Instruction: Kidneys took a hit due to the aggressive BMX drip to try and alleviate the pulmonary edema. He was on a drip to help with hypertension but has since been able to come off of it in the last 36 hours. Docs were concerned about heart complications as to why he suddenly doesnt need it anymore (blood pressure has been a big problem since being on ecmo) however his echocardiogram came back normal.

Output: Ok, ivig is contraindicated in renal failure. So, they might bide for time till kidney function improves. It is reassuring to hear that echo is normal.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Kidneys took a hit due to the aggressive BMX drip to try and alleviate the pulmonary edema. He was on a drip to help with hypertension but has since been able to come off of it in the last 36 hours. Docs were concerned about heart complications as to why he suddenly doesnt need it anymore (blood pressure has been a big problem since being on ecmo) however his echocardiogram came back normal.. ### Response: Ok, ivig is contraindicated in renal failure. So, they might bide for time till kidney function improves. It is reassuring to hear that echo is normal..


Instruction: rheum!  Would an underlying autoinflammatory disease be appropriate to suspect? Would it contribute to the severity? Aren't there some that are associated with congenital birth defects too (as OP stated below)?

Output: Yes and no!On parsing the thread, it is becoming ckear to think on lines of CVID. But, as OP stated, they gave done other rheuunatological workup.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: rheum!  Would an underlying autoinflammatory disease be appropriate to suspect? Would it contribute to the severity? Aren't there some that are associated with congenital birth defects too (as OP stated below)?. ### Response: Yes and no!On parsing the thread, it is becoming ckear to think on lines of CVID. But, as OP stated, they gave done other rheuunatological workup..


Instruction: What about the ones outside of IDs  like MEVF, MKD, Still's, etc. Would genetic testing be worth it for OP to ask about ?

Output: I like your thinking. You are covering a huge base. But until and unless we are privvy to all histories, blood work up and labs, we are just conjuncturing possibilities.Regarding genetic test, I do agree that it can be done. The PCP in this case has to make a decision!

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What about the ones outside of IDs  like MEVF, MKD, Still's, etc. Would genetic testing be worth it for OP to ask about ?. ### Response: I like your thinking. You are covering a huge base. But until and unless we are privvy to all histories, blood work up and labs, we are just conjuncturing possibilities.Regarding genetic test, I do agree that it can be done. The PCP in this case has to make a decision!.


Instruction: I dont know what constitutes a full immune work up. I know his immunology team says he has B cells but they dont do anything. They suspect something similar for his T cells but I was told they cant diagnose him while hes sick. His thyroid panel came back entirely normal. Is there something else I should ask about?

Output: Yeah. I understand that it may be impolite to ask:Could you provide the cytoflowmetry reports of CD 19+/ CD4+/ CD3+/ CD8+ cells?Since he was given ivig, I might not be able to interpret the current immunoglobulin levels (if atleast 3 weeks have not gone by since he was last given IVIg).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I dont know what constitutes a full immune work up. I know his immunology team says he has B cells but they dont do anything. They suspect something similar for his T cells but I was told they cant diagnose him while hes sick. His thyroid panel came back entirely normal. Is there something else I should ask about?. ### Response: Yeah. I understand that it may be impolite to ask:Could you provide the cytoflowmetry reports of CD 19+/ CD4+/ CD3+/ CD8+ cells?Since he was given ivig, I might not be able to interpret the current immunoglobulin levels (if atleast 3 weeks have not gone by since he was last given IVIg)..


Instruction: No, he doesnt. He started taking IVIG to help combat the CMV infection. Theyre thinking he has an undiagnosed immune disorder due to how severe the CMV infection was. Hes also had vaccines several times but when tested his body acts like its never seen it before.

Output: Ok. This is like common variable immune deficiency. The antibody producing b calls just aren't functioning well. That us why his viral illness knocked him bad.But with regular ivig, every 3 weekly (once he recovers) should help him have a normal-ish life.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: No, he doesnt. He started taking IVIG to help combat the CMV infection. Theyre thinking he has an undiagnosed immune disorder due to how severe the CMV infection was. Hes also had vaccines several times but when tested his body acts like its never seen it before.. ### Response: Ok. This is like common variable immune deficiency. The antibody producing b calls just aren't functioning well. That us why his viral illness knocked him bad.But with regular ivig, every 3 weekly (once he recovers) should help him have a normal-ish life..


Instruction: This makes sense to me, as the one case I have personally been involved with with a severe CMV viremia was a child with IgA deficiency, CVID, and bronchiectasis. I also sounds like he has had some chronic health issues in the past so it fits that some/all of this is connected. No specific clinical advice from me, but Ill be praying for your boy!

Output: While it wont give answers right now, Im surprised a full genetic work up hasnt been done. They could start with a targeted gene panel for immunodeficiency and or lung problems. In genetics having multiple seemingly unrelated issues is a GREAT reason TO GET testing not a reason to avoid it.I have seen kids recover from ARDS but its long and slow. Getting a second opinion is always your right, but jt doesnt sound like they could move him. Youre doing everything right for him. Im so sorry youre going through this.https://www.reddit.com/r/AskDocs/comments/13g4w5i/6_year_old_dying_from_ards_all_labs_are_negative/jjz5icx?utm_source=share&utm_medium=android_app&utm_name=androidcss&utm_term=1&utm_content=share_buttonThey did the work up

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This makes sense to me, as the one case I have personally been involved with with a severe CMV viremia was a child with IgA deficiency, CVID, and bronchiectasis. I also sounds like he has had some chronic health issues in the past so it fits that some/all of this is connected. No specific clinical advice from me, but Ill be praying for your boy!. ### Response: While it wont give answers right now, Im surprised a full genetic work up hasnt been done. They could start with a targeted gene panel for immunodeficiency and or lung problems. In genetics having multiple seemingly unrelated issues is a GREAT reason TO GET testing not a reason to avoid it.I have seen kids recover from ARDS but its long and slow. Getting a second opinion is always your right, but jt doesnt sound like they could move him. Youre doing everything right for him. Im so sorry youre going through this.https://www.reddit.com/r/AskDocs/comments/13g4w5i/6_year_old_dying_from_ards_all_labs_are_negative/jjz5icx?utm_source=share&utm_medium=android_app&utm_name=androidcss&utm_term=1&utm_content=share_buttonThey did the work up.


Instruction: 3 years, No diagnosis, Losing hopeSpecs: 23M, 140lb 61, no drinking, no drugs, no previous health conditions Negative Covid tests and vaxxedHey All,Ill try to keep this short, but here is the deal. Since early highschool my energy levels have always been low, my body has generally felt quite sluggish. I always just attributed this to long school hours and work. My dad would joke, its like you got the hangover without the partyAbout 2 years ago I was done with school and really made an attempt to increase my health and energy to actually enjoy my days. For the next year or so I attempted to improve health through a consistent sleep schedule, diet, regular exercise, vitamins/supplements, you name it, I tried it. But after feeling consistently worse I began to seek medical help for:Symptoms:Extreme fatigueOverall joint pain, but focused on my backConstant tired burning muscles (as if I climbed a mountain)Canker sores on soft tissue 1.5in+ in diameterMorning nauseaChillsHard lumps on lymph nodesNo staminaSince July of 2019 I began experiencing episodes consistently every 3 monthsFever 103+Mouth sores 1 in+ and tonsils covered in lesionsBed riddenMuscles burnInability to eat or drink due to mouth and throat lesionsMy docs were highly unhelpful as this was the height of covid and docs were quite busy. For the most part I was passed around with little to no results. I am self employed and this is the only reason I am still able to work, as my last episode had me bed ridden for nearly 5 weeks. I was prescribed Lidocaine, magic mouthwash, acyclovir, VitD3. None of these helpedFast forward to 2 weeks ago, and 6 doctors later, I now have $8,500 worth of blood work done. Everything is normal, except I am anemic and discovered 5 herniated discs in my lumbar and neck. My iron levels are ok, but red blood cell count is low.I have been tested for mono, flu, covid, recurring strep, rheumatoid factor, ana reflex, vitamin levels, thyroid, sleep disorders, allergies, just to name a few. All came back normal.Docs are at a loss and dont know where to go next.I have been turned down by Rheumatology, ENT, Hematology, due to lack of symptoms (more or less I look too healthy to hold a place in the queue). I have been told I have the exact same symptoms by friends and family with diagnoses like RA, Lupus, MS, Gall cancer, gout, lymphoma. But I am getting turned down by specialists so tests are not happening.My daily physical health has slipped to a point of now affecting my mental health. I need answers and cannot continue much longer like this. Nothing I try improves or alleviates any pain. I dont know what to do next.

Output: Ethnicity? Any family members with similar? How long do fevers last for? Is it 3 months like clockwork? What else occurs during these flares, just worsening of oral ulcers? Where exactly in the mouth are these ulcers? Any vomiting or abdominal pain?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 3 years, No diagnosis, Losing hopeSpecs: 23M, 140lb 61, no drinking, no drugs, no previous health conditions Negative Covid tests and vaxxedHey All,Ill try to keep this short, but here is the deal. Since early highschool my energy levels have always been low, my body has generally felt quite sluggish. I always just attributed this to long school hours and work. My dad would joke, its like you got the hangover without the partyAbout 2 years ago I was done with school and really made an attempt to increase my health and energy to actually enjoy my days. For the next year or so I attempted to improve health through a consistent sleep schedule, diet, regular exercise, vitamins/supplements, you name it, I tried it. But after feeling consistently worse I began to seek medical help for:Symptoms:Extreme fatigueOverall joint pain, but focused on my backConstant tired burning muscles (as if I climbed a mountain)Canker sores on soft tissue 1.5in+ in diameterMorning nauseaChillsHard lumps on lymph nodesNo staminaSince July of 2019 I began experiencing episodes consistently every 3 monthsFever 103+Mouth sores 1 in+ and tonsils covered in lesionsBed riddenMuscles burnInability to eat or drink due to mouth and throat lesionsMy docs were highly unhelpful as this was the height of covid and docs were quite busy. For the most part I was passed around with little to no results. I am self employed and this is the only reason I am still able to work, as my last episode had me bed ridden for nearly 5 weeks. I was prescribed Lidocaine, magic mouthwash, acyclovir, VitD3. None of these helpedFast forward to 2 weeks ago, and 6 doctors later, I now have $8,500 worth of blood work done. Everything is normal, except I am anemic and discovered 5 herniated discs in my lumbar and neck. My iron levels are ok, but red blood cell count is low.I have been tested for mono, flu, covid, recurring strep, rheumatoid factor, ana reflex, vitamin levels, thyroid, sleep disorders, allergies, just to name a few. All came back normal.Docs are at a loss and dont know where to go next.I have been turned down by Rheumatology, ENT, Hematology, due to lack of symptoms (more or less I look too healthy to hold a place in the queue). I have been told I have the exact same symptoms by friends and family with diagnoses like RA, Lupus, MS, Gall cancer, gout, lymphoma. But I am getting turned down by specialists so tests are not happening.My daily physical health has slipped to a point of now affecting my mental health. I need answers and cannot continue much longer like this. Nothing I try improves or alleviates any pain. I dont know what to do next.. ### Response: Ethnicity? Any family members with similar? How long do fevers last for? Is it 3 months like clockwork? What else occurs during these flares, just worsening of oral ulcers? Where exactly in the mouth are these ulcers? Any vomiting or abdominal pain?.


