Instruction: NAD but I've worked in potato warehouses for many years, and also spent days shovelling out rotten potatoes in enclosed spaces.. I've never had an issue so I found it kind of weird to have these symptoms without ingestionWhen were you near the rotten potatoes? At the beginning you said it was in the last few days but later on it said the last few weeks.Temperatures above 98.6 and below 100.4 are considered mild fevers. Ive had one for a few months now. Your temperature is nothing to worry about unless it goes to 103 or above or if it lasts longer than a week.Symptoms of solanine poisoning are mainly gastrointestinal and neurological. Symptoms usually appear in 8-12 hours and go away in 24-72 hours. It is also only considered to be toxic if it is ingested through food or drink.

Output: Temperatures below 100.4 are normal and not considered mild fevers. You are not having a mild fever for months, youre having a normal body temperature.Anything above 100.4 is considered a fever

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: NAD but I've worked in potato warehouses for many years, and also spent days shovelling out rotten potatoes in enclosed spaces.. I've never had an issue so I found it kind of weird to have these symptoms without ingestionWhen were you near the rotten potatoes? At the beginning you said it was in the last few days but later on it said the last few weeks.Temperatures above 98.6 and below 100.4 are considered mild fevers. Ive had one for a few months now. Your temperature is nothing to worry about unless it goes to 103 or above or if it lasts longer than a week.Symptoms of solanine poisoning are mainly gastrointestinal and neurological. Symptoms usually appear in 8-12 hours and go away in 24-72 hours. It is also only considered to be toxic if it is ingested through food or drink.. ### Response: Temperatures below 100.4 are normal and not considered mild fevers. You are not having a mild fever for months, youre having a normal body temperature.Anything above 100.4 is considered a fever.


Instruction: This is just a question but my normal temp is 97.6. Would 100.4 not be considered a fever? Or does that 100.4 go from possible normal temps and not the average body temp? Usually if my body is 3 degrees warmer than normal I don't feel well etc.

Output: Hi friend, no that wouldn't be considered a fever. The body has a much greater range of normal temperature in general than people who use the empiric system believe. "98.6" is actually the direct translation of 37 C into fahrenheit. In celsius, (which is how medicine measures temperatures, even in the USA), fever starts at 38 degrees. That directly translates to 100.4. (That's why a temp of 99 is not actually a fever.) Though it appears higher than the 98.6 we're used to hearing, it's actually well within normal limits.The usual frame I'm used to is 36.5-38 as sort of the guidelines. Your temperature of 97.6 translates to 36.4444. My guess for that is just that temperatures taken outside the body can be less accurate. That's not a concerningly low temp to me; basically you fit well within the normal standards and you would not qualify as having a fever until you reached 38 (or 100.4)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This is just a question but my normal temp is 97.6. Would 100.4 not be considered a fever? Or does that 100.4 go from possible normal temps and not the average body temp? Usually if my body is 3 degrees warmer than normal I don't feel well etc.. ### Response: Hi friend, no that wouldn't be considered a fever. The body has a much greater range of normal temperature in general than people who use the empiric system believe. "98.6" is actually the direct translation of 37 C into fahrenheit. In celsius, (which is how medicine measures temperatures, even in the USA), fever starts at 38 degrees. That directly translates to 100.4. (That's why a temp of 99 is not actually a fever.) Though it appears higher than the 98.6 we're used to hearing, it's actually well within normal limits.The usual frame I'm used to is 36.5-38 as sort of the guidelines. Your temperature of 97.6 translates to 36.4444. My guess for that is just that temperatures taken outside the body can be less accurate. That's not a concerningly low temp to me; basically you fit well within the normal standards and you would not qualify as having a fever until you reached 38 (or 100.4).


Instruction: High Hematocrit with Low iron. Should I see hematology ASAP or continue further investigations?Hematocrit peaked at 47.5 this year. (Normal high range is 44)Currently Ferritin is 9. (Normal range 16-165)37f. Af Am. 59. 140lbs.Problems.Persistent headache. Severe abdominal pain. Raynauds without spasm - hands stay cold. Severe chest pain. Abnormal EKG (compared to previous) w/t wave inversions. Intermittent claudication with 0.7 ABI post exercise. Paresthesias. Sudden high blood pressure since my hematocrit went out of range. Fatigue. Night sweats. Sudden high blood pressure when hematocrit went up to 46. 12 yrs ago, retinal detachment left and tears/holes both eyes retina surgeon can be signs of microvascular/hematology issues.Meds.Continuous BCP 12 years bc of heavy bleeding. Amlodopine off label for poor circulation in legs/hands.Saw a hematologist and they declined to test for JAK2 mutation for polycythemia Vera because hematocrit wasnt that high and EPO was low normal 3.2.Unlikely sleep apnea. Live at 100ft above sea level. Dont smoke. Changed houses since hematocrit started climbing years ago, so carbon monoxide unlikely. Drink a gallon of water daily. 3 cardiologists say I do not have a heart or cardiopulmonary problem. Entire body has been imaged neck down for large vessel blockages. Neurologist did EMG and entire spine has been imaged for paresthesias. All normal.Should I continue the endless investigations? I have GI, rheumatology appts scheduled.See hematology ASAP?Take an iron supplement and see if I feel better?

Output: I dont think you need workup at all

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: High Hematocrit with Low iron. Should I see hematology ASAP or continue further investigations?Hematocrit peaked at 47.5 this year. (Normal high range is 44)Currently Ferritin is 9. (Normal range 16-165)37f. Af Am. 59. 140lbs.Problems.Persistent headache. Severe abdominal pain. Raynauds without spasm - hands stay cold. Severe chest pain. Abnormal EKG (compared to previous) w/t wave inversions. Intermittent claudication with 0.7 ABI post exercise. Paresthesias. Sudden high blood pressure since my hematocrit went out of range. Fatigue. Night sweats. Sudden high blood pressure when hematocrit went up to 46. 12 yrs ago, retinal detachment left and tears/holes both eyes retina surgeon can be signs of microvascular/hematology issues.Meds.Continuous BCP 12 years bc of heavy bleeding. Amlodopine off label for poor circulation in legs/hands.Saw a hematologist and they declined to test for JAK2 mutation for polycythemia Vera because hematocrit wasnt that high and EPO was low normal 3.2.Unlikely sleep apnea. Live at 100ft above sea level. Dont smoke. Changed houses since hematocrit started climbing years ago, so carbon monoxide unlikely. Drink a gallon of water daily. 3 cardiologists say I do not have a heart or cardiopulmonary problem. Entire body has been imaged neck down for large vessel blockages. Neurologist did EMG and entire spine has been imaged for paresthesias. All normal.Should I continue the endless investigations? I have GI, rheumatology appts scheduled.See hematology ASAP?Take an iron supplement and see if I feel better?. ### Response: I dont think you need workup at all.


Instruction: Why is that? Does anything need to be done about my ferritin levels?Im at Stage 3 iron deficiency.https://maryannjacobsen.com/wp-content/uploads/2021/02/Stages-of-iron-deficiency.png

Output: I mean you need iron but there's no workup needed for your blood count

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Why is that? Does anything need to be done about my ferritin levels?Im at Stage 3 iron deficiency.https://maryannjacobsen.com/wp-content/uploads/2021/02/Stages-of-iron-deficiency.png. ### Response: I mean you need iron but there's no workup needed for your blood count.


Instruction: My hematocrit is 10% over the expected high range for African American women. So the equivalent in a white male would be 55 range.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578165/table/T2/?report=objectonlyAt what percentage over the norm for my gender and race does it need workup?Or is the white male range the standard that has to be used for everyone?

Output: What's your hemoglobin? That isn't an abnormal hematocrit

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My hematocrit is 10% over the expected high range for African American women. So the equivalent in a white male would be 55 range.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578165/table/T2/?report=objectonlyAt what percentage over the norm for my gender and race does it need workup?Or is the white male range the standard that has to be used for everyone?. ### Response: What's your hemoglobin? That isn't an abnormal hematocrit.


Instruction: 15+ also above the 97.5 percentile for my gender and race according to the US National Institutes of Health.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578165/table/T2/?report=objectonlyIm asking. If doctors dont trust the national institutes of health guidelines, what is the guideline I should expect them to use for abnormal?Do I need to be in the white male range for abnormal?Do I need to take iron supplements to pop my red blood cell counts into the abnormal for a white male range?

