Instruction: Based on all of your comments it truly sounds like its time for a second opinion. Your current oncologist doesnt sound effective nor compassionate and you and your husband deserve a doctor who will listen to your concerns, treat symptoms, and treat his cancer rather than wait another few weeks which could be crucial

Output: Im a urologist and I've treated cancer like this.So he should definitely be in some type of therapy if he has metastatic renal cell cancer. Typically this is immunotherapy which is typically not too hard on the body (this is significantly easier than something like chemo). There are many medications out there that all have pretty good effects on cancer. It sounds like your husband had a cytoreductive nephrectomy" where the kidney is taken out even though we know the cancer is spread. The goal is to just get as much cancer out as possible. Typically if there is remaining cancer (in the lungs for example) we then give immunotherapy however you do need to wait about 6 weeks after surgery for recovery. I'm not sure where he is on his recovery from surgery. Bottom line, I would talk to your oncologist about starting treatment, especially immunotherapy.Yes stage 4 = metastatic cancer. This is true of essentially all cancers.i will be blunt his prognosis is not good. With appropriate treatment his chance of living another 5 years is probably ~20%. This doesn't mean he'll die tomorrow but his time is limitedMore worrying is how young he is - 41 is incredibly young. You mentioned he is a veteran - he should see someone asap at the VA. If he had any exposure during combat he may be able to have all his medical bills covered. This is incredibly long and bureaucratic process but would be something I'd strongly suggest looking into.I am sorry but I hope this helps

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Based on all of your comments it truly sounds like its time for a second opinion. Your current oncologist doesnt sound effective nor compassionate and you and your husband deserve a doctor who will listen to your concerns, treat symptoms, and treat his cancer rather than wait another few weeks which could be crucial. ### Response: Im a urologist and I've treated cancer like this.So he should definitely be in some type of therapy if he has metastatic renal cell cancer. Typically this is immunotherapy which is typically not too hard on the body (this is significantly easier than something like chemo). There are many medications out there that all have pretty good effects on cancer. It sounds like your husband had a cytoreductive nephrectomy" where the kidney is taken out even though we know the cancer is spread. The goal is to just get as much cancer out as possible. Typically if there is remaining cancer (in the lungs for example) we then give immunotherapy however you do need to wait about 6 weeks after surgery for recovery. I'm not sure where he is on his recovery from surgery. Bottom line, I would talk to your oncologist about starting treatment, especially immunotherapy.Yes stage 4 = metastatic cancer. This is true of essentially all cancers.i will be blunt his prognosis is not good. With appropriate treatment his chance of living another 5 years is probably ~20%. This doesn't mean he'll die tomorrow but his time is limitedMore worrying is how young he is - 41 is incredibly young. You mentioned he is a veteran - he should see someone asap at the VA. If he had any exposure during combat he may be able to have all his medical bills covered. This is incredibly long and bureaucratic process but would be something I'd strongly suggest looking into.I am sorry but I hope this helps.


Instruction: It helps me, as you are being honest and upfront and thats what I need.So theres really not a good chance hes going to walk away from this? If you personally had to put time on it, can you tell me about how long?Thank you for that well thought out and honest reply. His doctors told him that he was going to be fine, but everything I have read online (I know Dr google isnt good, but I have scoured so many articles)Maybe thats why they want to wait until December? He is recovering very slowly. Hes also in a ton of pain and nothing I do helps. His doctors wont prescribe things as they claim its too hard to get around the red tape. I dont understand. Im treating him with edible THC as well as CBD because he wasnt eating. I was honest with them about this, and they didnt seem to see a problem with it.My heart is broken, but thank you for telling me your opinion here. It means a lot.

Output: Cancer related pain is one of the major indications for opioid pain meds. Im not sure what red tape these doctors are on about. I think its time for a second opinion.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: It helps me, as you are being honest and upfront and thats what I need.So theres really not a good chance hes going to walk away from this? If you personally had to put time on it, can you tell me about how long?Thank you for that well thought out and honest reply. His doctors told him that he was going to be fine, but everything I have read online (I know Dr google isnt good, but I have scoured so many articles)Maybe thats why they want to wait until December? He is recovering very slowly. Hes also in a ton of pain and nothing I do helps. His doctors wont prescribe things as they claim its too hard to get around the red tape. I dont understand. Im treating him with edible THC as well as CBD because he wasnt eating. I was honest with them about this, and they didnt seem to see a problem with it.My heart is broken, but thank you for telling me your opinion here. It means a lot.. ### Response: Cancer related pain is one of the major indications for opioid pain meds. Im not sure what red tape these doctors are on about. I think its time for a second opinion..


Instruction: NAD, but both of my parents had metastatic lung cancer. There was literally zero red tape in getting them pain meds. My father passed 7 years ago, and was getting fentanyl patches, morphine, and Norco. My mom just passed 3 months ago and she had morphine and OxyContin. Your husbands pain should be treated.

Output: Is he getting medical care through the military or civilian hospitals? There's a huge difference in quality as well as the fact that you cannot sue if a practitioner has dropped the ball.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: NAD, but both of my parents had metastatic lung cancer. There was literally zero red tape in getting them pain meds. My father passed 7 years ago, and was getting fentanyl patches, morphine, and Norco. My mom just passed 3 months ago and she had morphine and OxyContin. Your husbands pain should be treated.. ### Response: Is he getting medical care through the military or civilian hospitals? There's a huge difference in quality as well as the fact that you cannot sue if a practitioner has dropped the ball..


Instruction: If he has a positive Virchow node, they need to see him like right now

Output: This is all (unfortunately) correct except OPs husband didn't get cytoreductive radical nephrectomy but partial nephrectomy, due to having only one kidney to start with.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: If he has a positive Virchow node, they need to see him like right now. ### Response: This is all (unfortunately) correct except OPs husband didn't get cytoreductive radical nephrectomy but partial nephrectomy, due to having only one kidney to start with..


Instruction: That doesnt sound good.

Output: Yes, this partThey said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.doesn't sound good at all. Sounds like his metastases are growing pretty fast when he's already noticing bulging from lymph nodes and trouble breathing from lung metastases. But we don't really have enough information to make this determination right now. Missing information:The exact histopathology (is it clear cell renal cell carcinoma or something more exotic?)Imaging reportsThe date of imaging and surgery to get a feeling for the timeline and progression dynamicsWhy his treating physicians said that "his body encapsulated the tumor" when they also said he has lung metastases, and why they didn't indicate systemic therapy and why they seemed to think his prognosis is good.Taking the most likely case based on incomplete information: In metastatic classic clear cell renal cell carcinoma, no chemotherapy is indicated ever, because chemotherapeutic agents don't help, which has been tried and demonstrated over and over. Effective medications are immunotherapy (checkpoint inhibitor antibodies like pembrolizumab), TKIs (tyrosin kinase inhibitors that can be taken orally, like sunitinib, pazopanib, cabozantinib or axitinib) and as probably less effective alternatives medications that inhibit vascular growth (e.g. bevacizumab or lenvatinib) or mTOR-inhibitors (e.g. temsirolimus).What's indicated precipitates on your husband's other medications, comorbidities, performance status (overall health) and other stuff.Also, in oligometastatic renal cell carcinoma, locally ablative therapies can be used to kill all the metastases you can detect at the moment, for example radiosurgery, microwave ablation etc., but your husband's case doesn't sound like that from the very limited information we got.Edit: As /u/Porencephaly already wrote, your next step is to contact his oncologist's office. They need to determine what the problem is right now (maybe it's even an infection and not metastatic progression) probably with new CT imaging and formulate a plan of action.His trouble breathing could be due to anemia, or a number of infections, or heart problems, or lymph node metastases compressing blood vessels or a bronchus, or pleural effusion, or whatever else... this is all more probable than trouble breathing due to lung metastases themselves, which surpisingly rarely are symptomatic in this way.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: That doesnt sound good.. ### Response: Yes, this partThey said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.doesn't sound good at all. Sounds like his metastases are growing pretty fast when he's already noticing bulging from lymph nodes and trouble breathing from lung metastases. But we don't really have enough information to make this determination right now. Missing information:The exact histopathology (is it clear cell renal cell carcinoma or something more exotic?)Imaging reportsThe date of imaging and surgery to get a feeling for the timeline and progression dynamicsWhy his treating physicians said that "his body encapsulated the tumor" when they also said he has lung metastases, and why they didn't indicate systemic therapy and why they seemed to think his prognosis is good.Taking the most likely case based on incomplete information: In metastatic classic clear cell renal cell carcinoma, no chemotherapy is indicated ever, because chemotherapeutic agents don't help, which has been tried and demonstrated over and over. Effective medications are immunotherapy (checkpoint inhibitor antibodies like pembrolizumab), TKIs (tyrosin kinase inhibitors that can be taken orally, like sunitinib, pazopanib, cabozantinib or axitinib) and as probably less effective alternatives medications that inhibit vascular growth (e.g. bevacizumab or lenvatinib) or mTOR-inhibitors (e.g. temsirolimus).What's indicated precipitates on your husband's other medications, comorbidities, performance status (overall health) and other stuff.Also, in oligometastatic renal cell carcinoma, locally ablative therapies can be used to kill all the metastases you can detect at the moment, for example radiosurgery, microwave ablation etc., but your husband's case doesn't sound like that from the very limited information we got.Edit: As /u/Porencephaly already wrote, your next step is to contact his oncologist's office. They need to determine what the problem is right now (maybe it's even an infection and not metastatic progression) probably with new CT imaging and formulate a plan of action.His trouble breathing could be due to anemia, or a number of infections, or heart problems, or lymph node metastases compressing blood vessels or a bronchus, or pleural effusion, or whatever else... this is all more probable than trouble breathing due to lung metastases themselves, which surpisingly rarely are symptomatic in this way..


