Instruction: Hello Reddit,My younger brother was 27, Male, maybe 6 foot and 375 pounds, half white/asian, no drugs, no smoking, extremely rarely drinking (like less than once a month).I don't recall what his early symptoms were but I found a virtual chat that said he may of had "uncomplicated cystitis" and had antibiotics prescribed for it. He saw a urologist and eventually had a nephrostomy tube, then had surgery later and was noted with a failed kidney. They were unable to remove it due to his weight and having hemorrhage concerns, at least that was my understanding, and that's it for a his existing medical condition, with an exception.I'm first wondering how he developed this condition to begin with. Would the failed kidney have caused the infection? I wish I had the full records so I could paint a better picture, but ultimately I can only guess that his high blood pressure was a cause, plus having a high stress job.Ever since all this, he had to urinate every like hour and this caused issues with work and sleep. I really don't understand why this kept happening and nothing was given to him for it. Would having a failed kidney cause that? This started back at the end of 2020 and the tube and surgery may have been in Q2/3? I now can't remember what happened first.From that I'm mostly wondering about the reason for frequent urination and if he would have got infected some other way outside of high blood pressure. He almost never leaves the house, and I fear he'd only get sick if a family member came home with something.Fast forward to the bulk of my reason to post. On January 13, 2023 he mentioned some nasal congestion and some body aches. He didn't seem to get better on the 14th so I asked if he wanted to see a doctor and he said not yet. This eventually came with some headaches so we tried to go to an urgent care but the wait times were 3+ hours so we figured try a Teladoc (98point6 for this call) and get an appointment later. He mentions a head ache lasting 4-5 days, dull/sharp pains in waves from front to back, also going behind his eyes. He was taking ibuprofen, and was asked about a fever and he said he wasn't sure but his head seems warmer compared to his body. They basically said to take Afrin and Excedrin and go to urgent care if things don't get better. When he went to take the afrin that night, he blew his nose and had a nose bleed, and per our father he had nose bleeds from time to time, but not that super often.Come January 19 I take him to urgent care and I do have his visit summary. Blood pressure 174/89 (why the fuck didn't anyone talk about this), temporal temperature of 98.1 (maybe the medication lowered it?), pulse 90, respiration 18, oxygen saturation 97. They gave him Toradol and sent him home. I feel like a fucking asshole that I wasn't in there with him, I had to drop him off and attend a work meeting that I should of canceled, and our mother picked him up. This is all very local, like within 15 minute drives.He doesn't seem to get better and on the 22nd he talks about some vision issues so I immediately take him to the nearest ER, which is a satellite and not attached to a large hospital. He goes to a back room almost immediately after checking in - alone, and again I feel like a fucking loser as I should of gone there with him to help explain everything - who knows exactly what he said since he was dealing with headaches. I did come back and talk to one of the nurses, but that didn't seem to change anything they expected.He had the following lab tests done, CBC With Diff, CG4 PANEL POC, Comprehensive Metabolic Panel Poc, PCR Influenza A & B and Covid 19 (POCT). Also had a CT Head W/O Contrast and EKG. Done today was just the CG4 and Comprehensive Metabolic, guess the CBC was still processing? I don't recall any notes on this, and his MyChart is closed.They didn't seem to find anything, even though he had a 171/105 blood pressure, they did ask if he had history and I didn't have a full answer, but said it wouldn't be surprising since the rest of the family has medication for it, but he didn't have a primary care doctor to prescribe it. He had trouble finding one since COVID and it really pisses me off that I didn't help him find one somehow. He also had 100.1 temperature.They gave him .9% NaCl (NS), tylenol, benadryl, toradol and reglan, and sent him home.The next day I don't remember exactly what triggered this, maybe balance, but we took him to the ER attached to the hospital and the doctor almost immediately said he wasn't going home that night, he saw something. They put him in a gown and my brother was shivering mad, and he normally likes it cold. Sometime that night I believe he got a room and had some tests, and they said he had meningitis, and shortly after was uncertain of contagious so the room was adjusted and we had to wear N95 masks and a face shield / gown. This went for maybe 2-3 days, and it bothers me so much because this was the most critical time that I could of had talking to my brother and I minimized my time like a coward and asshole. I believe our mother was there the whole time though.After that 2-3 days it was cleared for bacterial and said likely viral (they never said what he had) and the additional PPE was stopped. I remember he texted me to bring apple juice, yogurt, and fruit cups, which I did, but asked if it was okay because I thought hospitals didn't want outside food. They said it was okay as long as it conformed to a low sodium diet, which those did.During this I know he had a lumbar puncture, which is likely how they found the meningitis, and had a CT/MRI that they said was clear. Then suddenly the next day he developed delirium. He was able to answer our questions and knew who we were, but it was like he was living in a video game or something. He'd also spring up very quickly pulling wires to urinate (and frequently) which caused concerns for the monitoring and fall prevention, since he was a little wobbly and I think bumped his side one day because of the bar being down for the accessibility access for the toilet.The doctors believed the delirium was due to his lowered sodium levels, which could have been to the frequent urination and low sodium diet. He was drinking a ton of Gatorade at home back home, probably around the 16th I was buying him multi-packs as I felt those helped me recover. Eventually they put him on a EEG and because of the frequent getting up and sometimes he'd just try to rip the things off, they restrained him. I wasn't there when it happened but our mom was there and it sounded a little traumatic, like saying "why are you doing this mommy, and then attempting to bite her". Not sure if that's exactly what happened but he was restrained. Either at that point or shortly after he did have a nurse assigned to be next to him 24/7 to monitor, and help him pee as he'd be responsive if he had to go and the nurses asked.During this delirium he'd talk about random stuff, sounded like he was in a game, he couldn't explain where he was, but he was still answering questions. Everyday I visited I'd ask if he knew who I was and he'd start by laughing and saying of course, and I had to be more specific with him and he'd confirm my name and that I'm his brother. During this time we had a family member with him 24/7, but would occasionally talk to him, I know I'd hold his hand and he'd squeeze back, but we'd end up sitting to the side talking to each or reading a book, etc.Finally on the 30th I was coming in to swap out with our father, who said that my brother was a bit quieter today, maybe he was finally getting some much needed sleep as it seemed like he wasn't getting any. I also noticed that he had an oxygen tube under his nose, which wasn't there before. I didn't want to wake him so I didn't do much, and this was the first day I decided to pop up my switch and play some yoshi crafted world, and I kept one ear bud out just in case.I know he had a lumbar puncture done either before I came or just as I came, and an MRI earlier (might have been the previous day, it's becoming a blur now and I hate it) and the neurologist said they see a lesion, and it looked like one of the quadrants of the brain. I honestly can't remember but it felt like a sizable portion. I also looked at the EEG from time to time as I assume they were looking for seizures and I swear I saw alerts on the machine detecting them.This was the first time that I was going to pull the all nighter, and it was normally our mother that would do that and I offered to stay but she wanted to get some rest which I understood. A bit after I was there I noticed they swapped the tube with an oxygen mask, and I regret to this day that I did not look at that monitor better, seeing if oxygen was dropping, etc. There was a nurse there but I don't know how well they were watching, I swear one of the guys before was on his phone most of the time. I remember there was a night shift change, and I don't recall how long after before the most traumatic part happens. I did ask if my brother snored normally to our parents, as I never really heard him sleep and our father said yes, and he should get a sleep study done. It reminded me of our father's sleep apnea when napping on the couch during movie night. I don't remember how long this went on for, but I think they adjusted the bed height or something, don't remember... yet another thing to add to my list of regrets.That night after playing a bit I remember my arms getting tired so I pulled the little side table near me to prop my switch up on so I could just use the remotes, and all of a sudden a bunch of nurses come rushing into the room and one of the nurses checks his neck and says no pulse, then a code blue is called. I am escorted out of the room and just panicking. I don't remember hearing the monitor beeping prior (remember 1 ear bud and I had the volume at like 1 tick), and I don't recall him snoring just before either. For all I know the sensors were faulted and he was out for awhile, I have no idea how immediate it was, or if maybe the table pulled/squeezed the oxygen tube (this all happened in like 10 seconds). I know that his monitor was beeping a lot earlier due to his blood pressure, and I don't know if they gave him medication, but I don't remember that monitor beeping at all that day. Maybe the last nurse silenced it? I don't know. I also don't know how well the nurse was watching. One of the nurses in the morning/afternoon was great and I know she was looking at his face and the monitor with great focus, and I fear the night nurses not so much. I know the nurse that night was from newborns, and just helping out.I don't understand why or how he code blued, how quick it was, or anything, but I know it took them over 20 minutes to bring him back and he was on a ventilator. They did the 24 hour thermal treatment of going cold then normal, and after that for the next few days they'd do an eye test and pain test with no responses. On February 1 they did some test with a dye to see blood movement in the brain and I saw the results that night saying there was little blood flow but not clinically brain dead. I had a spark of hope but knew I wasn't a doctor. The next day we talked to the neurologist and confirmed that he was indeed brain dead and I felt like I lost my brother for the 3rd time in that hospital. Once during delirium, then the cardiac arrest, and now. We had to decide when to pull the life support, and I watched him officially die, for what felt like the 4th time.Having to find the courage to join our father for the funeral arrangements, then the funeral which was a visitation before cremation, then picking up the urn a week later, it's been waves of trauma and it still feels like yesterday a month later. Everyday I've gone home to see my parents, and touch the urn and cry. I don't understand why he's in there and not at our house playing video games with his friends.I don't understand how he got sick to begin with, he moved in with me back in May and I tried to make things as comfortable for him as possible. This was his first winter with me and I think this house is a bit drier than the parents he lived with, but I wouldn't think that'd cause the issue. He almost never leaves, he works from home and plays games. If he caught anything it'd be from me, and I know I got sick at the end of June with COVID and he caught that from me, what a fucking loser I am. I did another trade show in September and got sick, not sure if he got it then, he didn't report time off to work (and he tries to take every time off he can).I don't understand why the teladoc didn't ask other questions, or the urgent care to find anything. Then later the first ER only commented on the high blood pressure, and it wasn't until the second ER that they knew something was up.Why did he get delirium, why did they let sodium levels drop? What was going on with the oxygen? With the monitoring he had, how did they let a cardiac arrest happen?I have so many questions and it pains me knowing that even if I get knew, it doesn't change that my baby brother is gone. We had so many plans this year, such as cooking better for ourselves, working out to lose weight, and most critically spending more time outside of his room to try new things like restaurants and take vacations. The last vacation I had with him was 2007, and he was in Hawaii with the parents in 2008 where I was rejected from going because I didn't have a job after high school.Before his delirium I remember one big ask, which was to get a hug, and that he was ready and wanting to go on adventures with me. I hadn't seen my brother much outside of a quick dinner talk from time to time, and when he moved in I was glad to be bonding with him again, and we didn't even get 1 year. We had so many plans, and the world robbed him of that.During the visitation I played the Halo song "Never Forget". He was a big Halo fan and that song always gave me the feels. I hugged his cold body for that entire song, wishing I could give him more.This is a long post and I apologize, I just needed to write, and I wonder if anyone knows what may have caused things. I fear that my lack of knowledge and experience failed to get him to the ER sooner, but it didn't seem like that even helped, they may have just done the same as they did on the first visit and turned him around.I failed to protect you brother, I am so sorry. This world is just not fair and you deserved so much more. You were the nicest person anyone would of met and you made those around you happier. I miss you so much brother, and I love you even more.I will see you again one day.