Output: Just fyi there's no such thing as a NIH guideline. You're just quoting a table in a very low impact journal. Pubmed is the central database where most publications are stored. Usually when a publication only makes it to a low impact journal, that's because there are significant flaws in the study.Every lab that runs these tests have slightly different results and their own reference range.It's somewhat futile to go on a endless journey for mildly abnormal tests because unless there's major clinical consequences, chances are it's nothing. As you said yourself, you're above the 97.5% but that means 2.5% of the population has hemoglobins higher than that which is you.Anyway good luck

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 15+ also above the 97.5 percentile for my gender and race according to the US National Institutes of Health.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578165/table/T2/?report=objectonlyIm asking. If doctors dont trust the national institutes of health guidelines, what is the guideline I should expect them to use for abnormal?Do I need to be in the white male range for abnormal?Do I need to take iron supplements to pop my red blood cell counts into the abnormal for a white male range?. ### Response: Just fyi there's no such thing as a NIH guideline. You're just quoting a table in a very low impact journal. Pubmed is the central database where most publications are stored. Usually when a publication only makes it to a low impact journal, that's because there are significant flaws in the study.Every lab that runs these tests have slightly different results and their own reference range.It's somewhat futile to go on a endless journey for mildly abnormal tests because unless there's major clinical consequences, chances are it's nothing. As you said yourself, you're above the 97.5% but that means 2.5% of the population has hemoglobins higher than that which is you.Anyway good luck.


Instruction: Is this some kind of blood cancer?25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you.

Output: This is a murky situation because both resurgence of HIV as well as other infections could cause high lymphocytes. If HIV is still negative then Id worry more about another underlying viral infection. If lymphs remain high and keep going up then Id ask for hematology consult. Your ID doc might want to send off flow cytometry to rule out any ominous diagnoses in the meantime. I wouldnt be too concerned about percentage of CD4 cells. Just worry about absolute count which is fine. High lymphs is nothing concerning unless it keeps going up on repeat.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is this some kind of blood cancer?25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you.. ### Response: This is a murky situation because both resurgence of HIV as well as other infections could cause high lymphocytes. If HIV is still negative then Id worry more about another underlying viral infection. If lymphs remain high and keep going up then Id ask for hematology consult. Your ID doc might want to send off flow cytometry to rule out any ominous diagnoses in the meantime. I wouldnt be too concerned about percentage of CD4 cells. Just worry about absolute count which is fine. High lymphs is nothing concerning unless it keeps going up on repeat..


Instruction: How concerned should I be regarding leukemia, lymphoma or some other blood related cancer

Output: Id have absolutely no concern for these things with these labs

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How concerned should I be regarding leukemia, lymphoma or some other blood related cancer. ### Response: Id have absolutely no concern for these things with these labs.


Instruction: Just had new panel taken yesterday that just came back via Labcorp. Numbers are still wonky. Being referred to hematologist . Confused and terrified

Output: No reason to be terrified. Your lymphs might be high but they arent going up. Numbers are seemingly almost the exact same as last time within deviation. Heme will likely send flow cytometry off but your ID doc couldve done this to get the ball rolling. Still doesnt seem like anything ominous. Bad things come with really bad labs, multiple cell lines affected and usually metabolic abnormalities.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Just had new panel taken yesterday that just came back via Labcorp. Numbers are still wonky. Being referred to hematologist . Confused and terrified. ### Response: No reason to be terrified. Your lymphs might be high but they arent going up. Numbers are seemingly almost the exact same as last time within deviation. Heme will likely send flow cytometry off but your ID doc couldve done this to get the ball rolling. Still doesnt seem like anything ominous. Bad things come with really bad labs, multiple cell lines affected and usually metabolic abnormalities..


Instruction: Is this Lymphoma/ some type of Blood cancer25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you.

Output: See what the haematologists say but I wouldnt be particularly concerned if your CD4% is lower, because your absolute lymphocyte count is high. When your lymphocyte count comes down your CD4 % will increase. I dont know why your lymphocyte count is (a bit) higher than normal, but its not usually anything concerning.The most important thing is that you are continuously undetectable on HIV viral load.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is this Lymphoma/ some type of Blood cancer25.Male.HIV undetectable. My HIV provider is very concerned regarding abnormalities found repeatedly on my labs since the start of the year. Previously, my CD4 Poz Lymph usually stayed in the 30s range. However this past year, that range has consistently been dropping. First 22; then 19, and 16... Since last summer, I have had a full workup related to abdominal pain, migraines and muscle weakness/discomfort and current severe rectal pain. My provider has expressed her concern regarding this and has now referred me out for a hematology/oncology consult. There is a history of blood disorders including blood related cancers on my dads side of the family. Can you give me any insight or advice on what I may be dealing with here? It would be greatly appreciated. Thank you.. ### Response: See what the haematologists say but I wouldnt be particularly concerned if your CD4% is lower, because your absolute lymphocyte count is high. When your lymphocyte count comes down your CD4 % will increase. I dont know why your lymphocyte count is (a bit) higher than normal, but its not usually anything concerning.The most important thing is that you are continuously undetectable on HIV viral load..


Instruction: Help with CBC results?Im a 30y/o white female, 52, 138lbs. I used to stay very active, workout consistently. I never drink or smoke, and the only meds Im on is Fluoxetine 60mg for clinical OCD diagnosed several years ago.For the past 8 months I have had severe fatigue, breathlessness, irritability, exercise intolerance, sleep disturbances, heart palpitations and it seems I am constantly ill from flus or colds.Bloodwork initially showed low ferritin so we assumed it was that and did iron infusions. My b12, folate and T4 and Vitamin D were all normal. My reticulocyte count was quite low previous to the infusions and after treatment, its still low. From what my doctor understands, the absolute reticulocyte count should have risen substantially (even elevated) in response to the iron infusions as it would help my bone marrow get stimulated to make more red blood cells.Why would this be? My doctor is sending me to Hematology Oncology because she doesnt like the blood work results either, but my appointment is 2 months out due to living in a remote region of the country (US). Can anyone help me decipher what all this means? (I will put link to pic of labs)

Output: What date did you get an iron infusion.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Help with CBC results?Im a 30y/o white female, 52, 138lbs. I used to stay very active, workout consistently. I never drink or smoke, and the only meds Im on is Fluoxetine 60mg for clinical OCD diagnosed several years ago.For the past 8 months I have had severe fatigue, breathlessness, irritability, exercise intolerance, sleep disturbances, heart palpitations and it seems I am constantly ill from flus or colds.Bloodwork initially showed low ferritin so we assumed it was that and did iron infusions. My b12, folate and T4 and Vitamin D were all normal. My reticulocyte count was quite low previous to the infusions and after treatment, its still low. From what my doctor understands, the absolute reticulocyte count should have risen substantially (even elevated) in response to the iron infusions as it would help my bone marrow get stimulated to make more red blood cells.Why would this be? My doctor is sending me to Hematology Oncology because she doesnt like the blood work results either, but my appointment is 2 months out due to living in a remote region of the country (US). Can anyone help me decipher what all this means? (I will put link to pic of labs). ### Response: What date did you get an iron infusion..


Instruction: I got the 2 dose formulation. Once on 9/23 and again on 9/28

Output: This seems like pretty acceptable/normal lab variations then for such a short interval between lab testing and iron treatment.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I got the 2 dose formulation. Once on 9/23 and again on 9/28. ### Response: This seems like pretty acceptable/normal lab variations then for such a short interval between lab testing and iron treatment..


Instruction: What are your thoughts as to the Retic count being low?

Output: I think it's likely appropriate given the timing. But, I'm not the specialist. I wouldn't stress

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What are your thoughts as to the Retic count being low?. ### Response: I think it's likely appropriate given the timing. But, I'm not the specialist. I wouldn't stress.


