/warmth, and hurting his legs more than topical wounds should. I also cant shake that the cough is still there.I also feel dismissed when I repeatedly ask if the cough and exhaustion could be related to his wounds.What do YOU think?

Output: Cephalexin is unlikely to be successful at treating a Staphylococcal impetigo. Treating that requires either Bactrim or clindamycin.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric impetigo or something else?Age: 5Weight: 43 lbsRelevant health background: Hes very picky with eating due to some sensory aversions, so he ends up eating a bit of a lopsided diet and barely eats any proteins. He takes multivitamins with iron and no other regular medications. We are in the US, and he is up to date on his vaccines.Maybe relevant maybe not: We live in an area that has brown recluse and black widow spiders. I havent personally seen any. This also began his very first week of Kindergarten. A cough accompanied it, but to be honest my son has a cough 80% of his life.TIMELINESept 2 - My son comes home from Kindergarten and tells me he has a bug bite and his leg hurts. I dont think anything of it, were driving when he tells me this so I dont immediately look.That evening, I see it when giving him a bath. It looks like a bug bite. I put a bandaid on it.Sept 3 - The bug bite is irritating him. Hes scratching at it, I replace the bandaid and give him neosporin.Sept 4 - When I remove the bandaid, the wound has grown considerably. This is the first time I take a photo. Now Im wondering if this was a spider bite. I put some neosporin on and leave it without a bandage Photo: https://imgur.com/a/rB1KJ7BSept 5 - The next day, it looks a bit larger, and with some dots surrounding it. https://imgur.com/a/QdcVImZSept 6 - No change, didnt photographSept 7 - We go to the zoo and he immediately begins complaining about his legs being soooo tired. He was excited to go to the zoo so this was unusual. He whined the whole time and insisted on being carried (hes 5, this is not typical). When we get in the car, he immediately falls asleep. This is important because he had not napped in THREE YEARS. He dropped his naps when he was 2 and never napped since. When we get home, his legs look a lot worse. Not only that, the little bumps around the area have begun popping up all down his back, shoulders, everywhere. https://imgur.com/a/bbCGtFVSept 8 - We visit his pediatrician. He takes one look and diagnosis impetigo. Hes very confident in this. Prescribes topical antibiotic and oral antibiotic for a week. Said he was fine to return to school as long as the wounds werent weeping.Sept 9-16 - The rapid progression stops almost immediately and it begins to heal after about 48 hours on antibiotics. Things are looking good! All my fears of flesh eating bacteria and so on start to go awaySept 21 - Another small sore pops up on the same leg, near his hip. Im immediately suspicious of it, and dont want it to progress, so we go back to the pediatrician the same day.She says it doesnt look anything like the others, and to just keep using the antibiotic ointment, but to add a daily bleach bath (1/4 cup bleach in a tub of water) to help ward off the bacteria living on the skin. She says impetigo is just staph or strep that found its way into a wound and is irritating it, so we just need to keep his skin clean. So we start that.MAYBE RELEVANT - She notes his tonsils are large and does a rapid swab for strep, which is negativeSept 28ish - He has a scrape. Its on the OTHER leg. Hes adamant that he fell and scratched it. We believe him and leave it alone.Oct 1 - Its considerably larger but he also keeps scratching it so were not sure what to think.Oct 2 - We took a walk today and he began complaining that his legs are sooo tired (I cannot stress enough what a hyper boy he is his legs are NOT tired). We go home and that other leg looks IDENTICAL to how the original looked. I go to the urgent care and insist on a skin swab, which they do but since theres no pus, they cannot guarantee accurate results. They prescribe 10 days of Cephalexin but say theyre just not convinced its bacterial. They said it just doesnt look like anything they can readily name.https://imgur.com/a/cObh69dI am worried because it seems to be jumping around his body, made worse by walking/warmth, and hurting his legs more than topical wounds should. I also cant shake that the cough is still there.I also feel dismissed when I repeatedly ask if the cough and exhaustion could be related to his wounds.What do YOU think?. ### Response: Cephalexin is unlikely to be successful at treating a Staphylococcal impetigo. Treating that requires either Bactrim or clindamycin..


Instruction: So do you feel it looks/sounds like impetigo? If it is, would the swab they took today tell me what bacteria its originating from?

Output: The photos remind me of a bullous impetigo in which the bullae have opened. A culture of the affected skin without fluid from an intact bulla would not show this; the diagnosis is a visual one. Non-bulbous impetigo is Streptococcal, but bullous impetigo is Staphylococcal and one must always treat for MRSA.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: So do you feel it looks/sounds like impetigo? If it is, would the swab they took today tell me what bacteria its originating from?. ### Response: The photos remind me of a bullous impetigo in which the bullae have opened. A culture of the affected skin without fluid from an intact bulla would not show this; the diagnosis is a visual one. Non-bulbous impetigo is Streptococcal, but bullous impetigo is Staphylococcal and one must always treat for MRSA..