Instruction: White/CaucasianGrandmother: Lupus, Rheumatoid ArthritisGrandfather: Rheumatoid Arthritis, Lupus, GoutAunt: MSUncle: Anemic, celiac, Rheumatoid Arthritis (I have consulted this uncle, he says it is not celiacs)Yes, 3 months like clockwork, no other symptoms I can think of. I have had stomach pains, but I attribute this to my doc prescribing me antibiotics. I cannot eat for the life of me everything burns when it touches the raw nerves on my throat, so the antibiotics on an empty stomach are likely to blame for the upset stomach. No vomiting.The flare ups ulcers are located on the insides of my lips and cheeks, tonsils, back of throat, and tongue. They are according to my dentist "the largest non surgical sores I have ever seen"

Output: Anyone in the family with recurrent fevers, recurrent mouth sores, recurrent tonsillitis or strep throat, underwent tonsillectomy?Any improvement with steroids?Any labwork during an attack? White count, ESR, CRP in particular.Did your rheumatologist comment on the fevers?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: White/CaucasianGrandmother: Lupus, Rheumatoid ArthritisGrandfather: Rheumatoid Arthritis, Lupus, GoutAunt: MSUncle: Anemic, celiac, Rheumatoid Arthritis (I have consulted this uncle, he says it is not celiacs)Yes, 3 months like clockwork, no other symptoms I can think of. I have had stomach pains, but I attribute this to my doc prescribing me antibiotics. I cannot eat for the life of me everything burns when it touches the raw nerves on my throat, so the antibiotics on an empty stomach are likely to blame for the upset stomach. No vomiting.The flare ups ulcers are located on the insides of my lips and cheeks, tonsils, back of throat, and tongue. They are according to my dentist "the largest non surgical sores I have ever seen". ### Response: Anyone in the family with recurrent fevers, recurrent mouth sores, recurrent tonsillitis or strep throat, underwent tonsillectomy?Any improvement with steroids?Any labwork during an attack? White count, ESR, CRP in particular.Did your rheumatologist comment on the fevers?.


Instruction: Nobody like mine. The grandmother had pretty bad mouth sores apparently, and she said it improved with her Lupus medication.I have not tried steroids, so I cannot speak to that... All of my blood work has been during non-flareup times. And I have not been able to see a Rheumatologist yet.

Output: Periodic fevers can be autoinflammatory or infectious in nature. Stability of symptoms favors autoinflammatory which falls under the domain of rheumatology. I wonder if the referral was for mouth sores only; I would highlight the periodic fevers as the indication for further evaluation. You can suggest the possibility of adult onset periodic fever, aphthous stomatitis, pharyngitis and adenitis (adult onset PFAPA) to your PCP, although other similar conditions must be considered as well. A negative ANA does not rule these conditions out. Your PCP can rediscuss the case with the rheumatology department. I would also suggest requesting an appointment with a rheumatologist at an academic center as they tend to have more exposure to and interest in unusual conditions. I would also ask your PCP if a referral to an infectious disease specialist would be useful.Agree with /u/m3tac0gniti0n regarding steroids. Patients with PFAPA have significant relief with steroids, so assuming infection is felt to be unlikely a course of steroids started with the next flare may be useful for relief and for diagnosis.Best of luck.https://rarediseases.info.nih.gov/diseases/5657/periodic-fever-aphthous-stomatitis-pharyngitis-and-adenitis

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nobody like mine. The grandmother had pretty bad mouth sores apparently, and she said it improved with her Lupus medication.I have not tried steroids, so I cannot speak to that... All of my blood work has been during non-flareup times. And I have not been able to see a Rheumatologist yet.. ### Response: Periodic fevers can be autoinflammatory or infectious in nature. Stability of symptoms favors autoinflammatory which falls under the domain of rheumatology. I wonder if the referral was for mouth sores only; I would highlight the periodic fevers as the indication for further evaluation. You can suggest the possibility of adult onset periodic fever, aphthous stomatitis, pharyngitis and adenitis (adult onset PFAPA) to your PCP, although other similar conditions must be considered as well. A negative ANA does not rule these conditions out. Your PCP can rediscuss the case with the rheumatology department. I would also suggest requesting an appointment with a rheumatologist at an academic center as they tend to have more exposure to and interest in unusual conditions. I would also ask your PCP if a referral to an infectious disease specialist would be useful.Agree with /u/m3tac0gniti0n regarding steroids. Patients with PFAPA have significant relief with steroids, so assuming infection is felt to be unlikely a course of steroids started with the next flare may be useful for relief and for diagnosis.Best of luck.https://rarediseases.info.nih.gov/diseases/5657/periodic-fever-aphthous-stomatitis-pharyngitis-and-adenitis.


Instruction: This was my first thought as well. My daughter had this syndrome when she was in her teens, it seemed to come about during her monthly cycle. It has subsided as she has entered adulthood. The lesions were restricted to her tonsils but with the high fever It mimicked strep and she always tested negative. She's 26 now and hasn't had enough episodes for at least 7 years.

Output: Feels like you nailed it! Well done!

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This was my first thought as well. My daughter had this syndrome when she was in her teens, it seemed to come about during her monthly cycle. It has subsided as she has entered adulthood. The lesions were restricted to her tonsils but with the high fever It mimicked strep and she always tested negative. She's 26 now and hasn't had enough episodes for at least 7 years.. ### Response: Feels like you nailed it! Well done!.


Instruction: Other than what is listed in my bloodwork, no. Thank you for your input, simply based on the feedback I have received I may ask my PCP for anymore thoughts regarding the possibility of celiac. Thank you for your input!Of course, I hope it might help you find an answer to your problem. Make sure you continue consuming gluten up til the testing is done. Cutting it out of your diet will cause the inflammatory markers to go down and may make it harder to detect.

Output: Just briefly looking over it,Sounds autoimmune.See if a rheumatologist will see you.The labs you provided do not help answer this question.This is also about as far from my specialty as you get, so if other docs offer ideas I would go with thatI'd say the same.Maybe some further autoantibodies tests should be done to rule out Lupus or vasculitides. Other tests that come to mind would be ANCA/Anti-Neutrophil Cytoplasmic Antibody and/or myositis immunoblot; ANA blot (and ENA blot if needed); rheumatic factor.Maybe, but it's a stretch, if it would be possible, I'd swab the sores and ask for some cultures (fungal and bacterial).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Other than what is listed in my bloodwork, no. Thank you for your input, simply based on the feedback I have received I may ask my PCP for anymore thoughts regarding the possibility of celiac. Thank you for your input!Of course, I hope it might help you find an answer to your problem. Make sure you continue consuming gluten up til the testing is done. Cutting it out of your diet will cause the inflammatory markers to go down and may make it harder to detect.. ### Response: Just briefly looking over it,Sounds autoimmune.See if a rheumatologist will see you.The labs you provided do not help answer this question.This is also about as far from my specialty as you get, so if other docs offer ideas I would go with thatI'd say the same.Maybe some further autoantibodies tests should be done to rule out Lupus or vasculitides. Other tests that come to mind would be ANCA/Anti-Neutrophil Cytoplasmic Antibody and/or myositis immunoblot; ANA blot (and ENA blot if needed); rheumatic factor.Maybe, but it's a stretch, if it would be possible, I'd swab the sores and ask for some cultures (fungal and bacterial)..


Instruction: Thank you for your input! I have had an ANA Reflex test done. Is this different from what you describe above? They have suggested swabbing the sores, but ENT turned me down at the time, now I am supposedly waiting for my next flare up and they would swab it then.... we'll see.

Output: Indeed, that's the right ANA test.Sorry about the ENT. If you have any labs that you could get these done, I'd suggest going in by yourself. Depending on your country, it might not cost much.Before swabbing, don't eat/drink anything, so it's best to get these tests before brushing your teeth, in the morning.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your input! I have had an ANA Reflex test done. Is this different from what you describe above? They have suggested swabbing the sores, but ENT turned me down at the time, now I am supposedly waiting for my next flare up and they would swab it then.... we'll see.. ### Response: Indeed, that's the right ANA test.Sorry about the ENT. If you have any labs that you could get these done, I'd suggest going in by yourself. Depending on your country, it might not cost much.Before swabbing, don't eat/drink anything, so it's best to get these tests before brushing your teeth, in the morning..


Instruction: Anti CCP Antibodies. And would recommend having the bloods done during the flare up with inflammation markers like ESR/CRP. Definitely sounds Autoimmune in nature.

Output: Yeah, during a flare up is the best choice. I saw that they already had CRP done and it was normal

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Anti CCP Antibodies. And would recommend having the bloods done during the flare up with inflammation markers like ESR/CRP. Definitely sounds Autoimmune in nature.. ### Response: Yeah, during a flare up is the best choice. I saw that they already had CRP done and it was normal.