Output: I'm sorry for your loss.Delirium can be caused by many factors including infections, metabolic imbalances, medications, and underlying medical conditions. In your brother's case, the low sodium levels may have played a role, but it is also possible that there were other contributing factors such as an underlying infection or a reaction to medications.His low sodium could be due to frequent urination, or due to his low sodium diet, or it could be due to an underlying medical condition such as adrenal insufficiency or kidney disease.Don't know about the oxygen - but, changes in oxygen levels can occur due to changes in respiratory function, changes in blood pressure, or changes in heart function.The fact that he was on monitoring does not guarantee that a cardiac arrest could not occur. It is possible that the cardiac arrest was due to an underlying medical condition or a sudden event such as an arrhythmia. But, ultimately I don't know.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hello Reddit,My younger brother was 27, Male, maybe 6 foot and 375 pounds, half white/asian, no drugs, no smoking, extremely rarely drinking (like less than once a month).I don't recall what his early symptoms were but I found a virtual chat that said he may of had "uncomplicated cystitis" and had antibiotics prescribed for it. He saw a urologist and eventually had a nephrostomy tube, then had surgery later and was noted with a failed kidney. They were unable to remove it due to his weight and having hemorrhage concerns, at least that was my understanding, and that's it for a his existing medical condition, with an exception.I'm first wondering how he developed this condition to begin with. Would the failed kidney have caused the infection? I wish I had the full records so I could paint a better picture, but ultimately I can only guess that his high blood pressure was a cause, plus having a high stress job.Ever since all this, he had to urinate every like hour and this caused issues with work and sleep. I really don't understand why this kept happening and nothing was given to him for it. Would having a failed kidney cause that? This started back at the end of 2020 and the tube and surgery may have been in Q2/3? I now can't remember what happened first.From that I'm mostly wondering about the reason for frequent urination and if he would have got infected some other way outside of high blood pressure. He almost never leaves the house, and I fear he'd only get sick if a family member came home with something.Fast forward to the bulk of my reason to post. On January 13, 2023 he mentioned some nasal congestion and some body aches. He didn't seem to get better on the 14th so I asked if he wanted to see a doctor and he said not yet. This eventually came with some headaches so we tried to go to an urgent care but the wait times were 3+ hours so we figured try a Teladoc (98point6 for this call) and get an appointment later. He mentions a head ache lasting 4-5 days, dull/sharp pains in waves from front to back, also going behind his eyes. He was taking ibuprofen, and was asked about a fever and he said he wasn't sure but his head seems warmer compared to his body. They basically said to take Afrin and Excedrin and go to urgent care if things don't get better. When he went to take the afrin that night, he blew his nose and had a nose bleed, and per our father he had nose bleeds from time to time, but not that super often.Come January 19 I take him to urgent care and I do have his visit summary. Blood pressure 174/89 (why the fuck didn't anyone talk about this), temporal temperature of 98.1 (maybe the medication lowered it?), pulse 90, respiration 18, oxygen saturation 97. They gave him Toradol and sent him home. I feel like a fucking asshole that I wasn't in there with him, I had to drop him off and attend a work meeting that I should of canceled, and our mother picked him up. This is all very local, like within 15 minute drives.He doesn't seem to get better and on the 22nd he talks about some vision issues so I immediately take him to the nearest ER, which is a satellite and not attached to a large hospital. He goes to a back room almost immediately after checking in - alone, and again I feel like a fucking loser as I should of gone there with him to help explain everything - who knows exactly what he said since he was dealing with headaches. I did come back and talk to one of the nurses, but that didn't seem to change anything they expected.He had the following lab tests done, CBC With Diff, CG4 PANEL POC, Comprehensive Metabolic Panel Poc, PCR Influenza A & B and Covid 19 (POCT). Also had a CT Head W/O Contrast and EKG. Done today was just the CG4 and Comprehensive Metabolic, guess the CBC was still processing? I don't recall any notes on this, and his MyChart is closed.They didn't seem to find anything, even though he had a 171/105 blood pressure, they did ask if he had history and I didn't have a full answer, but said it wouldn't be surprising since the rest of the family has medication for it, but he didn't have a primary care doctor to prescribe it. He had trouble finding one since COVID and it really pisses me off that I didn't help him find one somehow. He also had 100.1 temperature.They gave him .9% NaCl (NS), tylenol, benadryl, toradol and reglan, and sent him home.The next day I don't remember exactly what triggered this, maybe balance, but we took him to the ER attached to the hospital and the doctor almost immediately said he wasn't going home that night, he saw something. They put him in a gown and my brother was shivering mad, and he normally likes it cold. Sometime that night I believe he got a room and had some tests, and they said he had meningitis, and shortly after was uncertain of contagious so the room was adjusted and we had to wear N95 masks and a face shield / gown. This went for maybe 2-3 days, and it bothers me so much because this was the most critical time that I could of had talking to my brother and I minimized my time like a coward and asshole. I believe our mother was there the whole time though.After that 2-3 days it was cleared for bacterial and said likely viral (they never said what he had) and the additional PPE was stopped. I remember he texted me to bring apple juice, yogurt, and fruit cups, which I did, but asked if it was okay because I thought hospitals didn't want outside food. They said it was okay as long as it conformed to a low sodium diet, which those did.During this I know he had a lumbar puncture, which is likely how they found the meningitis, and had a CT/MRI that they said was clear. Then suddenly the next day he developed delirium. He was able to answer our questions and knew who we were, but it was like he was living in a video game or something. He'd also spring up very quickly pulling wires to urinate (and frequently) which caused concerns for the monitoring and fall prevention, since he was a little wobbly and I think bumped his side one day because of the bar being down for the accessibility access for the toilet.The doctors believed the delirium was due to his lowered sodium levels, which could have been to the frequent urination and low sodium diet. He was drinking a ton of Gatorade at home back home, probably around the 16th I was buying him multi-packs as I felt those helped me recover. Eventually they put him on a EEG and because of the frequent getting up and sometimes he'd just try to rip the things off, they restrained him. I wasn't there when it happened but our mom was there and it sounded a little traumatic, like saying "why are you doing this mommy, and then attempting to bite her". Not sure if that's exactly what happened but he was restrained. Either at that point or shortly after he did have a nurse assigned to be next to him 24/7 to monitor, and help him pee as he'd be responsive if he had to go and the nurses asked.During this delirium he'd talk about random stuff, sounded like he was in a game, he couldn't explain where he was, but he was still answering questions. Everyday I visited I'd ask if he knew who I was and he'd start by laughing and saying of course, and I had to be more specific with him and he'd confirm my name and that I'm his brother. During this time we had a family member with him 24/7, but would occasionally talk to him, I know I'd hold his hand and he'd squeeze back, but we'd end up sitting to the side talking to each or reading a book, etc.Finally on the 30th I was coming in to swap out with our father, who said that my brother was a bit quieter today, maybe he was finally getting some much needed sleep as it seemed like he wasn't getting any. I also noticed that he had an oxygen tube under his nose, which wasn't there before. I didn't want to wake him so I didn't do much, and this was the first day I decided to pop up my switch and play some yoshi crafted world, and I kept one ear bud out just in case.I know he had a lumbar puncture done either before I came or just as I came, and an MRI earlier (might have been the previous day, it's becoming a blur now and I hate it) and the neurologist said they see a lesion, and it looked like one of the quadrants of the brain. I honestly can't remember but it felt like a sizable portion. I also looked at the EEG from time to time as I assume they were looking for seizures and I swear I saw alerts on the machine detecting them.This was the first time that I was going to pull the all nighter, and it was normally our mother that would do that and I offered to stay but she wanted to get some rest which I understood. A bit after I was there I noticed they swapped the tube with an oxygen mask, and I regret to this day that I did not look at that monitor better, seeing if oxygen was dropping, etc. There was a nurse there but I don't know how well they were watching, I swear one of the guys before was on his phone most of the time. I remember there was a night shift change, and I don't recall how long after before the most traumatic part happens. I did ask if my brother snored normally to our parents, as I never really heard him sleep and our father said yes, and he should get a sleep study done. It reminded me of our father's sleep apnea when napping on the couch during movie night. I don't remember how long this went on for, but I think they adjusted the bed height or something, don't remember... yet another thing to add to my list of regrets.That night after playing a bit I remember my arms getting tired so I pulled the little side table near me to prop my switch up on so I could just use the remotes, and all of a sudden a bunch of nurses come rushing into the room and one of the nurses checks his neck and says no pulse, then a code blue is called. I am escorted out of the room and just panicking. I don't remember hearing the monitor beeping prior (remember 1 ear bud and I had the volume at like 1 tick), and I don't recall him snoring just before either. For all I know the sensors were faulted and he was out for awhile, I have no idea how immediate it was, or if maybe the table pulled/squeezed the oxygen tube (this all happened in like 10 seconds). I know that his monitor was beeping a lot earlier due to his blood pressure, and I don't know if they gave him medication, but I don't remember that monitor beeping at all that day. Maybe the last nurse silenced it? I don't know. I also don't know how well the nurse was watching. One of the nurses in the morning/afternoon was great and I know she was looking at his face and the monitor with great focus, and I fear the night nurses not so much. I know the nurse that night was from newborns, and just helping out.I don't understand why or how he code blued, how quick it was, or anything, but I know it took them over 20 minutes to bring him back and he was on a ventilator. They did the 24 hour thermal treatment of going cold then normal, and after that for the next few days they'd do an eye test and pain test with no responses. On February 1 they did some test with a dye to see blood movement in the brain and I saw the results that night saying there was little blood flow but not clinically brain dead. I had a spark of hope but knew I wasn't a doctor. The next day we talked to the neurologist and confirmed that he was indeed brain dead and I felt like I lost my brother for the 3rd time in that hospital. Once during delirium, then the cardiac arrest, and now. We had to decide when to pull the life support, and I watched him officially die, for what felt like the 4th time.Having to find the courage to join our father for the funeral arrangements, then the funeral which was a visitation before cremation, then picking up the urn a week later, it's been waves of trauma and it still feels like yesterday a month later. Everyday I've gone home to see my parents, and touch the urn and cry. I don't understand why he's in there and not at our house playing video games with his friends.I don't understand how he got sick to begin with, he moved in with me back in May and I tried to make things as comfortable for him as possible. This was his first winter with me and I think this house is a bit drier than the parents he lived with, but I wouldn't think that'd cause the issue. He almost never leaves, he works from home and plays games. If he caught anything it'd be from me, and I know I got sick at the end of June with COVID and he caught that from me, what a fucking loser I am. I did another trade show in September and got sick, not sure if he got it then, he didn't report time off to work (and he tries to take every time off he can).I don't understand why the teladoc didn't ask other questions, or the urgent care to find anything. Then later the first ER only commented on the high blood pressure, and it wasn't until the second ER that they knew something was up.Why did he get delirium, why did they let sodium levels drop? What was going on with the oxygen? With the monitoring he had, how did they let a cardiac arrest happen?I have so many questions and it pains me knowing that even if I get knew, it doesn't change that my baby brother is gone. We had so many plans this year, such as cooking better for ourselves, working out to lose weight, and most critically spending more time outside of his room to try new things like restaurants and take vacations. The last vacation I had with him was 2007, and he was in Hawaii with the parents in 2008 where I was rejected from going because I didn't have a job after high school.Before his delirium I remember one big ask, which was to get a hug, and that he was ready and wanting to go on adventures with me. I hadn't seen my brother much outside of a quick dinner talk from time to time, and when he moved in I was glad to be bonding with him again, and we didn't even get 1 year. We had so many plans, and the world robbed him of that.During the visitation I played the Halo song "Never Forget". He was a big Halo fan and that song always gave me the feels. I hugged his cold body for that entire song, wishing I could give him more.This is a long post and I apologize, I just needed to write, and I wonder if anyone knows what may have caused things. I fear that my lack of knowledge and experience failed to get him to the ER sooner, but it didn't seem like that even helped, they may have just done the same as they did on the first visit and turned him around.I failed to protect you brother, I am so sorry. This world is just not fair and you deserved so much more. You were the nicest person anyone would of met and you made those around you happier. I miss you so much brother, and I love you even more.I will see you again one day.. ### Response: I'm sorry for your loss.Delirium can be caused by many factors including infections, metabolic imbalances, medications, and underlying medical conditions. In your brother's case, the low sodium levels may have played a role, but it is also possible that there were other contributing factors such as an underlying infection or a reaction to medications.His low sodium could be due to frequent urination, or due to his low sodium diet, or it could be due to an underlying medical condition such as adrenal insufficiency or kidney disease.Don't know about the oxygen - but, changes in oxygen levels can occur due to changes in respiratory function, changes in blood pressure, or changes in heart function.The fact that he was on monitoring does not guarantee that a cardiac arrest could not occur. It is possible that the cardiac arrest was due to an underlying medical condition or a sudden event such as an arrhythmia. But, ultimately I don't know..