Instruction: Thank you!! Ill get him in ASAP!

Output: Heme/Onc fellow here, agree with everything youve said.Ill add my two cents and say that in addition to immunotherapy, VEGF inhibitors such as axitinib, cabozantinib, and lenvatinib are options as well. Many of the first-line treatment regimens are a combination of immunotherapy (either pembrolizumab or nivolumab) + one of the VEGF inhibitors. Combination immunotherapy (ipilimumab+nivolumab) is also an option as well for many patients. If someone has non-clear cell histology, the preferred regimens change a bit (and clinical trial is much preferred) but a lot of the same treatments are used.For someone who has a large burden of disease and is symptomatic from it, a combo of VEGF inhibitor + immunotherapy might be better than immunotherapy alone, just because the response rate is faster. But ultimately the choice depends a lot on factors like what other medical conditions someone has and what side effects theyre willing to tolerate, because we dont have any head-to-head trials showing that one regimen is better than the other.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you!! Ill get him in ASAP!. ### Response: Heme/Onc fellow here, agree with everything youve said.Ill add my two cents and say that in addition to immunotherapy, VEGF inhibitors such as axitinib, cabozantinib, and lenvatinib are options as well. Many of the first-line treatment regimens are a combination of immunotherapy (either pembrolizumab or nivolumab) + one of the VEGF inhibitors. Combination immunotherapy (ipilimumab+nivolumab) is also an option as well for many patients. If someone has non-clear cell histology, the preferred regimens change a bit (and clinical trial is much preferred) but a lot of the same treatments are used.For someone who has a large burden of disease and is symptomatic from it, a combo of VEGF inhibitor + immunotherapy might be better than immunotherapy alone, just because the response rate is faster. But ultimately the choice depends a lot on factors like what other medical conditions someone has and what side effects theyre willing to tolerate, because we dont have any head-to-head trials showing that one regimen is better than the other..


Instruction: Seeking information regarding dads renal cell carcinoma. Any urologists here?My dad has been having serious issues with vomiting, nausea, and weight loss. They ended up doing abdominal CT because colonoscopy and upper GI scope were normal. There was an incidental finding of a 2 cm heterogenous(I think???) lesion on one kidney. Per radiology report, it says renal cell carcinoma until proven otherwise.Today we saw the urological surgeon who said due to size of tumor and my dads age, hes a candidate for ablation and theyll give him a referral.The appointment was very rushed and I (29 F) went in with my dad because he has a history of TBI and has a hard time remembering/relaying medical info. We basically were just told that its cancer (which I figured from reading rad report) and that it can be ablated very quickly and the doctor then basically told my dad to drop his pants for a prostate exam so I made a swift exit.My questions lie in whether more imaging needs to be done on my dad to make sure theres not other cancer somewhere? The doc said most likely stage one but theyve only done the abd CT and nothing else?? I understand its a small tumor but does that automatically mean theres no metastasis?? I dont understand how they know that its only stage I without additional testing or imaging? Can anyone give me insight here about this process?We will be following up with that physician where I will be asking for clarification. It was such a whirlwind of an appt and I just didnt feel prepared to ask necessary questions.

Output: From the information provided, this is not standard of care - but giving us the image files (upload to e.g. dicomlibrary and CT report would be very helpful.Here is NCCN's very helpful patient guideline for kidney cancer.A suspicious 2 cm lesion on a kidney often, but not always is renal cell carcinoma. A 2 cm renal cell carcinoma that's confined to the kidney is usually pretty harmless and very unlikely to relapse or metastasize.The problem is that 1) staging is incomplete and 2) you won't have histology going along with this to confirm that it is indeed renal cell carcinoma and 3) your father has concerning symptoms that are as of yet unexplained.Initial evaluation and staging vitally includes comprehensive labs (CBC, metabolic panel, LDH), abdominal CT with and without contrast, chest CT (or at least, but that's discouraged in the guidelines, chest X-ray) and a thorough physical examination and history.If there are any alarming signs on history or examination, additional imaging must be done. I'd consider vomiting, nausea and weight loss to be alarming. At least brain imaging (preferably MRI) should be done to exclude brain metastases imho.Also, when not performing a partial nephrectomy, which would be preferable to ablation if possible, an initial core needle biopsy to secure histologic diagnosis is recommended. Otherwise you won't ever know what kind of 2 cm mass they burned. The NCCN guidelines stateBiopsy of small lesions confirms a diagnosis of malignancy for surveillance, cryosurgery, and radiofrequency ablation strategies. Ablative techniques may require multiple treatments to achieve the same local oncologic outcomes as conventional surgery.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Seeking information regarding dads renal cell carcinoma. Any urologists here?My dad has been having serious issues with vomiting, nausea, and weight loss. They ended up doing abdominal CT because colonoscopy and upper GI scope were normal. There was an incidental finding of a 2 cm heterogenous(I think???) lesion on one kidney. Per radiology report, it says renal cell carcinoma until proven otherwise.Today we saw the urological surgeon who said due to size of tumor and my dads age, hes a candidate for ablation and theyll give him a referral.The appointment was very rushed and I (29 F) went in with my dad because he has a history of TBI and has a hard time remembering/relaying medical info. We basically were just told that its cancer (which I figured from reading rad report) and that it can be ablated very quickly and the doctor then basically told my dad to drop his pants for a prostate exam so I made a swift exit.My questions lie in whether more imaging needs to be done on my dad to make sure theres not other cancer somewhere? The doc said most likely stage one but theyve only done the abd CT and nothing else?? I understand its a small tumor but does that automatically mean theres no metastasis?? I dont understand how they know that its only stage I without additional testing or imaging? Can anyone give me insight here about this process?We will be following up with that physician where I will be asking for clarification. It was such a whirlwind of an appt and I just didnt feel prepared to ask necessary questions.. ### Response: From the information provided, this is not standard of care - but giving us the image files (upload to e.g. dicomlibrary and CT report would be very helpful.Here is NCCN's very helpful patient guideline for kidney cancer.A suspicious 2 cm lesion on a kidney often, but not always is renal cell carcinoma. A 2 cm renal cell carcinoma that's confined to the kidney is usually pretty harmless and very unlikely to relapse or metastasize.The problem is that 1) staging is incomplete and 2) you won't have histology going along with this to confirm that it is indeed renal cell carcinoma and 3) your father has concerning symptoms that are as of yet unexplained.Initial evaluation and staging vitally includes comprehensive labs (CBC, metabolic panel, LDH), abdominal CT with and without contrast, chest CT (or at least, but that's discouraged in the guidelines, chest X-ray) and a thorough physical examination and history.If there are any alarming signs on history or examination, additional imaging must be done. I'd consider vomiting, nausea and weight loss to be alarming. At least brain imaging (preferably MRI) should be done to exclude brain metastases imho.Also, when not performing a partial nephrectomy, which would be preferable to ablation if possible, an initial core needle biopsy to secure histologic diagnosis is recommended. Otherwise you won't ever know what kind of 2 cm mass they burned. The NCCN guidelines stateBiopsy of small lesions confirms a diagnosis of malignancy for surveillance, cryosurgery, and radiofrequency ablation strategies. Ablative techniques may require multiple treatments to achieve the same local oncologic outcomes as conventional surgery..