Instruction: PBC DiagnosisI'm male, 30 years old, 5'11, 190 pounds. I have Hashimoto's disease and collagen vascular disease. I take 75mcg Synthroid and 400mg hydroxychloroquine per day. A couple years ago I tested positive for antimitochondrial antibodies at 1:80 titer. My liver enzymes have been normal. My total cholesterol is in range but my bad cholesterol is slightly high.My rheumatologist told me that the antibodies are usually seen in primary billiary cholangitis, but that they can be present in rheumatological diseases as well. My diagnosis of collagen vascular disease is a vague label as my only symptoms are low white count and low platelets, declining for a decade. Cancer was ruled out and they tried hydroxychloroquine, thinking it was autoimmune as I already had Hashimoto's disease. My blood counts have been higher since I've been taking hydroxychloroquine.I get my liver enzymes checked twice per year. Should I push for any other tests so that if I have PBC, it can be caught early? My rheumatologist said he wouldn't do a biopsy or ultrasound as my liver enzymes are normal. Is there anything else that can be done?

Output: You dont treat normal liver enzymes even if you had PBC. But you don't have pbc because your liver enzymes are normal

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: PBC DiagnosisI'm male, 30 years old, 5'11, 190 pounds. I have Hashimoto's disease and collagen vascular disease. I take 75mcg Synthroid and 400mg hydroxychloroquine per day. A couple years ago I tested positive for antimitochondrial antibodies at 1:80 titer. My liver enzymes have been normal. My total cholesterol is in range but my bad cholesterol is slightly high.My rheumatologist told me that the antibodies are usually seen in primary billiary cholangitis, but that they can be present in rheumatological diseases as well. My diagnosis of collagen vascular disease is a vague label as my only symptoms are low white count and low platelets, declining for a decade. Cancer was ruled out and they tried hydroxychloroquine, thinking it was autoimmune as I already had Hashimoto's disease. My blood counts have been higher since I've been taking hydroxychloroquine.I get my liver enzymes checked twice per year. Should I push for any other tests so that if I have PBC, it can be caught early? My rheumatologist said he wouldn't do a biopsy or ultrasound as my liver enzymes are normal. Is there anything else that can be done?. ### Response: You dont treat normal liver enzymes even if you had PBC. But you don't have pbc because your liver enzymes are normal.


Instruction: I've read that the antimitochondrial antibodies can show up years before the disease progresses. Is that true? Should I just continue to have my liver enzymes monitored each year?

Output: It can but there's nothing to treat

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I've read that the antimitochondrial antibodies can show up years before the disease progresses. Is that true? Should I just continue to have my liver enzymes monitored each year?. ### Response: It can but there's nothing to treat.


Instruction: Thanks for the responses. I just want to make sure if I develop the disease it can be caught early. I watched my grandfather die of cirrhosis (not autoimmune) and it is scary, especially as doctors tell me antimitochondrial antibodies are associated with the disease and studies I've read say that most people with the antibodies get the disease.

Output: People don't check for antimitochondrial antibody in the absence of abnormal liver tests so this is not true at all

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks for the responses. I just want to make sure if I develop the disease it can be caught early. I watched my grandfather die of cirrhosis (not autoimmune) and it is scary, especially as doctors tell me antimitochondrial antibodies are associated with the disease and studies I've read say that most people with the antibodies get the disease.. ### Response: People don't check for antimitochondrial antibody in the absence of abnormal liver tests so this is not true at all.


Instruction: The studies aren't true? Or my testing positive for the antibodies isn't true? My rheumatologist did a bunch of autoimmune bloodwork due to my low platelets and white blood cell counts. He said he tested for it as it can be positive in diseases like lupus.

Output: So it was for lupus. It's irrelevant to pbc because there was no indication to test it

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: The studies aren't true? Or my testing positive for the antibodies isn't true? My rheumatologist did a bunch of autoimmune bloodwork due to my low platelets and white blood cell counts. He said he tested for it as it can be positive in diseases like lupus.. ### Response: So it was for lupus. It's irrelevant to pbc because there was no indication to test it.


Instruction: They did a wide array of tests because of my white blood cell and platelet counts as they could not figure out why they were decreasing from year to year and all tests for cancer done by an oncologist were negative. The counts were getting dangerously low. The antimitochondrial antibodies came back positive along with antinuclear antibodies. Then they said I do not have lupus or any identifiable autoimmune disease, but only a vague collection of symptoms. They put me on hydroxychloroquine in hopes it would raise my blood counts as they could not figure out the cause and I already had one autoimmune disease. The rheumatologist said I do not have lupus and that he doesn't know what caused the positive antimitochondrial antibody test. He said it's possible it's a due to a rheumatic disease or that it just happened to turn up positive in the bloodwork.

Output: Right. But you don't order AMA for pbc unless your liver tests are abnormal. So this is generally worthless. What exactly are you trying to convince me of.If it turns out you have pbc down the line, then you may get treatment if your liver tests are very abnormal

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: They did a wide array of tests because of my white blood cell and platelet counts as they could not figure out why they were decreasing from year to year and all tests for cancer done by an oncologist were negative. The counts were getting dangerously low. The antimitochondrial antibodies came back positive along with antinuclear antibodies. Then they said I do not have lupus or any identifiable autoimmune disease, but only a vague collection of symptoms. They put me on hydroxychloroquine in hopes it would raise my blood counts as they could not figure out the cause and I already had one autoimmune disease. The rheumatologist said I do not have lupus and that he doesn't know what caused the positive antimitochondrial antibody test. He said it's possible it's a due to a rheumatic disease or that it just happened to turn up positive in the bloodwork.. ### Response: Right. But you don't order AMA for pbc unless your liver tests are abnormal. So this is generally worthless. What exactly are you trying to convince me of.If it turns out you have pbc down the line, then you may get treatment if your liver tests are very abnormal.


Instruction: Elevated esr and crp with sudden symptoms (started 2 weeks ago)Hi doctors!27 year old female 6 months postpartum, weaning of breastfeeding currently. (If relevant)A few weeks ago I got a bug (negative for covid) towards the end I started having hand cramps, foot cramps, muscle pain in my legs and arms and joints, tiny spasms all over including my face and then followed by pins and needles all over and sometimes a burning feeling in skin. I will state, I have had this type of thing happen before a couple years back. I also have severe health anxiety and have been under immense stress.I went to the dr. And he did blood work. Cbc, comprehensive panel, vit d, magnesium, b12, esr, and crp. Everything was normal except for the esr and crp. Esr was 40 and I cant remember the crp level, but it was mildly elevated. Fast forward to this week, I went to the er for related symptoms (they have improved some) dr re checked blood work. Esr went up to 55 so obviously I have some inflammation somewhere. They said it wouldnt be from being sick, not caused by being obese, or stressed or anxious. They kind of hinted at MS and let me tell you that sent me into a real panic. Dr suggested my pcp order a mri of spine and brain. My pcp did so and also sent an urgent referral to rheumatology. Urgent as in November 30th being the soonest appt.I looked at my labs from a few years back and had the same elevated markers that went back down. I also had a rheumatology panel done then and everything was normal. Ana negative.My symptoms seem to be improving but Im still not feeling 100%. I have been a ball of anxious nerves since this has started so its hard to tell the difference. Now Im convinced I have ms or some debilitating disease.

Output: ESR elevation is extremely nonspecific. Any inflammatory condition can raise it. Any sickness can get you to the 40-50s. It's up, but not particularly high.I think your doctor is probably managing things well from what you've described.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Elevated esr and crp with sudden symptoms (started 2 weeks ago)Hi doctors!27 year old female 6 months postpartum, weaning of breastfeeding currently. (If relevant)A few weeks ago I got a bug (negative for covid) towards the end I started having hand cramps, foot cramps, muscle pain in my legs and arms and joints, tiny spasms all over including my face and then followed by pins and needles all over and sometimes a burning feeling in skin. I will state, I have had this type of thing happen before a couple years back. I also have severe health anxiety and have been under immense stress.I went to the dr. And he did blood work. Cbc, comprehensive panel, vit d, magnesium, b12, esr, and crp. Everything was normal except for the esr and crp. Esr was 40 and I cant remember the crp level, but it was mildly elevated. Fast forward to this week, I went to the er for related symptoms (they have improved some) dr re checked blood work. Esr went up to 55 so obviously I have some inflammation somewhere. They said it wouldnt be from being sick, not caused by being obese, or stressed or anxious. They kind of hinted at MS and let me tell you that sent me into a real panic. Dr suggested my pcp order a mri of spine and brain. My pcp did so and also sent an urgent referral to rheumatology. Urgent as in November 30th being the soonest appt.I looked at my labs from a few years back and had the same elevated markers that went back down. I also had a rheumatology panel done then and everything was normal. Ana negative.My symptoms seem to be improving but Im still not feeling 100%. I have been a ball of anxious nerves since this has started so its hard to tell the difference. Now Im convinced I have ms or some debilitating disease.. ### Response: ESR elevation is extremely nonspecific. Any inflammatory condition can raise it. Any sickness can get you to the 40-50s. It's up, but not particularly high.I think your doctor is probably managing things well from what you've described..