Instruction: Im not sure if this is the appropriate place to post, Ill delete if not.33F, Current diagnoses: anemia, bulging discs, arthritis. Im on slow release iron and vitamin B12 daily and mobic and skelaxin PRN. I see a PCP regularly. Ive always been an anxious person but lately its been significantly worse. I lost my sister at the end of 2021, she was at home recovering from covid and died unexpectedly. It was a very traumatic experience, I watched the paramedics perform CPR on her. Im also a nurse, worked a covid unit the first 2 years of the pandemic. Ive got a lot of negative feelings from that as well, like most hcw. I find myself crying more often than not. I find myself unable to sleep because Im reliving the night my sister died and the days that followed. Its not just when Im asleep though. Itll hit me when Im driving or at the store, just these intrusive memories replaying and I cant make them stop.I work third shift, I come home and stand next to my husband because Im convinced hes not breathing. I have to watch his chest rise and fall several times before I believe hes ok. I panic if he doesnt respond to a text, I almost left work one night because I was freaking out convinced he was dead, he was home with covid and had just fallen asleep.I now work a unit thats not technically critical care but our patients are very sick. (Post op, pressors, a lines ) I often feel so heavy in my chest by the end of the night sometimes until I get home because Im so anxious that I have forgotten something or done something wrong.When I did my physical I did discuss my grief with my PCP but told her I felt like I was ok. I do this thing were I like to say Im ok even though I know Im not. Its getting to a point though its obviously interfering with my life. Im just not sure who to turn to. Ive never sought care for my mental health so I was going to go through my employers EAP but its so overwhelming. Theres therapists, social workers all kinds of options. But theres no psychiatrists available. I dont really know if theres a reason I should be seeking one or if I should just start with a therapist. I think I just feel overwhelmed by all of it and need help in which direction I should go.If youve read all of my ramblings I greatly appreciate it. Any and all advice is welcomed. Thank you all for your time!

Output: I think you would benefit the most from having both psychological and pharmacological therapy together.It sounds like you're in a different country than mine, and your healthcare system may be slightly different, but I hope this largely applies.I think your first step ought to be going back to your primary care doctor and telling them what you've written here.Your primary care doctor should be able to signpost you towards the appropriate psychological service, who can do their own assessment and determine what type of psychological therapy is best suited for your needs.At the same time, I think you would benefit also from pharmacological therapy, but it's not necessary for you to see a psychiatrist immediately. Your primary care doctor is trained to assess and prescribe treatment for common and uncomplicated psychiatric conditions. If it later becomes clear that your illness is more complex than it first appeared, or if you don't respond to the first or second-line treatments, you could explore getting a referral to see a psychiatrist then.You should also look into seeing your employer's occupational health service, who can, I hope, help support you in your work and make any necessary adjustments. I would strongly recommend discussing your health with them especially if your mental state starts interfering with your ability to work.I hope things start getting easier for you soon.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im not sure if this is the appropriate place to post, Ill delete if not.33F, Current diagnoses: anemia, bulging discs, arthritis. Im on slow release iron and vitamin B12 daily and mobic and skelaxin PRN. I see a PCP regularly. Ive always been an anxious person but lately its been significantly worse. I lost my sister at the end of 2021, she was at home recovering from covid and died unexpectedly. It was a very traumatic experience, I watched the paramedics perform CPR on her. Im also a nurse, worked a covid unit the first 2 years of the pandemic. Ive got a lot of negative feelings from that as well, like most hcw. I find myself crying more often than not. I find myself unable to sleep because Im reliving the night my sister died and the days that followed. Its not just when Im asleep though. Itll hit me when Im driving or at the store, just these intrusive memories replaying and I cant make them stop.I work third shift, I come home and stand next to my husband because Im convinced hes not breathing. I have to watch his chest rise and fall several times before I believe hes ok. I panic if he doesnt respond to a text, I almost left work one night because I was freaking out convinced he was dead, he was home with covid and had just fallen asleep.I now work a unit thats not technically critical care but our patients are very sick. (Post op, pressors, a lines ) I often feel so heavy in my chest by the end of the night sometimes until I get home because Im so anxious that I have forgotten something or done something wrong.When I did my physical I did discuss my grief with my PCP but told her I felt like I was ok. I do this thing were I like to say Im ok even though I know Im not. Its getting to a point though its obviously interfering with my life. Im just not sure who to turn to. Ive never sought care for my mental health so I was going to go through my employers EAP but its so overwhelming. Theres therapists, social workers all kinds of options. But theres no psychiatrists available. I dont really know if theres a reason I should be seeking one or if I should just start with a therapist. I think I just feel overwhelmed by all of it and need help in which direction I should go.If youve read all of my ramblings I greatly appreciate it. Any and all advice is welcomed. Thank you all for your time!. ### Response: I think you would benefit the most from having both psychological and pharmacological therapy together.It sounds like you're in a different country than mine, and your healthcare system may be slightly different, but I hope this largely applies.I think your first step ought to be going back to your primary care doctor and telling them what you've written here.Your primary care doctor should be able to signpost you towards the appropriate psychological service, who can do their own assessment and determine what type of psychological therapy is best suited for your needs.At the same time, I think you would benefit also from pharmacological therapy, but it's not necessary for you to see a psychiatrist immediately. Your primary care doctor is trained to assess and prescribe treatment for common and uncomplicated psychiatric conditions. If it later becomes clear that your illness is more complex than it first appeared, or if you don't respond to the first or second-line treatments, you could explore getting a referral to see a psychiatrist then.You should also look into seeing your employer's occupational health service, who can, I hope, help support you in your work and make any necessary adjustments. I would strongly recommend discussing your health with them especially if your mental state starts interfering with your ability to work.I hope things start getting easier for you soon..


