Instruction: I keep thinking amyloidosis but, his brother had MM. Entire family has heart disease and I'm thinking that they may all need to be tested.

Output: MM isnt typically genetic. Familial cases make up 0.3% of diagnoses. Amyloidosis can be familial but is not the same as AL amyloidosis associated with myeloma. If your husband by any chance served in Vietnam, agent orange exposure also increases risk of developing MM.Your husband likely has IgA myeloma given how high is IgA levels are, which is the second most common form. A bone marrow will help make the diagnosis formal. He likely isnt feeling well from either the myeloma or a possible opportunistic infection in the setting of immune dysfunction from the myeloma.He should be seen sooner than February or at least have a bone marrow done before this time. Someone should be following up sooner with these numbers.If interested, there is also a website run by a physician with myeloma that tracks labs and has physicians from all over weigh in on care. Its free and worth looking into if you are not close to a large academic center.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I keep thinking amyloidosis but, his brother had MM. Entire family has heart disease and I'm thinking that they may all need to be tested.. ### Response: MM isnt typically genetic. Familial cases make up 0.3% of diagnoses. Amyloidosis can be familial but is not the same as AL amyloidosis associated with myeloma. If your husband by any chance served in Vietnam, agent orange exposure also increases risk of developing MM.Your husband likely has IgA myeloma given how high is IgA levels are, which is the second most common form. A bone marrow will help make the diagnosis formal. He likely isnt feeling well from either the myeloma or a possible opportunistic infection in the setting of immune dysfunction from the myeloma.He should be seen sooner than February or at least have a bone marrow done before this time. Someone should be following up sooner with these numbers.If interested, there is also a website run by a physician with myeloma that tracks labs and has physicians from all over weigh in on care. Its free and worth looking into if you are not close to a large academic center..


Instruction: 35/F, nervous about upcoming appt...35 female, been dealing with a whole slew of issues for 3 years now. I am being seen at hematology/oncology for ongoing anemia. Was diagnosed with alpha thalassemia. Was also told I may have a slow growing lymphoma. Because of that, I had a bone marrow biopsy 3 years ago. No lymphoma shown, but was told it was only a 50/50 chance. Basically if it was in my bones. Doctor ordered a PET scan but my insurance said no. Been going back and forth trying to push for more testing but the doctors don't seem to want to do much of anything to help me. Blood work is almost normal, but symptoms are ongoing. Night sweats, low fevers at night, bone pain, fatigue. I have a ping pong sized lump on the back of my head. Brought it up to one of the doctors and they shrugged and said "no idea why you'd have a lump there." And left it at that. I've asked for a biopsy of other lumps with no luck.My next appt is this week. I have a hard time advocating for myself and pushing for further tests. I get told no and shut down.Any tips for voicing my concerns better? I hate feeling like this and I hate feeling so defeated after all my appointments.

Output: Very unlikely to be even slow growing lymphoma. Everyone is dealing with a whole slew of issues, honestly. Live life. Please dont look further for a disease. Youve done your due diligence.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 35/F, nervous about upcoming appt...35 female, been dealing with a whole slew of issues for 3 years now. I am being seen at hematology/oncology for ongoing anemia. Was diagnosed with alpha thalassemia. Was also told I may have a slow growing lymphoma. Because of that, I had a bone marrow biopsy 3 years ago. No lymphoma shown, but was told it was only a 50/50 chance. Basically if it was in my bones. Doctor ordered a PET scan but my insurance said no. Been going back and forth trying to push for more testing but the doctors don't seem to want to do much of anything to help me. Blood work is almost normal, but symptoms are ongoing. Night sweats, low fevers at night, bone pain, fatigue. I have a ping pong sized lump on the back of my head. Brought it up to one of the doctors and they shrugged and said "no idea why you'd have a lump there." And left it at that. I've asked for a biopsy of other lumps with no luck.My next appt is this week. I have a hard time advocating for myself and pushing for further tests. I get told no and shut down.Any tips for voicing my concerns better? I hate feeling like this and I hate feeling so defeated after all my appointments.. ### Response: Very unlikely to be even slow growing lymphoma. Everyone is dealing with a whole slew of issues, honestly. Live life. Please dont look further for a disease. Youve done your due diligence..


Instruction: Palpable Lymphnode for years no pain19, Male, 60, Very active and healthyHi there, 3 years ago I have noticed this lymphnode on the left side of my neck and when I turn my head to the other direction it feels huge. I have been to my GP and bloodwork was fine, he sent me to a surgeon who refused to do a biopsy and he sent to an infectious disease doctor who took LOADS of blood and it came back all good- I went back to the surgeon and he got tired of me and I pushed for hematology/oncology & he finally referred me there. When I went to the appointment she said she wasnt really worried and my blood was fine again. I have had 3 ultrasounds on it and it doesnt really seem to be getting bigger. Even after these 3 years it hasnt changed in size at all. Recently though I had a cold and a bunch of lymphnodes around it back enlarged and painful. They all went away but I was feeling this lymphnode again and its freaking me out. Its way bigger than my other nodes and it feels so hard. Im so irritated I never got a biopsy for it. Should I be concerned over lymphoma or no? Should I go back to the doctor? Please give me thoughts

Output: Should I be concerned over lymphoma or no?You've had 4 physicians, multiple US, and blood work suggesting its fine. I'm not sure what else a physician over the internet is going to tell you at this point.Im so irritated I never got a biopsy for itWhy? Would you be irritated if it came back normal but you had a complication from the biopsy that you are still dealing with today? Would you be satisfied knowing the biopsy was normal, but there is a chance for a false negative?its freaking me outI think the bigger issue here is your anxiety. It does not sound well managed. This will lead you to never be satisfied regardless of what you do or have done. I would suggest your seek mental health therapy/counseling for this.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Palpable Lymphnode for years no pain19, Male, 60, Very active and healthyHi there, 3 years ago I have noticed this lymphnode on the left side of my neck and when I turn my head to the other direction it feels huge. I have been to my GP and bloodwork was fine, he sent me to a surgeon who refused to do a biopsy and he sent to an infectious disease doctor who took LOADS of blood and it came back all good- I went back to the surgeon and he got tired of me and I pushed for hematology/oncology & he finally referred me there. When I went to the appointment she said she wasnt really worried and my blood was fine again. I have had 3 ultrasounds on it and it doesnt really seem to be getting bigger. Even after these 3 years it hasnt changed in size at all. Recently though I had a cold and a bunch of lymphnodes around it back enlarged and painful. They all went away but I was feeling this lymphnode again and its freaking me out. Its way bigger than my other nodes and it feels so hard. Im so irritated I never got a biopsy for it. Should I be concerned over lymphoma or no? Should I go back to the doctor? Please give me thoughts. ### Response: Should I be concerned over lymphoma or no?You've had 4 physicians, multiple US, and blood work suggesting its fine. I'm not sure what else a physician over the internet is going to tell you at this point.Im so irritated I never got a biopsy for itWhy? Would you be irritated if it came back normal but you had a complication from the biopsy that you are still dealing with today? Would you be satisfied knowing the biopsy was normal, but there is a chance for a false negative?its freaking me outI think the bigger issue here is your anxiety. It does not sound well managed. This will lead you to never be satisfied regardless of what you do or have done. I would suggest your seek mental health therapy/counseling for this..


Instruction: doc referring, can't figure out what's wrong, 32f 230lbs partial hysterectomy (have ovaries) in 2017 due to endo. Recently diagnosed PCOS after internal ultrasound. Massive weight gain within past year (80lbs) despite 900 cal diet and intermittent fasting. Whole body swelling, constant pain in feet, legs, back and pelvis area. I've had a slew of lab tests done and my doctor cannot figure out what is wrong. They are referring me to Hematology. They "don't want me to worry" so I'm getting half assed explanations. I'm frustrated and I really feel like my body is just giving up. My WBC has been elevated for over a year. I have attached pictures of my lab results. I have upcoming appointments for Hematology, a chest xray, CT scan of pelvis and Neurologist (daily headaches and vision issues) What would the point of a chest xray be if I'm not having difficulty breathing? Every time I ask for explanations they just skirt around it without giving me actual answers. I know speculation is not good but I would rather have an idea of what COULD be happening. https://imgur.com/a/sVjWCD9

Output: Have they ever ruled out hypercortisolism with a suppression test ? I can't find in your tests cortisol and ACTH values either

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: doc referring, can't figure out what's wrong, 32f 230lbs partial hysterectomy (have ovaries) in 2017 due to endo. Recently diagnosed PCOS after internal ultrasound. Massive weight gain within past year (80lbs) despite 900 cal diet and intermittent fasting. Whole body swelling, constant pain in feet, legs, back and pelvis area. I've had a slew of lab tests done and my doctor cannot figure out what is wrong. They are referring me to Hematology. They "don't want me to worry" so I'm getting half assed explanations. I'm frustrated and I really feel like my body is just giving up. My WBC has been elevated for over a year. I have attached pictures of my lab results. I have upcoming appointments for Hematology, a chest xray, CT scan of pelvis and Neurologist (daily headaches and vision issues) What would the point of a chest xray be if I'm not having difficulty breathing? Every time I ask for explanations they just skirt around it without giving me actual answers. I know speculation is not good but I would rather have an idea of what COULD be happening. https://imgur.com/a/sVjWCD9. ### Response: Have they ever ruled out hypercortisolism with a suppression test ? I can't find in your tests cortisol and ACTH values either.


Instruction: I don't believe so, that doesn't sound familiar. Is this something I should speak with Hematology about once I see them?