Instruction: Distended abdomen, fatty liver, enlarged spleen and left renal fullness?Hi everyone!Just wondering if anyone has any ideas as even my GP seems to be stumped!I'm female, 32, MODY diabetes on insulin and high blood pressure (on nifedipine). Have a history of colon polyps but most recent colonoscopy in June was clear.The last few months I've been struggling with swelling in my stomach (photo) I look heavily pregnant and it is so uncomfortable, and the few weeks I've started having pain around my right rib area and into my back. Also have extreme fatigue.2 different GPs examined me and both were certain it was fluid so referred me for ultrasounds.I had these last week and had the results today - there is no fluid! The ultrasound did confirm moderate fatty liver, an enlarged spleen and left renal fullness.GP has referred me to haematology to look into the spleen, but said the fatty liver is only moderate and wouldn't cause the pain etc. He also doesn't know what the left renal fullness means but I do have a repeat enal ultrasound tomorrow.Full blood count was normal, kidney function came back normal but GFR had dropped from 85 in April to 62 last week, ALT on liver function only slightly raised to 62, cholesteral high at 6.3 with triglycerides at 7.3mmol.Anybody have any ideas at all as to what could be causing the swelling etc?Thanks - sorry it was such a long post!

Output: An ultrasound cant tell the difference between fat and fibrosis. Your labs and imaging findings of enlarged spleen are concerning for possible liver disease. You should see a gastroenterologist for further work up.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Distended abdomen, fatty liver, enlarged spleen and left renal fullness?Hi everyone!Just wondering if anyone has any ideas as even my GP seems to be stumped!I'm female, 32, MODY diabetes on insulin and high blood pressure (on nifedipine). Have a history of colon polyps but most recent colonoscopy in June was clear.The last few months I've been struggling with swelling in my stomach (photo) I look heavily pregnant and it is so uncomfortable, and the few weeks I've started having pain around my right rib area and into my back. Also have extreme fatigue.2 different GPs examined me and both were certain it was fluid so referred me for ultrasounds.I had these last week and had the results today - there is no fluid! The ultrasound did confirm moderate fatty liver, an enlarged spleen and left renal fullness.GP has referred me to haematology to look into the spleen, but said the fatty liver is only moderate and wouldn't cause the pain etc. He also doesn't know what the left renal fullness means but I do have a repeat enal ultrasound tomorrow.Full blood count was normal, kidney function came back normal but GFR had dropped from 85 in April to 62 last week, ALT on liver function only slightly raised to 62, cholesteral high at 6.3 with triglycerides at 7.3mmol.Anybody have any ideas at all as to what could be causing the swelling etc?Thanks - sorry it was such a long post!. ### Response: An ultrasound cant tell the difference between fat and fibrosis. Your labs and imaging findings of enlarged spleen are concerning for possible liver disease. You should see a gastroenterologist for further work up..


Instruction: Dont you think a gynecological exam is warranted?

Output: I honestly dont know if abdominal fullness is a reason for a gyn exam. I wouldnt think so though if youre not having other symptoms (bleeding), but not my area of expertise

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Dont you think a gynecological exam is warranted?. ### Response: I honestly dont know if abdominal fullness is a reason for a gyn exam. I wouldnt think so though if youre not having other symptoms (bleeding), but not my area of expertise.


Instruction: That's doodoo. If fibrosis is significant, US can easily tell the difference between cirrhosis and fatty liver.

Output: An ultrasound can show other signs of cirrhosis and can give an idea if a liver is cirrhotic appearing but it doesnt actually measure fibrosis/scar tissue. Sono it doesnt show fibrosis. Youd need a biopsy or fibroscan for that. Or an mri with elastography. 97wrongggggff

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: That's doodoo. If fibrosis is significant, US can easily tell the difference between cirrhosis and fatty liver.. ### Response: An ultrasound can show other signs of cirrhosis and can give an idea if a liver is cirrhotic appearing but it doesnt actually measure fibrosis/scar tissue. Sono it doesnt show fibrosis. Youd need a biopsy or fibroscan for that. Or an mri with elastography. 97wrongggggff.


Instruction: You said if it can tell the difference. Measure is another thing. Ultrasound can tell the difference between a fatty liver and a highly fibrotic one/cirrhotic. But yeah, it can't measure the amount. Unless you do an ultrasound fibroscan. In that case. Ultrasound can measure the amount

Output: You can have an ultrasound that just shows fat and that liver can definitely be a cirrhotic liver even if the ultrasound doesnt call it. Thats my point.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: You said if it can tell the difference. Measure is another thing. Ultrasound can tell the difference between a fatty liver and a highly fibrotic one/cirrhotic. But yeah, it can't measure the amount. Unless you do an ultrasound fibroscan. In that case. Ultrasound can measure the amount . ### Response: You can have an ultrasound that just shows fat and that liver can definitely be a cirrhotic liver even if the ultrasound doesnt call it. Thats my point..


Instruction: My sebum creatinine level is 5.7 and I want to reduce it by following a renal diet. Is it possible?I am 23F, 55kgs and 5'1. I had high creatinine level of 17, then went through dialysis for 2 sessions and reduced it to 5.7. I do not want to go through dialysis again as it made me feel very weak and made me vomit blood and feel sick. Instead of dialysis, I want to follow the renal low protein diet and take my meds (ketosteril, iron supplements because of my low haemoglobin and antacids). Is it possible to reduce creatinine by this margin without dialysis?

Output: I suspect the answer is no, but it's a better question for your kidney doctor. My understanding is that the renal diet won't restore renal function, but reduces the amount of things that don't dialyze well (certain dietary proteins, phosphorus, etc). If you have been started on dialysis I suspect that your kidneys have failed. Your kidney doctor is the one tell give you prognosis if there is a chance of you regaining kidney function or if dialysis would be a long-term thing.I would strongly caution against trying this on your own or skipping dialysis sessions without first discussing with your kidney doctor. It's very possible that dialysis is literally keeping you alive.I'm sorry but this needs more info.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My sebum creatinine level is 5.7 and I want to reduce it by following a renal diet. Is it possible?I am 23F, 55kgs and 5'1. I had high creatinine level of 17, then went through dialysis for 2 sessions and reduced it to 5.7. I do not want to go through dialysis again as it made me feel very weak and made me vomit blood and feel sick. Instead of dialysis, I want to follow the renal low protein diet and take my meds (ketosteril, iron supplements because of my low haemoglobin and antacids). Is it possible to reduce creatinine by this margin without dialysis?. ### Response: I suspect the answer is no, but it's a better question for your kidney doctor. My understanding is that the renal diet won't restore renal function, but reduces the amount of things that don't dialyze well (certain dietary proteins, phosphorus, etc). If you have been started on dialysis I suspect that your kidneys have failed. Your kidney doctor is the one tell give you prognosis if there is a chance of you regaining kidney function or if dialysis would be a long-term thing.I would strongly caution against trying this on your own or skipping dialysis sessions without first discussing with your kidney doctor. It's very possible that dialysis is literally keeping you alive.I'm sorry but this needs more info..


Instruction: I'm willing to give any info. What should I add?

Output: I'd add the history: what doctor did you see, why was your creatinin so high/what was the reason for your kidney failure, did they tell you doing dialysis twice was enough? This post is very confusing

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm willing to give any info. What should I add?. ### Response: I'd add the history: what doctor did you see, why was your creatinin so high/what was the reason for your kidney failure, did they tell you doing dialysis twice was enough? This post is very confusing.