Instruction: My symptoms sound serious to me, but the doctor said otherwise. Am I crazy?21M. Been experiencing this for 4 months and its gradually getting worse. Ive been suffering from headaches and chronic arthritic type pain in my shoulders. My neck is stiff and is tight when I turn it from side to side. The centre of my neck is strained, im in a lot of pain and its stopping me from doing my job and uni work. Sometimes its dull and sometimes its really bad when it flares up, but its always there.They said they dont think its anything serious i.e. muscle tension, but theyll do my bloods anyway to check for inflammation. Im just concerned that nothing will show up if they do my bloods when the pain is dull and ill go back to being in pain all the time and I dont want to seem like im crazy going back to see them. If its something serious will it always show up as inflamed? Thanks

Output: I assume theyre trying to rule out anything rheumatological, which would indeed result in raised inflammatory markers if you have symptoms.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My symptoms sound serious to me, but the doctor said otherwise. Am I crazy?21M. Been experiencing this for 4 months and its gradually getting worse. Ive been suffering from headaches and chronic arthritic type pain in my shoulders. My neck is stiff and is tight when I turn it from side to side. The centre of my neck is strained, im in a lot of pain and its stopping me from doing my job and uni work. Sometimes its dull and sometimes its really bad when it flares up, but its always there.They said they dont think its anything serious i.e. muscle tension, but theyll do my bloods anyway to check for inflammation. Im just concerned that nothing will show up if they do my bloods when the pain is dull and ill go back to being in pain all the time and I dont want to seem like im crazy going back to see them. If its something serious will it always show up as inflamed? Thanks. ### Response: I assume theyre trying to rule out anything rheumatological, which would indeed result in raised inflammatory markers if you have symptoms..


Instruction: Thank you. If it doesnt show up, surely I cant be suffering chronically from all this for 4 months for it to just be muscle tension. Doesnt make sense.

Output: Very much could be to be honest.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you. If it doesnt show up, surely I cant be suffering chronically from all this for 4 months for it to just be muscle tension. Doesnt make sense.. ### Response: Very much could be to be honest..


Instruction: Asking on behalf of my sister. Liver lab levels insane, among other strange things.Because the leukemia/lymphoma lab is taking forever to come back yet we have a ton others, her pcp isnt giving her much more info. Wonky highs and lows.36F, overall healthy, non-drinker and never smoked. Had 2 successful pregnancies and birth. Eats and maintains healthy diet and exercise. 57 145. All vaccines.3 weeks ago she started feeling achey. No upper respiratory stuff but general aches, fatigue and headache. Took several covid tests and negative. Ended up going to Hawaii where she thought she actually had covid there and those were also negative. She was complaining of the same thing. At one point, thought it was sun poisoning. Shes seemed to get worse and worse. A week later, which was 2 days after returning home she went to the ER for what she thought was severe dehydration. It wasnt that but they werent sure what it was. Said to see her pcp.ER doc did a handful of labs. Initially told her to see her pcp for follow up labs for mono or leukemia. Her joints ache, a weird floaty face feeling, no fever, no upper respiratory, majority of joint pain is in her legs and toes feel strange. Headaches here and there. Otherwise, she feels okay. No notice of brushing, bloody noses, rapid weight loss.Labs below. If a number is in here more than once its because it was the second lab test when increased. Nothing of concern went down, but only up. Only test we are waiting on, of course, is the leukemia one. Mono all came back negative and no antibodies.Sediment rate 4 - normal, Smudge cells - mild, C reactive - higher at 12, Polychrom, platelet morph and others in category this tests were all few or normal, WBC 8.02, Rbc 5.1, Hemagblobin 14, Hematrocit 41, MCV 83, Mch 29, Mchc 35, Rdw sd. 40, Mpv 9 - low., Nrbc 0 , Neutrophils 23.5% low, Lymphocyte 70% high, Mono 3.9%, Eos 1.0 % bordering, Baso 1.2%, Ig .1, Neutrophil # 1.8, Lymphocyte # 5.64, Mono # .08, Eos .08, Baso # 10,Edited and added below AST -57, ALT 61,Others I missed: Anion gap 2, Globulin 3.5, Albumin/gobulin ratio 1All plasma levels seem in range besides glucose bordering high.Can anyone share if youve seen a blood work up look like this? The overall sickness has been going on for 3 weeks now and is increasingly getting worse.If its not CLL like our minds are nervously going towards, do you recommend she ask for a referral to hematology or rheumatology? Weve heard a virus already thrown in there and Im just wondering what virus out there does this to your body bc even tho Im not a dr her liver numbers arent ideal with some other markers showing some poor function Any comment to give insight would be great! Thanks.

Output: Where are the liver labs? And how did CLL get brought up?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Asking on behalf of my sister. Liver lab levels insane, among other strange things.Because the leukemia/lymphoma lab is taking forever to come back yet we have a ton others, her pcp isnt giving her much more info. Wonky highs and lows.36F, overall healthy, non-drinker and never smoked. Had 2 successful pregnancies and birth. Eats and maintains healthy diet and exercise. 57 145. All vaccines.3 weeks ago she started feeling achey. No upper respiratory stuff but general aches, fatigue and headache. Took several covid tests and negative. Ended up going to Hawaii where she thought she actually had covid there and those were also negative. She was complaining of the same thing. At one point, thought it was sun poisoning. Shes seemed to get worse and worse. A week later, which was 2 days after returning home she went to the ER for what she thought was severe dehydration. It wasnt that but they werent sure what it was. Said to see her pcp.ER doc did a handful of labs. Initially told her to see her pcp for follow up labs for mono or leukemia. Her joints ache, a weird floaty face feeling, no fever, no upper respiratory, majority of joint pain is in her legs and toes feel strange. Headaches here and there. Otherwise, she feels okay. No notice of brushing, bloody noses, rapid weight loss.Labs below. If a number is in here more than once its because it was the second lab test when increased. Nothing of concern went down, but only up. Only test we are waiting on, of course, is the leukemia one. Mono all came back negative and no antibodies.Sediment rate 4 - normal, Smudge cells - mild, C reactive - higher at 12, Polychrom, platelet morph and others in category this tests were all few or normal, WBC 8.02, Rbc 5.1, Hemagblobin 14, Hematrocit 41, MCV 83, Mch 29, Mchc 35, Rdw sd. 40, Mpv 9 - low., Nrbc 0 , Neutrophils 23.5% low, Lymphocyte 70% high, Mono 3.9%, Eos 1.0 % bordering, Baso 1.2%, Ig .1, Neutrophil # 1.8, Lymphocyte # 5.64, Mono # .08, Eos .08, Baso # 10,Edited and added below AST -57, ALT 61,Others I missed: Anion gap 2, Globulin 3.5, Albumin/gobulin ratio 1All plasma levels seem in range besides glucose bordering high.Can anyone share if youve seen a blood work up look like this? The overall sickness has been going on for 3 weeks now and is increasingly getting worse.If its not CLL like our minds are nervously going towards, do you recommend she ask for a referral to hematology or rheumatology? Weve heard a virus already thrown in there and Im just wondering what virus out there does this to your body bc even tho Im not a dr her liver numbers arent ideal with some other markers showing some poor function Any comment to give insight would be great! Thanks.. ### Response: Where are the liver labs? And how did CLL get brought up?.


Instruction: I just went ahead and edited. ALT, AST. Plus a couple others. Whats odd to me - a person that isnt close to a dr; her WBC seems to remain decent. And regardless if its infection or virus I would expect an increase.CLL was brought up bc of the higher absolute lympho count and the moderated smudge cell. The ER doc wrote it on discharge to pcp.

Output: I'm a ED physician, and this...sounds unusual. In CLL, the white count should be significantly elevated which in this case, it is not. Furthermore, the presence of smudge cells is not necessarily indicative of CLL. I be surprised if this was CLL. This is likely some sort of viral infection if I had to guess.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I just went ahead and edited. ALT, AST. Plus a couple others. Whats odd to me - a person that isnt close to a dr; her WBC seems to remain decent. And regardless if its infection or virus I would expect an increase.CLL was brought up bc of the higher absolute lympho count and the moderated smudge cell. The ER doc wrote it on discharge to pcp.. ### Response: I'm a ED physician, and this...sounds unusual. In CLL, the white count should be significantly elevated which in this case, it is not. Furthermore, the presence of smudge cells is not necessarily indicative of CLL. I be surprised if this was CLL. This is likely some sort of viral infection if I had to guess..


Instruction: Odd skin reaction to my hands and feet occurring 3 times recently with no changes in lifestyleAge - 26Sex - MaleHeight - 6'Weight - 185Race - CaucasianDuration of complaint + Location - Longest was the first time, on both hands lasting around 3-4 weeks before fully healing The second time on the feet was only 2-3 days The most recent time, today, again on both hands only not as severe as the first time. I have pics only of today's episode but I took a few sets over some hours to see the changes.Any existing relevant medical issues - NoneCurrent medications - NoneInclude a photo if relevanthttps://imgur.com/gallery/rrcI6jTEdit: just added some description of each e6Hey everyone, hopefully someone might know what's going on. So these pictures are 3 hours apart from the initial reaction I felt. This is now the third time something like this happened but each time has been different. They feel like an annoying chemical itch/burn and come out of nowhere.The first time about 2 months ago my wife and I had gone to the neighborhood pool. Maybe 3-4 minutes getting into the pool and my hands started burning so I pulled them out and they looked like what happen today but a good bit worse. It took about a month to completely heal. I hadn't done anything about it because I assumed it was some reaction to a pool cleaner or something. That day also was fairly busy and there wasn't anyone else showing the same thing. Also it was strange because I had completely submerged as soon as i got in and I didn't have them show up anywhere else. On top of that they looked raisin shriveled for like 2 hours after only 5-10 in the water.The second time is strange too because it looked the same but happened on my feet and it went from 0 - foot arching pain from the burning. I literally walked in the bathroom and I pulled one boot off and I thought I had ants biting me or something. I took off my sock and the same red blotchy chemically burn look and feel all over my foot. I showered right away they felt better and in 2days they went from fairly tender to no issue.Today is the most recent occurrence happening while I was sitting with a patient in the back of the ambulance. I was typing my report and they started burning again from nothing to pretty sensitive really quick. The pictures I posted are about 3 hours apart from each other if that might help anything at all. But even though it's on my hands like the first time, the severity was not nearly as bad as the first time and looks much better after a few hours than that did for a week or two.