Instruction: So sick Im afraid Ill die35F, white, 5'4" was generally healthy except for Ehlers Danlos and trauma-related mental health (being addressed) Was bitten several times by a mouse (no rash) and a month later, soon after having an operation of tubal ligation and IUD replacement (to stop periods) began having sporadic fevers. Thought it was due to surgical wound, took antibiotics, sporadic fevers continued. My surgical wounds are healing very slowly as in 6-8 weeks. This was October. December, elevated temp ranging from 99-101 every day. Shortness of breath, but chest CT showed healthy lungs. Nausea and weight loss but abdominal CT showed no problems. Persistent need to cough and clear throat and difficulty doing so, having to cough for a minute to clear it enough to talk.No one knows whats wrong. I now feel like Im dying. I dont say that to be cute, I feel like I need someone to watch me and Im scared. I have a hematology appt but its at the end of March and who knows if they can help me either.POSITIVE TESTS: mycoplasma hominis, ureaplasma urealyticum, SED rate 44 mm/hr and D-DIMER abnormal at 321 ng/mLIm taking doxycycline and am 2 days in and feel nothing.Negative tests done: CT scan of chest with contrast, ie no blood clots, Covid, CBC with platelet, mono, blood cx aer & an, urinalysis, panel hepatic function, lipase, cbc w pits/auto diff, chemistry labs, protein total serum, serum electrophoresis, TB test, ck total, rheumatoid factor, hiv, lactate, hs C-reactive protein, and sed rate ESR. All mostly within range.Help.EDIT some have said to add my meds, Im on a lot dont judge lolLexapro, Wellbutrin, Vraylar, Nuvigil, Provigil, Xywav, Glyco-whatever (the sweating pill), prazosin for nightmares, topamax, vit D, levothyroxine (thyroid just checked and normal), fiber, linzess, and I receive ketamine/lidocaine infusions but those started post-fevers

Output: Need clarification, the organisms that you listed, were they wound cultures, blood culture, sputum cultures?If wound cultures, were they superficial, deep, or tissue (in that they took a chunk of tissue to culture)D-dimer and ESR will both be elevated in infectious processes, although it would be odd for CRP to be normal

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: So sick Im afraid Ill die35F, white, 5'4" was generally healthy except for Ehlers Danlos and trauma-related mental health (being addressed) Was bitten several times by a mouse (no rash) and a month later, soon after having an operation of tubal ligation and IUD replacement (to stop periods) began having sporadic fevers. Thought it was due to surgical wound, took antibiotics, sporadic fevers continued. My surgical wounds are healing very slowly as in 6-8 weeks. This was October. December, elevated temp ranging from 99-101 every day. Shortness of breath, but chest CT showed healthy lungs. Nausea and weight loss but abdominal CT showed no problems. Persistent need to cough and clear throat and difficulty doing so, having to cough for a minute to clear it enough to talk.No one knows whats wrong. I now feel like Im dying. I dont say that to be cute, I feel like I need someone to watch me and Im scared. I have a hematology appt but its at the end of March and who knows if they can help me either.POSITIVE TESTS: mycoplasma hominis, ureaplasma urealyticum, SED rate 44 mm/hr and D-DIMER abnormal at 321 ng/mLIm taking doxycycline and am 2 days in and feel nothing.Negative tests done: CT scan of chest with contrast, ie no blood clots, Covid, CBC with platelet, mono, blood cx aer & an, urinalysis, panel hepatic function, lipase, cbc w pits/auto diff, chemistry labs, protein total serum, serum electrophoresis, TB test, ck total, rheumatoid factor, hiv, lactate, hs C-reactive protein, and sed rate ESR. All mostly within range.Help.EDIT some have said to add my meds, Im on a lot dont judge lolLexapro, Wellbutrin, Vraylar, Nuvigil, Provigil, Xywav, Glyco-whatever (the sweating pill), prazosin for nightmares, topamax, vit D, levothyroxine (thyroid just checked and normal), fiber, linzess, and I receive ketamine/lidocaine infusions but those started post-fevers. ### Response: Need clarification, the organisms that you listed, were they wound cultures, blood culture, sputum cultures?If wound cultures, were they superficial, deep, or tissue (in that they took a chunk of tissue to culture)D-dimer and ESR will both be elevated in infectious processes, although it would be odd for CRP to be normal.


Instruction: They were all blood tests! No wound cultures or sputum cultures

Output: Blood cultures? I'm still unsure how they got these organisms

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: They were all blood tests! No wound cultures or sputum cultures. ### Response: Blood cultures? I'm still unsure how they got these organisms.


Instruction: Oooo are you talking about the mycoplasma hominis? That was a vaginal swab (embarrassing)

Output: Same with ureaplasma?Ok just wanted to check this wasn't in the blood or something, but given location this is not a big deal and likely normal Flora.Sorry unfortunately I don't have much to offer, but at least you can be assured these organisms are likely not related to what's going on.A lot of things don't really add up in your post. You say you're "generally healthy" but you're on over 13 medications. What's the Topamax for? Migraines or seizures? How about the cariprazine? Were any of these medications started recently? Glycopyrrolate that I am assuming you're taking as well as Topamax can cause elevated body temperatures and the combination of the both of them might be the cause of your symptoms.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Oooo are you talking about the mycoplasma hominis? That was a vaginal swab (embarrassing). ### Response: Same with ureaplasma?Ok just wanted to check this wasn't in the blood or something, but given location this is not a big deal and likely normal Flora.Sorry unfortunately I don't have much to offer, but at least you can be assured these organisms are likely not related to what's going on.A lot of things don't really add up in your post. You say you're "generally healthy" but you're on over 13 medications. What's the Topamax for? Migraines or seizures? How about the cariprazine? Were any of these medications started recently? Glycopyrrolate that I am assuming you're taking as well as Topamax can cause elevated body temperatures and the combination of the both of them might be the cause of your symptoms..


Instruction: Topimax for weight loss, Vraylar+Lexapro+Wellbutrin for depression/anxiety/ptsd. When I said I was healthy I meant physically healthy? Guess I shouldve said fat. I do have narcolepsy, I forgot to say that but I view it as so separate. But ty for the info about the glyco and topamax! Ill bring that up with my doc and see if maybe that has to do with it. No new meds, latest one was Xywav in the summer.

Output: While Topiramate does induce weight loss it's not usually my first choice. In addition, it's usually contraindicated in people with mental health disorders and is known to increase the risk of suicide. It also causes drowsiness and you already have narcolepsy. Given the interraction with the glycopyrrolate as well I'd discuss with your physician about transitioning to another agent such as a GLP1 agonist if the goal is really just weight loss.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Topimax for weight loss, Vraylar+Lexapro+Wellbutrin for depression/anxiety/ptsd. When I said I was healthy I meant physically healthy? Guess I shouldve said fat. I do have narcolepsy, I forgot to say that but I view it as so separate. But ty for the info about the glyco and topamax! Ill bring that up with my doc and see if maybe that has to do with it. No new meds, latest one was Xywav in the summer.. ### Response: While Topiramate does induce weight loss it's not usually my first choice. In addition, it's usually contraindicated in people with mental health disorders and is known to increase the risk of suicide. It also causes drowsiness and you already have narcolepsy. Given the interraction with the glycopyrrolate as well I'd discuss with your physician about transitioning to another agent such as a GLP1 agonist if the goal is really just weight loss..


Instruction: Platelets count of 2000, but sent home?I was in the emergency room for bruising and petechiae. They checked my blood and everything came back within normal range except my platelets which came back at 2. They said I need to see an expert so they sent me home and told me to follow up with hematology tomorrow. They gave me 40 mg of dexamethasone. When I was there they made it seem like no big deal, but now when Im researching it Im a bit concerned. Other stories say people were immediately hospitalized for levels of 5-10 and efforts were made to quickly increase their levels. Now I cant sleep because Im so worried and cant find any real answers. Should I be concerned that they sent me home? Is 2 a level that will cause me to die in my sleep or something?25 female 53 150 lbs Regularly Prescribed 150 mg lamictal and 50 mg Vyvanse Dont smoke or use any recreational drugs Only other health problem is possible PCOS (based on polycystic appearing ovaries and low SHBG) I also currently have a cold if thats relevant? COVID test negative.

Output: uhh... yeah not sure why they would've sent you home. Was it a community hospital? Is there a university hospital nearby?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Platelets count of 2000, but sent home?I was in the emergency room for bruising and petechiae. They checked my blood and everything came back within normal range except my platelets which came back at 2. They said I need to see an expert so they sent me home and told me to follow up with hematology tomorrow. They gave me 40 mg of dexamethasone. When I was there they made it seem like no big deal, but now when Im researching it Im a bit concerned. Other stories say people were immediately hospitalized for levels of 5-10 and efforts were made to quickly increase their levels. Now I cant sleep because Im so worried and cant find any real answers. Should I be concerned that they sent me home? Is 2 a level that will cause me to die in my sleep or something?25 female 53 150 lbs Regularly Prescribed 150 mg lamictal and 50 mg Vyvanse Dont smoke or use any recreational drugs Only other health problem is possible PCOS (based on polycystic appearing ovaries and low SHBG) I also currently have a cold if thats relevant? COVID test negative.. ### Response: uhh... yeah not sure why they would've sent you home. Was it a community hospital? Is there a university hospital nearby?.


Instruction: Yes, a community hospital. How would I go about transferring to a university hospital? Just call them and tell them whats going on?

Output: Or just go to another ED? Your platelet is 2,000 right?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes, a community hospital. How would I go about transferring to a university hospital? Just call them and tell them whats going on?. ### Response: Or just go to another ED? Your platelet is 2,000 right?.