Output: It's an endocrine disorder that would fit most of your symptoms (and also the high WBC count)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I don't believe so, that doesn't sound familiar. Is this something I should speak with Hematology about once I see them?. ### Response: It's an endocrine disorder that would fit most of your symptoms (and also the high WBC count).


Instruction: Wow, after looking at this I have SO many of the symptoms. I've been living with unbearable stress for about 2 1/2 years, it's caused crippling anxiety and I feel like I'm about to pop. I don't know if major stress could cause this or add to it. I'm calling my doctor now to see how I can have this testing done. Thank you so so much.

Output: Let me know if you have updates. The first step is a simple blood test (performed in the morning around 8AM), to measure Cortisol and ACTH.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Wow, after looking at this I have SO many of the symptoms. I've been living with unbearable stress for about 2 1/2 years, it's caused crippling anxiety and I feel like I'm about to pop. I don't know if major stress could cause this or add to it. I'm calling my doctor now to see how I can have this testing done. Thank you so so much.. ### Response: Let me know if you have updates. The first step is a simple blood test (performed in the morning around 8AM), to measure Cortisol and ACTH..


Instruction: Just curious, why 8am? Is it tied to when most people get up or does it have to do with circadian rhythms and such?

Output: The reference values are based on that time, when there should be the physiological peak of cortisol. Hormones fluctuate a lot during the day, cortisol more than others, so a simple blood draw is usually not enough to get a diagnosis. Performing it at the right time helps a bit, knowing that it should be at its highest level of the day ( the lowest is around midnight )

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Just curious, why 8am? Is it tied to when most people get up or does it have to do with circadian rhythms and such?. ### Response: The reference values are based on that time, when there should be the physiological peak of cortisol. Hormones fluctuate a lot during the day, cortisol more than others, so a simple blood draw is usually not enough to get a diagnosis. Performing it at the right time helps a bit, knowing that it should be at its highest level of the day ( the lowest is around midnight ).


Instruction: I think the question is more so of "how does the body know what time it is?". If someone sleeps 11 am to 7 pm, it would be really interesting for cortisol to still be highest at 8 am.

Output: That is a great question. People with insomnia or who work night shifts might have altered cyclesI might be misremembering, and of course would defer to you (you being an endorcrinologist..), but I feel that I remember reading in medical school about the cortisol cycle being the least affected by behavioral changes in sleep-wake of most the diurnal cycles.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I think the question is more so of "how does the body know what time it is?". If someone sleeps 11 am to 7 pm, it would be really interesting for cortisol to still be highest at 8 am.. ### Response: That is a great question. People with insomnia or who work night shifts might have altered cyclesI might be misremembering, and of course would defer to you (you being an endorcrinologist..), but I feel that I remember reading in medical school about the cortisol cycle being the least affected by behavioral changes in sleep-wake of most the diurnal cycles..


Instruction: I'm not sure, the second picture of my lab results has a TSH free line but it doesn't look out of range (that I can tell)

Output: Your TSH is fine, 0.7 is a good value

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm not sure, the second picture of my lab results has a TSH free line but it doesn't look out of range (that I can tell). ### Response: Your TSH is fine, 0.7 is a good value.


Instruction: I don't know how to edit my post and not sure this info would be relevant but I'm always hot, constantly sweating. My temperature is usually around 99f. Also, both of my armpits are swollen, some days it hurts to even move my arms. The only time I've experienced something like that was after receiving my 2nd dose of Moderna and I was told it was swollen lymph nodes.

Output: Is it possible youre night eating?If you were eating a strict 900 kcal diet I have a hard time imagining you would be maintaining that weight.Do you take ambien by chance?Also why exactly are you referred to heme? You posted a mountain of labs and no one here will review them all for free, do you know what labs exactly are abnormal they were concerned with?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I don't know how to edit my post and not sure this info would be relevant but I'm always hot, constantly sweating. My temperature is usually around 99f. Also, both of my armpits are swollen, some days it hurts to even move my arms. The only time I've experienced something like that was after receiving my 2nd dose of Moderna and I was told it was swollen lymph nodes.. ### Response: Is it possible youre night eating?If you were eating a strict 900 kcal diet I have a hard time imagining you would be maintaining that weight.Do you take ambien by chance?Also why exactly are you referred to heme? You posted a mountain of labs and no one here will review them all for free, do you know what labs exactly are abnormal they were concerned with?.


Instruction: Mystery left abdominal painUpdate about 160 days later: mystery solved Had colonoscopy+EGD and emptying study. All that was found was mild gastroparesis. Two days ago I had a diagnostic laparoscopy and surgeon found deep endometriosis behind my uterus. Also found a large nodule of endometriosis higher up on my left abdominal wall, which explains the pain. Will have it removed in a few months and should be pain free.Original post: 32F 5'6" 125lbs I have had left abdominal pain for about 3+ years now. It is directly left of my belly button. Most of the time, it's very dull and barely noticeable. However, a few days before my period it starts to intensify. Then during my period it is intense, to the point where my daily activities are limited. It has been getting worse over the months/years.The pain feels kind of like a pulled muscle, and when I move/sneeze/cough, it is extreme. The only thing I can relate it to is a labor contraction. When I move or stand up straight, also extreme. If I hit a bump driving in my car, extreme pain. Then after about a week, it fades away to a duller pain until it comes back more fiercely next month.I began the process of exploring this pain with my OB/GYN in 2019 and at the time it began, I had already had two miscarriages. I've had several pelvic ultrasounds and all were normal. We started the discussion of endometriosis and had some appointments set up with a surgeon for a consult on the laparoscopic surgery needed to diagnose it...and then he pandemic hit. My appointment got bumped, and bumped again, and then I got pregnant with my son who was born early 2021. I had no pain while pregnant and the pain didn't return until my period did.Early this year (2022), I saw my doctor again for the pain, loss of appetite, weight loss (now at about 35lbs lost in 2022), nausea. They did several blood tests and my WBC, RBC, and platelets all came in low. I was referred to hematology/oncology where we did bone marrow biopsies and several other tests. No cancer was found, but it appears my bone marrow might be in the early stages of failure, perhaps developing aplastic anemia. I get my blood counts monitored each month and they have been low, but stable, so no action required at this time. Hematology also did another pelvic ultrasound and a CT scan of chest/abdomen/pelvis. My spleen is slightly (barely) enlarged, otherwise everything is normal. No masses found.Now that hematology has done their thing, GI will finally see me. I saw them last week and am scheduled for an EGD and colonoscopy early Jan 2023.The doctors are reluctant to explore endometriosis at this point. Their reasons are: I had a "successful pregnancy", they do not want to do the surgery because of my blood counts being low (too risky I guess), and there really isn't much they can do if it's endometriosis anyways. They had me try an oral contraceptive for a few months and that did not help.Any ideas on what this could be? What questions I need to be asking? What other tests to request? Im at a loss and growing weary of spending money on all these tests that are coming back negative.

Output: Have you been checked for an umbilical hernia? either by imaging or by a general surgeon?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Mystery left abdominal painUpdate about 160 days later: mystery solved Had colonoscopy+EGD and emptying study. All that was found was mild gastroparesis. Two days ago I had a diagnostic laparoscopy and surgeon found deep endometriosis behind my uterus. Also found a large nodule of endometriosis higher up on my left abdominal wall, which explains the pain. Will have it removed in a few months and should be pain free.Original post: 32F 5'6" 125lbs I have had left abdominal pain for about 3+ years now. It is directly left of my belly button. Most of the time, it's very dull and barely noticeable. However, a few days before my period it starts to intensify. Then during my period it is intense, to the point where my daily activities are limited. It has been getting worse over the months/years.The pain feels kind of like a pulled muscle, and when I move/sneeze/cough, it is extreme. The only thing I can relate it to is a labor contraction. When I move or stand up straight, also extreme. If I hit a bump driving in my car, extreme pain. Then after about a week, it fades away to a duller pain until it comes back more fiercely next month.I began the process of exploring this pain with my OB/GYN in 2019 and at the time it began, I had already had two miscarriages. I've had several pelvic ultrasounds and all were normal. We started the discussion of endometriosis and had some appointments set up with a surgeon for a consult on the laparoscopic surgery needed to diagnose it...and then he pandemic hit. My appointment got bumped, and bumped again, and then I got pregnant with my son who was born early 2021. I had no pain while pregnant and the pain didn't return until my period did.Early this year (2022), I saw my doctor again for the pain, loss of appetite, weight loss (now at about 35lbs lost in 2022), nausea. They did several blood tests and my WBC, RBC, and platelets all came in low. I was referred to hematology/oncology where we did bone marrow biopsies and several other tests. No cancer was found, but it appears my bone marrow might be in the early stages of failure, perhaps developing aplastic anemia. I get my blood counts monitored each month and they have been low, but stable, so no action required at this time. Hematology also did another pelvic ultrasound and a CT scan of chest/abdomen/pelvis. My spleen is slightly (barely) enlarged, otherwise everything is normal. No masses found.Now that hematology has done their thing, GI will finally see me. I saw them last week and am scheduled for an EGD and colonoscopy early Jan 2023.The doctors are reluctant to explore endometriosis at this point. Their reasons are: I had a "successful pregnancy", they do not want to do the surgery because of my blood counts being low (too risky I guess), and there really isn't much they can do if it's endometriosis anyways. They had me try an oral contraceptive for a few months and that did not help.Any ideas on what this could be? What questions I need to be asking? What other tests to request? Im at a loss and growing weary of spending money on all these tests that are coming back negative.. ### Response: Have you been checked for an umbilical hernia? either by imaging or by a general surgeon?.