Instruction: (Almost) 4yo Boy, Many Symptoms, No AnswersBorn 3/2019.Waking up at night from a dead sleep with leg pain for nearly a year now. Happens once or twice a month usually. Right leg more frequently. Chalked up to growing pains. When he wakes up, give him Tylenol, get the heating pad out and wrap his legs. Rub his back and he falls asleep. Seems fine in the morning. Sometimes has complained of pain during the day, but could be a ploy for medicine. Points to his shins, knees, and thighs as sources of pain.Complains of headaches occasionally (I've never even heard the word, "headache" come out of his older brother's mouth). Goes away with Tylenol.Was vomiting a lot last year. I started tracking and the average was 1.5x a month. No fever or other symptoms; would complain of nausea, boot, then be back to normal within an hour. Went to pediatrician on 8/19/22, she recommended we go to the ER because we could get all testing done rapidly and at once. Went to ER, had bloodwork done (normal at the time, no cancer markers), was diagnosed with cyclical vomiting syndrome. Debated on whether to do a CAT scan or MRI, opted to not. Has only vomited 1x since then, was this past October. Not much nausea or vomiting since.Swollen lymph node in armpit and back of neck, both on left side. Just discovered armpit one today. Neck node has been enlarged for over six months. No biopsy, superficial exams by multiple doctors, all advise this is normal and not a concern. Soft, movable, and less than 2cm in size. Hasn't grown.He often just looks pale compared to the rest of the family (we are white, British decent), but could be chalked up to recent rainy weather and being stuck indoors for winter. He also seems thinner than the rest of us, just bonier than his older brother was. Always craves sweets. Weight and height are good, around 70th percentile.I found swelling in the back of his knee four weeks ago. Right posterior, left of the popliteal fossa, about the size of an avocado pit. Puffy, not hard. Took him to the pedi two weeks ago, and she said likely a cyst, but referred me to an orthopedic surgeon for further evaluation. Have appointment this Friday to get it checked (she said probably an ultrasound). She also checked him for a wet cough that he's had for over two months. Said she heard crackling in his lungs, prescribed inhaler, doesn't seem to be helping, will have a follow up next week to check his lungs again. Cough is annoying, but not really impacting day-to-day activities. Still very active and happy kid.Went on a long walk today and he woke up again with knee pain, said only right one hurts. Did the usual late-night treatment and now he's asleep.I am debating on whether to take him to the ER again. Our firstborn was healthy as a horse, never in the ER and sick with typical symptoms. I don't want to be too overzealous with an appointment coming up, but all of these symptoms just have my mom radar screaming there's something really wrong with him. I assume the ortho won't do another blood panel at the time, so it'll be a referral if they find something wrong. I just don't know if I want to keep dragging out discovery appointments for the next few weeks vs. going to the ER and asking for the gamut of tests.Any feedback at all is appreciated. We have a PPO and are financially stable, so cost isn't an issue.