Instruction: Yeah its 2 and the rage is 140-150 so Im pretty sure that translates to 2,000. Will a different ER do anything different? Even if its the same hospital network?I have an appointment with the hematologist around noon. Theyre being pretty casual about this. Should I push to be kept? Or to have them intervene some how like a transfusion?

Output: Just meet with them at noon

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yeah its 2 and the rage is 140-150 so Im pretty sure that translates to 2,000. Will a different ER do anything different? Even if its the same hospital network?I have an appointment with the hematologist around noon. Theyre being pretty casual about this. Should I push to be kept? Or to have them intervene some how like a transfusion?. ### Response: Just meet with them at noon.


Instruction: Hypoferritinemia?Im 23 F. 53 and 125 pounds.I have severe gastroparesis (gj tube because of it), IBS, endometriosis, and now hypoferritinemia without anemia as well.I got a letter in the mail from my doctor saying hematology thinks I have hypoferritinemia without anemia due to a combination of malabsorption and losing a lot of blood from endometriosis issues. Im constantly dizzy and my joint pain baseline is never below a 7 anymore. They said it could possibly be because of this, but they arent sure.Other than a letter that said my ferritin levels were 4 & I also had low folate levels, so I was to schedule an iron infusion appointment a few weeks out, I havent heard anything else.My biggest questions are is this something that would likely be chronic, or fixed with a single iron infusion? & is there anything I can do to help correct this?

Output: If you have a GJ and bowel problems you'll probably have ongoing absorption problems anyway.Have you considered trying to stop the periods with contraception so you're not losing more blood at least? You should avoid the pill if absorption is an issue but depot, implant and coils would be good options.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hypoferritinemia?Im 23 F. 53 and 125 pounds.I have severe gastroparesis (gj tube because of it), IBS, endometriosis, and now hypoferritinemia without anemia as well.I got a letter in the mail from my doctor saying hematology thinks I have hypoferritinemia without anemia due to a combination of malabsorption and losing a lot of blood from endometriosis issues. Im constantly dizzy and my joint pain baseline is never below a 7 anymore. They said it could possibly be because of this, but they arent sure.Other than a letter that said my ferritin levels were 4 & I also had low folate levels, so I was to schedule an iron infusion appointment a few weeks out, I havent heard anything else.My biggest questions are is this something that would likely be chronic, or fixed with a single iron infusion? & is there anything I can do to help correct this?. ### Response: If you have a GJ and bowel problems you'll probably have ongoing absorption problems anyway.Have you considered trying to stop the periods with contraception so you're not losing more blood at least? You should avoid the pill if absorption is an issue but depot, implant and coils would be good options..


Instruction: Ive used the pill for 12 years to try and limit periods, but Ive always bled through it anyway. My gyn is hesitant about using any other hormonal birth control because of how rapidly the endometriosis grows back after being removed. They didnt want to use any IUDs because of level of cramping I already get. They said at this point my options are to either keep taking the pill and hope it helps or get pregnant and hope that helps.Ive been on over 20 medications for a year to try and help my symptoms, but I see no improvement from any of them whatsoever except sometimes the dissolving zofran helps my nausea. I dont know if this is another sign of an absorption issue.

Output: I'm surprised they are happy with the pill given your presumed absorption problems. A method that prevents ovulation eg the depot would be ideal and will make endometriosis better.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Ive used the pill for 12 years to try and limit periods, but Ive always bled through it anyway. My gyn is hesitant about using any other hormonal birth control because of how rapidly the endometriosis grows back after being removed. They didnt want to use any IUDs because of level of cramping I already get. They said at this point my options are to either keep taking the pill and hope it helps or get pregnant and hope that helps.Ive been on over 20 medications for a year to try and help my symptoms, but I see no improvement from any of them whatsoever except sometimes the dissolving zofran helps my nausea. I dont know if this is another sign of an absorption issue.. ### Response: I'm surprised they are happy with the pill given your presumed absorption problems. A method that prevents ovulation eg the depot would be ideal and will make endometriosis better..


Instruction: 2.5 year olds bloodwork. Concerned.My 2.5 year old daughter has been refusing food, tired and constipsted. I get picky eating is a thing but this is beyond picky. Shes losing weight. Her doctor didnt seem concerned but there are levels on her chart that are totally abnormal and Im at a loss as to what I can do.WBC Learn more about this 5.96 103/uL WBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.80 103/uL - 13.50 103/uLRBC Learn more about this 5.07 106/uL RBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.70 106/uL - 5.40 106/uLHemoglobin Learn more about this 13.7 g/dL Hemoglobin Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.5 g/dL - 16.0 g/dLHematocrit Learn more about this 40.0 % Hematocrit Date: May 21, 2021 08:49 a.m. PDT Reference Range:29.0 % - 48.0 %MCV Learn more about this 78.9 fL MCV Date: May 21, 2021 08:49 a.m. PDT Reference Range:74.0 fL - 99.0 fLMCH Learn more about this 27.0 pg MCH Date: May 21, 2021 08:49 a.m. PDT Reference Range:25.0 pg - 32.2 pgMCHC Learn more about this 34.3 g/dL MCHC Date: May 21, 2021 08:49 a.m. PDT Reference Range:31.0 g/dL - 37.0 g/dLRDW Learn more about this 12.3 % RDW Date: May 21, 2021 08:49 a.m. PDT Reference Range:11.6 % - 14.4 %Platelets Learn more about this 370 103/uL Platelets Date: May 21, 2021 08:49 a.m. PDT Reference Range:150 103/uL - 450 103/uLMPV Learn more about this 8.4 fL MPV Date: May 21, 2021 08:49 a.m. PDT Reference Range:7.3 fL - 12.4 fLNeutrophil % Auto Learn more about this 33.8 % Neutrophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:33.6 % - 77.5 %Lymphocyte % Auto Learn more about this 57.7 % Lymphocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.0 % - 59.0 %Monocyte % Auto Learn more about this 7.6 % Monocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.0 % - 12.5 %Eosinophil % Auto Learn more about this 0.70 % (Low) Eosinophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 % - 4.00 %Basophil % Auto Learn more about this 0.2 % Basophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 1.0 %Imm. Granulocyte % Learn more about this 0.0 % Imm. Granulocyte % Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 0.4 %Neutro Absolute Learn more about this 2.02 103/uL Neutro Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.50 103/uL - 8.60 103/uLLymph Absolute Learn more about this 3.44 103/uL Lymph Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 103/uL - 7.30 103/uLMono Absolute Learn more about this 0.45 103/uL Mono Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 1.20 103/uLEos Absolute Learn more about this 0.04 103/uL Eos Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 0.50 103/uLBaso Absolute Learn more about this < 0.04 103/uL Baso Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 2.80 103/uLRetic Count.LC Learn more about this 1.3 % Retic Count.LC Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.6-2.6Imm. Granulocyte Absolute Learn more about this < 0.04 103/uL Imm. Granulocyte Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 0.10 103/uLMiscellaneous Hematology Sed Rate Learn more about this 16 Sed Rate Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 - 20 Routine ChemistrySodium Learn more about this 137 mmol/L Sodium Date: May 21, 2021 08:49 a.m. PDT Reference Range:137 mmol/L - 145 mmol/LPotassium Lvl Learn more about this 4.2 mmol/L Potassium Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 mmol/L - 5.1 mmol/LChloride Learn more about this 102 mmol/L Chloride Date: May 21, 2021 08:49 a.m. PDT Reference Range:98 mmol/L - 107 mmol/LCO2 Learn more about this 21 mmol/L (Low) CO2 Date: May 21, 2021 08:49 a.m. PDT Reference Range:22 mmol/L - 30 mmol/LAGAP Learn more about this 14 mmol/L AGAP Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mmol/L - 16 mmol/LBUN Learn more about this 16 mg/dL BUN Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mg/dL - 17 mg/dLCreatinine Level Learn more about this 0.30 mg/dL Creatinine Level Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg/dL - 0.70 mg/dLBUN/Creat Ratio Learn more about this 53.3 ratio (High) BUN/Creat Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.0 ratio - 20.0 ratioGlucose Lvl Learn more about this 88 mg/dL Glucose Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:74 mg/dL - 106 mg/dLCalcium Learn more about this 10.4 mg/dL (High) Calcium Date: May 21, 2021 08:49 a.m. PDT Reference Range:8.4 mg/dL - 10.2 mg/dLProtein Total Learn more about this 7.7 g/dL Protein Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.3 g/dL - 8.2 g/dLAlbumin Learn more about this 4.8 g/dL Albumin Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 g/dL - 5.0 g/dLA/G Ratio Learn more about this 1.7 ratio A/G Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.0 ratio - 2.2 ratioBilirubin Total Learn more about this 0.30 mg/dL Bilirubin Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg/dL - 1.30 mg/dLBilirubin Direct Learn more about this 0.0 mg/dL Bilirubin Direct Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg/dL - 0.3 mg/dLAmylase Lvl Learn more about this 68 U/L Amylase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:30 U/L - 110 U/LLipase Lvl Learn more about this 55 U/L Lipase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:23 U/L - 300 U/LAlk Phos Learn more about this 215 U/L (High) Alk Phos Date: May 21, 2021 08:49 a.m. PDT Reference Range:38 U/L - 126 U/LALT Learn more about this 19 U/L ALT Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 U/L - 34 U/LAST Learn more about this 57 U/L (High) AST Date: May 21, 2021 08:49 a.m. PDT Reference Range:14 U/L - 36 U/LCRP Learn more about this < 0.5 mg/dL CRP Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg/dL - 0.9 mg/dLGlobulin Learn more about this 2.9 g/dL Globulin Date: May 21, 2021 08:49 a.m. PDT Reference Range:2.2 g/dL - 3.7 g/dLImmunology/Serology Mono Screen Learn more about this Negative Mono Screen Date: May 21, 2021 08:49 a.m. PDT Reference Range:Negative