Instruction: I have not met with a general surgeon. My CT scan of chest/abdomen/pelvis didn't show anything, which I'm not sure if it would or not. I brought up a hernia to my PCP because I had read an article about how hernias in females are often harder to diagnose and she felt my stomach and said she didn't think it was that. I will bring it up again.ETA: Wouldn't I have been in excruciating pain throughout pregnancy with a hernia, especially toward the end? I didn't have the abdominal pain at all during pregnancy. Just curious!

Output: My CT scan of chest/abdomen/pelvis didn't show anythingIn my experience, radiologists often do not report simple fat containing hernias, so I always look at the CT images myself to see if there is actually a hernia that just wasn't commented on by the radiologistread an article about how hernias in females are often harder to diagnoseyou are probably referring to inguinal hernias not umbilical hernias. Maybe you could ask for a referral to a general surgeon depending on what ur pcp saysWouldn't I have been in excruciating pain throughout pregnancy with a hernia,No. Hernias can cause pain but many of them do not. And women very frequently get umbilical hernias during pregnancy. So thats why your history of pregnancy and now periumbilical pain made me think possible hernia.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have not met with a general surgeon. My CT scan of chest/abdomen/pelvis didn't show anything, which I'm not sure if it would or not. I brought up a hernia to my PCP because I had read an article about how hernias in females are often harder to diagnose and she felt my stomach and said she didn't think it was that. I will bring it up again.ETA: Wouldn't I have been in excruciating pain throughout pregnancy with a hernia, especially toward the end? I didn't have the abdominal pain at all during pregnancy. Just curious!. ### Response: My CT scan of chest/abdomen/pelvis didn't show anythingIn my experience, radiologists often do not report simple fat containing hernias, so I always look at the CT images myself to see if there is actually a hernia that just wasn't commented on by the radiologistread an article about how hernias in females are often harder to diagnoseyou are probably referring to inguinal hernias not umbilical hernias. Maybe you could ask for a referral to a general surgeon depending on what ur pcp saysWouldn't I have been in excruciating pain throughout pregnancy with a hernia,No. Hernias can cause pain but many of them do not. And women very frequently get umbilical hernias during pregnancy. So thats why your history of pregnancy and now periumbilical pain made me think possible hernia..


Instruction: Is this hematology panel indicative of chronic lymphocytic leukemia in a 61yo female?HematologyWBCA134.0-10.010*9/LRBC4.463.50-5.0010*12/LHemoglobin140115-155g/LHematocrit0.40.35-0.45L/LMCV9182-98flMCH31.427.5-33.5pgMCHC347300-370g/LRDW1311.5-14.5%Platelet Count270150-40010*9/LDifferentialNeutrophils4.12.0-7.510*9/LLymphocytesA7.91.0-4.010*9/LMonocytes0.70.1-0.810*9/LEosinophils0.20.0-0.710*9/LBasophils0.10.0-0.210*9/LGranulocytes Immature00.0-0.110*9/LWBC MorphologySMUDGE CELLS presentRBC MorphologySTOMATOCYTES presentHematology CommentsResults are pending ...Recent screening torso MRI:Potential mild cardiomegaly. Note that this is not a study accurate for cardiac evaluation. Possibility of left ventricular hypertrophy is raised. Please correlate clinically and with dedicated echocardiogram or MR imaging as required.An increased number of lymph nodes at both axilla and hila although these are still measuring within normal sizeA mild degree of edema at the lower gastroesophageal junction, may indicate chronic gastroesophageal reflux disease. Mucosal details are not available.Both kidneys have focal areas of volume loss; this is worse on the left and may indicate scar tissue, sonographic evaluation for any underlying pathology would be beneficial. Is there any concern for embolic events?Multilevel degenerative disc disease, described above. There is also likely bilateral L5 spondylolysis with potential for malalignment in addition to the scoliosis.There is a nonspecific bone lesion at the posterior left femoral head, a somewhat similar configuration focus at bilateral posterior pubic bodies. These potentially may be compatible with erosions or subchondral cyst formation, Recommend nonurgent radiographic correlation.Borderline prominent spleen correlate clinically.A small segment 7 cystic lesion can be assessed with nonemergent ultrasound. Possibly septated hepatic cyst, hemangioma or less likely cystadenoma. Reported using speech recognition.

Output: Not really. White count is only 13

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is this hematology panel indicative of chronic lymphocytic leukemia in a 61yo female?HematologyWBCA134.0-10.010*9/LRBC4.463.50-5.0010*12/LHemoglobin140115-155g/LHematocrit0.40.35-0.45L/LMCV9182-98flMCH31.427.5-33.5pgMCHC347300-370g/LRDW1311.5-14.5%Platelet Count270150-40010*9/LDifferentialNeutrophils4.12.0-7.510*9/LLymphocytesA7.91.0-4.010*9/LMonocytes0.70.1-0.810*9/LEosinophils0.20.0-0.710*9/LBasophils0.10.0-0.210*9/LGranulocytes Immature00.0-0.110*9/LWBC MorphologySMUDGE CELLS presentRBC MorphologySTOMATOCYTES presentHematology CommentsResults are pending ...Recent screening torso MRI:Potential mild cardiomegaly. Note that this is not a study accurate for cardiac evaluation. Possibility of left ventricular hypertrophy is raised. Please correlate clinically and with dedicated echocardiogram or MR imaging as required.An increased number of lymph nodes at both axilla and hila although these are still measuring within normal sizeA mild degree of edema at the lower gastroesophageal junction, may indicate chronic gastroesophageal reflux disease. Mucosal details are not available.Both kidneys have focal areas of volume loss; this is worse on the left and may indicate scar tissue, sonographic evaluation for any underlying pathology would be beneficial. Is there any concern for embolic events?Multilevel degenerative disc disease, described above. There is also likely bilateral L5 spondylolysis with potential for malalignment in addition to the scoliosis.There is a nonspecific bone lesion at the posterior left femoral head, a somewhat similar configuration focus at bilateral posterior pubic bodies. These potentially may be compatible with erosions or subchondral cyst formation, Recommend nonurgent radiographic correlation.Borderline prominent spleen correlate clinically.A small segment 7 cystic lesion can be assessed with nonemergent ultrasound. Possibly septated hepatic cyst, hemangioma or less likely cystadenoma. Reported using speech recognition.. ### Response: Not really. White count is only 13.


Instruction: Was the presence of smudge cells that tripped me up, but maybe that can be normal? Right now she's been having chest pain and I highly suspect CAD but without a positive ECG or elevated troponin they won't do anything further.

Output: CLL typically has white counts in the hundreds, not 13.Without more details on the chest pain I cant really comment

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Was the presence of smudge cells that tripped me up, but maybe that can be normal? Right now she's been having chest pain and I highly suspect CAD but without a positive ECG or elevated troponin they won't do anything further.. ### Response: CLL typically has white counts in the hundreds, not 13.Without more details on the chest pain I cant really comment.


Instruction: Please, please help...no one can figure out whats wrong and at my wits endI've posted here before and no one ever seems to answer but I'm getting so sick that I'm basically bed bound from pain.I'm a 32 yo woman, overweight at 280 lbs, diagnosed with Sjogren's, PCOS, and on these medicines:Metoprolol for tachycardia I've had since childhood Metformin for PCOS Spironolactone for low potassium I've had since childhood (used to have constant racing heart and passed out a lot as a kid because of low potassium) as well as PCOS Nuvigil for chronic fatigue Pilocarpine for Sjogren's dryness Doxepin for ribcage pain Rosuvastatin for high cholesterol Low dose naltrexone 3mg for chronic pain Trintellix for depressionA few years ago, like 5 years now, I was healthy and 125 lbs. Then I had my 2nd child, was about 180 after she was born, and developed PCOS. I could not lose weight and gained a little more and got to about 225.In Dec 2019, my psychiatrist put me on Trileptal for mood stability. About a month later, I started to develop pitting edema and severe low ribcage pain and then had absolutely zero appetite whatsoever. I went to the ER with grade 4 edema, severe low rib pain, and blood in my urine and bloody vaginal discharge. No sign of infection, no excess protein, nothing really out of the ordinary aside from GFR that would dip into the 50s before sometimes coming up again and blood. I did get low iron and potassium, needed iv potassium several times, but they could find nothing to easily explain symptoms. This goes on for nearly a year...I got up to 325 lbs even though I could barely eat or get out of bed. I truly thought I would die.I stopped taking my medicine when I couldn't eat, and noticed I felt worse after taking it again. I also felt worse if I exercised. So I stopped Trileptal and rested for about a month and slowly seemed to recover. Then my OBGYN found uterine polyps and I had surgery to remove them. The next month, my gallbladder was removed. The next month, I had surgery to "fix" my urethra since they thought maybe I was having urinary problems stemming from that.But I got better and tried to be okay mentally with the constant dismissals I got from so damn many docs before I finally got some help. It was extremely difficult and I suffered with health anxiety because of it but have done great with therapy. I even managed to get my weight down to 235 after starting exercise after being sure my kidneys were fine again at a consistent GFR over 110.Then a month ago, I got a very bad case of flu. The lower rib pain came back bad. I dismissed it as flu. Recovered from it, then had several days where every muscle in my body felt like it had been lifting heavy weights for days. Everything hurt, and doc said maybe mild myositis from flu. Then I noticed urinary changes. I normally have frequent urination, going a few times a night and usually at least every hour or more. No one can find a cause though. But suddenly not going at night at all and only going like 3 times in the day. Started having white flecks in urine sometimes and strong odor. Then urinalysis started showing blood in urine consistently. Then sharp pains in urethra all the way to anus at times, which I'd had before as well. I have brown vaginal discharge too. A few days ago, I couldn't pee at all and was sent to the er. They can find no reason for my symptoms...nothing on ct, no bacteria in culture, no stones, no nothing. No one knows, but I had to have a foley catheter inserted (was very painful like stabbing) because I had retention and could not pee. Was sent home with it and had it removed next day and I was able to pee again but then developed pitting edema. It's currently grade 1. No cause can be found.I will add in case it is relevant, just before the flu, my pcm referred me to neurology for mris of head and spine and nerve conduction test. I've been having nerve pain for several months. Buzzing, tingling, numbness, shocks, in various places for sustained periods and sometimes just sudden and then goes away. She was thinking the lower rib cage pain may actually be nerve pain since it feels burning at times like the burning headaches in the base of my skull and my neck. My thyroid is sometimes hypo but usually fine, my b12 and magnesium are normal, and I do not have any markers of diabetes other than just being fat currently. My grandma has MS, which she believes was healed by Jesus, but I know enough about it to know that's what she's trying to rule out I'm pretty sure.Can anyone, please , give me some insight about what might be wrong with me? I'm in so much pain with the gnawing, burning pain in the bottom of my ribcage and the electric shock pains in my urethra and anus, and I am so scared of the fact I've got urinary bleeding, vaginal bleeding, and putting edema but no one knows what's up. I've seen rheumatology, nephrology, urology, obgyn, even was sent to a hematology oncologist as a hail-mary.I stay away from Googleing anything because for one, I have too many symptoms to easily fit in a search bar, and I know there's no good coming out of looking at it anyway. I have gotten better care since changing hospital systems after last time this happened, the urologist I saw kept insisting the blood in my urine was from my vagina even though I still had blood in my urine after a catheter was used to sample, and I e just had a really hard time getting docs to push to figure out what's wrong. It feels like since I don't appear to be imminently dying, and they dismiss my pain and exhaustion, no one sees a point in helping.So sorry for the long post but I'm just trying to give as much context as I can. Please let me know if you have any questions as I'm happy to answer.