Output: This is not a typical palmoplantar rash. I would be concerned that this dermal inflammatory reaction patter could be caused by a rheumatologic condition or similar. I suggest you seek dermatologic care. A skin biopsy and laboratory evaluation seems appropriate.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Odd skin reaction to my hands and feet occurring 3 times recently with no changes in lifestyleAge - 26Sex - MaleHeight - 6'Weight - 185Race - CaucasianDuration of complaint + Location - Longest was the first time, on both hands lasting around 3-4 weeks before fully healing The second time on the feet was only 2-3 days The most recent time, today, again on both hands only not as severe as the first time. I have pics only of today's episode but I took a few sets over some hours to see the changes.Any existing relevant medical issues - NoneCurrent medications - NoneInclude a photo if relevanthttps://imgur.com/gallery/rrcI6jTEdit: just added some description of each e6Hey everyone, hopefully someone might know what's going on. So these pictures are 3 hours apart from the initial reaction I felt. This is now the third time something like this happened but each time has been different. They feel like an annoying chemical itch/burn and come out of nowhere.The first time about 2 months ago my wife and I had gone to the neighborhood pool. Maybe 3-4 minutes getting into the pool and my hands started burning so I pulled them out and they looked like what happen today but a good bit worse. It took about a month to completely heal. I hadn't done anything about it because I assumed it was some reaction to a pool cleaner or something. That day also was fairly busy and there wasn't anyone else showing the same thing. Also it was strange because I had completely submerged as soon as i got in and I didn't have them show up anywhere else. On top of that they looked raisin shriveled for like 2 hours after only 5-10 in the water.The second time is strange too because it looked the same but happened on my feet and it went from 0 - foot arching pain from the burning. I literally walked in the bathroom and I pulled one boot off and I thought I had ants biting me or something. I took off my sock and the same red blotchy chemically burn look and feel all over my foot. I showered right away they felt better and in 2days they went from fairly tender to no issue.Today is the most recent occurrence happening while I was sitting with a patient in the back of the ambulance. I was typing my report and they started burning again from nothing to pretty sensitive really quick. The pictures I posted are about 3 hours apart from each other if that might help anything at all. But even though it's on my hands like the first time, the severity was not nearly as bad as the first time and looks much better after a few hours than that did for a week or two.. ### Response: This is not a typical palmoplantar rash. I would be concerned that this dermal inflammatory reaction patter could be caused by a rheumatologic condition or similar. I suggest you seek dermatologic care. A skin biopsy and laboratory evaluation seems appropriate..


Instruction: Sudden loss of mobility - PCP refuses referral/treatmentHello, I'm a 32(F) in the USA. African-American, 5'2" and 144lbs. On Jan 3, 2022, I woke up around 2am with a terrible migraine. I had light sensitivity, confusion and extreme pressure behind right eye. Took excedrin but was unable to sleep due to pain. I was finally able to sleep about 45mins later as meds kicked in. Woke up the next day with a regular headache and soreness in right eye. On Jan. 5th, I suddenly became dizziness at work. The room began to rock and tilt causing loss of balance. My right ear felt clogged and I had pain in jaw joint on the right side. I was taken to ER and evaluated for heart attack, stroke etc. All tests came back normal. I remained in the hospital due to continued dizziness/imbalance but all tests including MRI of head and neck were clear. Was given motion sickness meds but it didn't help. While in hospital, I started having pain in my right hip joint. The joint also pops/clicks with movement. I've experienced the popping/clicking since I was 14 years old (18 years and counting) but this is the first time there has been pain. The pain has spread across my lower back. The pain started as a stabbing, pinching pain and is now an achy and the best way I can describe it is bone deep.I also have weakness in my right leg and intermittent numbness. Two weeks ago, I began to experience multiple episodes of urinary and fecal incontinence. The hip and back pain has gotten worse and the dizziness is the same as when it started. Almost all blood test and urine test have come back normal except for my vitamin d levels. My vitamin d value is 10ng/ml and I was prescribed over the counter vitamin d3 pills (1000unit)An MRI of my lumber spine was done (full report is linked). My PCP said it looked fine but didnt explain anything further. On the MRI it mentions the following:DISCS: L4-5 and L5-S1 disc desiccation and mild to moderate L5-S1 disc space narrowing.BONES: Slight chronic marrow signal changes. Body heights are generally maintained throughout.L3-L4: Slight posterior element degenerative change. Spinal canal and neural foramina are patent.L4-L5: Mild right eccentric disc bulge is slightly improved. Annular fissure. Slight posterior element degenerative changes. Spinal canal and neural foramina are essentially patent.L5-S1: Mild right eccentric disc bulge. Mild posterior element degenerative change. Spinal canal is patent. Slight predominantly bright neural foraminal encroachment.EXISTING MEDICAL ISSUESexercise induced asthma (I take Albuterol as needed)arnold chiari malformationthalassemia traitintermittent fatigueI've also had reoccurring migraines since I was 15 years old along with random, unexplained swelling of my hands and feet. Most recent flare up was unexplained very visible swelling of my left leg in July 2021. (Went to ER and tested negative for clots and gout)I suffer from random bouts of stomach inflammation that has been misdiagnosed as gallbladder disease (gall bladder was removed when I was 16) and has now been attributed to GERD. ( I take omeprazole for stomach and I have a history of stomach ulcers). Most recent flare was October 2021I've also had debilitating back pain since I was 15 years old and have completed physical therapy, acupuncture, multiple courses of steroid injections in my spine and at least 3 courses of prednisone. Pain has been caused by unexplained muscle spasms and bulging discs. I have these flare up at least twice a year.I sometimes have rashes that appear on my back and arms that are often misdiagnosed as ringworm (photos included). Fungal test always comes back negative. So far, the rashes have been diagnosed as eczema and rosacea. Flare ups occur approx once a year for the past 15 years. Rashes sometimes itch but its very mild. Most recent flare up occurred in November 2021.CURRENT SITUATION I requested a referral to be seen in rheumatology and at the spine clinic. PCP did blood test for rheumatoid arthritis plus urine test which came back normal and has refused my rheumatology referral request. PCP also will not refer to spine clinic and has instead enrolled me in a group physical therapy workshop.Dizziness has not changed in 2 months, pain is getting worse, muscle weakness is getting worse but I haven't been prescribed anything. I've been told to use ice and heat and to stretch.LIFESTYLE PRIOR TO CONDITION Before this began, I was very active. I practiced yoga once a week and took dance lessons twice a week. I'm also an avid hiker. I did not fall, over stretched or injure myself in any way prior to these issues. Due to the random flare ups of swollen legs and fingers, I also meal prep and am conscience of what I eat so I believe my diet is pretty good. I've always been an athletic. I played basketball, ran track and played tennis from first grade through high school. In college, I swam and took dance classes most semesters.I'm not used to being in this much pain and not being unable to move for this long. I feel like my PCP doesn't care. I don't know what's happening to my body and because my blood work looks normal, I'm being ignored. Please help! I just want my life back.

Output: This is a rather complex history so I think it's difficult to give you any proper in-depth input. My main concern here is why you are being managed for this neurological condition by your PCP. Have you seen a neurologist for this? The reason I ask is that you're having multiple neurological symptoms with this sudden bout of headache and unilateral weakness and numbness that you have described. And MRI might be sufficient but a proper and thorough neurological exam is also needed. Unfortunately our current healthcare system does not allow for an in-depth neurological exam even in the neurologists office but at least it's worth a try.Agreed completely. Depending on the specifics of your history and exam, a total spine MRI, maybe slightly different types (sequences) of brain MRI, EMG, full neuropathy and rheumatologic panels may be warranted, as well as imaging of your hip.I will say, for what it's worth, that the fact that the numbness is intermittent is encouraging, and nothing on this lumbar MR report is dangerous or significantly abnormal (though it certainly could account for your back pain). Weakness in a single limb is typically a concerning thing to hear, however issues with the hip joint like you seem to be describing can cause weakness in the muscles surrounding the hip.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sudden loss of mobility - PCP refuses referral/treatmentHello, I'm a 32(F) in the USA. African-American, 5'2" and 144lbs. On Jan 3, 2022, I woke up around 2am with a terrible migraine. I had light sensitivity, confusion and extreme pressure behind right eye. Took excedrin but was unable to sleep due to pain. I was finally able to sleep about 45mins later as meds kicked in. Woke up the next day with a regular headache and soreness in right eye. On Jan. 5th, I suddenly became dizziness at work. The room began to rock and tilt causing loss of balance. My right ear felt clogged and I had pain in jaw joint on the right side. I was taken to ER and evaluated for heart attack, stroke etc. All tests came back normal. I remained in the hospital due to continued dizziness/imbalance but all tests including MRI of head and neck were clear. Was given motion sickness meds but it didn't help. While in hospital, I started having pain in my right hip joint. The joint also pops/clicks with movement. I've experienced the popping/clicking since I was 14 years old (18 years and counting) but this is the first time there has been pain. The pain has spread across my lower back. The pain started as a stabbing, pinching pain and is now an achy and the best way I can describe it is bone deep.I also have weakness in my right leg and intermittent numbness. Two weeks ago, I began to experience multiple episodes of urinary and fecal incontinence. The hip and back pain has gotten worse and the dizziness is the same as when it started. Almost all blood test and urine test have come back normal except for my vitamin d levels. My vitamin d value is 10ng/ml and I was prescribed over the counter vitamin d3 pills (1000unit)An MRI of my lumber spine was done (full report is linked). My PCP said it looked fine but didnt explain anything further. On the MRI it mentions the following:DISCS: L4-5 and L5-S1 disc desiccation and mild to moderate L5-S1 disc space narrowing.BONES: Slight chronic marrow signal changes. Body heights are generally maintained throughout.L3-L4: Slight posterior element degenerative change. Spinal canal and neural foramina are patent.L4-L5: Mild right eccentric disc bulge is slightly improved. Annular fissure. Slight posterior element degenerative changes. Spinal canal and neural foramina are essentially patent.L5-S1: Mild right eccentric disc bulge. Mild posterior element degenerative change. Spinal canal is patent. Slight predominantly bright neural foraminal encroachment.EXISTING MEDICAL ISSUESexercise induced asthma (I take Albuterol as needed)arnold chiari malformationthalassemia traitintermittent fatigueI've also had reoccurring migraines since I was 15 years old along with random, unexplained swelling of my hands and feet. Most recent flare up was unexplained very visible swelling of my left leg in July 2021. (Went to ER and tested negative for clots and gout)I suffer from random bouts of stomach inflammation that has been misdiagnosed as gallbladder disease (gall bladder was removed when I was 16) and has now been attributed to GERD. ( I take omeprazole for stomach and I have a history of stomach ulcers). Most recent flare was October 2021I've also had debilitating back pain since I was 15 years old and have completed physical therapy, acupuncture, multiple courses of steroid injections in my spine and at least 3 courses of prednisone. Pain has been caused by unexplained muscle spasms and bulging discs. I have these flare up at least twice a year.I sometimes have rashes that appear on my back and arms that are often misdiagnosed as ringworm (photos included). Fungal test always comes back negative. So far, the rashes have been diagnosed as eczema and rosacea. Flare ups occur approx once a year for the past 15 years. Rashes sometimes itch but its very mild. Most recent flare up occurred in November 2021.CURRENT SITUATION I requested a referral to be seen in rheumatology and at the spine clinic. PCP did blood test for rheumatoid arthritis plus urine test which came back normal and has refused my rheumatology referral request. PCP also will not refer to spine clinic and has instead enrolled me in a group physical therapy workshop.Dizziness has not changed in 2 months, pain is getting worse, muscle weakness is getting worse but I haven't been prescribed anything. I've been told to use ice and heat and to stretch.LIFESTYLE PRIOR TO CONDITION Before this began, I was very active. I practiced yoga once a week and took dance lessons twice a week. I'm also an avid hiker. I did not fall, over stretched or injure myself in any way prior to these issues. Due to the random flare ups of swollen legs and fingers, I also meal prep and am conscience of what I eat so I believe my diet is pretty good. I've always been an athletic. I played basketball, ran track and played tennis from first grade through high school. In college, I swam and took dance classes most semesters.I'm not used to being in this much pain and not being unable to move for this long. I feel like my PCP doesn't care. I don't know what's happening to my body and because my blood work looks normal, I'm being ignored. Please help! I just want my life back.. ### Response: This is a rather complex history so I think it's difficult to give you any proper in-depth input. My main concern here is why you are being managed for this neurological condition by your PCP. Have you seen a neurologist for this? The reason I ask is that you're having multiple neurological symptoms with this sudden bout of headache and unilateral weakness and numbness that you have described. And MRI might be sufficient but a proper and thorough neurological exam is also needed. Unfortunately our current healthcare system does not allow for an in-depth neurological exam even in the neurologists office but at least it's worth a try.Agreed completely. Depending on the specifics of your history and exam, a total spine MRI, maybe slightly different types (sequences) of brain MRI, EMG, full neuropathy and rheumatologic panels may be warranted, as well as imaging of your hip.I will say, for what it's worth, that the fact that the numbness is intermittent is encouraging, and nothing on this lumbar MR report is dangerous or significantly abnormal (though it certainly could account for your back pain). Weakness in a single limb is typically a concerning thing to hear, however issues with the hip joint like you seem to be describing can cause weakness in the muscles surrounding the hip..