Output: All these results look very normal, with the exception of a mildly elevated AST and Alk phos (most likely from a virus). Nothing here gives much of an idea what may be going on.Children can also have elevated Alk Phos from simply growing, so absolutely no worries there. Agree about the AST potentially being viral in origin. At my place we'd recheck that (by itself) in a few months but not worry about it in the meantime.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 2.5 year olds bloodwork. Concerned.My 2.5 year old daughter has been refusing food, tired and constipsted. I get picky eating is a thing but this is beyond picky. Shes losing weight. Her doctor didnt seem concerned but there are levels on her chart that are totally abnormal and Im at a loss as to what I can do.WBC Learn more about this 5.96 103/uL WBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.80 103/uL - 13.50 103/uLRBC Learn more about this 5.07 106/uL RBC Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.70 106/uL - 5.40 106/uLHemoglobin Learn more about this 13.7 g/dL Hemoglobin Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.5 g/dL - 16.0 g/dLHematocrit Learn more about this 40.0 % Hematocrit Date: May 21, 2021 08:49 a.m. PDT Reference Range:29.0 % - 48.0 %MCV Learn more about this 78.9 fL MCV Date: May 21, 2021 08:49 a.m. PDT Reference Range:74.0 fL - 99.0 fLMCH Learn more about this 27.0 pg MCH Date: May 21, 2021 08:49 a.m. PDT Reference Range:25.0 pg - 32.2 pgMCHC Learn more about this 34.3 g/dL MCHC Date: May 21, 2021 08:49 a.m. PDT Reference Range:31.0 g/dL - 37.0 g/dLRDW Learn more about this 12.3 % RDW Date: May 21, 2021 08:49 a.m. PDT Reference Range:11.6 % - 14.4 %Platelets Learn more about this 370 103/uL Platelets Date: May 21, 2021 08:49 a.m. PDT Reference Range:150 103/uL - 450 103/uLMPV Learn more about this 8.4 fL MPV Date: May 21, 2021 08:49 a.m. PDT Reference Range:7.3 fL - 12.4 fLNeutrophil % Auto Learn more about this 33.8 % Neutrophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:33.6 % - 77.5 %Lymphocyte % Auto Learn more about this 57.7 % Lymphocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:10.0 % - 59.0 %Monocyte % Auto Learn more about this 7.6 % Monocyte % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:4.0 % - 12.5 %Eosinophil % Auto Learn more about this 0.70 % (Low) Eosinophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 % - 4.00 %Basophil % Auto Learn more about this 0.2 % Basophil % Auto Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 1.0 %Imm. Granulocyte % Learn more about this 0.0 % Imm. Granulocyte % Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 % - 0.4 %Neutro Absolute Learn more about this 2.02 103/uL Neutro Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.50 103/uL - 8.60 103/uLLymph Absolute Learn more about this 3.44 103/uL Lymph Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.00 103/uL - 7.30 103/uLMono Absolute Learn more about this 0.45 103/uL Mono Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 1.20 103/uLEos Absolute Learn more about this 0.04 103/uL Eos Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 0.50 103/uLBaso Absolute Learn more about this < 0.04 103/uL Baso Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 2.80 103/uLRetic Count.LC Learn more about this 1.3 % Retic Count.LC Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.6-2.6Imm. Granulocyte Absolute Learn more about this < 0.04 103/uL Imm. Granulocyte Absolute Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.00 103/uL - 0.10 103/uLMiscellaneous Hematology Sed Rate Learn more about this 16 Sed Rate Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 - 20 Routine ChemistrySodium Learn more about this 137 mmol/L Sodium Date: May 21, 2021 08:49 a.m. PDT Reference Range:137 mmol/L - 145 mmol/LPotassium Lvl Learn more about this 4.2 mmol/L Potassium Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 mmol/L - 5.1 mmol/LChloride Learn more about this 102 mmol/L Chloride Date: May 21, 2021 08:49 a.m. PDT Reference Range:98 mmol/L - 107 mmol/LCO2 Learn more about this 21 mmol/L (Low) CO2 Date: May 21, 2021 08:49 a.m. PDT Reference Range:22 mmol/L - 30 mmol/LAGAP Learn more about this 14 mmol/L AGAP Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mmol/L - 16 mmol/LBUN Learn more about this 16 mg/dL BUN Date: May 21, 2021 08:49 a.m. PDT Reference Range:7 mg/dL - 17 mg/dLCreatinine Level Learn more about this 0.30 mg/dL Creatinine Level Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg/dL - 0.70 mg/dLBUN/Creat Ratio Learn more about this 53.3 ratio (High) BUN/Creat Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.0 ratio - 20.0 ratioGlucose Lvl Learn more about this 88 mg/dL Glucose Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:74 mg/dL - 106 mg/dLCalcium Learn more about this 10.4 mg/dL (High) Calcium Date: May 21, 2021 08:49 a.m. PDT Reference Range:8.4 mg/dL - 10.2 mg/dLProtein Total Learn more about this 7.7 g/dL Protein Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:6.3 g/dL - 8.2 g/dLAlbumin Learn more about this 4.8 g/dL Albumin Date: May 21, 2021 08:49 a.m. PDT Reference Range:3.5 g/dL - 5.0 g/dLA/G Ratio Learn more about this 1.7 ratio A/G Ratio Date: May 21, 2021 08:49 a.m. PDT Reference Range:1.0 ratio - 2.2 ratioBilirubin Total Learn more about this 0.30 mg/dL Bilirubin Total Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.20 mg/dL - 1.30 mg/dLBilirubin Direct Learn more about this 0.0 mg/dL Bilirubin Direct Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg/dL - 0.3 mg/dLAmylase Lvl Learn more about this 68 U/L Amylase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:30 U/L - 110 U/LLipase Lvl Learn more about this 55 U/L Lipase Lvl Date: May 21, 2021 08:49 a.m. PDT Reference Range:23 U/L - 300 U/LAlk Phos Learn more about this 215 U/L (High) Alk Phos Date: May 21, 2021 08:49 a.m. PDT Reference Range:38 U/L - 126 U/LALT Learn more about this 19 U/L ALT Date: May 21, 2021 08:49 a.m. PDT Reference Range:0 U/L - 34 U/LAST Learn more about this 57 U/L (High) AST Date: May 21, 2021 08:49 a.m. PDT Reference Range:14 U/L - 36 U/LCRP Learn more about this < 0.5 mg/dL CRP Date: May 21, 2021 08:49 a.m. PDT Reference Range:0.0 mg/dL - 0.9 mg/dLGlobulin Learn more about this 2.9 g/dL Globulin Date: May 21, 2021 08:49 a.m. PDT Reference Range:2.2 g/dL - 3.7 g/dLImmunology/Serology Mono Screen Learn more about this Negative Mono Screen Date: May 21, 2021 08:49 a.m. PDT Reference Range:Negative. ### Response: All these results look very normal, with the exception of a mildly elevated AST and Alk phos (most likely from a virus). Nothing here gives much of an idea what may be going on.Children can also have elevated Alk Phos from simply growing, so absolutely no worries there. Agree about the AST potentially being viral in origin. At my place we'd recheck that (by itself) in a few months but not worry about it in the meantime..