Output: In the absence of objective findings on imaging and testing, it is possible that weight in itself can cause the multi-system problems that you have. Obesity unfortunately affects numerous organ systems in subtle ways initially.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Please, please help...no one can figure out whats wrong and at my wits endI've posted here before and no one ever seems to answer but I'm getting so sick that I'm basically bed bound from pain.I'm a 32 yo woman, overweight at 280 lbs, diagnosed with Sjogren's, PCOS, and on these medicines:Metoprolol for tachycardia I've had since childhood Metformin for PCOS Spironolactone for low potassium I've had since childhood (used to have constant racing heart and passed out a lot as a kid because of low potassium) as well as PCOS Nuvigil for chronic fatigue Pilocarpine for Sjogren's dryness Doxepin for ribcage pain Rosuvastatin for high cholesterol Low dose naltrexone 3mg for chronic pain Trintellix for depressionA few years ago, like 5 years now, I was healthy and 125 lbs. Then I had my 2nd child, was about 180 after she was born, and developed PCOS. I could not lose weight and gained a little more and got to about 225.In Dec 2019, my psychiatrist put me on Trileptal for mood stability. About a month later, I started to develop pitting edema and severe low ribcage pain and then had absolutely zero appetite whatsoever. I went to the ER with grade 4 edema, severe low rib pain, and blood in my urine and bloody vaginal discharge. No sign of infection, no excess protein, nothing really out of the ordinary aside from GFR that would dip into the 50s before sometimes coming up again and blood. I did get low iron and potassium, needed iv potassium several times, but they could find nothing to easily explain symptoms. This goes on for nearly a year...I got up to 325 lbs even though I could barely eat or get out of bed. I truly thought I would die.I stopped taking my medicine when I couldn't eat, and noticed I felt worse after taking it again. I also felt worse if I exercised. So I stopped Trileptal and rested for about a month and slowly seemed to recover. Then my OBGYN found uterine polyps and I had surgery to remove them. The next month, my gallbladder was removed. The next month, I had surgery to "fix" my urethra since they thought maybe I was having urinary problems stemming from that.But I got better and tried to be okay mentally with the constant dismissals I got from so damn many docs before I finally got some help. It was extremely difficult and I suffered with health anxiety because of it but have done great with therapy. I even managed to get my weight down to 235 after starting exercise after being sure my kidneys were fine again at a consistent GFR over 110.Then a month ago, I got a very bad case of flu. The lower rib pain came back bad. I dismissed it as flu. Recovered from it, then had several days where every muscle in my body felt like it had been lifting heavy weights for days. Everything hurt, and doc said maybe mild myositis from flu. Then I noticed urinary changes. I normally have frequent urination, going a few times a night and usually at least every hour or more. No one can find a cause though. But suddenly not going at night at all and only going like 3 times in the day. Started having white flecks in urine sometimes and strong odor. Then urinalysis started showing blood in urine consistently. Then sharp pains in urethra all the way to anus at times, which I'd had before as well. I have brown vaginal discharge too. A few days ago, I couldn't pee at all and was sent to the er. They can find no reason for my symptoms...nothing on ct, no bacteria in culture, no stones, no nothing. No one knows, but I had to have a foley catheter inserted (was very painful like stabbing) because I had retention and could not pee. Was sent home with it and had it removed next day and I was able to pee again but then developed pitting edema. It's currently grade 1. No cause can be found.I will add in case it is relevant, just before the flu, my pcm referred me to neurology for mris of head and spine and nerve conduction test. I've been having nerve pain for several months. Buzzing, tingling, numbness, shocks, in various places for sustained periods and sometimes just sudden and then goes away. She was thinking the lower rib cage pain may actually be nerve pain since it feels burning at times like the burning headaches in the base of my skull and my neck. My thyroid is sometimes hypo but usually fine, my b12 and magnesium are normal, and I do not have any markers of diabetes other than just being fat currently. My grandma has MS, which she believes was healed by Jesus, but I know enough about it to know that's what she's trying to rule out I'm pretty sure.Can anyone, please , give me some insight about what might be wrong with me? I'm in so much pain with the gnawing, burning pain in the bottom of my ribcage and the electric shock pains in my urethra and anus, and I am so scared of the fact I've got urinary bleeding, vaginal bleeding, and putting edema but no one knows what's up. I've seen rheumatology, nephrology, urology, obgyn, even was sent to a hematology oncologist as a hail-mary.I stay away from Googleing anything because for one, I have too many symptoms to easily fit in a search bar, and I know there's no good coming out of looking at it anyway. I have gotten better care since changing hospital systems after last time this happened, the urologist I saw kept insisting the blood in my urine was from my vagina even though I still had blood in my urine after a catheter was used to sample, and I e just had a really hard time getting docs to push to figure out what's wrong. It feels like since I don't appear to be imminently dying, and they dismiss my pain and exhaustion, no one sees a point in helping.So sorry for the long post but I'm just trying to give as much context as I can. Please let me know if you have any questions as I'm happy to answer.. ### Response: In the absence of objective findings on imaging and testing, it is possible that weight in itself can cause the multi-system problems that you have. Obesity unfortunately affects numerous organ systems in subtle ways initially..


Instruction: Can someone decipher my hematology panel?Age: 36Gender: MaleWeight: 88kgs, Height, 175cmsLocation: CanadaEthnicity: SE AsianMeds: 40mg Pantaprazole 2x a dayGot some bw done recently for stomach pains, crazy ACID reflux nausea, bloating and right sided flank pain. Seeing my GP on Sunday, but wanted some ideas in the mean time.Image at link below:https://imgur.com/GaF9PCg

Output: To me it looks like iron deficiency

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can someone decipher my hematology panel?Age: 36Gender: MaleWeight: 88kgs, Height, 175cmsLocation: CanadaEthnicity: SE AsianMeds: 40mg Pantaprazole 2x a dayGot some bw done recently for stomach pains, crazy ACID reflux nausea, bloating and right sided flank pain. Seeing my GP on Sunday, but wanted some ideas in the mean time.Image at link below:https://imgur.com/GaF9PCg. ### Response: To me it looks like iron deficiency.


Instruction: Thanks. That's kind of what I gathered from my uneducated Googling, but I just don't have any fatigue, brittle nails, hair etc. The only symptoms of worry (which started this whole thing) have been crazy acid reflux, nausea , bloatedness, abdominal aches and pains and sharp flank pains.

Output: The deficiency isnt big enough yet to affect your hb more something to be aware ofThe other symptoms sounds like something else. Consider this probable iron deficiency as an accidental find during tests

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks. That's kind of what I gathered from my uneducated Googling, but I just don't have any fatigue, brittle nails, hair etc. The only symptoms of worry (which started this whole thing) have been crazy acid reflux, nausea , bloatedness, abdominal aches and pains and sharp flank pains.. ### Response: The deficiency isnt big enough yet to affect your hb more something to be aware ofThe other symptoms sounds like something else. Consider this probable iron deficiency as an accidental find during tests.