Output: I've usually noticed that when your mom radar is screaming, it's better to take your kid to the ER. The symptoms you have mentioned could be due to a viral infection, but I'm still perplexed as to why the doctors decided against the CT or MRI and did they perform abdominal Ultrasound?. Also , cyclic vomiting syndrome can cause dehydration, lethargy , pallor, and muscle weakness. I hope he's taking his fluids well.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: (Almost) 4yo Boy, Many Symptoms, No AnswersBorn 3/2019.Waking up at night from a dead sleep with leg pain for nearly a year now. Happens once or twice a month usually. Right leg more frequently. Chalked up to growing pains. When he wakes up, give him Tylenol, get the heating pad out and wrap his legs. Rub his back and he falls asleep. Seems fine in the morning. Sometimes has complained of pain during the day, but could be a ploy for medicine. Points to his shins, knees, and thighs as sources of pain.Complains of headaches occasionally (I've never even heard the word, "headache" come out of his older brother's mouth). Goes away with Tylenol.Was vomiting a lot last year. I started tracking and the average was 1.5x a month. No fever or other symptoms; would complain of nausea, boot, then be back to normal within an hour. Went to pediatrician on 8/19/22, she recommended we go to the ER because we could get all testing done rapidly and at once. Went to ER, had bloodwork done (normal at the time, no cancer markers), was diagnosed with cyclical vomiting syndrome. Debated on whether to do a CAT scan or MRI, opted to not. Has only vomited 1x since then, was this past October. Not much nausea or vomiting since.Swollen lymph node in armpit and back of neck, both on left side. Just discovered armpit one today. Neck node has been enlarged for over six months. No biopsy, superficial exams by multiple doctors, all advise this is normal and not a concern. Soft, movable, and less than 2cm in size. Hasn't grown.He often just looks pale compared to the rest of the family (we are white, British decent), but could be chalked up to recent rainy weather and being stuck indoors for winter. He also seems thinner than the rest of us, just bonier than his older brother was. Always craves sweets. Weight and height are good, around 70th percentile.I found swelling in the back of his knee four weeks ago. Right posterior, left of the popliteal fossa, about the size of an avocado pit. Puffy, not hard. Took him to the pedi two weeks ago, and she said likely a cyst, but referred me to an orthopedic surgeon for further evaluation. Have appointment this Friday to get it checked (she said probably an ultrasound). She also checked him for a wet cough that he's had for over two months. Said she heard crackling in his lungs, prescribed inhaler, doesn't seem to be helping, will have a follow up next week to check his lungs again. Cough is annoying, but not really impacting day-to-day activities. Still very active and happy kid.Went on a long walk today and he woke up again with knee pain, said only right one hurts. Did the usual late-night treatment and now he's asleep.I am debating on whether to take him to the ER again. Our firstborn was healthy as a horse, never in the ER and sick with typical symptoms. I don't want to be too overzealous with an appointment coming up, but all of these symptoms just have my mom radar screaming there's something really wrong with him. I assume the ortho won't do another blood panel at the time, so it'll be a referral if they find something wrong. I just don't know if I want to keep dragging out discovery appointments for the next few weeks vs. going to the ER and asking for the gamut of tests.Any feedback at all is appreciated. We have a PPO and are financially stable, so cost isn't an issue.. ### Response: I've usually noticed that when your mom radar is screaming, it's better to take your kid to the ER. The symptoms you have mentioned could be due to a viral infection, but I'm still perplexed as to why the doctors decided against the CT or MRI and did they perform abdominal Ultrasound?. Also , cyclic vomiting syndrome can cause dehydration, lethargy , pallor, and muscle weakness. I hope he's taking his fluids well..


Instruction: The ER doc and a random physician's assistant both advised against the CT (radiation unnecessary) and MRI (would require sedation) because it would be invasive and likely unnecessary given the results of the blood panel we got this past August. He already had the swollen neck lymph node by that point, but it was dismissed as normal. No one spoke of an abdominal ultrasound at all.He hasn't had a vomiting episode in a while, which I'm grateful for, but he is a very finicky eater. Often says he's not hungry or full, but I try not to stress because his weight and height have been increasing on the right trajectory and he's at the 70th percentile.The tone I perceive from doctors is that I'm overreacting because this is my "baby" and there's nothing wrong with him, but it's just such a stark contrast to his older brother. I think I'm pretty laid back overall as a mom, but this has me questioning myself. Thanks for the two cents.

Output: You are welcome. Usually, CVS is triggered by a stressor or a food . Has your pedi advised you to keep a diary to identify it ?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: The ER doc and a random physician's assistant both advised against the CT (radiation unnecessary) and MRI (would require sedation) because it would be invasive and likely unnecessary given the results of the blood panel we got this past August. He already had the swollen neck lymph node by that point, but it was dismissed as normal. No one spoke of an abdominal ultrasound at all.He hasn't had a vomiting episode in a while, which I'm grateful for, but he is a very finicky eater. Often says he's not hungry or full, but I try not to stress because his weight and height have been increasing on the right trajectory and he's at the 70th percentile.The tone I perceive from doctors is that I'm overreacting because this is my "baby" and there's nothing wrong with him, but it's just such a stark contrast to his older brother. I think I'm pretty laid back overall as a mom, but this has me questioning myself. Thanks for the two cents.. ### Response: You are welcome. Usually, CVS is triggered by a stressor or a food . Has your pedi advised you to keep a diary to identify it ?.


Instruction: Nope, same deal, no mention of keeping a diary. I was essentially told that he'd probably grow out of it, not to worry if he wasnt losing weight. Based on your matrix, I would define it as mild now. He recovers fast and the issues were really confined to early/mid 2022.

Output: Maybe he was under some kind of stress at that time , you never know with young kids. But it's good that it's resolved now. The enlarged lymph nodes , in my opinion , need to be investigated, most probably it's due to a viral or bacterial infection, and there's no harm in repeating tests so if antibiotics are needed , they can be given at the right time.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nope, same deal, no mention of keeping a diary. I was essentially told that he'd probably grow out of it, not to worry if he wasnt losing weight. Based on your matrix, I would define it as mild now. He recovers fast and the issues were really confined to early/mid 2022.. ### Response: Maybe he was under some kind of stress at that time , you never know with young kids. But it's good that it's resolved now. The enlarged lymph nodes , in my opinion , need to be investigated, most probably it's due to a viral or bacterial infection, and there's no harm in repeating tests so if antibiotics are needed , they can be given at the right time..