Instruction: What type of medical tests should I ask my doctor to perform to look at underlying medical issues or deficiencies that might be responsible for my hair loss. I have complained in the past and she only looked at iron.Im a 34F who has lost probably 60% of my hair over the past 3 years. I have no history or family members with hair loss. I am east European with light brown, fair hair. However, I have always been complimented with how full, soft, lush my hair is. Hair loss is all over rather than patterned.

Output: This post has very little information about your general health, no information about your medications, inadequate information about the alopecia distribution, and no quality images of your scalp. Meaningful comment is not appropriate.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What type of medical tests should I ask my doctor to perform to look at underlying medical issues or deficiencies that might be responsible for my hair loss. I have complained in the past and she only looked at iron.Im a 34F who has lost probably 60% of my hair over the past 3 years. I have no history or family members with hair loss. I am east European with light brown, fair hair. However, I have always been complimented with how full, soft, lush my hair is. Hair loss is all over rather than patterned.. ### Response: This post has very little information about your general health, no information about your medications, inadequate information about the alopecia distribution, and no quality images of your scalp. Meaningful comment is not appropriate..


Instruction: No medications (aside from Advil as needed), not considered alopecia, images wouldnt be relevant considering to the average person, it just looks like I have thin hair, but I know what it was beforehand and the loss I experience showering daily.I have always had perfect health. Also, I have a very clean diet, eat white meat or fish daily, lots of organic produce, avoid fast food or junk food (besides chocolate). Dont smoke, drink maybe 2 glasses of wine per month. Active lifestyle.I do still experience cystic acne as an adult, and have oily skin.

Output: Hair loss is alopecia. If you choose not to share relevant information, meaningful comment is not appropriate.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: No medications (aside from Advil as needed), not considered alopecia, images wouldnt be relevant considering to the average person, it just looks like I have thin hair, but I know what it was beforehand and the loss I experience showering daily.I have always had perfect health. Also, I have a very clean diet, eat white meat or fish daily, lots of organic produce, avoid fast food or junk food (besides chocolate). Dont smoke, drink maybe 2 glasses of wine per month. Active lifestyle.I do still experience cystic acne as an adult, and have oily skin.. ### Response: Hair loss is alopecia. If you choose not to share relevant information, meaningful comment is not appropriate..


Instruction: This response is a bit harsh, and repetitive. Perhaps you could assist the OP by describing what YOU consider to be meaningful and relevant, as it appears she is trying. Also, you are the one with the degree.

Output: Good suggestion. I need precise information on the anatomic distribution of the hair loss. Additionally, I need information on the appearance of the scalp and the hair follicle appearance in involved and uninvolved areas.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This response is a bit harsh, and repetitive. Perhaps you could assist the OP by describing what YOU consider to be meaningful and relevant, as it appears she is trying. Also, you are the one with the degree.. ### Response: Good suggestion. I need precise information on the anatomic distribution of the hair loss. Additionally, I need information on the appearance of the scalp and the hair follicle appearance in involved and uninvolved areas..


Instruction: 26F, 57, 177lbs SLE Lupus, Ehlers Danlos syndrome, and pseudo tumor cerebriThis is the first post and I took the advice given and got medical help. Well the ER didnt do anything but, give me fluids they did another CT with contrast and told me the findings were most likely old. Plus I take blood thinners already and I should be fine ( I take blood thinners because I have a stent in my brain and I had heart surgery long story). The new CT showed  IMPRESSION:Tiny sliver of hyperdensity seen in the right frontal lobe along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage.Proximal Jugular Veins: Diminutive on the right, normal on the left.I also got in contact with the on call doctor since my neurosurgeon is on vacation and he said the location of hemorrhage isnt concerning. Plus if all I have is an headache I should be fine. Just to note he did see the ct report or films.So I just want to be sure Im make a good decision to not do anything. I still have a terrible headache accompanied with nausea that doesnt seem to go away. My mom is worried and keeps insisting I need to take this seriously.I hope this is legible its hard to type with a terrible headache. Thanks again I appreciate you guys

Output: you're on a blood thinner and they said its okay to continue while you have a hemorrhage? what?! did you have an angiogram? i don't understand this. do you have a cereberal venous thrombus?Physician/NeurosurgeonWe get a huge number of consults for hemorrhage that are almost certainly not hemorrhages on our review. If a neurosurgeon already consulted and said this is nothing then that is reasonably likely to be true. It could be artifact, calcification, post-op change from a prior procedure, or any number of other things. I think OP should track down the on-call neurosurgeon again and get a better explanation.Physician, Emergency Medicine | Moderatorone would assume a radiologist would be a little more careful in hedging if they werent sure. lord knows they hedge when they need toPhysician/NeurosurgeonThat is a poor assumption. They call surface SAH all the time that arent. There is a lot of volume averaging on the hemispheric convexities and it makes little light spots appear pretty regularly.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 26F, 57, 177lbs SLE Lupus, Ehlers Danlos syndrome, and pseudo tumor cerebriThis is the first post and I took the advice given and got medical help. Well the ER didnt do anything but, give me fluids they did another CT with contrast and told me the findings were most likely old. Plus I take blood thinners already and I should be fine ( I take blood thinners because I have a stent in my brain and I had heart surgery long story). The new CT showed  IMPRESSION:Tiny sliver of hyperdensity seen in the right frontal lobe along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage.Proximal Jugular Veins: Diminutive on the right, normal on the left.I also got in contact with the on call doctor since my neurosurgeon is on vacation and he said the location of hemorrhage isnt concerning. Plus if all I have is an headache I should be fine. Just to note he did see the ct report or films.So I just want to be sure Im make a good decision to not do anything. I still have a terrible headache accompanied with nausea that doesnt seem to go away. My mom is worried and keeps insisting I need to take this seriously.I hope this is legible its hard to type with a terrible headache. Thanks again I appreciate you guys. ### Response: you're on a blood thinner and they said its okay to continue while you have a hemorrhage? what?! did you have an angiogram? i don't understand this. do you have a cereberal venous thrombus?Physician/NeurosurgeonWe get a huge number of consults for hemorrhage that are almost certainly not hemorrhages on our review. If a neurosurgeon already consulted and said this is nothing then that is reasonably likely to be true. It could be artifact, calcification, post-op change from a prior procedure, or any number of other things. I think OP should track down the on-call neurosurgeon again and get a better explanation.Physician, Emergency Medicine | Moderatorone would assume a radiologist would be a little more careful in hedging if they werent sure. lord knows they hedge when they need toPhysician/NeurosurgeonThat is a poor assumption. They call surface SAH all the time that arent. There is a lot of volume averaging on the hemispheric convexities and it makes little light spots appear pretty regularly..


Instruction: Is this standard practice? Hematology question.Female, 50, Arizona. Too many ailments to list.I've been anemic for at least a couple of years. One of my Dr's asked me who was managing my anemia. Ummm, nobody? So she referred me to a hematologist. The next day, I received a seemingly random text from a cancer center. The Dr she referred me to is both an oncologist and hematologist. Thus the cancer center wanting to schedule me an appointment.

Output: Nope thats normal. Hematology and oncology often are done in the same fellowship. Doesnt mean you have cancer at all54ReplyShare

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is this standard practice? Hematology question.Female, 50, Arizona. Too many ailments to list.I've been anemic for at least a couple of years. One of my Dr's asked me who was managing my anemia. Ummm, nobody? So she referred me to a hematologist. The next day, I received a seemingly random text from a cancer center. The Dr she referred me to is both an oncologist and hematologist. Thus the cancer center wanting to schedule me an appointment.. ### Response: Nope thats normal. Hematology and oncology often are done in the same fellowship. Doesnt mean you have cancer at all54ReplyShare.


Instruction: Assistance for interpreting Ultrasound, Chemistry, Hematology, and Urinalysis resultsGood day everyone!! May i ask for assistance with interpreting/reading may mom's results (shown in pictures above) and her potential ailment, we're really suffering financially these past few days, i'm very sorry and thank you for those who would help!! Gender: F Age: 60

Output: Who ordered the tests for her? They need to be the one to interpret the tests because they know what they are looking for. Tests in isolation with no context really arent useful. The lab that processes tests also have parameters that are normal based on the sample processing, and none are listed.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Assistance for interpreting Ultrasound, Chemistry, Hematology, and Urinalysis resultsGood day everyone!! May i ask for assistance with interpreting/reading may mom's results (shown in pictures above) and her potential ailment, we're really suffering financially these past few days, i'm very sorry and thank you for those who would help!! Gender: F Age: 60. ### Response: Who ordered the tests for her? They need to be the one to interpret the tests because they know what they are looking for. Tests in isolation with no context really arent useful. The lab that processes tests also have parameters that are normal based on the sample processing, and none are listed..