Instruction: Multiple diagnostic tests and still no answers.Hi there! I am just looking for any answer, preferably from someone who has a background in hematology? I am a 29 year old female, and was hospitalized for an unknown illness in April (fever, chills, all over body aches). The doctors ran many tests (HIV, mono, Covid, Flu, RSV, blood cultures, abdominal CT, pelvic exam, pelvic ultrasound, CBC tests, etc.) and still were not able to find what was causing my symptoms. I worked with an internal medicine specialist after my hospitalization because I continued to get sick and have fevers every couple of weeks until July. She ended up testing me for many infectious diseases and they were negative (with the exception of EBV, but this didn't look like something new). Also tested me for an ANA marker (negative). Her biggest concern were my elevated platelets and WBC. She noticed these had been elevated for >6 months. I had a peripheral blood smear and saw slight leukocytosis with left-shifted neutrophilia and monocytosis, slight thrombocytosis with normal platelet morphology. No abnormal circulating cell populations identified.She referred me to a hematologist who I have been working with but still no answers. The hematologist tested me for a JAK2 mutation (negative), CALR mutation (negative), BCR-ABL (negative), and redid my CBC count. She had been thinking potentially essential thrombocythemia (ET). This time my reticulocytes are elevated and my circulating antibodies are elevated. I do not have an iron deficiency. My WBC and platelets continue to be elevated and they ran another peripheral blood smear with similar findings. Everything seems to point to "favor reactive/inflammatory". However, in looking through my historical lab reports, we can see this blood work has actually been a pattern for the past 9 years! I have begged her to do a bone marrow biopsy just to triple check for ET or other MPNs because it seems that about 50% of patients with ET have no genetic mutation but she said no. I just feel like I need to know why my bone marrow is pumping out immature blood cells and extras of others. Now she's referring me to a rheumatologist and I don't understand why except that I may have chronic inflammation. I have no joint/muscle/bone pain, my ANA marker test was negative. Could it potentially be something like autoimmune hemolytic anemia since my reticulocytes are elevated and antibodies?I'm just so tired of being dismissed by doctors over the years and not having answers. I am so exhausted all the time. I just want someone else to give me another opinion or potential ideas for new avenues to explore. I am following up with the hematologist in January and have an appointment with a rheumatologist that same week, hoping to get in earlier if someone cancels.Thank you so much in advance.

Output: Were you tested for a mutation in a gene called MPL?Does your peripheral blood still show a left shift, or has that resolved?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Multiple diagnostic tests and still no answers.Hi there! I am just looking for any answer, preferably from someone who has a background in hematology? I am a 29 year old female, and was hospitalized for an unknown illness in April (fever, chills, all over body aches). The doctors ran many tests (HIV, mono, Covid, Flu, RSV, blood cultures, abdominal CT, pelvic exam, pelvic ultrasound, CBC tests, etc.) and still were not able to find what was causing my symptoms. I worked with an internal medicine specialist after my hospitalization because I continued to get sick and have fevers every couple of weeks until July. She ended up testing me for many infectious diseases and they were negative (with the exception of EBV, but this didn't look like something new). Also tested me for an ANA marker (negative). Her biggest concern were my elevated platelets and WBC. She noticed these had been elevated for >6 months. I had a peripheral blood smear and saw slight leukocytosis with left-shifted neutrophilia and monocytosis, slight thrombocytosis with normal platelet morphology. No abnormal circulating cell populations identified.She referred me to a hematologist who I have been working with but still no answers. The hematologist tested me for a JAK2 mutation (negative), CALR mutation (negative), BCR-ABL (negative), and redid my CBC count. She had been thinking potentially essential thrombocythemia (ET). This time my reticulocytes are elevated and my circulating antibodies are elevated. I do not have an iron deficiency. My WBC and platelets continue to be elevated and they ran another peripheral blood smear with similar findings. Everything seems to point to "favor reactive/inflammatory". However, in looking through my historical lab reports, we can see this blood work has actually been a pattern for the past 9 years! I have begged her to do a bone marrow biopsy just to triple check for ET or other MPNs because it seems that about 50% of patients with ET have no genetic mutation but she said no. I just feel like I need to know why my bone marrow is pumping out immature blood cells and extras of others. Now she's referring me to a rheumatologist and I don't understand why except that I may have chronic inflammation. I have no joint/muscle/bone pain, my ANA marker test was negative. Could it potentially be something like autoimmune hemolytic anemia since my reticulocytes are elevated and antibodies?I'm just so tired of being dismissed by doctors over the years and not having answers. I am so exhausted all the time. I just want someone else to give me another opinion or potential ideas for new avenues to explore. I am following up with the hematologist in January and have an appointment with a rheumatologist that same week, hoping to get in earlier if someone cancels.Thank you so much in advance.. ### Response: Were you tested for a mutation in a gene called MPL?Does your peripheral blood still show a left shift, or has that resolved?.


Instruction: Hi! I wasnt tested for an MPL mutation, just CALR, JAK2, and BCR-ABL. The left shift was still there in my last blood test in late September. Not sure if it has been a left shift the whole time but in my past records (over 9 yes) my WBC is almost always elevated in addition to my platelets.

Output: You might try asking for a MPL mutation test (can be done from DNA extracted from your peripheral blood or bone marrow aspirate). Also, do you know if your CALR test was done by PCR and electrophoresis, or sequencing (i.e., next generation sequencing, NGS)? The PCR + electrophoresis method can usually identify but not characterize atypical mutations (i.e., not type 1 or type 2), whereas NGS can identify and characterize any mutations. Only about 1/8 of essential thrombocythemias are "triple negative" (lacking mutations in JAK2, CALR, and MPL).Another angle would be trying again to get a bone marrow biopsy and see what that shows.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hi! I wasnt tested for an MPL mutation, just CALR, JAK2, and BCR-ABL. The left shift was still there in my last blood test in late September. Not sure if it has been a left shift the whole time but in my past records (over 9 yes) my WBC is almost always elevated in addition to my platelets.. ### Response: You might try asking for a MPL mutation test (can be done from DNA extracted from your peripheral blood or bone marrow aspirate). Also, do you know if your CALR test was done by PCR and electrophoresis, or sequencing (i.e., next generation sequencing, NGS)? The PCR + electrophoresis method can usually identify but not characterize atypical mutations (i.e., not type 1 or type 2), whereas NGS can identify and characterize any mutations. Only about 1/8 of essential thrombocythemias are "triple negative" (lacking mutations in JAK2, CALR, and MPL).Another angle would be trying again to get a bone marrow biopsy and see what that shows..


Instruction: What are your thoughts on the left shift?

Output: That's nonspecific. Causes could range from an infectious process, an autoimmune process, a malignant process, or none of the above.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What are your thoughts on the left shift?. ### Response: That's nonspecific. Causes could range from an infectious process, an autoimmune process, a malignant process, or none of the above..


Instruction: Oh okay I see. Thank you! Did you see my other comment about the CALR test type?

Output: Yeah -- so it's almost certain you don't have a classic CALR mutation (type 1 or type 2) but some small possibility remains you have an atypical one.If you end up getting a bone marrow biopsy done by someone (you can always ask the rheumatologist to order one and see what they say), you can always try to get a comprehensive NGS panel done on the resulting sample. Depending on who your healthcare system contracts with, this is usually a 50-75 gene panel that would include JAK2, CALR, and MPL, as well as various other genes commonly mutated in myeloid malignancies. It could still be negative, though -- about 1/4 to 1/3 of the NGS panel cases I sign out are negative. Hopefully this is something your insurance would pay for, as this is a very pricy test.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Oh okay I see. Thank you! Did you see my other comment about the CALR test type?. ### Response: Yeah -- so it's almost certain you don't have a classic CALR mutation (type 1 or type 2) but some small possibility remains you have an atypical one.If you end up getting a bone marrow biopsy done by someone (you can always ask the rheumatologist to order one and see what they say), you can always try to get a comprehensive NGS panel done on the resulting sample. Depending on who your healthcare system contracts with, this is usually a 50-75 gene panel that would include JAK2, CALR, and MPL, as well as various other genes commonly mutated in myeloid malignancies. It could still be negative, though -- about 1/4 to 1/3 of the NGS panel cases I sign out are negative. Hopefully this is something your insurance would pay for, as this is a very pricy test..


Instruction: Do I have hepatitis b? [Lab Results]Hi there, I just recently started going to the VA and they did a lot of blood test on me. I will l double check with my PCP but to be frank, I would like a second opinion either way.Does the below indicate that I am positive for hep b, and it seems as though I've contracted it within the last 6 months. Is this accurate?Mandatory stats: 36M, 5'10", 230lbs, white, no existing medical issues with STDs except I have HPV, no medication, moderate drinker, smoke cannabis moderately. USA.Lab Test: Hepatitis PanelLab Type: Chemistry/HematologyOrdering Provider: [REDACTED]Ordering Location: [REDACTED]Specimen: Serum (substance)Date/Time Collected: 30 Sep 2022 @ 1305Collected Location: [REDACTED]-------------------------------------------------------------------------Test Name: HEPATITIS B SURFACE AbResult: POSITIVE Units: --Reference Range: Interpretation: Never infected with the virus (consider giving vaccine)HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - negativeHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - negativeInfection likely took place over the last six months and is still active.HEPATITIS B SURFACE Ag - POSITIVEHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- POSITIVEHEPATITIS B SURFACE Ab - negativeInfection likely took place over the past six months and is in theprocess of clearing.  A false-positive is another possibility(HIV-positive people with this particular test result should have theirHBV viral load checked).HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- POSITIVEHEPATITIS B SURFACE Ab - negativeInfection likely took place more than six months ago and has beensuccessfully controlled by the immune system.HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - POSITIVEThe vaccine was successfully given to prevent HBV infection.HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - negativeHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - POSITIVEChronic HBV InfectionHEPATITIS B SURFACE Ag - POSITIVEHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - negative Performing Location: [REDACTED]Status: Final----------------------Test Name: HEPATITIS B CORE TOTALResult: NEGATIVE Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Final----------------------Test Name: HEPATITIS B CORE IgMResult: --Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Pending----------------------Test Name: HEPATITIS B SURFACE AgResult: NEGATIVE Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Final=========================================================================