Instruction: Would bladder or ovaries be checked on a CT scan for renal stones?A few months ago I (24f) was in the ER for gross hematuria and the doctors there did a CT scan, suspecting renal stones. Nothing showed up, and its now suspected to be related to my endometriosis as its having a cyclic presentation around my period.The doctors also noted a 4 cm ovarian cyst on my right ovary, which makes me think that the CT scan wasnt just focused on the kidneys.Anyway, all this to say: Im pretty sure the gross hematuria is from bladder endometriosis (which my doctors believe it to be), but Im a bit worried its something more serious like a tumor or large cyst. Would my earlier CT scan rule out these possibilities, or should I maybe make an appointment to do more imaging?

Output: Would have been seen on the CT.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Would bladder or ovaries be checked on a CT scan for renal stones?A few months ago I (24f) was in the ER for gross hematuria and the doctors there did a CT scan, suspecting renal stones. Nothing showed up, and its now suspected to be related to my endometriosis as its having a cyclic presentation around my period.The doctors also noted a 4 cm ovarian cyst on my right ovary, which makes me think that the CT scan wasnt just focused on the kidneys.Anyway, all this to say: Im pretty sure the gross hematuria is from bladder endometriosis (which my doctors believe it to be), but Im a bit worried its something more serious like a tumor or large cyst. Would my earlier CT scan rule out these possibilities, or should I maybe make an appointment to do more imaging?. ### Response: Would have been seen on the CT..


Instruction: Potential Renal neoplastyWent to er for massive dehydration and what I thought was a intestinal blockage. That issue resolved itself but during CT scan for blockages, etc, noticed something on my kidney."Indeterminate lesion in the lower pole of the left kidney measuring 1.7 x 1.5 cm. This is suspicious for a possible renal neoplasm. A follow-up non emergent dedicated pre and post-contrast renal CT would be recommended to further evaluate."Not asking for medical advice, going to get it further checked asap, but anyone with experience here - how concerned should I be? It's the weekend and I can't call pcp and I'm trying to keep my wife from panicking, honestly. The er doc seemed fairly concerned.

Output: Based on CT results it's literally indeterminate. You need further imaging which will likely happen rather quickly.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Potential Renal neoplastyWent to er for massive dehydration and what I thought was a intestinal blockage. That issue resolved itself but during CT scan for blockages, etc, noticed something on my kidney."Indeterminate lesion in the lower pole of the left kidney measuring 1.7 x 1.5 cm. This is suspicious for a possible renal neoplasm. A follow-up non emergent dedicated pre and post-contrast renal CT would be recommended to further evaluate."Not asking for medical advice, going to get it further checked asap, but anyone with experience here - how concerned should I be? It's the weekend and I can't call pcp and I'm trying to keep my wife from panicking, honestly. The er doc seemed fairly concerned.. ### Response: Based on CT results it's literally indeterminate. You need further imaging which will likely happen rather quickly..


Instruction: potential kidney/renal issues? or maybe something else?Hi,I really need so advice, I'm 27 male from UK, bmi within range, slim/average build,Over a year ago now I had a dull ache in my right mid back side which radiated down my flank.I saw my Dr who did a urine sample and a ultrasound, both were fine.. a year ago, however the pain has still persisted.I've gone back and forth to the Dr's who are now being quite stubborn and won't do anything else apart from constant urine tests which come back normal, they won't assist or try other avenues.This pain has continued to plague me, sometimes I have zero pain, live normally, and a hour or so later or the next day I could get the pain back which feels like a deep ache, (like I've been kicked in the testes) this hasn't got any better by itself for a year. And now it's starting to worry me as now when the pain happens, I now get a tender testicle on my right side.At first I thought maybe my underwear are a bit tight, so I've spent a lot of time not wearing underwear to give them space, it's made no difference, as soon as that back pain starts it moves down my flank, and eventually in my testicle where the pain can last 1hr to 5hrs and if like magic completely disappears until the next episode which is usually that same day or the next.I dont know where else to turn, I'm considering going private for gp , who could push me back onto the nhs and refer me. Bypassing my nhs gp. I'm starting to be concerned it could be something more serious which is not being detected and could get worse.I just want the pain to go.The pain severity out of 10 can range from a 2, to a 8, it makes me feel nauseated if it's bad.Thanks in advance.

Output: Sounds like a ventil stone in the right ureter, can be seen easily with a native CT scan of abdomen/pelvis.The ultrasounds and urine analysis were done to rule out the most common causes which are hydronephrosis and pyelonephritis.A ventil ureter stone doesn't always cause a hydronephrosis to be seen in the ultrasound. And a microhematurie although is present in most cases of urolithiasis but not always.The next logical step is a native CT scan. Book an appointment with your urologist

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: potential kidney/renal issues? or maybe something else?Hi,I really need so advice, I'm 27 male from UK, bmi within range, slim/average build,Over a year ago now I had a dull ache in my right mid back side which radiated down my flank.I saw my Dr who did a urine sample and a ultrasound, both were fine.. a year ago, however the pain has still persisted.I've gone back and forth to the Dr's who are now being quite stubborn and won't do anything else apart from constant urine tests which come back normal, they won't assist or try other avenues.This pain has continued to plague me, sometimes I have zero pain, live normally, and a hour or so later or the next day I could get the pain back which feels like a deep ache, (like I've been kicked in the testes) this hasn't got any better by itself for a year. And now it's starting to worry me as now when the pain happens, I now get a tender testicle on my right side.At first I thought maybe my underwear are a bit tight, so I've spent a lot of time not wearing underwear to give them space, it's made no difference, as soon as that back pain starts it moves down my flank, and eventually in my testicle where the pain can last 1hr to 5hrs and if like magic completely disappears until the next episode which is usually that same day or the next.I dont know where else to turn, I'm considering going private for gp , who could push me back onto the nhs and refer me. Bypassing my nhs gp. I'm starting to be concerned it could be something more serious which is not being detected and could get worse.I just want the pain to go.The pain severity out of 10 can range from a 2, to a 8, it makes me feel nauseated if it's bad.Thanks in advance.. ### Response: Sounds like a ventil stone in the right ureter, can be seen easily with a native CT scan of abdomen/pelvis.The ultrasounds and urine analysis were done to rule out the most common causes which are hydronephrosis and pyelonephritis.A ventil ureter stone doesn't always cause a hydronephrosis to be seen in the ultrasound. And a microhematurie although is present in most cases of urolithiasis but not always.The next logical step is a native CT scan. Book an appointment with your urologist.


Instruction: Thank you this sounds similar, I will have to ask my Gp as in the UK we can't book direct with specialists, you need a gp to do so if they feel it's necessary.I cant find anything on ventil stones, but have found a lot of info on ureter stones which sounds very similar. Thanks again

Output: Ventil stones are rare, i have only 2-3 cases per year. I don't know if the name in english is same as in german, we call them ventil stones because they act as a ventil or imagine as a Gate, the ventil stone moves a bit=blocks urinary tract causing hydronephrosis and massive pain, then a bit later this stone moves again and opens the way so to say and then urine flows normally and hydronephrosis dissappear so pain goes away. The native CT scan can 100% detect it. If you experience fever with the pain you rush to the Er, otherwise go to your gp as you said.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you this sounds similar, I will have to ask my Gp as in the UK we can't book direct with specialists, you need a gp to do so if they feel it's necessary.I cant find anything on ventil stones, but have found a lot of info on ureter stones which sounds very similar. Thanks again. ### Response: Ventil stones are rare, i have only 2-3 cases per year. I don't know if the name in english is same as in german, we call them ventil stones because they act as a ventil or imagine as a Gate, the ventil stone moves a bit=blocks urinary tract causing hydronephrosis and massive pain, then a bit later this stone moves again and opens the way so to say and then urine flows normally and hydronephrosis dissappear so pain goes away. The native CT scan can 100% detect it. If you experience fever with the pain you rush to the Er, otherwise go to your gp as you said..


Instruction: I have a secret IUD and need to undergo a non-invasive pelvic ultrasound, will it be detected?Hi! I'm a 22 year old woman who lives in a conservative Muslim society and I need to undergo a pelvic ultrasound to test for PCOS. I secretly got an IUD while living abroad, never thought I would have to move back to my home country so wasn't prepared for this situation. My mother accompanies me wherever I go because I'm never allowed out of the house alone.I recently had my blood checked and the test report includes: levels of FSH, LH, estradiol, progesterone, testosterone, renal function tests, liver function tests and a lipid profile. Can a doctor come to a conclusion about whether I have PCOS based off my hormone levels, or is an ultrasound mandatory?