Instruction: Thank you. I'm glad the MR report looks good. My doctor didn't talk to me about it so I've been very confused/concerned. She hasn't done a neuropathy panel or ordered any hip imaging. As for rheumatology panels, I had a serum rheumatoid factor test, a cyclic citrullinated peptide test, a uric acid test and a ESR. I was told that they all came back normal which is why she won't refer me to rheumatology. I will push for hip imaging because that's where most of my pain is. Thanks for the suggestion

Output: The other workup may or may not be necessary but yes, a simple hip XR makes sense based on your symptoms. I had a patient not so long ago who had gotten multiple extremely extensive neurological workups for left leg weakness, including chasing things that ended up being asymptomatic incidental findings. She presented to us for hip pain soon after, and it became very obvious (supported by an X ray confirming our suspicions) that the weakness was entirely due to arthritis. You never know.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you. I'm glad the MR report looks good. My doctor didn't talk to me about it so I've been very confused/concerned. She hasn't done a neuropathy panel or ordered any hip imaging. As for rheumatology panels, I had a serum rheumatoid factor test, a cyclic citrullinated peptide test, a uric acid test and a ESR. I was told that they all came back normal which is why she won't refer me to rheumatology. I will push for hip imaging because that's where most of my pain is. Thanks for the suggestion. ### Response: The other workup may or may not be necessary but yes, a simple hip XR makes sense based on your symptoms. I had a patient not so long ago who had gotten multiple extremely extensive neurological workups for left leg weakness, including chasing things that ended up being asymptomatic incidental findings. She presented to us for hip pain soon after, and it became very obvious (supported by an X ray confirming our suspicions) that the weakness was entirely due to arthritis. You never know..


Instruction: I only saw the neurologist while in admitted in the hospital. The visit lasted about 15 minutes. He did brief an assessment, told me that my x-rays and mri looked fine and that was pretty much it. I've asked my PCP for a referral to neurology as well but she keeps saying that since nothing has shown up in any blood work or x-rays, she can't do it. I asked her if it's possible to have a neurological or auto immune disorder that doesn't show up on x-rays and tests but I haven't gotten an answer.

Output: I am not sure which country you're in but for us here in the US healthcare system when you are in the health insurance system you get health insurance quality care. I often advise my patients to seek out a private neurologist for a deeper exam and insight into what's going on. A neurologist couldn't even examine the right hand in 15 minutes much less do a full head to toe Neuro exam. I encourage you to Google a full neurological exam on YouTube and see what it takes and how extensive it is. When the insurance company will only reimburse you per visit and you have 500k in student loans and malpractice insurance and each patient is a potential lawsuit you tend to do something cursory, order a test and if the test is negative you're protected. I know this isn't fair to patients but it's the agreement we have reached as a society in managing healthcare so I'm trying to arm you with the knowledge to get the right care.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I only saw the neurologist while in admitted in the hospital. The visit lasted about 15 minutes. He did brief an assessment, told me that my x-rays and mri looked fine and that was pretty much it. I've asked my PCP for a referral to neurology as well but she keeps saying that since nothing has shown up in any blood work or x-rays, she can't do it. I asked her if it's possible to have a neurological or auto immune disorder that doesn't show up on x-rays and tests but I haven't gotten an answer.. ### Response: I am not sure which country you're in but for us here in the US healthcare system when you are in the health insurance system you get health insurance quality care. I often advise my patients to seek out a private neurologist for a deeper exam and insight into what's going on. A neurologist couldn't even examine the right hand in 15 minutes much less do a full head to toe Neuro exam. I encourage you to Google a full neurological exam on YouTube and see what it takes and how extensive it is. When the insurance company will only reimburse you per visit and you have 500k in student loans and malpractice insurance and each patient is a potential lawsuit you tend to do something cursory, order a test and if the test is negative you're protected. I know this isn't fair to patients but it's the agreement we have reached as a society in managing healthcare so I'm trying to arm you with the knowledge to get the right care..


Instruction: Thank you for this. Yes I'm in the US and I have insurance through Kaiser Permanente because my employer has a contract with them. I've had horrible experiences with this hospital and thanks to your response, I now understand why. My next step is going to be working with a private provider. I'm definitely stressed about this because I know the cost will be high but I need to know what's happening to me.

Output: I haven't heard the best things about Kaiser I must say. I worked there myself before and I wouldn't want to be a sick patient there.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for this. Yes I'm in the US and I have insurance through Kaiser Permanente because my employer has a contract with them. I've had horrible experiences with this hospital and thanks to your response, I now understand why. My next step is going to be working with a private provider. I'm definitely stressed about this because I know the cost will be high but I need to know what's happening to me.. ### Response: I haven't heard the best things about Kaiser I must say. I worked there myself before and I wouldn't want to be a sick patient there..


Instruction: Bad Burn on Hand is Getting Worse Over Time Despite Being on Antibiotics.[34] [F]Pictures - https://imgur.com/a/D5iF0BI34F,5'10.5,13 Stone,Caucasian,1Bad Burn + 1 Lesser,Possible Neurological Issue or Rheumatological Issue (MS/Epilepsy or Fibromyalgia are possibilities being discussed 7 years in)Meds -Lyrica 75mg 2x p/d + 25mg at night.Solpadol - 3 x p/d, 1-2 tablets ( 30mg/500mg ) per taking.Xanax - 0.25-0.5mg when neededAugmentin - I don't have any left to know the dose but it was for Tooth Abscess that was bad and landed me in ERAmoxicillin 500mg one, three times a day.Flagyl 400mg one, three p/dSolpadine 7/500mg for times of lesser pain. Not taken regularly.Aceclofenac (Vitafen)100mg. One p/dDrink once maybe every two-three months.Smoke heavily, daily.Location: IrelandHi all!I burned my ring finger, and, to a lesser degree, my pinky, on a metal pot about two weeks ago.I had a tooth abscess at the time and aprox 5 days went to Caredoc (Irish out of hours Doctor that isn't Hospital) where i was given Amoxicillin.I didn't get the Burn checked out because at the time it was just red and sore like a usual Burn.Next day tooth was worse so I went to A&E where I was given Augmentin as apparently Amoxicillin + the strength was never going to clear up that type of infection.So, for the last 1.5 (ish) weeks I have been on a variety of antibiotics.However, my hand has been getting worse every day.Today, I woke up and my entire hand is swollen and sore.This hadn't been an issue until today.Yesterday was the first time I noticed some swelling but it was only on Ring Finger and pinky.The other cuts on my hand also were filled with pus though they had no reason to be and, weren't before the weekend.I had the Amoxicillin left over so started taking that again.