Output: Vaccinated and immune

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Do I have hepatitis b? [Lab Results]Hi there, I just recently started going to the VA and they did a lot of blood test on me. I will l double check with my PCP but to be frank, I would like a second opinion either way.Does the below indicate that I am positive for hep b, and it seems as though I've contracted it within the last 6 months. Is this accurate?Mandatory stats: 36M, 5'10", 230lbs, white, no existing medical issues with STDs except I have HPV, no medication, moderate drinker, smoke cannabis moderately. USA.Lab Test: Hepatitis PanelLab Type: Chemistry/HematologyOrdering Provider: [REDACTED]Ordering Location: [REDACTED]Specimen: Serum (substance)Date/Time Collected: 30 Sep 2022 @ 1305Collected Location: [REDACTED]-------------------------------------------------------------------------Test Name: HEPATITIS B SURFACE AbResult: POSITIVE Units: --Reference Range: Interpretation: Never infected with the virus (consider giving vaccine)HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - negativeHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - negativeInfection likely took place over the last six months and is still active.HEPATITIS B SURFACE Ag - POSITIVEHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- POSITIVEHEPATITIS B SURFACE Ab - negativeInfection likely took place over the past six months and is in theprocess of clearing.  A false-positive is another possibility(HIV-positive people with this particular test result should have theirHBV viral load checked).HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- POSITIVEHEPATITIS B SURFACE Ab - negativeInfection likely took place more than six months ago and has beensuccessfully controlled by the immune system.HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - POSITIVEThe vaccine was successfully given to prevent HBV infection.HEPATITIS B SURFACE Ag - negativeHEPATITIS B CORE TOTAL - negativeHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - POSITIVEChronic HBV InfectionHEPATITIS B SURFACE Ag - POSITIVEHEPATITIS B CORE TOTAL - POSITIVEHEPATITIS B CORE IgM --- negativeHEPATITIS B SURFACE Ab - negative Performing Location: [REDACTED]Status: Final----------------------Test Name: HEPATITIS B CORE TOTALResult: NEGATIVE Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Final----------------------Test Name: HEPATITIS B CORE IgMResult: --Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Pending----------------------Test Name: HEPATITIS B SURFACE AgResult: NEGATIVE Units: --Reference Range: Interpretation: -- Performing Location: [REDACTED]Status: Final=========================================================================. ### Response: Vaccinated and immune.


Instruction: Nutritional advice regarding protein shakes/liquid dietHi guys! Im not really sure if this is the right place to post this, but I figured its worth a shot:) Im 22 female, 53 and about 220lbs (yes Im overweight, yes Im working on it, Ive lost 20lbs in the last 4 or so months) with autism and ARFID, I was also recently diagnosed with PCOS. Im currently only taking yaz birth control. Ive struggled with eating/wanting to eat since high school, and typically I only eat once a day because Im either not hungry or the thought of eating makes me feel sick. Recently, since I was diagnosed with pcos, Ive been placed on birth control. Ive noticed that I get hungrier faster than I used to, which isnt necessarily a bad thing. The issue is within an hour of eating, Im starving again. Ive just constantly felt empty but because im so hungry, I feel sick and cant eat, which obviously makes everything worse. My question is, since I dont have a nutritionist atm, and I have to go to the store Tuesday for groceries, if you guys had any recommendations on protein shakes or simple snacks that are super filling/cheap that I can get until I can work with someone on my diet? Im just so tired of feeling like this lmao

Output: Your weight and PCOS put you at risk for diabetes. Talk to your doctor about adding metformin to your regimen. Get screened for diabetes. In the meantime high protein/low carb diet will help, but dont do it for too long.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nutritional advice regarding protein shakes/liquid dietHi guys! Im not really sure if this is the right place to post this, but I figured its worth a shot:) Im 22 female, 53 and about 220lbs (yes Im overweight, yes Im working on it, Ive lost 20lbs in the last 4 or so months) with autism and ARFID, I was also recently diagnosed with PCOS. Im currently only taking yaz birth control. Ive struggled with eating/wanting to eat since high school, and typically I only eat once a day because Im either not hungry or the thought of eating makes me feel sick. Recently, since I was diagnosed with pcos, Ive been placed on birth control. Ive noticed that I get hungrier faster than I used to, which isnt necessarily a bad thing. The issue is within an hour of eating, Im starving again. Ive just constantly felt empty but because im so hungry, I feel sick and cant eat, which obviously makes everything worse. My question is, since I dont have a nutritionist atm, and I have to go to the store Tuesday for groceries, if you guys had any recommendations on protein shakes or simple snacks that are super filling/cheap that I can get until I can work with someone on my diet? Im just so tired of feeling like this lmao. ### Response: Your weight and PCOS put you at risk for diabetes. Talk to your doctor about adding metformin to your regimen. Get screened for diabetes. In the meantime high protein/low carb diet will help, but dont do it for too long..


Instruction: How many nutritional supplement drinks is it safe or wise to drink in a day?In the past several months I have experienced a significant (and possibly severe) reduction in my appetite. I'm just not hungry, and I can't force myself to eat without feeling sick. Which more often than not leads to me not eating for several days, usually without even realizing it. I also can't sleep at night.. yay me. But that's not what I am addressing here.I had someone tell me since I'm not eating as much as I should, I should drink those Ensure shakes to make up for some of the nutrients I am not getting. What I want to know is how many should I be drinking each day? Just one? I also got myself fruit and spinach and stuff to make some healthy smoothies. I'm trying to plan good meals to eat, but my lack of appetite is making that harder than it probably should be.Diagnosed: ADHD, low blood sugar, asthma, and depression Current meds: Singulair for asthma Female, 5'6", 130lbs

Output: They're designed nutritionally balanced so you just need to match the calories you need.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How many nutritional supplement drinks is it safe or wise to drink in a day?In the past several months I have experienced a significant (and possibly severe) reduction in my appetite. I'm just not hungry, and I can't force myself to eat without feeling sick. Which more often than not leads to me not eating for several days, usually without even realizing it. I also can't sleep at night.. yay me. But that's not what I am addressing here.I had someone tell me since I'm not eating as much as I should, I should drink those Ensure shakes to make up for some of the nutrients I am not getting. What I want to know is how many should I be drinking each day? Just one? I also got myself fruit and spinach and stuff to make some healthy smoothies. I'm trying to plan good meals to eat, but my lack of appetite is making that harder than it probably should be.Diagnosed: ADHD, low blood sugar, asthma, and depression Current meds: Singulair for asthma Female, 5'6", 130lbs. ### Response: They're designed nutritionally balanced so you just need to match the calories you need..


Instruction: Could lack of nutrition explain my (86F) Grandmother's poor health?I hope this is a relevant place to post this, I'm not sure which sub is best, but any opinions would be extremely welcome. Sorry for the long post.My Grandmother is 86 years old, lives in the UK and in the past 4 years has seen a tremendous downturn in her health and wellbeing. She suffererd a broken ankle 4 years ago abroad, and was put on a plane for a 9 hour flight home despite this so she could be treated for free in the UK. Shortly after she fell in the bathroom and hit her head, and her health has never even close to recovered since. Doctors have done every test they're willing to do on the NHS and they never find anything wrong.Those events certainly marked the start of her decline, but she is now getting much worse. She has no energy, often doesn't get out of bed, and is extremely unsteady on her feet. She describes this as being like a massive head rush where her legs simply give out every time she stands up. She can't cope with any situation outside of the absolute normal, is getting confused all the time but not in a way that reminds me of dementia. It's more that she simply doesn't seem to be able to think clearly or quickly. Her actual memory is generally ok. She is on Bisoprolol for a heart condition, and otherwise just vitamins.I do her shopping for her every week, and it's a constant argument. She wants me to buy enough food for MAYBE 2 days at most every week. I buy her more but it often just gets put in the freezer or goes out of date. She insists she eats plenty, but I simply can't see this being true. She weighs about 6.5 stone and hasn't got an ounce of fat on her body, she is scared to drink because of having to get to the toilet also.I don't live with her so I can't say for sure how much she eats, but it's can't be much at all. A brioche roll in the morning, a cake or something in the afternoon at most, abd no more than half a small ready meal on the evening, but again, I only buy her maybe 3 days worth of meals at most and they're often uneaten.She is beyond frustrated that she is just getting worse and worse, but I can't help but think the answer may be as simple as she is almost always nearly starving. She is a very stubborn person and refuses to even try to just eat more, or even try to sip a nutrient rich shake or something just to see if it helps. She talks like a person with a weight disorder to be perfectly honest.I appreciate that most of this stuff sounds like she's just old, but she's declining so rapidly, I just want to try anything that gets her even a small amount of quality of life back. I hope this is somewhere within the accepted rules of the sub, any opinions would be appreciated. Thanks.