Output: Yes, they will 100% see it on an ultrasound.Often the hormone results are all theyll need for the diagnosis, but in some cases doctors will recommend the ultrasound to get information on the size and appearance of the ovaries. Its possible to decline to get the ultrasound. If you really dont want one, the doctor may be okay with skipping it.Or is there a way you can go to the ultrasound with another family member who you trust to know about the IUD?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have a secret IUD and need to undergo a non-invasive pelvic ultrasound, will it be detected?Hi! I'm a 22 year old woman who lives in a conservative Muslim society and I need to undergo a pelvic ultrasound to test for PCOS. I secretly got an IUD while living abroad, never thought I would have to move back to my home country so wasn't prepared for this situation. My mother accompanies me wherever I go because I'm never allowed out of the house alone.I recently had my blood checked and the test report includes: levels of FSH, LH, estradiol, progesterone, testosterone, renal function tests, liver function tests and a lipid profile. Can a doctor come to a conclusion about whether I have PCOS based off my hormone levels, or is an ultrasound mandatory?. ### Response: Yes, they will 100% see it on an ultrasound.Often the hormone results are all theyll need for the diagnosis, but in some cases doctors will recommend the ultrasound to get information on the size and appearance of the ovaries. Its possible to decline to get the ultrasound. If you really dont want one, the doctor may be okay with skipping it.Or is there a way you can go to the ultrasound with another family member who you trust to know about the IUD?.


Instruction: Could they slip a written note to the tech or doctor to not verbally mention the IUD in front of mom?

Output: In conservative Muslim countries, it's not uncommon for doctors to share information about adult children with their parents. It would not be safe to send this type of note/email and risk it being shared with the parents.Read more here. (Excerpt from "Factors influencing sexual and reproductive health of Muslim women: a systematic review" below)" Unmarried women seemed to be concerned with healthcare providers informing family members about their visits and expressed worries regarding providers sharing information discussed during consultations. For some single women, family members often accompanied them during health visits, making it impossible for them to discuss any issues privately.A study in Egypt revealed that although patient records were stored securely in filing cabinets in the family planning clinics, a number of healthcare providers stated that they allowed family members to view womens health records. In addition to providers lack of respect for confidentiality, another contributing factor is that in the Egyptian family health model, womens medical records are a part of the combined family health records and could be easily accessed by any family member "

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Could they slip a written note to the tech or doctor to not verbally mention the IUD in front of mom?. ### Response: In conservative Muslim countries, it's not uncommon for doctors to share information about adult children with their parents. It would not be safe to send this type of note/email and risk it being shared with the parents.Read more here. (Excerpt from "Factors influencing sexual and reproductive health of Muslim women: a systematic review" below)" Unmarried women seemed to be concerned with healthcare providers informing family members about their visits and expressed worries regarding providers sharing information discussed during consultations. For some single women, family members often accompanied them during health visits, making it impossible for them to discuss any issues privately.A study in Egypt revealed that although patient records were stored securely in filing cabinets in the family planning clinics, a number of healthcare providers stated that they allowed family members to view womens health records. In addition to providers lack of respect for confidentiality, another contributing factor is that in the Egyptian family health model, womens medical records are a part of the combined family health records and could be easily accessed by any family member ".


Instruction: Thank you so much for your answer! I was not aware of this!

Output: #1. PCOS can be diagnosed by simply having irregular or absent cycles plus excess hair growth. Ultrasound is definitely not necessary. #2. Unfortunately, if a pelvic ultrasound is done the IUD will be quite obvious.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much for your answer! I was not aware of this!. ### Response: #1. PCOS can be diagnosed by simply having irregular or absent cycles plus excess hair growth. Ultrasound is definitely not necessary. #2. Unfortunately, if a pelvic ultrasound is done the IUD will be quite obvious..


Instruction: NAD, but is it possible for you to call your doctor on your own? Explain the situation, I'm not sure if that is feasible where you are or not, but they really do need accurate medical history

Output: You don't need an ultrasound to diagnose PCOS. It's clinical history + exam + hormone levels.If you have a hormonal IUD, though, this can affect diagnosis and treatment plan. Hormonal contraceptives are the first line treatment for PCOS, anyway.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: NAD, but is it possible for you to call your doctor on your own? Explain the situation, I'm not sure if that is feasible where you are or not, but they really do need accurate medical history. ### Response: You don't need an ultrasound to diagnose PCOS. It's clinical history + exam + hormone levels.If you have a hormonal IUD, though, this can affect diagnosis and treatment plan. Hormonal contraceptives are the first line treatment for PCOS, anyway..


Instruction: In Australia you wouldn't need it because you already meet criteria. That being said the treatment doesn't really change wether you label it as PCOS or not - it's to go on hormonal contraceptives.

Output: In your case, you still don't need the ultrasound tbh. You need clinical OR laboratory signs of hyperandrogenism (in your case, hirsutism) Coupled with absent periods, you have two features. As long as they don't suspect another etiology (which can be tested for via blood), you can be diagnosed.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: In Australia you wouldn't need it because you already meet criteria. That being said the treatment doesn't really change wether you label it as PCOS or not - it's to go on hormonal contraceptives.. ### Response: In your case, you still don't need the ultrasound tbh. You need clinical OR laboratory signs of hyperandrogenism (in your case, hirsutism) Coupled with absent periods, you have two features. As long as they don't suspect another etiology (which can be tested for via blood), you can be diagnosed..


Instruction: Sorry to piggyback this comment but just out of curiosity, can PCOS ever be a possible diagnosis even if hormonal blood test results indicate otherwise? I have always some of the physical symptoms (long periods, cystic acne, mild hirsutism), and my consultant gynaecologist diagnosed me with having PCOS after observing that my ovaries were enlarged and pearly during a laparoscopy to excise endometriosis. But bloods I had taken when I was much younger, and further bloods I had taken 2-3 years after this surgery showed that my androgen & testosterone levels were within normal ranges, so my GPs opinion is that I dont have it (regardless of my consultants observations). Ive never quite known what to make of this difference in opinions. Any thoughts?

Output: Yes, if hormonal blood tests are normal and there's no obvious signs of hyperandrogenism (in your case, the hirsutism seems subtle), then that's when ultrasound comes into play. Your GYN did a laparascopy and visualized the ovaries directly, which would replace the ultrasound in this case. Also, women with PCOS tend to have skipped or absent periods, not prolonged periods. So, I can see why your GP would be skeptical.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry to piggyback this comment but just out of curiosity, can PCOS ever be a possible diagnosis even if hormonal blood test results indicate otherwise? I have always some of the physical symptoms (long periods, cystic acne, mild hirsutism), and my consultant gynaecologist diagnosed me with having PCOS after observing that my ovaries were enlarged and pearly during a laparoscopy to excise endometriosis. But bloods I had taken when I was much younger, and further bloods I had taken 2-3 years after this surgery showed that my androgen & testosterone levels were within normal ranges, so my GPs opinion is that I dont have it (regardless of my consultants observations). Ive never quite known what to make of this difference in opinions. Any thoughts?. ### Response: Yes, if hormonal blood tests are normal and there's no obvious signs of hyperandrogenism (in your case, the hirsutism seems subtle), then that's when ultrasound comes into play. Your GYN did a laparascopy and visualized the ovaries directly, which would replace the ultrasound in this case. Also, women with PCOS tend to have skipped or absent periods, not prolonged periods. So, I can see why your GP would be skeptical..


Instruction: MRI Renal ResultsAbdominal Wall: Umbilical defect approximately 9mm TRVCan someone explain this to me? Is this a hernia, if so how is this possible?Also originally I received the mri for a renal mass that was first discovered in 2017 of 3.6 cm and on my recent MRI exam is now 1.1 cm? Does this mean it could still be cancerous or most likely benign?