Instruction: PLEASE help me figure out why my legs/feet are cyanotic and can't get oxygen when sitting down. No quality of life and at risk of further permanent damage. Every specialist and hospital is baffled :( Pic inside.'ve posted here before in the past (now deleted), but that was over a year ago. I got a lot of great suggestions and every one of them has now been ruled out.History:30 year old white female, thin, non-drinker, vapes nicotine, no drugs or medsHealth issues prior to this situation: POTS, heart arrhythmias, and EDSA year ago, after my post, I was hospitalized with a vast array of neurological symptoms. To make a long story short, I ended up having a severe B12 deficiency that went unnoticed for 2 years. Low serum B12, extremely high homocysteine and MMA.After getting on the B12 injections, all of my initial symptoms have resolved, except this leg thing which I've never been told is related to the deficiency and idk if it is.Leg Issue:Feet PictureDuration: 15 monthsOnset: Began with some numbness in my toes and transient foot pain when walking, also difficult to walk as if I couldn't feel where my feet were (although sensation was intact). Coloration starts looking funny. A month later, I was sitting at my desk working for about 4 hours and looked down and my feet/calves looked like corpse limbs. Saw a vascular surgeon and had a terrible result on ankle brachial index test. He had me admitted to a major hospital and warned me of risk of double amputation. After release from hospital with no answers, I saw about a million specialists.Symptoms: when in a dependent position (sitting, essentially), it takes about 10 minutes for my feet/calves to start turning colors. They became ice cold to the touch, mottled, dark purple/blue (and sometimes blackish), and there is no detectable pulse in the feet or ankles on doppler or otherwise during this state. The longer I sit, the worse they get. It also has begun to spread higher and higher, if I sit too long it will now go all the way up to my thighs. It is not painful when sitting, they simply feel freezing cold. When I stand up to walk, they are moderately painful (not nerve pain, achey), and walking is clumsy and difficult for a bit. Occasionally, they will become hot, swollen, and bright red but there is no identifiable trigger for this. It happens rarely and isn't related to sitting or elevating them, unsure if this is even related. This cyanosis issue has caused muscle and nerve damage in my feet. Also, lack of toenail growth and yellow thick toenail color.What helps: elevation, when I elevate them, eventually the color will return to normal (pale) and the temperature usually stays cold. Walking also can help the blood flow return to normal. That's it. Soaks in warm water will help the warmth return, but does not solve anything else.What we've ruled out and tests done:Raynaud's syndromeCardiac causesPAD - MRI of both legs showed no atherosclerosis or other signs of PAD. Doctor mentioned "the veins in that area are very narrow but no other findings". He didn't write that on the report and MRI was marked as normal.I had 2 venous doppler exams. Both were done while my legs were elevated and in their good state. Both exams were normal. I expressed again, when elevated they have good blood flow, can they please do the test while my legs are dependent? They said it isn't possible.POTS Blood Pooling - It's not blood pooling, it's a lack of blood flow or a lack of oxygenated bloodBurger's syndromeAll autoimmune conditionsHematologic conditionsDependent acrocyanosis caused by POTSPretty much everything else that I'm sure I'm forgetting hereWorking Diagnoses: PVD of unknown cause, Venous Insufficiency of Legs (Don't know how they got to any of these conclusions but they are also just guesses at Doctor's admission)Other Factors: I do have motor (distal axonal) neuropathy throughout my body, caused by the b12 deficiency, however I have been told this is not related, and the neuropathy is also present in my arms and hands which have no issues in dependent positions.So for one year now under advice of my doctors, I have my feet elevated pretty much at all times. I can not sit on a couch with someone, I can't sit at a desk to work, I can't sit ever. This is affecting all areas of my life, I am babying my feet and legs all day long. I can't do normal things without being able to sit like a normal person.I am out of options, and completely desperate to save my feet. They are already muscle atrophied and partially paralyzed. They are very painful at night when I'm lying in bed (but not usually during the day).Summation: Cyanotic, cold, pulseless feet and calves when sitting. Every time. Will spread up my entire legs if I sit long enough. Clinical damage to muscles and nerves in affected area. MRI and venous doppler are normal. Feet are fine when I'm standing, walking around, or have them elevated. There are NO triggers to this except sitting. (Not triggered by temperature, stress, foods, anything but sitting). There is NOTHING that alleviates this situation except for elevation or walking.I have no idea what is happening but I can not live like this anymore. I have no quality of life. No doctor can give me any answer.I have lost all faith in solving this, but maybe a reddit miracle can happen. You never know. If you read this far, thanks for reading.

Output: How was Buerger disease ruled out? Biopsy?This is clearly severe peripheral arterial or venular disease - either medium vessel or small vessel.You ABSOLUTELY should not be using any nicotine products. This is in all likelihood driving the process.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: PLEASE help me figure out why my legs/feet are cyanotic and can't get oxygen when sitting down. No quality of life and at risk of further permanent damage. Every specialist and hospital is baffled :( Pic inside.'ve posted here before in the past (now deleted), but that was over a year ago. I got a lot of great suggestions and every one of them has now been ruled out.History:30 year old white female, thin, non-drinker, vapes nicotine, no drugs or medsHealth issues prior to this situation: POTS, heart arrhythmias, and EDSA year ago, after my post, I was hospitalized with a vast array of neurological symptoms. To make a long story short, I ended up having a severe B12 deficiency that went unnoticed for 2 years. Low serum B12, extremely high homocysteine and MMA.After getting on the B12 injections, all of my initial symptoms have resolved, except this leg thing which I've never been told is related to the deficiency and idk if it is.Leg Issue:Feet PictureDuration: 15 monthsOnset: Began with some numbness in my toes and transient foot pain when walking, also difficult to walk as if I couldn't feel where my feet were (although sensation was intact). Coloration starts looking funny. A month later, I was sitting at my desk working for about 4 hours and looked down and my feet/calves looked like corpse limbs. Saw a vascular surgeon and had a terrible result on ankle brachial index test. He had me admitted to a major hospital and warned me of risk of double amputation. After release from hospital with no answers, I saw about a million specialists.Symptoms: when in a dependent position (sitting, essentially), it takes about 10 minutes for my feet/calves to start turning colors. They became ice cold to the touch, mottled, dark purple/blue (and sometimes blackish), and there is no detectable pulse in the feet or ankles on doppler or otherwise during this state. The longer I sit, the worse they get. It also has begun to spread higher and higher, if I sit too long it will now go all the way up to my thighs. It is not painful when sitting, they simply feel freezing cold. When I stand up to walk, they are moderately painful (not nerve pain, achey), and walking is clumsy and difficult for a bit. Occasionally, they will become hot, swollen, and bright red but there is no identifiable trigger for this. It happens rarely and isn't related to sitting or elevating them, unsure if this is even related. This cyanosis issue has caused muscle and nerve damage in my feet. Also, lack of toenail growth and yellow thick toenail color.What helps: elevation, when I elevate them, eventually the color will return to normal (pale) and the temperature usually stays cold. Walking also can help the blood flow return to normal. That's it. Soaks in warm water will help the warmth return, but does not solve anything else.What we've ruled out and tests done:Raynaud's syndromeCardiac causesPAD - MRI of both legs showed no atherosclerosis or other signs of PAD. Doctor mentioned "the veins in that area are very narrow but no other findings". He didn't write that on the report and MRI was marked as normal.I had 2 venous doppler exams. Both were done while my legs were elevated and in their good state. Both exams were normal. I expressed again, when elevated they have good blood flow, can they please do the test while my legs are dependent? They said it isn't possible.POTS Blood Pooling - It's not blood pooling, it's a lack of blood flow or a lack of oxygenated bloodBurger's syndromeAll autoimmune conditionsHematologic conditionsDependent acrocyanosis caused by POTSPretty much everything else that I'm sure I'm forgetting hereWorking Diagnoses: PVD of unknown cause, Venous Insufficiency of Legs (Don't know how they got to any of these conclusions but they are also just guesses at Doctor's admission)Other Factors: I do have motor (distal axonal) neuropathy throughout my body, caused by the b12 deficiency, however I have been told this is not related, and the neuropathy is also present in my arms and hands which have no issues in dependent positions.So for one year now under advice of my doctors, I have my feet elevated pretty much at all times. I can not sit on a couch with someone, I can't sit at a desk to work, I can't sit ever. This is affecting all areas of my life, I am babying my feet and legs all day long. I can't do normal things without being able to sit like a normal person.I am out of options, and completely desperate to save my feet. They are already muscle atrophied and partially paralyzed. They are very painful at night when I'm lying in bed (but not usually during the day).Summation: Cyanotic, cold, pulseless feet and calves when sitting. Every time. Will spread up my entire legs if I sit long enough. Clinical damage to muscles and nerves in affected area. MRI and venous doppler are normal. Feet are fine when I'm standing, walking around, or have them elevated. There are NO triggers to this except sitting. (Not triggered by temperature, stress, foods, anything but sitting). There is NOTHING that alleviates this situation except for elevation or walking.I have no idea what is happening but I can not live like this anymore. I have no quality of life. No doctor can give me any answer.I have lost all faith in solving this, but maybe a reddit miracle can happen. You never know. If you read this far, thanks for reading.. ### Response: How was Buerger disease ruled out? Biopsy?This is clearly severe peripheral arterial or venular disease - either medium vessel or small vessel.You ABSOLUTELY should not be using any nicotine products. This is in all likelihood driving the process..


Instruction: Thank you so much for replying.I don't actually remember how they ruled it out, but I brought it up to multiple specialists who had various reasons why it wasn't. But even still, I did quit vaping/nicotine for 9 months during this and the condition continued to worsen. I started using my vape lightly again recently, but I will stop 100%.Is it possibly reversible if I stop immediately? (I'm stopping regardless after reading your message).And just one more question, I also thought obvious PAD but they say it's ruled out because no atherosclerosis and normal doppler. Is that inaccurate?

Output: You can still have an inflammatory/autoimmune process causing similar symptoms.I dont know what workup youve had, but ruling out all autoimmune conditions is a pretty significant claim, though with the right lab work you can estimate a likelihood.Id consider some of the vasculitides/rheumatic conditions such as anti phospholipid syndrome, cryoglobulunemic vasculitis, etc. they often come with other manifestations but there is obviously not a full history and physical exam above.Many of these are associated with autoimmune diseases such as lupus, but they are not pathognomonic by any means.Have they done a biopsy?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much for replying.I don't actually remember how they ruled it out, but I brought it up to multiple specialists who had various reasons why it wasn't. But even still, I did quit vaping/nicotine for 9 months during this and the condition continued to worsen. I started using my vape lightly again recently, but I will stop 100%.Is it possibly reversible if I stop immediately? (I'm stopping regardless after reading your message).And just one more question, I also thought obvious PAD but they say it's ruled out because no atherosclerosis and normal doppler. Is that inaccurate?. ### Response: You can still have an inflammatory/autoimmune process causing similar symptoms.I dont know what workup youve had, but ruling out all autoimmune conditions is a pretty significant claim, though with the right lab work you can estimate a likelihood.Id consider some of the vasculitides/rheumatic conditions such as anti phospholipid syndrome, cryoglobulunemic vasculitis, etc. they often come with other manifestations but there is obviously not a full history and physical exam above.Many of these are associated with autoimmune diseases such as lupus, but they are not pathognomonic by any means.Have they done a biopsy?.