Output: Fractures are a huge risk factor for older people, and her story is not uncommon. While her poor food intake might make the decline worse, the relationship might be the other way around: she's feeling poorly and therefore has lost her appetite.I'd recommend you have a chat with her and her doctor first, where you bring up your concerns. It's also not uncommon for older people to be reluctant to discuss these kinds of issues with their doctors and family members to avoid "being a bother" or feeling like a burden. The issue is that those little things pile up quickly, and if they aren't taken care of, they become bigger problems. It might be best then of you bring them up, but keep in mind that she might be embarrassed. I am concerned about the dosage of her bisoprolol, as the feeling of her legs suddenly giving out might be a sign that she needs a lower dose or perhaps a different medication all together, but if she hasn't mentioned it to her GP then they wouldn't be aware of it. It might also be time to discuss perhaps getting a carer for a few hours every day, to ensure she's eating and reduce her risk of falling or getting UTIs from avoiding the toilet.It is important to remember that your gran is an adult, and so long as her mind is still all there, she can make her own decisions, even when neither you nor her doctor agree with her. Losing whatever control she has over her life, be that over her food or her medical care, could have a much bigger impact to her wellbeing than what you're perceiving from her intake right now, so all of these conversations need to be approached tactfully and keeping her as the decision maker.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Could lack of nutrition explain my (86F) Grandmother's poor health?I hope this is a relevant place to post this, I'm not sure which sub is best, but any opinions would be extremely welcome. Sorry for the long post.My Grandmother is 86 years old, lives in the UK and in the past 4 years has seen a tremendous downturn in her health and wellbeing. She suffererd a broken ankle 4 years ago abroad, and was put on a plane for a 9 hour flight home despite this so she could be treated for free in the UK. Shortly after she fell in the bathroom and hit her head, and her health has never even close to recovered since. Doctors have done every test they're willing to do on the NHS and they never find anything wrong.Those events certainly marked the start of her decline, but she is now getting much worse. She has no energy, often doesn't get out of bed, and is extremely unsteady on her feet. She describes this as being like a massive head rush where her legs simply give out every time she stands up. She can't cope with any situation outside of the absolute normal, is getting confused all the time but not in a way that reminds me of dementia. It's more that she simply doesn't seem to be able to think clearly or quickly. Her actual memory is generally ok. She is on Bisoprolol for a heart condition, and otherwise just vitamins.I do her shopping for her every week, and it's a constant argument. She wants me to buy enough food for MAYBE 2 days at most every week. I buy her more but it often just gets put in the freezer or goes out of date. She insists she eats plenty, but I simply can't see this being true. She weighs about 6.5 stone and hasn't got an ounce of fat on her body, she is scared to drink because of having to get to the toilet also.I don't live with her so I can't say for sure how much she eats, but it's can't be much at all. A brioche roll in the morning, a cake or something in the afternoon at most, abd no more than half a small ready meal on the evening, but again, I only buy her maybe 3 days worth of meals at most and they're often uneaten.She is beyond frustrated that she is just getting worse and worse, but I can't help but think the answer may be as simple as she is almost always nearly starving. She is a very stubborn person and refuses to even try to just eat more, or even try to sip a nutrient rich shake or something just to see if it helps. She talks like a person with a weight disorder to be perfectly honest.I appreciate that most of this stuff sounds like she's just old, but she's declining so rapidly, I just want to try anything that gets her even a small amount of quality of life back. I hope this is somewhere within the accepted rules of the sub, any opinions would be appreciated. Thanks.. ### Response: Fractures are a huge risk factor for older people, and her story is not uncommon. While her poor food intake might make the decline worse, the relationship might be the other way around: she's feeling poorly and therefore has lost her appetite.I'd recommend you have a chat with her and her doctor first, where you bring up your concerns. It's also not uncommon for older people to be reluctant to discuss these kinds of issues with their doctors and family members to avoid "being a bother" or feeling like a burden. The issue is that those little things pile up quickly, and if they aren't taken care of, they become bigger problems. It might be best then of you bring them up, but keep in mind that she might be embarrassed. I am concerned about the dosage of her bisoprolol, as the feeling of her legs suddenly giving out might be a sign that she needs a lower dose or perhaps a different medication all together, but if she hasn't mentioned it to her GP then they wouldn't be aware of it. It might also be time to discuss perhaps getting a carer for a few hours every day, to ensure she's eating and reduce her risk of falling or getting UTIs from avoiding the toilet.It is important to remember that your gran is an adult, and so long as her mind is still all there, she can make her own decisions, even when neither you nor her doctor agree with her. Losing whatever control she has over her life, be that over her food or her medical care, could have a much bigger impact to her wellbeing than what you're perceiving from her intake right now, so all of these conversations need to be approached tactfully and keeping her as the decision maker..


Instruction: Are 'superfood' nutrition supplements sufficient to keep my body from going into a nutritional deficit?27M. Occasional tobacco smoker. 5 foot 7.5 inches. Exercise regularly.Obviously, it's best to maintain a diverse and healthy diet filled with vegetables, fruits, meats, grains, nuts, etc.I'm well aware of that, but I've got a ton of other stuff in life going on that I'm trying to focus on, and diet is currently not my top priority. That being said, if I'm going to maintain a "minimally effective" dose of nutrients towards my diet - is taking a superfood supplement enough to stave off diseases, etc? Or would this be throwing a tiny bandaid over a gash?I eat mostly healthy foods, rice, meat, oatmeal, frozen fruits etc, but sometimes I just don't make the effort to eat enough fruits and vegetables. Mainly, there is a lack of diversity in the fruits I eat. I've heard that in general, you should try to eat diversely so you don't miss any crucial nutrients.Is supplementing with a nutritional powder like Green Vibrance from Vibrant Health or Vital Reds sufficient if I have somewhat of a healthy, but repetitive diet?

Output: With a good balanced diet (which you clearly have) there is absolutely nothing to be gained from vitamin supplements.The supplements are at best less effective than a regular diet, and have potential for harm. You should avoid using them unless recommended by a physician.The point of a good diet is less that there are definite nutrients needed and more that eating a variety of foods with non-caloric bulk reduces risk of weight gain and metabolic syndrome. Theres no evidence that supplements of specific vitamins are good for you without specific deficiency; theres no evidence for superfood supplements and very little to justify the super in so-called superfoods.Eating a perfect diet every day is not practically achievable for most people. Eating a good diet mostly is whats important.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Are 'superfood' nutrition supplements sufficient to keep my body from going into a nutritional deficit?27M. Occasional tobacco smoker. 5 foot 7.5 inches. Exercise regularly.Obviously, it's best to maintain a diverse and healthy diet filled with vegetables, fruits, meats, grains, nuts, etc.I'm well aware of that, but I've got a ton of other stuff in life going on that I'm trying to focus on, and diet is currently not my top priority. That being said, if I'm going to maintain a "minimally effective" dose of nutrients towards my diet - is taking a superfood supplement enough to stave off diseases, etc? Or would this be throwing a tiny bandaid over a gash?I eat mostly healthy foods, rice, meat, oatmeal, frozen fruits etc, but sometimes I just don't make the effort to eat enough fruits and vegetables. Mainly, there is a lack of diversity in the fruits I eat. I've heard that in general, you should try to eat diversely so you don't miss any crucial nutrients.Is supplementing with a nutritional powder like Green Vibrance from Vibrant Health or Vital Reds sufficient if I have somewhat of a healthy, but repetitive diet?. ### Response: With a good balanced diet (which you clearly have) there is absolutely nothing to be gained from vitamin supplements.The supplements are at best less effective than a regular diet, and have potential for harm. You should avoid using them unless recommended by a physician.The point of a good diet is less that there are definite nutrients needed and more that eating a variety of foods with non-caloric bulk reduces risk of weight gain and metabolic syndrome. Theres no evidence that supplements of specific vitamins are good for you without specific deficiency; theres no evidence for superfood supplements and very little to justify the super in so-called superfoods.Eating a perfect diet every day is not practically achievable for most people. Eating a good diet mostly is whats important..


Instruction: Nutrition questionI've been really good about monitoring calories, saturated fats, etc for a while and have lost quite a bit of weight. Is it wrong to splurge for a single night? I'll be having pizza with my folks and don't want to mess with my overall health.

Output: I am not in the slightest concerned about you eating pizza for the evening. What worries me is the general context here, what is your relationship with food like? How much do you weigh and how quickly are you losing weight? If you're counting calories, how many do you eat in a day?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nutrition questionI've been really good about monitoring calories, saturated fats, etc for a while and have lost quite a bit of weight. Is it wrong to splurge for a single night? I'll be having pizza with my folks and don't want to mess with my overall health.. ### Response: I am not in the slightest concerned about you eating pizza for the evening. What worries me is the general context here, what is your relationship with food like? How much do you weigh and how quickly are you losing weight? If you're counting calories, how many do you eat in a day?.


Instruction: I keep getting quad cramps above the knee every time i go hiking. Is this a nutrition issue or just overall shape?Want to preface this by saying i plan to see a dr or even nutritionist next week. However right now I'm on a hiking trip, so just kind of hoping for any quick advice.I'm 30M in good shape and health, but cardio has never been huge for me. Lately I've been doing spin a few times a week trying to change that habit. I've been hiking for a few years and never had any issues until the past year or so. All of a sudden every single hike i do, once it starts to get challenging i get bad cramps in both my quads right above the knee on the inner side.I've been trying to totally change my hydration habits, drinking a lot before and during the hike. Gatorade before and during, even tried supplementing with those emergency electrolyte packs. No change.I know it's a long shot but anyone ever had this start to happen and figure out how to fix? Or is it just getting in better shape?