Instruction: Husband with osteonecrosis and little game plan besides narcotics- is he being managed appropriately?Just a HUGE thanks in advance to anybody who responds. I'm a talker and I'm livid right now, so I'm trying to keep this just to necessities but may fail and leave out key details and/or talk about things that aren't necessary. To preface- I come from a "medical family" but it's primarily neuro and psych rather than ortho. I devour medical literature, podcasts, etc, have worked as nursing staff in psych and derm, just got my master's in health sciences, and am planning to apply to med school this cycle- so basically, please feel free to talk to me in technical terms, link to articles, etc as appropriate.Now onto the issue.Husband is 28M, 5'8.5", 225lbs, white, occasionally smokes cigars (maybe a cigar or two a year?), and drinks moderately (down from heavy drinking a few years ago as part of work culture). About 5 weeks ago was diagnosed with osteonecrosis in both femoral heads. Started having pain just in his right hip in May, but really started to notice in June as it was limiting mobility. Got to the point in July where he couldn't go up and down the stairs- I was gone and he was texting me he had to army crawl back up the stairs to bed. Initially, he got an x-ray which had some "fringe" or something to that effect (I wasn't in the appointment so I don't really know what was said about it) but was concerning for possible osteonecrosis and MRI was recommended. While waiting, he went to PT, and the PT thought perhaps bursitis if not ON, but the pain kept worsening. Got an MRI at the end of August which showed osteonecrosis in both hips involving over 50% of both femoral heads. Right side had marked edema extending into the femoral neck and noted a "mild asphericity of the head consistent with mild depression," subchondral fluid cleft, and diffusive mildly thinned cartilage. Left side had edema as well extending into the neck.Husband was referred to ortho, which in itself was a headache as PCP had to send that referral FOUR times. As we're waiting, his pain is getting worse to the point where he was using a cane and then progressed to needing a full set of crutches. If you could see his gait- it's just awful and was placing stress on other joints and was leading to back pain too. PCP started him on Celebrex 1000mg QAM for two weeks and then 500mg QAM after as well as gabapentin (titrated up to 900mg QHS). Got several labs drawn to check for a cause- including autoimmune labs- and the only abnormality was low vitamin D (15 ng/mL), so he was also started on OTC D3 5000IU daily and a prescription weekly dose of D2 (I can't remember the dosing). . The Celebrex seemed to help him the most, but after about a week on that, it was still only "barely" helping. As time went on waiting for ortho, the way he described the pain and sensation also changed, with more "grinding" pain.In what I've been able to read, it seems there are treatments that can help the pain (narcotics, staying off the joint, fluid aspiration for edema) and may treat earlier stages of disease (eg, core decompression, treating underlying cause to get blood flow back to the bone), but once the femoral head collapses, hip replacement becomes standard of care.When we were finally able to meet with ortho, the doc, while personable and nice, didn't really give us a lot of info. He didn't stage the disease at time of MRI, but kept saying "mild." This annoys me because with the amount of pain he is in and asphericity of the femoral head, I wouldn't classify anything he's experiencing as "mild" myself, and surely not "caught early/in early disease stage." We tried to impress the pain aspect and how limited his mobility is because of the pain. Doc kept hinting at "something stronger" to manage the pain and said we could schedule for aspiration for the edema. Also mentioned that he needed to stay off the joint as much as possible and should be using the crutches for any walking. Husband is terrified of needles (aspiration is done fully conscious and may need to be done every week or two to control pain from the edema), and with a history of SUDs in his family, being on narcotics for longer than a few days is also terrifying and he prefers not to. We asked about hip replacement, and he seemed not to want to do it, citing Husband's age. ORtho requested workup for potential coagulation disorder because we could "save the hips" if this was caused by a treatable clotting disorder, and he referred to hematology. No further discussion about replacement or why he didn't want to pursue it- just the age and potential for a clotting disorder.Neither one of us was thrilled with this. I wasn't convinced that restoring blood flow would magically re-shape his femoral head, especially with how he is now describing grinding pain. His half sister also does have a clotting disorder, but it's Factor V deficiency, so it's that she doesn't clot appropriately. But fine. Took them a week to get the referral to hematology, and a few days later, we have to call hematology and essentially was told he is a "low priority" patient and they wouldn't see him (they were rude, but I do get it because oncology patients need to take priority). Ortho refused to order the tests because "we don't really order tests" and said they'd send it to PCP. No follow-up scheduled with ortho until after the coag tests. This was about two weeks ago.About 10 days ago, his pain advanced so much that he finally did call in to the ortho clinic to as he was unable to sleep he was in so much pain. I picked up a script for 5mg oxycodone for him, and he's been taking this before bed reliably since and sometimes needs it during the day due to the pain. He hates it, and it barely touches the pain anyway. He called again last week because he is still in so much pain and essentially demanded to see the surgeon himself so we can get real answers about how we are not just going to "manage" the pain but resolve it. Thankfully, we see the surgeon tomorrow.Anyway, so today, we were able to meet with his PCP via telemedicine (he couldn't get to the actual hospital due to his limited mobility right now and still make it to the ortho appointment tomorrow). His PCP essentially said they a) weren't going to order any of the coag tests ortho wanted (they didn't have any notes from ortho and "it isn't standard of care") and if they wanted coag tests, they'd have to order themselves, and b) my husband "needs" to be more active, going to PT, walking, swimming if he can't put weight on it (note: the only pools here this time of year are at expensive gyms we cannot afford to go to), etc. My husband literally cannot do that. If he goes up and down the stairs more than once in a day, he's knocked on his ass in pain for the next 24 hours. He tried to impress this upon her, but she just kept saying how he needs to move it to avoid muscle atrophy, and if he can't, then the pain isn't managed appropriately. I don't disagree about his pain- it's not managed well at all- but her solution was to increase the gabapentin which tbh I don't think is helping him at all anyway. The bit about moving the joint more though directly goes against everything I've read about the disease, what the ortho told us, and what he experiences- he can manage his pain by being totally 100% sedentary, but that's not a lifestyle he wants (nor what is good long-term).So, wonderful docs of reddit, is he being managed appropriately so far? Is there something more I can do to ensure he has good care? I don't go into telemed visits with him since he takes him on headphones, but I do have to go with him when he goes in to the clinic since he cannot get around with me. I asked my older sis to send me some of the info on UpToDate so I can read more about what is actual standard of care. I cannot for the life of me feel good about it, and I feel like nobody is listening to him and his pain and what HE wants (solution, not management). Our world has radically shifted very rapidly, as he cannot do much at all or engage in hobbies or household chores or even the fun parts of a relationship most of the time. We are seeing a therapist to help manage it, even, but all the medical teams seem to be doing is throwing narcotics and giving him mixed messages and refusing to actually give us real insight into the disease process or why they don't want to resolve it. And yeah, I'm really mad about it all.Thanks again to anybody that can give me any insight into this.