Instruction: No biopsy due to concerns about infection/wound not healing with the blood flow issues.You're right, I have no idea if they truly ruled out all autoimmune diseases. But I did have significant testing for it. The main hospital did all their own testing and when I was negative for everything, the doctor worked with Mayo Clinic and used their full autoimmune testing panel or whatever and was still negative for everything.I do remember some reasons coming up: no inflammation markers, negative ANA multiple times, 3 rheumatologists cleared me and told me it was vascular not rheumatological in origin. I was tested for and all the types of vasculitis (without biopsy just blood work).And these are some of the reasons I can remember for saying no to Buerger's:- My symptoms only come on in the dependent position and at no other time, all their tests showed no blockages or clogging or weird patterns of veins, no claudication, no blood clots, no change in symptoms when exposed to cold, and I think some more stuff. I know my vascular surgeon sent images and case history to some massive network of vascular specialists and the consensus was that it was not buergers (but again, who knows).My neurologist is absolutely convinced that I have Marfan syndrome but I did not get the genetic testing for it yet. And I'm not aware if that can cause this but it's the only other thing I can think of.EDIT: I just went through my mega document of all my labs and tests, and anti phospholipid syndrome could fit, because I do have a history of blood clots and also recurrent miscarriages (5 by the time I was 29). I am trying to find the exact lab names of the tests for this right now to confirm (that's always hard lol). (I found the names, I was tested for aCL IgG and IgM antibodies and results say<10 GPL<10 MPLThey also looked at regular IgA = 288.9, IgM = 50There's a bunch of other IgA and IgM and IgG tests in there too with other words in front of them that I don't understand but all seem normal.

Output: Did they do lupus anticoagulant (LA) or anti-beta2 glycoprotein 1 (a(beta)2GPI) with those antibody tests? It sounds likely that those will have been covered in the workup described. If so then its unlikely to be anti phospholipid syndrome, at least from initial workup. Given the description of symptoms there is still a possibility of antibodies to other things such as anti prothrombin, anti-annexin, anti-phosphatidylserine, etc, but the clinical correlation is weak at this time and testing is not routinely performed since there is much uncertainty about their significance. It may be something a rheumatologist could speak to in more detail.One of the key criteria with testing though is that testing should occur within a short period of time from any event such as blood clots or miscarriage if I remember correctly. If it is not done within a short period of time it may not show up on testing (I dont routinely deal with APS so I dont know the timing recommendations). I could not say if the current cutaneous and vascular manifestations would be included, but a rheumatologist may be able advise further.I do agree it is worth another follow up and discussion with a rheumatologist again to discuss the possibility of the diagnoses in this thread, multiple good differentials on the list from other physicians as well. It sounds like youve already had an extensive workup, but at the end of the day if you have a progressive pathology and no answers, you have to keep searching and discussing it. Best of luck.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: No biopsy due to concerns about infection/wound not healing with the blood flow issues.You're right, I have no idea if they truly ruled out all autoimmune diseases. But I did have significant testing for it. The main hospital did all their own testing and when I was negative for everything, the doctor worked with Mayo Clinic and used their full autoimmune testing panel or whatever and was still negative for everything.I do remember some reasons coming up: no inflammation markers, negative ANA multiple times, 3 rheumatologists cleared me and told me it was vascular not rheumatological in origin. I was tested for and all the types of vasculitis (without biopsy just blood work).And these are some of the reasons I can remember for saying no to Buerger's:- My symptoms only come on in the dependent position and at no other time, all their tests showed no blockages or clogging or weird patterns of veins, no claudication, no blood clots, no change in symptoms when exposed to cold, and I think some more stuff. I know my vascular surgeon sent images and case history to some massive network of vascular specialists and the consensus was that it was not buergers (but again, who knows).My neurologist is absolutely convinced that I have Marfan syndrome but I did not get the genetic testing for it yet. And I'm not aware if that can cause this but it's the only other thing I can think of.EDIT: I just went through my mega document of all my labs and tests, and anti phospholipid syndrome could fit, because I do have a history of blood clots and also recurrent miscarriages (5 by the time I was 29). I am trying to find the exact lab names of the tests for this right now to confirm (that's always hard lol). (I found the names, I was tested for aCL IgG and IgM antibodies and results say<10 GPL<10 MPLThey also looked at regular IgA = 288.9, IgM = 50There's a bunch of other IgA and IgM and IgG tests in there too with other words in front of them that I don't understand but all seem normal.. ### Response: Did they do lupus anticoagulant (LA) or anti-beta2 glycoprotein 1 (a(beta)2GPI) with those antibody tests? It sounds likely that those will have been covered in the workup described. If so then its unlikely to be anti phospholipid syndrome, at least from initial workup. Given the description of symptoms there is still a possibility of antibodies to other things such as anti prothrombin, anti-annexin, anti-phosphatidylserine, etc, but the clinical correlation is weak at this time and testing is not routinely performed since there is much uncertainty about their significance. It may be something a rheumatologist could speak to in more detail.One of the key criteria with testing though is that testing should occur within a short period of time from any event such as blood clots or miscarriage if I remember correctly. If it is not done within a short period of time it may not show up on testing (I dont routinely deal with APS so I dont know the timing recommendations). I could not say if the current cutaneous and vascular manifestations would be included, but a rheumatologist may be able advise further.I do agree it is worth another follow up and discussion with a rheumatologist again to discuss the possibility of the diagnoses in this thread, multiple good differentials on the list from other physicians as well. It sounds like youve already had an extensive workup, but at the end of the day if you have a progressive pathology and no answers, you have to keep searching and discussing it. Best of luck..


Instruction: Huh, that's very interesting.I was told they tested for all lupus stuff but I don't see LA or the other antibody tests in my records, unless they're using different acronyms for it or something. They did do a bunch of prothrombin tests which were normal.Thank you so much for your help here. I think I need to go to a different state to see a rheumatologist, I've seen all the best where I live and after looking at my labs they tell me they can't do anything for me. But I'll keep trying.

Output: Lupus anticoagulant is actually not associated with lupus, rather it is associated with APS, as is the anti beta 2 one mentioned previously.They are part of the testing for the Sapporo criteria in APS diagnosis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Huh, that's very interesting.I was told they tested for all lupus stuff but I don't see LA or the other antibody tests in my records, unless they're using different acronyms for it or something. They did do a bunch of prothrombin tests which were normal.Thank you so much for your help here. I think I need to go to a different state to see a rheumatologist, I've seen all the best where I live and after looking at my labs they tell me they can't do anything for me. But I'll keep trying.. ### Response: Lupus anticoagulant is actually not associated with lupus, rather it is associated with APS, as is the anti beta 2 one mentioned previously.They are part of the testing for the Sapporo criteria in APS diagnosis..


Instruction: Did they ever do an angiogram while you were symptomatic? Or a mri or Ct with contrast while you had active symptoms?

Output: The problem with the studies you received such as the MRI and CTA is they dont have the resolution to see smaller blood vessels. This would require a biopsy. Some medium and small vessel diseases respond to immune suppression with steroids etc, the treatment for Buergers is not smoking. Others such as livedoid vasculopathy (a vein disease) require anticoagulation.So again not vaping is essential to save your legs. Wouldnt recommend other nicotine containing products such as patch or gum, but bupropion and varenicline are effective smoking cessation aids.Personally if smoking cessation isnt effective and the symptoms progress I would want the biopsy despite the admittedly very high wound healing risk. There may be a proximal area with less advanced disease that is amenable, and your symptoms are end-stage.Can PM me if you have specific questions.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Did they ever do an angiogram while you were symptomatic? Or a mri or Ct with contrast while you had active symptoms?. ### Response: The problem with the studies you received such as the MRI and CTA is they dont have the resolution to see smaller blood vessels. This would require a biopsy. Some medium and small vessel diseases respond to immune suppression with steroids etc, the treatment for Buergers is not smoking. Others such as livedoid vasculopathy (a vein disease) require anticoagulation.So again not vaping is essential to save your legs. Wouldnt recommend other nicotine containing products such as patch or gum, but bupropion and varenicline are effective smoking cessation aids.Personally if smoking cessation isnt effective and the symptoms progress I would want the biopsy despite the admittedly very high wound healing risk. There may be a proximal area with less advanced disease that is amenable, and your symptoms are end-stage.Can PM me if you have specific questions..


Instruction: Thank you so much.I did not have that spinal reflex test done. And I understand now about the biopsy. I am quitting cold turkey, I don't react well to bupropion or most medications honestly.I will ask for the biopsy and I do have a referral right now to a new hematologist, only problem is all the new specialists I see just keep telling me everything has already been ruled out. I'll still go though of course!

Output: Uh ignore the spinal reflex part, that is a lame joke

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much.I did not have that spinal reflex test done. And I understand now about the biopsy. I am quitting cold turkey, I don't react well to bupropion or most medications honestly.I will ask for the biopsy and I do have a referral right now to a new hematologist, only problem is all the new specialists I see just keep telling me everything has already been ruled out. I'll still go though of course!. ### Response: Uh ignore the spinal reflex part, that is a lame joke.


Instruction: LOL and I was sitting here googling that, confused as hell. So now you've made me laugh and you've terrified me with the end-stage comment :OI guess it's time to submit my application for Dignitas. Can you pls write me my physician recommendation? It would also be lovely if you could attend my death, Switzerland is beautiful. (and maybe write a eulogy about me too, I think you'd be very good at that)

Output: No no end-stage vascular disease not end-stage you.Stop vaping (done). Advocate for a biopsy in an area that has a little better blood flow but might provide an adequate specimen. Followup with the specialists and try your best to stay positive even though it's a shitty situation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: LOL and I was sitting here googling that, confused as hell. So now you've made me laugh and you've terrified me with the end-stage comment :OI guess it's time to submit my application for Dignitas. Can you pls write me my physician recommendation? It would also be lovely if you could attend my death, Switzerland is beautiful. (and maybe write a eulogy about me too, I think you'd be very good at that). ### Response: No no end-stage vascular disease not end-stage you.Stop vaping (done). Advocate for a biopsy in an area that has a little better blood flow but might provide an adequate specimen. Followup with the specialists and try your best to stay positive even though it's a shitty situation..