Output: Occasionally burns can cause dep tissue infections. Returning to a doctor seems wise

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Bad Burn on Hand is Getting Worse Over Time Despite Being on Antibiotics.[34] [F]Pictures - https://imgur.com/a/D5iF0BI34F,5'10.5,13 Stone,Caucasian,1Bad Burn + 1 Lesser,Possible Neurological Issue or Rheumatological Issue (MS/Epilepsy or Fibromyalgia are possibilities being discussed 7 years in)Meds -Lyrica 75mg 2x p/d + 25mg at night.Solpadol - 3 x p/d, 1-2 tablets ( 30mg/500mg ) per taking.Xanax - 0.25-0.5mg when neededAugmentin - I don't have any left to know the dose but it was for Tooth Abscess that was bad and landed me in ERAmoxicillin 500mg one, three times a day.Flagyl 400mg one, three p/dSolpadine 7/500mg for times of lesser pain. Not taken regularly.Aceclofenac (Vitafen)100mg. One p/dDrink once maybe every two-three months.Smoke heavily, daily.Location: IrelandHi all!I burned my ring finger, and, to a lesser degree, my pinky, on a metal pot about two weeks ago.I had a tooth abscess at the time and aprox 5 days went to Caredoc (Irish out of hours Doctor that isn't Hospital) where i was given Amoxicillin.I didn't get the Burn checked out because at the time it was just red and sore like a usual Burn.Next day tooth was worse so I went to A&E where I was given Augmentin as apparently Amoxicillin + the strength was never going to clear up that type of infection.So, for the last 1.5 (ish) weeks I have been on a variety of antibiotics.However, my hand has been getting worse every day.Today, I woke up and my entire hand is swollen and sore.This hadn't been an issue until today.Yesterday was the first time I noticed some swelling but it was only on Ring Finger and pinky.The other cuts on my hand also were filled with pus though they had no reason to be and, weren't before the weekend.I had the Amoxicillin left over so started taking that again.. ### Response: Occasionally burns can cause dep tissue infections. Returning to a doctor seems wise.


Instruction: Thank you for the reply.I definitely will be returning, i just was looking for some insight moreso, not medical advice as i dont have any experience with this type of burn.I can't get an appointment for two weeks. That seems like quite a long time to me but I'm not a doctor.

Output: If it gets much worse, seek emergency care.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for the reply.I definitely will be returning, i just was looking for some insight moreso, not medical advice as i dont have any experience with this type of burn.I can't get an appointment for two weeks. That seems like quite a long time to me but I'm not a doctor.. ### Response: If it gets much worse, seek emergency care..


Instruction: Also, do you have any idea what level burn this is? I'm having a hard time figuring it out.

Output: It seems like a full thickness burn.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Also, do you have any idea what level burn this is? I'm having a hard time figuring it out.. ### Response: It seems like a full thickness burn..


Instruction: Clots, cysts, and no diagnosis +7m on ...27yo female, 84kg 5ft9, presents w/ multiple clots in stomach - splenic vein thrombosis, mesenteric vein thrombosis, portal vein thrombosis, for main concern - in addition to other clots present in stomach (8 total). Cysts in spleen and liver, constant upper right flank pain w/ sickness and diarrhea and stomach distension. Right shoulder/neck pain. Constant tonsillitis issue, constant fatigue periods followed by unable to sleep for extended periods of time too.Docs determined clots as idiopathic, now on enoxaparin injections 150ml and codeine for pain management. Been under investigation since Dec-21, w/ no ACTUAL diagnosis. Clots were not caused by a trauma.Had CT, MRI, colonoscopy/endoscopy. No IBS. Cirrhosis. No gallstones or issues with gallbladder. Seen a haematologist full thrombosis panel completed: all genetic, autoimmune, deficiencies, all negative in tests. Jak2/PNH/anticardiolipin/beta2 glycoprotein all negative. Thought hyatid disease for the clots given in spleen/liver, however, negative. Under gastroenterology, rheumatology issues ruled out.Abnormal perfusion areas in liver, calcified splenic cysts appear to be long standing but benign in recent MRI. Fatty deposits for 'cysts' in liver, but appear benign again.Recommended weight loss to aid with symptoms and also reduced fats in diet considerably (got an air fryer), lost 10kg since but upper right quadrant pain seems to be getting worse again and sickness/diarrhea.Getting frustrated with lack of diagnosis as to why clots formed, cysts formed, and what's actually happening to me.No previous medical/family history of clots or cysts. Mom has had 3 miscarriages, Dad has cardiovascular issues. Both grandmother's had cancer - bowel and throat.Awaiting elastography of liver to measure scarring so far.Anything else I should be requesting to aid in a diagnosis? Any thoughts on a diagnosis?

Output: Sorry to hear about your troubles. My first thought was a missed covid infection. You may have had it without any particular symptoms, but it can still (rarely) lead to systemic thrombosis in otherwise healthy people. If this ends up being the case, the good news is that it will likely get better. Heres an example case report: https://casereports.bmj.com/content/14/1/e241027

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Clots, cysts, and no diagnosis +7m on ...27yo female, 84kg 5ft9, presents w/ multiple clots in stomach - splenic vein thrombosis, mesenteric vein thrombosis, portal vein thrombosis, for main concern - in addition to other clots present in stomach (8 total). Cysts in spleen and liver, constant upper right flank pain w/ sickness and diarrhea and stomach distension. Right shoulder/neck pain. Constant tonsillitis issue, constant fatigue periods followed by unable to sleep for extended periods of time too.Docs determined clots as idiopathic, now on enoxaparin injections 150ml and codeine for pain management. Been under investigation since Dec-21, w/ no ACTUAL diagnosis. Clots were not caused by a trauma.Had CT, MRI, colonoscopy/endoscopy. No IBS. Cirrhosis. No gallstones or issues with gallbladder. Seen a haematologist full thrombosis panel completed: all genetic, autoimmune, deficiencies, all negative in tests. Jak2/PNH/anticardiolipin/beta2 glycoprotein all negative. Thought hyatid disease for the clots given in spleen/liver, however, negative. Under gastroenterology, rheumatology issues ruled out.Abnormal perfusion areas in liver, calcified splenic cysts appear to be long standing but benign in recent MRI. Fatty deposits for 'cysts' in liver, but appear benign again.Recommended weight loss to aid with symptoms and also reduced fats in diet considerably (got an air fryer), lost 10kg since but upper right quadrant pain seems to be getting worse again and sickness/diarrhea.Getting frustrated with lack of diagnosis as to why clots formed, cysts formed, and what's actually happening to me.No previous medical/family history of clots or cysts. Mom has had 3 miscarriages, Dad has cardiovascular issues. Both grandmother's had cancer - bowel and throat.Awaiting elastography of liver to measure scarring so far.Anything else I should be requesting to aid in a diagnosis? Any thoughts on a diagnosis?. ### Response: Sorry to hear about your troubles. My first thought was a missed covid infection. You may have had it without any particular symptoms, but it can still (rarely) lead to systemic thrombosis in otherwise healthy people. If this ends up being the case, the good news is that it will likely get better. Heres an example case report: https://casereports.bmj.com/content/14/1/e241027.


Instruction: I'm vaccinated, had 3 injections.

Output: Good for you! This makes it less likely, though still possible.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm vaccinated, had 3 injections.. ### Response: Good for you! This makes it less likely, though still possible..


Instruction: Confused from Rheumatology appointment. Doc seemed concerned but also not?25M, 6'4, 195lbs.Been dealing with some health issues that have been affecting me pretty heavily and it was suggested I see a rheumatologist just to be safe.He ran some panels where there seemed to be some out of range factors that he wasn't concerned about. The three he did bring up, though, was aANA Screen IFA - Positive | Pattern was Nuclear, Speckled.ANA Titer - 1:40WBC - 2.4 x10(3)/mcLHe wasn't worried about these results, either. My WBC is usually right below reference range, but not typically this low. He did say that that WBC count should have an eye kept on it.. but not to worry about a positive ANA screen or a titer of 1:40.Is this anything I should check up on? The bouts of what I deal with are really messing with daily life and aside from an endoscopy (which I struggle to believe would be causing any of my issues) that showed gastritis and duodenitis, as well as some labs that came back "out of range" here and there.. these results seem to atleast possibly point towards something?Any feedback is appreciated, thank you.If any other labs are needed, please let me know. I can pull them from online.

Output: Low WBC and positive ANA are two criteria for lupus. You did not specify what your health issues were though.The presence of a nuclear speckled pattern is often indicative of an autoimmune disorder, as it suggests the presence of antinuclear antibodies.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Confused from Rheumatology appointment. Doc seemed concerned but also not?25M, 6'4, 195lbs.Been dealing with some health issues that have been affecting me pretty heavily and it was suggested I see a rheumatologist just to be safe.He ran some panels where there seemed to be some out of range factors that he wasn't concerned about. The three he did bring up, though, was aANA Screen IFA - Positive | Pattern was Nuclear, Speckled.ANA Titer - 1:40WBC - 2.4 x10(3)/mcLHe wasn't worried about these results, either. My WBC is usually right below reference range, but not typically this low. He did say that that WBC count should have an eye kept on it.. but not to worry about a positive ANA screen or a titer of 1:40.Is this anything I should check up on? The bouts of what I deal with are really messing with daily life and aside from an endoscopy (which I struggle to believe would be causing any of my issues) that showed gastritis and duodenitis, as well as some labs that came back "out of range" here and there.. these results seem to atleast possibly point towards something?Any feedback is appreciated, thank you.If any other labs are needed, please let me know. I can pull them from online.. ### Response: Low WBC and positive ANA are two criteria for lupus. You did not specify what your health issues were though.The presence of a nuclear speckled pattern is often indicative of an autoimmune disorder, as it suggests the presence of antinuclear antibodies..