Output: Osteonecrosis / avascular necrosis of the hip, it can be bad. I kinda agree with the ortho - be as reluctant as possible with a hip prosthesis. I don't like the term "hip replacement", cause it makes it sound like you change the hip with an equivalent. It's not. A metal prosthesis has a limited life span - 10 - 20 years. Given enough time, the prosthesis will eventually fail. He's young, so he'll be doomed to have a failure while still in prime age. Then he'll have a bigger problem, since replacing a replacement is a much bigger surgery, sometimes it may not be possible at all, and there's a chance he'll have to remove a hip joint altogether while still only 40-some years old.There's a chance his osteonecrosis may dwindle, without completely destroying the femoral head. Sometimes it just leaves a small irregularity in the top joint surface, and it can be usable. I often see that the "acute" inflammation like necrosis dies out. It would be wise to wait and see how things progress. Hopefully, he can have pain relief with medications temporarily.So, I think the treatment right now seems wise. You want the problem to be solved right now with a hip replacement, but the ortho know that will bite you back in a few decades. When he says it's mild, he's probably referring to how it looks on xray, and mild there is a good thing.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Husband with osteonecrosis and little game plan besides narcotics- is he being managed appropriately?Just a HUGE thanks in advance to anybody who responds. I'm a talker and I'm livid right now, so I'm trying to keep this just to necessities but may fail and leave out key details and/or talk about things that aren't necessary. To preface- I come from a "medical family" but it's primarily neuro and psych rather than ortho. I devour medical literature, podcasts, etc, have worked as nursing staff in psych and derm, just got my master's in health sciences, and am planning to apply to med school this cycle- so basically, please feel free to talk to me in technical terms, link to articles, etc as appropriate.Now onto the issue.Husband is 28M, 5'8.5", 225lbs, white, occasionally smokes cigars (maybe a cigar or two a year?), and drinks moderately (down from heavy drinking a few years ago as part of work culture). About 5 weeks ago was diagnosed with osteonecrosis in both femoral heads. Started having pain just in his right hip in May, but really started to notice in June as it was limiting mobility. Got to the point in July where he couldn't go up and down the stairs- I was gone and he was texting me he had to army crawl back up the stairs to bed. Initially, he got an x-ray which had some "fringe" or something to that effect (I wasn't in the appointment so I don't really know what was said about it) but was concerning for possible osteonecrosis and MRI was recommended. While waiting, he went to PT, and the PT thought perhaps bursitis if not ON, but the pain kept worsening. Got an MRI at the end of August which showed osteonecrosis in both hips involving over 50% of both femoral heads. Right side had marked edema extending into the femoral neck and noted a "mild asphericity of the head consistent with mild depression," subchondral fluid cleft, and diffusive mildly thinned cartilage. Left side had edema as well extending into the neck.Husband was referred to ortho, which in itself was a headache as PCP had to send that referral FOUR times. As we're waiting, his pain is getting worse to the point where he was using a cane and then progressed to needing a full set of crutches. If you could see his gait- it's just awful and was placing stress on other joints and was leading to back pain too. PCP started him on Celebrex 1000mg QAM for two weeks and then 500mg QAM after as well as gabapentin (titrated up to 900mg QHS). Got several labs drawn to check for a cause- including autoimmune labs- and the only abnormality was low vitamin D (15 ng/mL), so he was also started on OTC D3 5000IU daily and a prescription weekly dose of D2 (I can't remember the dosing). . The Celebrex seemed to help him the most, but after about a week on that, it was still only "barely" helping. As time went on waiting for ortho, the way he described the pain and sensation also changed, with more "grinding" pain.In what I've been able to read, it seems there are treatments that can help the pain (narcotics, staying off the joint, fluid aspiration for edema) and may treat earlier stages of disease (eg, core decompression, treating underlying cause to get blood flow back to the bone), but once the femoral head collapses, hip replacement becomes standard of care.When we were finally able to meet with ortho, the doc, while personable and nice, didn't really give us a lot of info. He didn't stage the disease at time of MRI, but kept saying "mild." This annoys me because with the amount of pain he is in and asphericity of the femoral head, I wouldn't classify anything he's experiencing as "mild" myself, and surely not "caught early/in early disease stage." We tried to impress the pain aspect and how limited his mobility is because of the pain. Doc kept hinting at "something stronger" to manage the pain and said we could schedule for aspiration for the edema. Also mentioned that he needed to stay off the joint as much as possible and should be using the crutches for any walking. Husband is terrified of needles (aspiration is done fully conscious and may need to be done every week or two to control pain from the edema), and with a history of SUDs in his family, being on narcotics for longer than a few days is also terrifying and he prefers not to. We asked about hip replacement, and he seemed not to want to do it, citing Husband's age. ORtho requested workup for potential coagulation disorder because we could "save the hips" if this was caused by a treatable clotting disorder, and he referred to hematology. No further discussion about replacement or why he didn't want to pursue it- just the age and potential for a clotting disorder.Neither one of us was thrilled with this. I wasn't convinced that restoring blood flow would magically re-shape his femoral head, especially with how he is now describing grinding pain. His half sister also does have a clotting disorder, but it's Factor V deficiency, so it's that she doesn't clot appropriately. But fine. Took them a week to get the referral to hematology, and a few days later, we have to call hematology and essentially was told he is a "low priority" patient and they wouldn't see him (they were rude, but I do get it because oncology patients need to take priority). Ortho refused to order the tests because "we don't really order tests" and said they'd send it to PCP. No follow-up scheduled with ortho until after the coag tests. This was about two weeks ago.About 10 days ago, his pain advanced so much that he finally did call in to the ortho clinic to as he was unable to sleep he was in so much pain. I picked up a script for 5mg oxycodone for him, and he's been taking this before bed reliably since and sometimes needs it during the day due to the pain. He hates it, and it barely touches the pain anyway. He called again last week because he is still in so much pain and essentially demanded to see the surgeon himself so we can get real answers about how we are not just going to "manage" the pain but resolve it. Thankfully, we see the surgeon tomorrow.Anyway, so today, we were able to meet with his PCP via telemedicine (he couldn't get to the actual hospital due to his limited mobility right now and still make it to the ortho appointment tomorrow). His PCP essentially said they a) weren't going to order any of the coag tests ortho wanted (they didn't have any notes from ortho and "it isn't standard of care") and if they wanted coag tests, they'd have to order themselves, and b) my husband "needs" to be more active, going to PT, walking, swimming if he can't put weight on it (note: the only pools here this time of year are at expensive gyms we cannot afford to go to), etc. My husband literally cannot do that. If he goes up and down the stairs more than once in a day, he's knocked on his ass in pain for the next 24 hours. He tried to impress this upon her, but she just kept saying how he needs to move it to avoid muscle atrophy, and if he can't, then the pain isn't managed appropriately. I don't disagree about his pain- it's not managed well at all- but her solution was to increase the gabapentin which tbh I don't think is helping him at all anyway. The bit about moving the joint more though directly goes against everything I've read about the disease, what the ortho told us, and what he experiences- he can manage his pain by being totally 100% sedentary, but that's not a lifestyle he wants (nor what is good long-term).So, wonderful docs of reddit, is he being managed appropriately so far? Is there something more I can do to ensure he has good care? I don't go into telemed visits with him since he takes him on headphones, but I do have to go with him when he goes in to the clinic since he cannot get around with me. I asked my older sis to send me some of the info on UpToDate so I can read more about what is actual standard of care. I cannot for the life of me feel good about it, and I feel like nobody is listening to him and his pain and what HE wants (solution, not management). Our world has radically shifted very rapidly, as he cannot do much at all or engage in hobbies or household chores or even the fun parts of a relationship most of the time. We are seeing a therapist to help manage it, even, but all the medical teams seem to be doing is throwing narcotics and giving him mixed messages and refusing to actually give us real insight into the disease process or why they don't want to resolve it. And yeah, I'm really mad about it all.Thanks again to anybody that can give me any insight into this.. ### Response: Osteonecrosis / avascular necrosis of the hip, it can be bad. I kinda agree with the ortho - be as reluctant as possible with a hip prosthesis. I don't like the term "hip replacement", cause it makes it sound like you change the hip with an equivalent. It's not. A metal prosthesis has a limited life span - 10 - 20 years. Given enough time, the prosthesis will eventually fail. He's young, so he'll be doomed to have a failure while still in prime age. Then he'll have a bigger problem, since replacing a replacement is a much bigger surgery, sometimes it may not be possible at all, and there's a chance he'll have to remove a hip joint altogether while still only 40-some years old.There's a chance his osteonecrosis may dwindle, without completely destroying the femoral head. Sometimes it just leaves a small irregularity in the top joint surface, and it can be usable. I often see that the "acute" inflammation like necrosis dies out. It would be wise to wait and see how things progress. Hopefully, he can have pain relief with medications temporarily.So, I think the treatment right now seems wise. You want the problem to be solved right now with a hip replacement, but the ortho know that will bite you back in a few decades. When he says it's mild, he's probably referring to how it looks on xray, and mild there is a good thing..


Instruction: hanks for the reply. We know he would need another replacement in his life time (or multiple replacements of the hardware) if he were to have it replaced now, although the rate of failure of that THA is what is unknown to me and what nobody seems to have discussed with us. My best friends mother had bilateral THA in her teens and is in her 50s now with an additional 3 replacements, and is still healthy, so I may have some rose colored glasses with the n=1 sample size there. I think I will look up the data about revisions.I worry so much because I see his QOL just deteriorating in front of me. He doesnt want to die, but I know he doesnt want to live like this. Not just the pain but being unable to do what he finds meaningful. Pain management is great when theres a positive end in sight, but if its going to be a long-term that has a very high likelihood of ending in THA anyway, I cant imagine he would want to live like that. The trajectory hasnt been good so far, and Im somebody that needs hard data and numbers to reconcile any differences between patterns I see and what I am told might happen. As a radiologist, you may not have an answer, but how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)? Do you get to know who is symptomatic and how symptomatic? Previously I was trying to find studies or case studies and just couldnt find anything promising myself, and I was also focused on the quality of his pain, since there seems to be a different type of pain now.Along the same vein, how often is common to repeat images while waiting? How quickly have you seen deterioration? Its only been 5 weeks since the MRI and just shy of 3 months since the X-ray, but I am worried about how its progressing and wondering if it may not be as early or mild now as it was then.