Instruction: Hematology questions. (mother with acquired aplastic anemia)Obligatory info so the bot doesn't eat me: 69F , 5'3 ", 185lb , White , USA , Former smoker but 20 years totally off, no drinking or illicit drugs, full list of prescriptions is further down the post, duration of about 6 months (2 pre-diagnosis, 4 post-diagnosis) location of complaint is... blood?First, thanks for looking. I know my questions here are going to be weird and kind of specific. My mother was diagnosed with acquired severe aplastic anemia this past July. For those who don't know it is a disease of bone marrow failure which means the creation of different types of blood cells is severely limited.I'll try to be short about it - my mom had increasing weakness and bruising until ending up in the ER with Hgb of 4.6, platelets of 4, WBC 3.2, ANC 1, ALC 2; she spent a week in the hospital where they did a bone marrow biopsy and a million other tests to figure out the cause. (previous to this she had no other health issues)July 12th she was diagnosed with aplastic anemia, with bone marrow cellularity of 20%, reticulocytes between 0.02-0.03 (range 0.018 - 0.158 x10E+12/L), very tiny PNH clone (<1%) was given a PICC line and started horse ATG on July 14th in combination with cyclosporine 600mg + Promacta 150mg. Had almost no issues with the ATG treatment but became refractory to platelets pretty quickly and thankfully HLA matched ones were found. She was released once they found the appropriate dosing for the cyclosporine to not be at toxic levels.My mom is still going twice a week to the heme/onc clinic for blood tests and receiving blood if Hgb dips below 8 (approximately every 3/4 weeks) and platelets if they dip below 20 (approximately every 7-11 days). The tests are monitoring the need for transfusions, monitoring for blood cell lineage response, as well as checking for liver and kidney function.Currently taking 125mg x2 a day of Cyclosporine, 150mg Promacta, 20mg prednisone, along with 400mg acyclovir, levofloxacin, fluconazole, B12, Folic Acid, Vitamin D3/Calcium, 20mg x 2 Famotidine and 25mg metoprolol (for heart palpitations, the only med she was on previous to this) I'm sorry I don't remember offhand the exact dosings of the preventative antimicrobials and for the vitamins.I was asked to post the full lab values, so I am only going to post the most recent ones which were taken 11/29.Of note: Last blood transfusion 11/11, last platelet transfusion 11/26 (HLA matched, I guess they work really well)ComponentYour ValueStandard RangeFlagWBC3.8 X10E+09/L3.8 - 10.6 X10E+09/LRBC2.44 X10E+12/L3.73 - 4.89 X10E+12/LLHgb8.2 g/dL11.6 - 14.6 g/dLLHematocrit(HCT)23.2 %34.1 - 43.3 %LMCV95.0 fL82.6 - 97.4 fLMCH33.7 pg27.8 - 33.4 pgHMCHC35.5 g/dL32.7 - 35.5 g/dLRDW25.9 %11.8 - 15.2 % HPlatelets143 X10E+09/L156 - 369 X10E+09/LLMean Platelet Volume8.1 fL6.8 - 10.4 fLNEUTROPHILS %46.1 %44 - 77 %LYMPHS %44.6 %13 - 44 %HMONOS %8.8 %4 - 13 %EOS %0.1 %0 - 6 %BASO %0.4 %0 - 1 %ABS Neutrophils1.8 X10E+09/L2.24 - 7.68 X10E+09/LLABS Lymphocytes1.7 X10E+09/L0.80 - 3.65 X10E+09/LABS Monocytes0.3 X10E+09/L0.30 - 0.90 X10E+09/LABSOLUTE EOS0.0 X10E+09/L0.00 - 0.40 X10E+09/LABS Basophils0.0 X10E+09/L0.00 - 0.06 X10E+09/LTYPE OF DIFFERENTIAL | Auto diff performed RBC Morphology 1+ PolychromasiaOnto the questionsAfter all that, my questions are mainly about what certain things in the blood values mean and also things I have heard from other patients with this disease that I want to confirm if they are real or not. There isn't really time to discuss any of this when my mom sees the hematologist at the clinic and I don't want to be a bother acting like I know anything about blood or medicine and asking a million dumb questions.1.) What does +1 polychromasia mean here? From what I understand it's off-color red blood cells, usually very young ones. It has shown up on almost every CBC since treatment began.2.) What does the elevated RDW mean here? It has been elevated since treatment.3.) How does getting transfusions of red blood cells affect these numbers? I asked once about the most recent reticulocyte count (3.2%, ARC 0.084 x10E+12/L) hoping that it was indicating some response to the immune suppression, but was told that donor blood will also have reticulocytes in it so the count doesn't matter.4.) Things such as nucleated red blood cells and ovalocytes have also occasionally popped up on the reports alongside the polychromasia. What do they mean in this context?5.) Is it correct to understand that on diagnosis her bone marrow could only make enough cells for a Hgb of 4.6, but that it may have improved since then, but still be under the transfusion threshold? (ie if it improved to 6.5 or so but they wouldn't know if she continues to get transfused <8)6.) My mother's doctor is a hematologist/oncologist but does not seem to have any specialty in treating aplastic anemia, tho he seems to be doing things mostly right. I have been trying to find someone in the city that does have some specialty in aplastic anemia but it has been very hard. I have been through the AAMDSIF listings for her city and not come up with much. I am surprised because there is a major medical school and center there with a full heme/onc division and also sections for benign hematology and rare blood diseases. Is it weird to try and contact these sections for help finding a hematologist with an interest or specialty in treating this?I think that's all I have for now - feel free to ask for any more information needed, I've got piles of it. If you're wondering why I'm so rabid about this, my father had leukemia and I was too young to understand why they were doing the things to him they did, or why they didn't do other things, and it seemed like he was adrift in a sea of complicated medical situations and opinions and unusual symptoms. This time, I want to know as much as possible, to be able to advocate and educate. I am also very interested in medicine and anatomy (but I'm too dumb for something like medical school, so it's just a weird special interest)

Output: Agree with answers from /u/Spicy_Antigen.Regarding her doctor, he certainly has treated aplastic anemia before. I don't know if there are really enough aplastic anemia patient for any hematologist to have a "specialty" in it. If you want a second opinion, I'd reach out to the major medical center in her city.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hematology questions. (mother with acquired aplastic anemia)Obligatory info so the bot doesn't eat me: 69F , 5'3 ", 185lb , White , USA , Former smoker but 20 years totally off, no drinking or illicit drugs, full list of prescriptions is further down the post, duration of about 6 months (2 pre-diagnosis, 4 post-diagnosis) location of complaint is... blood?First, thanks for looking. I know my questions here are going to be weird and kind of specific. My mother was diagnosed with acquired severe aplastic anemia this past July. For those who don't know it is a disease of bone marrow failure which means the creation of different types of blood cells is severely limited.I'll try to be short about it - my mom had increasing weakness and bruising until ending up in the ER with Hgb of 4.6, platelets of 4, WBC 3.2, ANC 1, ALC 2; she spent a week in the hospital where they did a bone marrow biopsy and a million other tests to figure out the cause. (previous to this she had no other health issues)July 12th she was diagnosed with aplastic anemia, with bone marrow cellularity of 20%, reticulocytes between 0.02-0.03 (range 0.018 - 0.158 x10E+12/L), very tiny PNH clone (<1%) was given a PICC line and started horse ATG on July 14th in combination with cyclosporine 600mg + Promacta 150mg. Had almost no issues with the ATG treatment but became refractory to platelets pretty quickly and thankfully HLA matched ones were found. She was released once they found the appropriate dosing for the cyclosporine to not be at toxic levels.My mom is still going twice a week to the heme/onc clinic for blood tests and receiving blood if Hgb dips below 8 (approximately every 3/4 weeks) and platelets if they dip below 20 (approximately every 7-11 days). The tests are monitoring the need for transfusions, monitoring for blood cell lineage response, as well as checking for liver and kidney function.Currently taking 125mg x2 a day of Cyclosporine, 150mg Promacta, 20mg prednisone, along with 400mg acyclovir, levofloxacin, fluconazole, B12, Folic Acid, Vitamin D3/Calcium, 20mg x 2 Famotidine and 25mg metoprolol (for heart palpitations, the only med she was on previous to this) I'm sorry I don't remember offhand the exact dosings of the preventative antimicrobials and for the vitamins.I was asked to post the full lab values, so I am only going to post the most recent ones which were taken 11/29.Of note: Last blood transfusion 11/11, last platelet transfusion 11/26 (HLA matched, I guess they work really well)ComponentYour ValueStandard RangeFlagWBC3.8 X10E+09/L3.8 - 10.6 X10E+09/LRBC2.44 X10E+12/L3.73 - 4.89 X10E+12/LLHgb8.2 g/dL11.6 - 14.6 g/dLLHematocrit(HCT)23.2 %34.1 - 43.3 %LMCV95.0 fL82.6 - 97.4 fLMCH33.7 pg27.8 - 33.4 pgHMCHC35.5 g/dL32.7 - 35.5 g/dLRDW25.9 %11.8 - 15.2 % HPlatelets143 X10E+09/L156 - 369 X10E+09/LLMean Platelet Volume8.1 fL6.8 - 10.4 fLNEUTROPHILS %46.1 %44 - 77 %LYMPHS %44.6 %13 - 44 %HMONOS %8.8 %4 - 13 %EOS %0.1 %0 - 6 %BASO %0.4 %0 - 1 %ABS Neutrophils1.8 X10E+09/L2.24 - 7.68 X10E+09/LLABS Lymphocytes1.7 X10E+09/L0.80 - 3.65 X10E+09/LABS Monocytes0.3 X10E+09/L0.30 - 0.90 X10E+09/LABSOLUTE EOS0.0 X10E+09/L0.00 - 0.40 X10E+09/LABS Basophils0.0 X10E+09/L0.00 - 0.06 X10E+09/LTYPE OF DIFFERENTIAL | Auto diff performed RBC Morphology 1+ PolychromasiaOnto the questionsAfter all that, my questions are mainly about what certain things in the blood values mean and also things I have heard from other patients with this disease that I want to confirm if they are real or not. There isn't really time to discuss any of this when my mom sees the hematologist at the clinic and I don't want to be a bother acting like I know anything about blood or medicine and asking a million dumb questions.1.) What does +1 polychromasia mean here? From what I understand it's off-color red blood cells, usually very young ones. It has shown up on almost every CBC since treatment began.2.) What does the elevated RDW mean here? It has been elevated since treatment.3.) How does getting transfusions of red blood cells affect these numbers? I asked once about the most recent reticulocyte count (3.2%, ARC 0.084 x10E+12/L) hoping that it was indicating some response to the immune suppression, but was told that donor blood will also have reticulocytes in it so the count doesn't matter.4.) Things such as nucleated red blood cells and ovalocytes have also occasionally popped up on the reports alongside the polychromasia. What do they mean in this context?5.) Is it correct to understand that on diagnosis her bone marrow could only make enough cells for a Hgb of 4.6, but that it may have improved since then, but still be under the transfusion threshold? (ie if it improved to 6.5 or so but they wouldn't know if she continues to get transfused <8)6.) My mother's doctor is a hematologist/oncologist but does not seem to have any specialty in treating aplastic anemia, tho he seems to be doing things mostly right. I have been trying to find someone in the city that does have some specialty in aplastic anemia but it has been very hard. I have been through the AAMDSIF listings for her city and not come up with much. I am surprised because there is a major medical school and center there with a full heme/onc division and also sections for benign hematology and rare blood diseases. Is it weird to try and contact these sections for help finding a hematologist with an interest or specialty in treating this?I think that's all I have for now - feel free to ask for any more information needed, I've got piles of it. If you're wondering why I'm so rabid about this, my father had leukemia and I was too young to understand why they were doing the things to him they did, or why they didn't do other things, and it seemed like he was adrift in a sea of complicated medical situations and opinions and unusual symptoms. This time, I want to know as much as possible, to be able to advocate and educate. I am also very interested in medicine and anatomy (but I'm too dumb for something like medical school, so it's just a weird special interest). ### Response: Agree with answers from /u/Spicy_Antigen.Regarding her doctor, he certainly has treated aplastic anemia before. I don't know if there are really enough aplastic anemia patient for any hematologist to have a "specialty" in it. If you want a second opinion, I'd reach out to the major medical center in her city..