Output: Tiny (presumably fat-containing) umbilical hernia which is so common that half the time we don't mention it.Can't conclude anything about the renal lesion without the full description. If it's one complete thing that has decreased in size, then yes it's benign. If there was a 3.6 cm cystic lesion that has gotten smaller but now has suspicious features, that's a different story.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: MRI Renal ResultsAbdominal Wall: Umbilical defect approximately 9mm TRVCan someone explain this to me? Is this a hernia, if so how is this possible?Also originally I received the mri for a renal mass that was first discovered in 2017 of 3.6 cm and on my recent MRI exam is now 1.1 cm? Does this mean it could still be cancerous or most likely benign?. ### Response: Tiny (presumably fat-containing) umbilical hernia which is so common that half the time we don't mention it.Can't conclude anything about the renal lesion without the full description. If it's one complete thing that has decreased in size, then yes it's benign. If there was a 3.6 cm cystic lesion that has gotten smaller but now has suspicious features, that's a different story..


Instruction: Respiratory rate while sleeping?Age: 26 Gender: Male Weight: 170 lbs Height: 510I do not smoke or drink.Hello! I have been monitoring my sleep with my apple watch and have seen my respiratory rate be pretty low which from what Ive seen isnt good.Occasionally I see it between 10-11 and apparently last night at 9.5?I dont know if you guys can offer if the apple watch is even a good indicator or accurate. Which is why I rather ask yall.Thank you for helping, wishing you the best.

Output: That's normal

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Respiratory rate while sleeping?Age: 26 Gender: Male Weight: 170 lbs Height: 510I do not smoke or drink.Hello! I have been monitoring my sleep with my apple watch and have seen my respiratory rate be pretty low which from what Ive seen isnt good.Occasionally I see it between 10-11 and apparently last night at 9.5?I dont know if you guys can offer if the apple watch is even a good indicator or accurate. Which is why I rather ask yall.Thank you for helping, wishing you the best.. ### Response: That's normal.


Instruction: Thank you so much!At what point would you consider it to be abnormal? I obviously have no knowledge other than the vagueness I see which is 12-20.

Output: It's more abnormal to be tracking your resp rate while asleep.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much!At what point would you consider it to be abnormal? I obviously have no knowledge other than the vagueness I see which is 12-20.. ### Response: It's more abnormal to be tracking your resp rate while asleep..


Instruction: 68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important?

Output: Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important?. ### Response: Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding..


Instruction: I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions

Output: It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions. ### Response: It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother..


Instruction: Myasthenia gravis and respiratory infectionHi my first language is not english so please excuse any mistakes. I (24f) have Myasthenia gravis and even though I take several immunosuppressants such as Prednisolon, Azathioprin and weekly Efgartigimod alfa infusions my symptoms are quite severe.I had multiple myasthenic crises the last few months. The last time I was in the hospital was this January because my symptoms worsened due to a covid infection and I was treated with intravenous immunoglobulins and nirmatrelvir/ritonavir. I was released 10 days ago.Two days ago I started to notice that I have symptoms of a respiratory infection (coughing, runny nose, sore throat, breathing is difficult and so on) and the symptoms of my MG worsened too. I am really afraid to call my doctors because they work at the hospital and when my symptoms get worse they admit me to the hospital. I can't stand hospitals anymore. I had several plasmapheresises, was intubated, had a feeding tube, a thymectomy and so on. I am very thankful for all their efforts and they saved my life several times but everything in me has the urge to be as far away from the hospital as possible...Do you think I should be admitted again or is there any possible solution to treat this at home? And if I contact my doctors would it be irresponsible of them to treat me at home?

Output: Sorry, but I dont think your question can be answered over the internet. The decision to treat for an MG flair requires a thorough physical exam. It may be worthwhile to note that MG can be very difficult to treat, and its reasonable for your doctor to be conservative and bring you into the hospital. If left untreated it can be rapidly fatal, especially if youre at home.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Myasthenia gravis and respiratory infectionHi my first language is not english so please excuse any mistakes. I (24f) have Myasthenia gravis and even though I take several immunosuppressants such as Prednisolon, Azathioprin and weekly Efgartigimod alfa infusions my symptoms are quite severe.I had multiple myasthenic crises the last few months. The last time I was in the hospital was this January because my symptoms worsened due to a covid infection and I was treated with intravenous immunoglobulins and nirmatrelvir/ritonavir. I was released 10 days ago.Two days ago I started to notice that I have symptoms of a respiratory infection (coughing, runny nose, sore throat, breathing is difficult and so on) and the symptoms of my MG worsened too. I am really afraid to call my doctors because they work at the hospital and when my symptoms get worse they admit me to the hospital. I can't stand hospitals anymore. I had several plasmapheresises, was intubated, had a feeding tube, a thymectomy and so on. I am very thankful for all their efforts and they saved my life several times but everything in me has the urge to be as far away from the hospital as possible...Do you think I should be admitted again or is there any possible solution to treat this at home? And if I contact my doctors would it be irresponsible of them to treat me at home?. ### Response: Sorry, but I dont think your question can be answered over the internet. The decision to treat for an MG flair requires a thorough physical exam. It may be worthwhile to note that MG can be very difficult to treat, and its reasonable for your doctor to be conservative and bring you into the hospital. If left untreated it can be rapidly fatal, especially if youre at home..


Instruction: (26F) If a breathing pattern disorder is corrected (respiratory alkalosis/chronic hyperventilation), how long does it take for serum bicarbonate to return to normal levels?I developed chronic hyperventilation due to tachycardia. Sustained low CO2 dropped my bicarbonate levels. My heart rate is now under control and breathing pattern disorder in the process of being corrected. How long can I expect it to take for my bicarbonate levels to return to a normal range?

Output: Bicarbonate levels will usually normalise within days once CO2 levels are corrected. The kidneys are very good at what they do - I wouldnt worry too much about your bicarb levels if all else is well/improving.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: (26F) If a breathing pattern disorder is corrected (respiratory alkalosis/chronic hyperventilation), how long does it take for serum bicarbonate to return to normal levels?I developed chronic hyperventilation due to tachycardia. Sustained low CO2 dropped my bicarbonate levels. My heart rate is now under control and breathing pattern disorder in the process of being corrected. How long can I expect it to take for my bicarbonate levels to return to a normal range?. ### Response: Bicarbonate levels will usually normalise within days once CO2 levels are corrected. The kidneys are very good at what they do - I wouldnt worry too much about your bicarb levels if all else is well/improving..


Instruction: Viral respiratory infection fever not getting better.22M, 5'10, 157 lbs, no drug use, no known health conditions or allergies. I got sick early in the morning on January 7th around 1 AM or so. Instantly got hit with fever, cough, sore throat, headache. Jan 9th I developed severe ear pain and pressure as well as ringing and echoing. NP looked and said it was an ear infection and prescribed amoxicillin. On January 7th my fever peaked at around 101.5-102. I took Tylenol to reduce it and it worked well. On the days after that my fever fluctuates from around 99.5 F to 100.5-101 F. It hasn't gone down from there. Doctor's office didn't detect fever today but they were using a forehead thermometer. At home my thermometer once again showed 99.5 which has now increased to 101 in the evening. My oxygen levels, HR, and BP were all fine. I cough a lot with mucus and sometimes it hurts but nothing crazy. Should I be worried? How long does fever typically last and when should I seek out help? I took a covid test today and should be getting results tomorrow as well.

Output: That's fine. Nothing to worry about

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Viral respiratory infection fever not getting better.22M, 5'10, 157 lbs, no drug use, no known health conditions or allergies. I got sick early in the morning on January 7th around 1 AM or so. Instantly got hit with fever, cough, sore throat, headache. Jan 9th I developed severe ear pain and pressure as well as ringing and echoing. NP looked and said it was an ear infection and prescribed amoxicillin. On January 7th my fever peaked at around 101.5-102. I took Tylenol to reduce it and it worked well. On the days after that my fever fluctuates from around 99.5 F to 100.5-101 F. It hasn't gone down from there. Doctor's office didn't detect fever today but they were using a forehead thermometer. At home my thermometer once again showed 99.5 which has now increased to 101 in the evening. My oxygen levels, HR, and BP were all fine. I cough a lot with mucus and sometimes it hurts but nothing crazy. Should I be worried? How long does fever typically last and when should I seek out help? I took a covid test today and should be getting results tomorrow as well.. ### Response: That's fine. Nothing to worry about.