Instruction: 27F immunocompromised and sick for two weeks. Getting worse. Rheumatologist is out of town and ER doctor sent me home pending blood test results that are still processing. Insight?Demographics: 27 female. Height 5ft 6in, weight 190lbs. Married.Conditions: rheumatoid arthritis and lupus; SVT.Meds: 2000mg sulfasalazine, 400mg plaquenil, 200mg Cimzia injection every two weeks.Non-smoker, no alcohol, no caffeine.Duration of complaint: 2weeksI have four doses of pfizer covid vaccine.Currently negative for covid.Two weeks ago before my scheduled Cimzia injection I spiked a low-grade fever. It was about 37.8c. Since then, my temperatures have been 37.5c to 38.5c. Acetaminophen will not bring my temperature down. It initially started with fatigue and headache and fever.Last week I began to get a sore throat, sweating, clamminess, chills, mild sinus pressure, confusion, shortness of breath, and a slight cough.I went in for monthly rheumatology bloodwork on 7/28. Ill attach the results. Mildly decreased WBC and Neutrophils.On 7/29 I went to the emergency room as my primary doctor instructed me to because I was not improving. Many cultures were taken. WBC further decreased and neutrophils were more than half of the previous day. There is a WBC Morphology pending pathologist review.Sepsis cultures have not shown any growth over the day.X-ray of chest showed no abnormality.Im confused as to what could be causing this. The ER doctor also said he was confused and it could be a medication or a nasty virus (was not tested for these) and that I have neutropenia and I am quite immune compromised but left it at that.Today, 7/30, I have had more difficulty breathing, particularly with movement or talking. Im coughing green/yellow thick mucus. More fatigue. My lungs feel heavy.Im thinking of heading back to the ER tomorrow if symptoms get worse, but Im not sure it will do any good for me or provide me with more.Is there any insights?Ive reached out to my rheumatologists receptionist as well as my primary doctor. However, Monday here is a holiday so the offices are closed. The earliest I could see my primary is on Tuesday, and Im not sure how much further it will progress by then.here is the link to my imgur albumI understand that some of the blood work with the hematology panel is still pending.Also, what does it mean with the WBC morphology Reviewed by technologist Sent to Pathologist for review?Thank you in advanced

Output: I wouldn't wait a day more. Go to the ER. In my opinion you should be started on broad spectrum antibiotics asap, while waiting for results.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 27F immunocompromised and sick for two weeks. Getting worse. Rheumatologist is out of town and ER doctor sent me home pending blood test results that are still processing. Insight?Demographics: 27 female. Height 5ft 6in, weight 190lbs. Married.Conditions: rheumatoid arthritis and lupus; SVT.Meds: 2000mg sulfasalazine, 400mg plaquenil, 200mg Cimzia injection every two weeks.Non-smoker, no alcohol, no caffeine.Duration of complaint: 2weeksI have four doses of pfizer covid vaccine.Currently negative for covid.Two weeks ago before my scheduled Cimzia injection I spiked a low-grade fever. It was about 37.8c. Since then, my temperatures have been 37.5c to 38.5c. Acetaminophen will not bring my temperature down. It initially started with fatigue and headache and fever.Last week I began to get a sore throat, sweating, clamminess, chills, mild sinus pressure, confusion, shortness of breath, and a slight cough.I went in for monthly rheumatology bloodwork on 7/28. Ill attach the results. Mildly decreased WBC and Neutrophils.On 7/29 I went to the emergency room as my primary doctor instructed me to because I was not improving. Many cultures were taken. WBC further decreased and neutrophils were more than half of the previous day. There is a WBC Morphology pending pathologist review.Sepsis cultures have not shown any growth over the day.X-ray of chest showed no abnormality.Im confused as to what could be causing this. The ER doctor also said he was confused and it could be a medication or a nasty virus (was not tested for these) and that I have neutropenia and I am quite immune compromised but left it at that.Today, 7/30, I have had more difficulty breathing, particularly with movement or talking. Im coughing green/yellow thick mucus. More fatigue. My lungs feel heavy.Im thinking of heading back to the ER tomorrow if symptoms get worse, but Im not sure it will do any good for me or provide me with more.Is there any insights?Ive reached out to my rheumatologists receptionist as well as my primary doctor. However, Monday here is a holiday so the offices are closed. The earliest I could see my primary is on Tuesday, and Im not sure how much further it will progress by then.here is the link to my imgur albumI understand that some of the blood work with the hematology panel is still pending.Also, what does it mean with the WBC morphology Reviewed by technologist Sent to Pathologist for review?Thank you in advanced. ### Response: I wouldn't wait a day more. Go to the ER. In my opinion you should be started on broad spectrum antibiotics asap, while waiting for results..


Instruction: How do you feel about patients bringing their own files?How do you feel about patients who bring their own files?Im a 28F and was recently diagnosed with a chronic illness and have at least one more serious medical issue suspected. Im asking for advice navigating the diagnostic and treatment process for multiple complex medical issues.Is there anything a CI patient like me can do to make diagnosing and treating easier? Ive heard other chronically ill patients advise to bring a folder full of all medications, symptoms and symptom changes, lab results, etc. to hand to the doctor each visit. Is that something helpful or would you just think they were extra/a hypochondriac?Are there any other things ci patients can do/not do to help? Pet peeves? Im having to go to my pcp or a specialist ALL the time recently and want to make the process as smooth as possible.(For the auto mod: 28F, 5 ft. 10 in., 140 lbs approx., white, dealing with autonomic dysfunction and suspected autoimmune issues as diagnosed by my pcp, neurology, cardiology, and rheumatology teams, have had symptoms for 10 years, medical history previously listed, not taking any relevant medications, no drinking, smoking, or recreational drugs)

Output: You can bring it but I'd prefer it being sent over before our visit OR letting us review it after the visit. A summary is preferable unless it's truly relevant to what I'm seeing you for. There's just not enough time in a clinic visit to go through a huge stack of medical records

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How do you feel about patients bringing their own files?How do you feel about patients who bring their own files?Im a 28F and was recently diagnosed with a chronic illness and have at least one more serious medical issue suspected. Im asking for advice navigating the diagnostic and treatment process for multiple complex medical issues.Is there anything a CI patient like me can do to make diagnosing and treating easier? Ive heard other chronically ill patients advise to bring a folder full of all medications, symptoms and symptom changes, lab results, etc. to hand to the doctor each visit. Is that something helpful or would you just think they were extra/a hypochondriac?Are there any other things ci patients can do/not do to help? Pet peeves? Im having to go to my pcp or a specialist ALL the time recently and want to make the process as smooth as possible.(For the auto mod: 28F, 5 ft. 10 in., 140 lbs approx., white, dealing with autonomic dysfunction and suspected autoimmune issues as diagnosed by my pcp, neurology, cardiology, and rheumatology teams, have had symptoms for 10 years, medical history previously listed, not taking any relevant medications, no drinking, smoking, or recreational drugs). ### Response: You can bring it but I'd prefer it being sent over before our visit OR letting us review it after the visit. A summary is preferable unless it's truly relevant to what I'm seeing you for. There's just not enough time in a clinic visit to go through a huge stack of medical records.


Instruction: So giving you a copy you could keep would be helpful? Ill keep that in mind!

Output: Only if it's relevant

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: So giving you a copy you could keep would be helpful? Ill keep that in mind!. ### Response: Only if it's relevant.


Instruction: Unexplained Wounds need help to find answersMy husband served over in Iraq in 2011 and came home due to a machine gun falling on his groin and he had to have nerve blocks. 4 years later he started developing these ulcers that in a matter of hours would turn necrotic. When he was over in Irag he was stationed near burn pits. We've been to countless specialists such as dermatology, infectious disease, rheumatology, wound care. We've been to 10 different hospitals and not one doctor can find the cause of this. For about 2 years we thought it was Pyroderma Gangernosum, but with PG if you cut into it, it will make it worse. With my husband it helps. We have become so hopeless and this is so debilitating. Hes lost countless jobs we are praying to find answers and find someone who has this awful disease that may know what it is. My Husband is 27 years of age 5 ft 5 he weighs 200lbs doesnt smoke or drink. unexplained Wounds

Output: Buruli UlcersBrucelosisI only suggest those two as Ive had a patient with the first one who served in the Middle East, and initially a differential was the second. We also get the Buruli ulcers here, but we call them Bairnsdale ulcersId suggest an infectious diseases specialist.What is a burn pit?Oddly enough I couldnt link the WHO page for the first one.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Unexplained Wounds need help to find answersMy husband served over in Iraq in 2011 and came home due to a machine gun falling on his groin and he had to have nerve blocks. 4 years later he started developing these ulcers that in a matter of hours would turn necrotic. When he was over in Irag he was stationed near burn pits. We've been to countless specialists such as dermatology, infectious disease, rheumatology, wound care. We've been to 10 different hospitals and not one doctor can find the cause of this. For about 2 years we thought it was Pyroderma Gangernosum, but with PG if you cut into it, it will make it worse. With my husband it helps. We have become so hopeless and this is so debilitating. Hes lost countless jobs we are praying to find answers and find someone who has this awful disease that may know what it is. My Husband is 27 years of age 5 ft 5 he weighs 200lbs doesnt smoke or drink. unexplained Wounds. ### Response: Buruli UlcersBrucelosisI only suggest those two as Ive had a patient with the first one who served in the Middle East, and initially a differential was the second. We also get the Buruli ulcers here, but we call them Bairnsdale ulcersId suggest an infectious diseases specialist.What is a burn pit?Oddly enough I couldnt link the WHO page for the first one..


Instruction: Please do this! I have met someone who has had similar complaints and they were not able to get a definitive diagnosis.Also, Schnooks, are you a physician in Australia? I understand Buruli ulcers had some what became an issue in 2018 there. While it isn't an issue here in the States, I wonder if this contributes to misdiagnosis? Thanks for your input!

Output: I am, anaesthetic registrar.Its not my area, but I think theyre still a problem and actually getting worse (spreading, increasing frequency). They certainly make the news more frequently. Despite the fact theres a syndrome Bairnsdale ulcer down here, apparently theyre a frequently forgotten diagnosis. So it wouldnt surprise me if the same illness would be far from front of mind elsewhere in the world.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Please do this! I have met someone who has had similar complaints and they were not able to get a definitive diagnosis.Also, Schnooks, are you a physician in Australia? I understand Buruli ulcers had some what became an issue in 2018 there. While it isn't an issue here in the States, I wonder if this contributes to misdiagnosis? Thanks for your input!. ### Response: I am, anaesthetic registrar.Its not my area, but I think theyre still a problem and actually getting worse (spreading, increasing frequency). They certainly make the news more frequently. Despite the fact theres a syndrome Bairnsdale ulcer down here, apparently theyre a frequently forgotten diagnosis. So it wouldnt surprise me if the same illness would be far from front of mind elsewhere in the world..