Instruction: Iron vs Iron Saturation? [Hematology]Can anyone explain the practical difference between these two test values (not just the technical definition), and what it would mean if someone had normal Iron but low Iron Saturation?i.e. How could the saturation end up low but the iron level itself stay normal, physiologically?The numbers are 63 mcg and 18%, respectively, in case you're wondering, with the range listed at 50->180 for Iron and 20->48% for the Iron sat.tyvm!Age: 30, Height: 180cm, Sex: M, Non Smoker

Output: It's not easy to ELI5 this. Iron level basically just measures the amount of "free" iron released by your body into your bloodstream at the very second that your blood was drawn. It will change from hour to hour and day to day. The iron level is basically meaningless because it doesn't tell you anything about how much iron you actually have in your body. For example, your body needs a certain amount of iron in your blood at any given point. Even if you're iron deficient, you could have 63 on your lab and you could be iron overloaded, and it could still be 63 on your lab.The iron sat tells you indirectly how much iron is stored in your body. A low saturation means your body stores are low.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Iron vs Iron Saturation? [Hematology]Can anyone explain the practical difference between these two test values (not just the technical definition), and what it would mean if someone had normal Iron but low Iron Saturation?i.e. How could the saturation end up low but the iron level itself stay normal, physiologically?The numbers are 63 mcg and 18%, respectively, in case you're wondering, with the range listed at 50->180 for Iron and 20->48% for the Iron sat.tyvm!Age: 30, Height: 180cm, Sex: M, Non Smoker. ### Response: It's not easy to ELI5 this. Iron level basically just measures the amount of "free" iron released by your body into your bloodstream at the very second that your blood was drawn. It will change from hour to hour and day to day. The iron level is basically meaningless because it doesn't tell you anything about how much iron you actually have in your body. For example, your body needs a certain amount of iron in your blood at any given point. Even if you're iron deficient, you could have 63 on your lab and you could be iron overloaded, and it could still be 63 on your lab.The iron sat tells you indirectly how much iron is stored in your body. A low saturation means your body stores are low..


Instruction: What can these blood tests indicate? (Infectious doctors? hematology doctors? Nuerologists? )Male, 28, 68 kg, 183 cm. White. Sweden. Previously diagnosed with Lyme Disease. One major event of disease progression was food poisoning from eating raw fish.Symptomatic presentation:Numbness in body and limbs, and in skinDecreased body awarenessAnhedoniaDecreased sense of smellDecreased sense of touchDecreased hearing quality, level and resolutionLost access to brain areas and higher functionsBrain fogShort term memory affectedAffected bodily, space and time perceptionTingling in skinFloaters in eyesWeight lossMuscle lossDepersonalizationDerealizationAn altered mental state described as a conscious comaChronic fatigueNauseaSexual dysfunction, loss of sexuality, anorgasmiaGeneral weaknessVery dry skinNot able to have a feverTESTS DONE IN JUNE: VEGF-A 114 pg/ml, reference: >42,6 pg/ml. Candida glabrata 1,6 x 10^6 KBE / g Stool, reference <1.0 x 10^3 (<----*>Streptococcus Sp. ELISPOT 4.1 (ref > 3).**[**U75] ASO (streptolizyna)  255,03 u/ml < 200.Tryptophan Metabolism in urineSerotonin PathwayKynurenine Pathway IgG subcategory Type 4 1, 14 g/l, 0,004-0,86 Zonulin 71,88 ng/ml <55 Lactate / pyruvate 13,7 Quotient <12,9 Adrenaline 6,20 ug/g Crea 2,0 - 5,5 Dopamine 126,81 ug/g Crea 130 - 240Histamine in stool 1419,7 ng/ml <959Blod Analysis Cabinet of Medical AnalystBabesia sp 2.9% (out of 500 assessed erythrocytes) other detected co-infections: - Bartonella spFound in the analyzed fields of view: Pathological erythrocytes: anisocytosis (defense mechanism?)misshapen blood cells: - ovalocytes, lacrimocytes, dacrocytes - it may indicate an infection of the haematopoietic systemInternal cell structures : rod-shaped, branched, ring-shaped, grainy, - may indicate a multispecies parasitic infection

Output: Thats a rather eccentric collection of lab results. What kind of doctor ordered these?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What can these blood tests indicate? (Infectious doctors? hematology doctors? Nuerologists? )Male, 28, 68 kg, 183 cm. White. Sweden. Previously diagnosed with Lyme Disease. One major event of disease progression was food poisoning from eating raw fish.Symptomatic presentation:Numbness in body and limbs, and in skinDecreased body awarenessAnhedoniaDecreased sense of smellDecreased sense of touchDecreased hearing quality, level and resolutionLost access to brain areas and higher functionsBrain fogShort term memory affectedAffected bodily, space and time perceptionTingling in skinFloaters in eyesWeight lossMuscle lossDepersonalizationDerealizationAn altered mental state described as a conscious comaChronic fatigueNauseaSexual dysfunction, loss of sexuality, anorgasmiaGeneral weaknessVery dry skinNot able to have a feverTESTS DONE IN JUNE: VEGF-A 114 pg/ml, reference: >42,6 pg/ml. Candida glabrata 1,6 x 10^6 KBE / g Stool, reference <1.0 x 10^3 (<----*>Streptococcus Sp. ELISPOT 4.1 (ref > 3).**[**U75] ASO (streptolizyna)  255,03 u/ml < 200.Tryptophan Metabolism in urineSerotonin PathwayKynurenine Pathway IgG subcategory Type 4 1, 14 g/l, 0,004-0,86 Zonulin 71,88 ng/ml <55 Lactate / pyruvate 13,7 Quotient <12,9 Adrenaline 6,20 ug/g Crea 2,0 - 5,5 Dopamine 126,81 ug/g Crea 130 - 240Histamine in stool 1419,7 ng/ml <959Blod Analysis Cabinet of Medical AnalystBabesia sp 2.9% (out of 500 assessed erythrocytes) other detected co-infections: - Bartonella spFound in the analyzed fields of view: Pathological erythrocytes: anisocytosis (defense mechanism?)misshapen blood cells: - ovalocytes, lacrimocytes, dacrocytes - it may indicate an infection of the haematopoietic systemInternal cell structures : rod-shaped, branched, ring-shaped, grainy, - may indicate a multispecies parasitic infection. ### Response: Thats a rather eccentric collection of lab results. What kind of doctor ordered these?.


Instruction: Infectious disease specialists.

Output: Oncology? You don't mention a history of cancer

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Infectious disease specialists.. ### Response: Oncology? You don't mention a history of cancer.


Instruction: My bad. It wasn't specialist in oncology. The doctor works and conducts research with supportive therapies for cancer, hyperthermia.Only labs that are off are being posted of course. 50+ more tests have been done. Including 2 MRIs of the brain and spine.

Output: These labs suggest your doctor(s) are not practicing modern, evidence-based medicine.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My bad. It wasn't specialist in oncology. The doctor works and conducts research with supportive therapies for cancer, hyperthermia.Only labs that are off are being posted of course. 50+ more tests have been done. Including 2 MRIs of the brain and spine.. ### Response: These labs suggest your doctor(s) are not practicing modern, evidence-based medicine..