Instruction: M19 70 kg . Possible influenza but no respiratory problems.Hi . So my sister got influenza, and got diagnosed. And then I got the fever and the dizziness.So here are my concerns. I a barely coughing (I had like 10 painful coughs the whole day) but other than that I am breathing fine. I am feeling kind of itchyich in my trachea but nothing more.I am also concerned by my dizziness that comes and goes for 5 seconds.Thoughts?

Output: Im not sure I follow your question. Influenza has a spectrum of symptoms. Sounds like you have influenza.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: M19 70 kg . Possible influenza but no respiratory problems.Hi . So my sister got influenza, and got diagnosed. And then I got the fever and the dizziness.So here are my concerns. I a barely coughing (I had like 10 painful coughs the whole day) but other than that I am breathing fine. I am feeling kind of itchyich in my trachea but nothing more.I am also concerned by my dizziness that comes and goes for 5 seconds.Thoughts?. ### Response: Im not sure I follow your question. Influenza has a spectrum of symptoms. Sounds like you have influenza..


Instruction: How do you clinically distinguish a Viral Upper Respiratory Tract Illness from a Bacterial one?Medical student here, year 2Well I've been reading about respiratory pathogens and found out that while viruses are the most common cause for these, bacterial infections can have terrible sequelae when not treated (RHD), so how does a doctor clinically determine if the person presenting to them has Viral or bacterial infection so that right measures can be taken?I'm assuming throat swabs for every single person wouldn't be very economical and just or would they be?

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.Streptococcal pharyngitis is a fairly distinct clinical syndrome compared to a garden variety viral respiratory infection. Classically, the symptoms are severe sore throat and fever, and the signs are exudative tonsillitis and tender anterior cervical lymphadenopathy. While sore throat is common in viral infection, exudative tonsillitis is less so, and viral syndromes are often accompanied by cough and coryza, which strep infections do not produce.These distinctions are codified in the Modified Centor Criteria, which can give you a pretest probability for the presence of strep throat, and guide your testing and treatment decisions. Here is a link to a calculator that can help you.https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitisBacterial infections of the respiratory tract typically refer to pharyngitis, tracheitis, sinusitis, or pneumonia depending where along the tract you are worried about. Each will have their own physical exam findings, risk factors and severity that over time, you learn to distinguish.Since you're mentioning throat swabs, testing for EBV, flu, RSV, COVID, or Group A Strep can quickly be done with rapid point-of-care testing if they have risk factors (we can use clinical decision making tools like Centor criteria to help us as well).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How do you clinically distinguish a Viral Upper Respiratory Tract Illness from a Bacterial one?Medical student here, year 2Well I've been reading about respiratory pathogens and found out that while viruses are the most common cause for these, bacterial infections can have terrible sequelae when not treated (RHD), so how does a doctor clinically determine if the person presenting to them has Viral or bacterial infection so that right measures can be taken?I'm assuming throat swabs for every single person wouldn't be very economical and just or would they be?. ### 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.Streptococcal pharyngitis is a fairly distinct clinical syndrome compared to a garden variety viral respiratory infection. Classically, the symptoms are severe sore throat and fever, and the signs are exudative tonsillitis and tender anterior cervical lymphadenopathy. While sore throat is common in viral infection, exudative tonsillitis is less so, and viral syndromes are often accompanied by cough and coryza, which strep infections do not produce.These distinctions are codified in the Modified Centor Criteria, which can give you a pretest probability for the presence of strep throat, and guide your testing and treatment decisions. Here is a link to a calculator that can help you.https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitisBacterial infections of the respiratory tract typically refer to pharyngitis, tracheitis, sinusitis, or pneumonia depending where along the tract you are worried about. Each will have their own physical exam findings, risk factors and severity that over time, you learn to distinguish.Since you're mentioning throat swabs, testing for EBV, flu, RSV, COVID, or Group A Strep can quickly be done with rapid point-of-care testing if they have risk factors (we can use clinical decision making tools like Centor criteria to help us as well)..


Instruction: Are there these associations like, if pharyngitis is bacterial in etiology the person most likely presents with fever, while viruses produce a runny nose, are any such associations there and are these correct?

Output: Not that simple. Viral infections can also cause fever. Runny nose tends to be more viral than bacterial.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Are there these associations like, if pharyngitis is bacterial in etiology the person most likely presents with fever, while viruses produce a runny nose, are any such associations there and are these correct?. ### Response: Not that simple. Viral infections can also cause fever. Runny nose tends to be more viral than bacterial..


Instruction: M25 215lb viral respiratory infection and low body tempHello Im M25 and weigh 215 lb. I have been recently (yesterday)diagnosed with a viral respiratory infection and have been experiencing mostly coughing (for a week) and sinus drainage; however, my body temperature has remained consistently lower than normal. Im typically at 98.6 F but Im currently approximately at 96.4. Im using a thermometer under my tongue. Is this drop in body temperature normal?

Output: This does not sound concerning. Try a blanket.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: M25 215lb viral respiratory infection and low body tempHello Im M25 and weigh 215 lb. I have been recently (yesterday)diagnosed with a viral respiratory infection and have been experiencing mostly coughing (for a week) and sinus drainage; however, my body temperature has remained consistently lower than normal. Im typically at 98.6 F but Im currently approximately at 96.4. Im using a thermometer under my tongue. Is this drop in body temperature normal?. ### Response: This does not sound concerning. Try a blanket..


Instruction: Thank you for your comment. What worries me is that Im wearing a jacket and am using a blanket in bed right now.

Output: Throw away your thermometer for an easier life.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your comment. What worries me is that Im wearing a jacket and am using a blanket in bed right now.. ### Response: Throw away your thermometer for an easier life..


Instruction: Can you get an outer ear infection from upper respiratory illness?~2.5 weeks ago I caught a mild illness  sore throat with swollen lymph nodes on left side only. Negative COVID tests.My left ear felt a little clogged afterwards but seemed to be improving.Yesterday, it rebelled. Lots of pain inside, worse today. Jaws a bit sore too and sometimes the pain spikes when I turn my head left.Diagnosed with outer ear infection, prescribed Ciprodex drops.After curiously reading up on it (only had an inner & middle one before), Im feeling confused and wondering if this makes sense.- How does a throat illness/infection end up in your outer ear? Are they unrelated?- Can you get an outer ear infection if your ear hasnt been wet recently?- If it isnt an outer ear infection, will the drops still work?Most of what I read talked about swimmers ear and there being water involved, but embarrassingly between the illness and some other stuff I havent showered in like 2 weeks so it's been dry.I've had past vestibular issues so am extra concerned about addressing this right/quickly so it doesn't start causing other trouble.Thanks!