Output: Lack of calcium or potassium and dehydration is the most common cause- I dont think this needs a doctor but do take more than just a light supplement. A banana is actually perfect for preventing cramps.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I keep getting quad cramps above the knee every time i go hiking. Is this a nutrition issue or just overall shape?Want to preface this by saying i plan to see a dr or even nutritionist next week. However right now I'm on a hiking trip, so just kind of hoping for any quick advice.I'm 30M in good shape and health, but cardio has never been huge for me. Lately I've been doing spin a few times a week trying to change that habit. I've been hiking for a few years and never had any issues until the past year or so. All of a sudden every single hike i do, once it starts to get challenging i get bad cramps in both my quads right above the knee on the inner side.I've been trying to totally change my hydration habits, drinking a lot before and during the hike. Gatorade before and during, even tried supplementing with those emergency electrolyte packs. No change.I know it's a long shot but anyone ever had this start to happen and figure out how to fix? Or is it just getting in better shape?. ### Response: Lack of calcium or potassium and dehydration is the most common cause- I dont think this needs a doctor but do take more than just a light supplement. A banana is actually perfect for preventing cramps..


Instruction: Internist advised to go to hospital for nutrition but when?Hello,22year old female who has been vomiting for the past 13 days. Was referred to an internist. He has referred me to a gastroenterologist.The internist was concerned about my nutrition intake and told me I may have to go to the hospital for some type of supplemental nutrition. I asked him when but he was vague about it, and said I would feel shitty.Well, Ive felt shitty for a while, and was wondering at one point I would need to go for some type of supplemental nutrition. Have been vomiting all food for 13 days, and some fluids. Have lost weight (do not have a scale), but clothes are loose, and I track my calories and last week averaged 150 cals and this week averaged 300.I did have to pick up a prescription today and discussed it with the pharmacist who advised me to go, but I was hoping I could also get a doctors opinion since I would prefer not to go to the hospital if I do not have to.Thanks!

Output: I would go today. 300 calories a day is not sustainable and your *body will be taking damage from that.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Internist advised to go to hospital for nutrition but when?Hello,22year old female who has been vomiting for the past 13 days. Was referred to an internist. He has referred me to a gastroenterologist.The internist was concerned about my nutrition intake and told me I may have to go to the hospital for some type of supplemental nutrition. I asked him when but he was vague about it, and said I would feel shitty.Well, Ive felt shitty for a while, and was wondering at one point I would need to go for some type of supplemental nutrition. Have been vomiting all food for 13 days, and some fluids. Have lost weight (do not have a scale), but clothes are loose, and I track my calories and last week averaged 150 cals and this week averaged 300.I did have to pick up a prescription today and discussed it with the pharmacist who advised me to go, but I was hoping I could also get a doctors opinion since I would prefer not to go to the hospital if I do not have to.Thanks!. ### Response: I would go today. 300 calories a day is not sustainable and your *body will be taking damage from that..


Instruction: (1) In general hypoechoic lesion worst than hyperechoic?(2) I've been taking supplements such as Vit-D (2000IU almost 4 times a week), NAC and Zinc (once in a while) to avoid Covid based on what i've read. I also take whey protein/collagen at times for recovery after the run/weights. I've been reading taking too much protein or anti-oxidants can also cause cancer? Please comment if anti-oxidants can actually cause reverse damage?(3) I know ultrasound is safe in general, but what are your comments/thoughts on heat on the organs if i go for scan once every year. The radiologist scanned 15 minutes on my liver which was bit too much IMO(4) Would you recommend me to go for MRI? I know MRI are safe (no radiation), but again those Radio Frequency, no one knows how it impacts us in the long run?As you can read, i am anxious and hypochondriac. Would love to read your thoughts and comments.PS - Scan if you want to see https://imgur.com/a/GofAWbX

Output: Hypoechoic is generally better and a cyst, but it depends on the actual look and situation. Hemangiomas are benign.Antioxidants seem to help, but there's not enough knowledge to say how much. (Maybe my own knowledge). That being said, antioxidants don't negate bad habits like smoking, alcohol, etc. Better diets and habits are the main way to reverse damage. There's a lot of literature easily found regarding epithelial oxidative injury. Too much anything seems to be bad. Water, protein, oxygen, etc etc.Ultrasound is considered safe. It is used on babies' brains if that helps you feel better.You should get an MRI if the impression on your scan says that the lesions need that kind of evaluation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: (1) In general hypoechoic lesion worst than hyperechoic?(2) I've been taking supplements such as Vit-D (2000IU almost 4 times a week), NAC and Zinc (once in a while) to avoid Covid based on what i've read. I also take whey protein/collagen at times for recovery after the run/weights. I've been reading taking too much protein or anti-oxidants can also cause cancer? Please comment if anti-oxidants can actually cause reverse damage?(3) I know ultrasound is safe in general, but what are your comments/thoughts on heat on the organs if i go for scan once every year. The radiologist scanned 15 minutes on my liver which was bit too much IMO(4) Would you recommend me to go for MRI? I know MRI are safe (no radiation), but again those Radio Frequency, no one knows how it impacts us in the long run?As you can read, i am anxious and hypochondriac. Would love to read your thoughts and comments.PS - Scan if you want to see https://imgur.com/a/GofAWbX. ### Response: Hypoechoic is generally better and a cyst, but it depends on the actual look and situation. Hemangiomas are benign.Antioxidants seem to help, but there's not enough knowledge to say how much. (Maybe my own knowledge). That being said, antioxidants don't negate bad habits like smoking, alcohol, etc. Better diets and habits are the main way to reverse damage. There's a lot of literature easily found regarding epithelial oxidative injury. Too much anything seems to be bad. Water, protein, oxygen, etc etc.Ultrasound is considered safe. It is used on babies' brains if that helps you feel better.You should get an MRI if the impression on your scan says that the lesions need that kind of evaluation..


Instruction: How quickly can you develop nutrition-based anemia?Thanks to lockdown and a breakup, something I thought never possible happened--I (28/F) began relapsing into anorexia, which I recovered from several years ago. For the past month, my diet has cratered, generally hitting 700-1000 calories a day. What I do eat is horrible--popcorn, Clif bars, and protein shakes. That's it--no other foods. Needless to say, I have lost a significant amount of weight, and I was thin to begin with. (For reference, I'm 5'2 and am 99 lb now--I was about 105 before).I run for 30 min 4x a week. Lately it has become harder and harder; my heart rate skyrockets, and I tire quickly. Is it possible for anemia to have set in due to poor diet already? I've struggled with that in the past due to the ED, with similar symptoms.(To be clear, I *know* I have to address my eating disorder; I am not so naive as to reduce the problem here to just anemia. I've done this rodeo before; I've already hit the weight I said I would stop at, and of course I am still restricting, because that's just how EDs work. I am seeking therapeutic help.)

Output: It will be hard to tell you that and honestly probably easier to just get your labs checked. In theory, yes, it can happen but it would require a lot of conditional circumstances existing prior to this month to tip you over. In reality, probably not:You need to be iron deficient prior to this month so that your body can't make adequate RBCs this monthYour blood cells typically last up to 120 days, so you shouldn't drop significantly in a single month under normal circumstances even if iron deficientYou are female and if menstruating, that could be a source but usually it isn't enough in a single month (unless you were anemic to begin with or severely iron deficient to begin with or heavy menses)Honestly, your fatigue, heart rate, exercise intolerance is probably due to your inadequate caloric intake and your body trying to preserve energy (and breaking down your body fat/muscle)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How quickly can you develop nutrition-based anemia?Thanks to lockdown and a breakup, something I thought never possible happened--I (28/F) began relapsing into anorexia, which I recovered from several years ago. For the past month, my diet has cratered, generally hitting 700-1000 calories a day. What I do eat is horrible--popcorn, Clif bars, and protein shakes. That's it--no other foods. Needless to say, I have lost a significant amount of weight, and I was thin to begin with. (For reference, I'm 5'2 and am 99 lb now--I was about 105 before).I run for 30 min 4x a week. Lately it has become harder and harder; my heart rate skyrockets, and I tire quickly. Is it possible for anemia to have set in due to poor diet already? I've struggled with that in the past due to the ED, with similar symptoms.(To be clear, I *know* I have to address my eating disorder; I am not so naive as to reduce the problem here to just anemia. I've done this rodeo before; I've already hit the weight I said I would stop at, and of course I am still restricting, because that's just how EDs work. I am seeking therapeutic help.). ### Response: It will be hard to tell you that and honestly probably easier to just get your labs checked. In theory, yes, it can happen but it would require a lot of conditional circumstances existing prior to this month to tip you over. In reality, probably not:You need to be iron deficient prior to this month so that your body can't make adequate RBCs this monthYour blood cells typically last up to 120 days, so you shouldn't drop significantly in a single month under normal circumstances even if iron deficientYou are female and if menstruating, that could be a source but usually it isn't enough in a single month (unless you were anemic to begin with or severely iron deficient to begin with or heavy menses)Honestly, your fatigue, heart rate, exercise intolerance is probably due to your inadequate caloric intake and your body trying to preserve energy (and breaking down your body fat/muscle).


Instruction: Anemia isnt the only potential issue here. All your cells in your body need food for energy. If you are using much more energy then you are putting in to your body, you're gonna run out of energy. You're starving yourself. Like when someone is ill from starvation. Just slightly slower.

Output: Possible, but it's more likely that there are other factors contributing to your easy fatigue, such as dehydration and overall lack of metabolic fuel due to your restricting. While you're seeking help, I think it would be advisable to cut down on your exercise regime as well.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Anemia isnt the only potential issue here. All your cells in your body need food for energy. If you are using much more energy then you are putting in to your body, you're gonna run out of energy. You're starving yourself. Like when someone is ill from starvation. Just slightly slower.. ### Response: Possible, but it's more likely that there are other factors contributing to your easy fatigue, such as dehydration and overall lack of metabolic fuel due to your restricting. While you're seeking help, I think it would be advisable to cut down on your exercise regime as well..