Output: This is a common thing that gets referred to me, and as an ENT this issue slowly kills me inside. Differentiating between an outer and middle ear infection should be quite simple.If you can answer yes to the following questions, then you may have an outer ear infection (aka otitis externa):Is there white/yellow/brown/red stuff draining from my ear?Does the physical ear hurt when I pull on it or press on it?Did it hurt when they stuck the otoscope in my ear canal (more than it may usually if you have sensitive ears)?When they examined the ear, did they see redness, inflammation, drainage in the ear canal itself?If no, then you don't have an external ear infection.If you have a middle ear infection and they gave you drops, the only time this is useful is if you have a hole in your eardrum, and this will often also lead to drainage from the ear.A middle ear infection can be quite painful as well, but you shouldn't be able to really touch the pain in the same way.What is very common post-cold and what you may likely have is Eustachian tube dysfunction. This can result in fluid in the middle ear space, but doesn't necessarily mean an infection. This is treated from the nose side with either short course afrin, sudafed, oral steroid (low dose, short course), Flonase, saline irrigations, or any combination of the above.This all comes with the obvious caveat that I have not examined you and cannot specifically comment on your case or rule out an otitis externa, otitis media, or whatever else.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can you get an outer ear infection from upper respiratory illness?~2.5 weeks ago I caught a mild illness  sore throat with swollen lymph nodes on left side only. Negative COVID tests.My left ear felt a little clogged afterwards but seemed to be improving.Yesterday, it rebelled. Lots of pain inside, worse today. Jaws a bit sore too and sometimes the pain spikes when I turn my head left.Diagnosed with outer ear infection, prescribed Ciprodex drops.After curiously reading up on it (only had an inner & middle one before), Im feeling confused and wondering if this makes sense.- How does a throat illness/infection end up in your outer ear? Are they unrelated?- Can you get an outer ear infection if your ear hasnt been wet recently?- If it isnt an outer ear infection, will the drops still work?Most of what I read talked about swimmers ear and there being water involved, but embarrassingly between the illness and some other stuff I havent showered in like 2 weeks so it's been dry.I've had past vestibular issues so am extra concerned about addressing this right/quickly so it doesn't start causing other trouble.Thanks!. ### Response: This is a common thing that gets referred to me, and as an ENT this issue slowly kills me inside. Differentiating between an outer and middle ear infection should be quite simple.If you can answer yes to the following questions, then you may have an outer ear infection (aka otitis externa):Is there white/yellow/brown/red stuff draining from my ear?Does the physical ear hurt when I pull on it or press on it?Did it hurt when they stuck the otoscope in my ear canal (more than it may usually if you have sensitive ears)?When they examined the ear, did they see redness, inflammation, drainage in the ear canal itself?If no, then you don't have an external ear infection.If you have a middle ear infection and they gave you drops, the only time this is useful is if you have a hole in your eardrum, and this will often also lead to drainage from the ear.A middle ear infection can be quite painful as well, but you shouldn't be able to really touch the pain in the same way.What is very common post-cold and what you may likely have is Eustachian tube dysfunction. This can result in fluid in the middle ear space, but doesn't necessarily mean an infection. This is treated from the nose side with either short course afrin, sudafed, oral steroid (low dose, short course), Flonase, saline irrigations, or any combination of the above.This all comes with the obvious caveat that I have not examined you and cannot specifically comment on your case or rule out an otitis externa, otitis media, or whatever else..


Instruction: can cutting off sugar cure an upper respiratory infection?20F, 5'4, 116 lbs., do not drink, do not smoke/drink/use drugs, USAI got sick around October 29, 2022, after going to the doctor, I was prescribed a 10-day antibiotic dose that was finished around November 11. Although my harsh symptoms were gone afterward, such as tiredness, body ache, and congestion, all of a sudden after the antibiotics I got this harsh cough that was productive with green mucus. The cough was not a dry cough like I had before/during my antibiotics but rather came from my chest and is very loud. I have trouble breathing with this cough. Knowing its been around 40 days and I haven't stopped coughing so much so my back is killing me from the constant coughing, 4 days ago I went to the doctor. He basically told me to cut off sugar from my diet, no junk food, and eat only vegetables and soup for 20 days and I should feel better. (I was a little confused about this suggestion because he never asked about my diet beforehand, previously, I didn't eat junk food every day and I include veggies and fruit in almost every meal. I am quite active and have been consistently healthy.) I was not prescribed anything that can help my mucus but was prescribed cough syrup and an inhaler.I am not sure if a change in diet is a solution and I'm wondering if I should ask for a chest x-ray because I have difficulty breathing.Also this doctor didn't even check my breathing until I had asked him to. He said my lungs sounded fine but did hear mucus in my bronchi.Side note: after finishing my antibiotics I took probiotic pills and drank kombucha, could that have caused this?

Output: Generally speaking, eating less sugar and increasing plant-based food is a good thing for your health; but you shouldnt expect this change to make any real difference with an acute infection. I expect in 20 days youre going to feel a lot better regardless of a change in your diet.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: can cutting off sugar cure an upper respiratory infection?20F, 5'4, 116 lbs., do not drink, do not smoke/drink/use drugs, USAI got sick around October 29, 2022, after going to the doctor, I was prescribed a 10-day antibiotic dose that was finished around November 11. Although my harsh symptoms were gone afterward, such as tiredness, body ache, and congestion, all of a sudden after the antibiotics I got this harsh cough that was productive with green mucus. The cough was not a dry cough like I had before/during my antibiotics but rather came from my chest and is very loud. I have trouble breathing with this cough. Knowing its been around 40 days and I haven't stopped coughing so much so my back is killing me from the constant coughing, 4 days ago I went to the doctor. He basically told me to cut off sugar from my diet, no junk food, and eat only vegetables and soup for 20 days and I should feel better. (I was a little confused about this suggestion because he never asked about my diet beforehand, previously, I didn't eat junk food every day and I include veggies and fruit in almost every meal. I am quite active and have been consistently healthy.) I was not prescribed anything that can help my mucus but was prescribed cough syrup and an inhaler.I am not sure if a change in diet is a solution and I'm wondering if I should ask for a chest x-ray because I have difficulty breathing.Also this doctor didn't even check my breathing until I had asked him to. He said my lungs sounded fine but did hear mucus in my bronchi.Side note: after finishing my antibiotics I took probiotic pills and drank kombucha, could that have caused this?. ### Response: Generally speaking, eating less sugar and increasing plant-based food is a good thing for your health; but you shouldnt expect this change to make any real difference with an acute infection. I expect in 20 days youre going to feel a lot better regardless of a change in your diet..


Instruction: My (35m) heartrate is not going down after recovering from a respiratory virus.I'm 35, male, 5'11 and 215lbs. I was fighting a respiratory virus for the last 2 weeks. My symptoms are basically gone at this point, but my RHR has not recovered. It is normally around 62bpm and has been stuck around 92bpm for the last few days. I understand that it can be elevated while fighting an illness, but I expected it to return to normal as I got better. I do not drink caffeine, alcohol, or take any medications that could raise it. I have an appointment to get a Holter monitor for an unrelated sinus arrhythmia in a couple weeks and I'm concerned it might skew the results. The only thing I can think of is I haven't been eating much in the last couple weeks due to a sensitive stomach so I don't know if the lack of nutrients might be causing something to be going on. I've been drinking lots of water as well.

Output: Give it a few months to reset

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My (35m) heartrate is not going down after recovering from a respiratory virus.I'm 35, male, 5'11 and 215lbs. I was fighting a respiratory virus for the last 2 weeks. My symptoms are basically gone at this point, but my RHR has not recovered. It is normally around 62bpm and has been stuck around 92bpm for the last few days. I understand that it can be elevated while fighting an illness, but I expected it to return to normal as I got better. I do not drink caffeine, alcohol, or take any medications that could raise it. I have an appointment to get a Holter monitor for an unrelated sinus arrhythmia in a couple weeks and I'm concerned it might skew the results. The only thing I can think of is I haven't been eating much in the last couple weeks due to a sensitive stomach so I don't know if the lack of nutrients might be causing something to be going on. I've been drinking lots of water as well.. ### Response: Give it a few months to reset.


Instruction: 26F - little streaks and spots of blood in phlegm but no symptomatic respiratory/sinus/throat illness and no coughing26FWhen I brush my teeth, I suck the mucus in my throat out into my mouth and spit into the sink. For the past few days, I've noticed bright red spots and streaks within the mucus. Not too much but it's there. I have had no recent infections or illnesses. No recent coughing or sore throat either. Everything sinus or respiratory has been normal. I used to vape and smoke between 18-23 years of age, and the volume of air I can take in during a deep inhale has shortened as a result of the smoking/vaping based on my subjective, highly inconclusive observations.Have been experiencing noticeable and moderate ongoing fatigue as well.

Output: Not concerning. Congratulations on being nicotine free though! your body thanks you.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 26F - little streaks and spots of blood in phlegm but no symptomatic respiratory/sinus/throat illness and no coughing26FWhen I brush my teeth, I suck the mucus in my throat out into my mouth and spit into the sink. For the past few days, I've noticed bright red spots and streaks within the mucus. Not too much but it's there. I have had no recent infections or illnesses. No recent coughing or sore throat either. Everything sinus or respiratory has been normal. I used to vape and smoke between 18-23 years of age, and the volume of air I can take in during a deep inhale has shortened as a result of the smoking/vaping based on my subjective, highly inconclusive observations.Have been experiencing noticeable and moderate ongoing fatigue as well.. ### Response: Not concerning. Congratulations on being nicotine free though! your body thanks you..