Output: how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)Don't have an exact number, but it's not uncommon to improve, and I'm often amazed of how well some seemingly terrible looking hips can end up, given time. Conditions with bone marrow edema are generally painful. I believe bone marrow edema in itself is causing much of the pain. The edema will usually / eventually resolve in time. A few months at least. Sometimes more than half a year. When / if the edema is gone, remaining pain will often depend on how damaged the joint surfaces are, and degree of osteoarthritis. From the description you quoted, it's not too damaged now. "Mild depression of the joint surface, mild cartilage thinning", I have an image in my head how that looks, and it's not too bad. As long as the joint surface isn't completely destroyed - and it isn't on those exams he's taken - there is a chance yet he could avoid THA.There is a chance it may develop into further joint destruction, but can only wait and see for that. Follow-up MRI 3-6 months after the first, maybe, depends on the clinical situation. Regular xray is often enough to assess damage to the joint surface.Also - while I'm not really questioning the diagnosis he's given, there are different conditions that causes bone marrow edema in the femoral head. "Transient migratory osteoporosis" is self limiting, and possible to mix up with osteonecrosis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: hanks for the reply. We know he would need another replacement in his life time (or multiple replacements of the hardware) if he were to have it replaced now, although the rate of failure of that THA is what is unknown to me and what nobody seems to have discussed with us. My best friends mother had bilateral THA in her teens and is in her 50s now with an additional 3 replacements, and is still healthy, so I may have some rose colored glasses with the n=1 sample size there. I think I will look up the data about revisions.I worry so much because I see his QOL just deteriorating in front of me. He doesnt want to die, but I know he doesnt want to live like this. Not just the pain but being unable to do what he finds meaningful. Pain management is great when theres a positive end in sight, but if its going to be a long-term that has a very high likelihood of ending in THA anyway, I cant imagine he would want to live like that. The trajectory hasnt been good so far, and Im somebody that needs hard data and numbers to reconcile any differences between patterns I see and what I am told might happen. As a radiologist, you may not have an answer, but how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)? Do you get to know who is symptomatic and how symptomatic? Previously I was trying to find studies or case studies and just couldnt find anything promising myself, and I was also focused on the quality of his pain, since there seems to be a different type of pain now.Along the same vein, how often is common to repeat images while waiting? How quickly have you seen deterioration? Its only been 5 weeks since the MRI and just shy of 3 months since the X-ray, but I am worried about how its progressing and wondering if it may not be as early or mild now as it was then.. ### Response: how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)Don't have an exact number, but it's not uncommon to improve, and I'm often amazed of how well some seemingly terrible looking hips can end up, given time. Conditions with bone marrow edema are generally painful. I believe bone marrow edema in itself is causing much of the pain. The edema will usually / eventually resolve in time. A few months at least. Sometimes more than half a year. When / if the edema is gone, remaining pain will often depend on how damaged the joint surfaces are, and degree of osteoarthritis. From the description you quoted, it's not too damaged now. "Mild depression of the joint surface, mild cartilage thinning", I have an image in my head how that looks, and it's not too bad. As long as the joint surface isn't completely destroyed - and it isn't on those exams he's taken - there is a chance yet he could avoid THA.There is a chance it may develop into further joint destruction, but can only wait and see for that. Follow-up MRI 3-6 months after the first, maybe, depends on the clinical situation. Regular xray is often enough to assess damage to the joint surface.Also - while I'm not really questioning the diagnosis he's given, there are different conditions that causes bone marrow edema in the femoral head. "Transient migratory osteoporosis" is self limiting, and possible to mix up with osteonecrosis..


Instruction: Help with hematology analysisIm a male 39 years old, 78 kg, 173 cm. I use CBD for anxiety daily, no other medication. My MCV seems to be a bit high in the analysis.MCV 98.1 Hemoglobin 9.3 mmol/l Erithrocytes 4.8 / pl Hematocrit 0.47 l/l Thrombocytes 214 NL Leukocytes 6.4 NLAll other parameters, including thyroid TSA and liver ALAT are good, also glucoses, glycosilated hg, cholesterol and triglycerides are good. I drink almost daily, but no more that a couple of beers, smoke socially, and dont do other drugs. Red meat consumption is very low but Im not vegetarian. My diet is (I think) good, but probably too much bread. Should I worry about the MCV? What does it mean? What could be the consequences?Edit: I should also say that I do boxing 2/3 times a week, and bike 10km 5 days a week.

Output: The most likely cause is your alcohol use. Alcohol is a well known cause of macrocytosis.Other possible etiologies include B12 deficiency (worth checking a B12 level but unlikely in your case), hemolytic anemia (very unlikely in your case as your hemoglobin is normal), liver disease, certain bone marrow disorders such as genetic conditions or MDS (those are very unlikely in your case).The macrocytosis itself is not concerning but it does mean that you have significant alcohol use. I would try to cut down.It's helps determine the cause of your anemia (low hemoglobin). You shouldn't worry, but you should follow up with your doctor to go through the next steps to work up your anemia with a high MCV. This is a common thing that has a pretty well trod diagnostic pathway that you and your doctor can work through

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Help with hematology analysisIm a male 39 years old, 78 kg, 173 cm. I use CBD for anxiety daily, no other medication. My MCV seems to be a bit high in the analysis.MCV 98.1 Hemoglobin 9.3 mmol/l Erithrocytes 4.8 / pl Hematocrit 0.47 l/l Thrombocytes 214 NL Leukocytes 6.4 NLAll other parameters, including thyroid TSA and liver ALAT are good, also glucoses, glycosilated hg, cholesterol and triglycerides are good. I drink almost daily, but no more that a couple of beers, smoke socially, and dont do other drugs. Red meat consumption is very low but Im not vegetarian. My diet is (I think) good, but probably too much bread. Should I worry about the MCV? What does it mean? What could be the consequences?Edit: I should also say that I do boxing 2/3 times a week, and bike 10km 5 days a week.. ### Response: The most likely cause is your alcohol use. Alcohol is a well known cause of macrocytosis.Other possible etiologies include B12 deficiency (worth checking a B12 level but unlikely in your case), hemolytic anemia (very unlikely in your case as your hemoglobin is normal), liver disease, certain bone marrow disorders such as genetic conditions or MDS (those are very unlikely in your case).The macrocytosis itself is not concerning but it does mean that you have significant alcohol use. I would try to cut down.It's helps determine the cause of your anemia (low hemoglobin). You shouldn't worry, but you should follow up with your doctor to go through the next steps to work up your anemia with a high MCV. This is a common thing that has a pretty well trod diagnostic pathway that you and your doctor can work through.


Instruction: Diagnosed with Chronic Myeloid Leukemia in November, fired from oncology office, 2 months without chemon September went to the ER for feeling under the weather and some blood work came back abnormal and I was referred to a hematology oncologist a month later. Went in and did the biopsy and everything. The doctor said that she calculated the risk from all the numbers and I'm in the intermediate risk stage but hopefully with the oral chemo for life, I should be able to keep it from turning into AML or the least, extend the quality of life.Come to find out that the doctor I was rushed in to see was actually a traveling doctor and she'd be leaving at the end of November. I then was forced to see a male doctor in the practice instead of the other female due to scheduling conflicts and bad weather. I felt very uncomfortable with the doctors bedside manner, the way he implied that I somehow forced a surgeon to take my thyroid out instead of trying medications first, didn't let me talk and explain that I was experiencing bad side effects from the chemo and also experiencing pain. This all happened and came to a head in March.He basically said that I was seeking drugs and that he wouldn't make any changes to my treatment (which was Bosulif 400mg/once a day). I was given a prescription and 5 refills. I then tried to speak to the director about being switched back to the female doctor and she said that the male Dr wouldn't sign off on that and if I was unhappy with the decision I can seek treatment elsewhere.I got my last refill in February and so have been off chemo since Feb 22nd. I tried to get into another oncology office but after the previous cancer center sent over my records, I've been told 4 times now that they have the referral and will contact me by end of day or the next day, for the last 3ish weeks.I can feel the pain in my thighs, hip/pelvic bone is growing and starting to get to effecting my daily routine.Does anyone have any advice on what I can do from here?Edit in case it's relevant: I also have Addisons and Graves Disease (well I had my thyroid taken out last June), Idiopathic Intracranial Hypertension, Thyroid Eye Disease, Ulcers, Gastritis, and gastroperisis.

Output: So what you have been taking is a -tinib drug which inhibits/blocks a growth hormone receptor (called tyrosine kinase). It really isn't classified as chemotherapy. That said, I would see a primary care doctor for now, to have the prescription renewed, while you wait to establish with a new oncologist.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Diagnosed with Chronic Myeloid Leukemia in November, fired from oncology office, 2 months without chemon September went to the ER for feeling under the weather and some blood work came back abnormal and I was referred to a hematology oncologist a month later. Went in and did the biopsy and everything. The doctor said that she calculated the risk from all the numbers and I'm in the intermediate risk stage but hopefully with the oral chemo for life, I should be able to keep it from turning into AML or the least, extend the quality of life.Come to find out that the doctor I was rushed in to see was actually a traveling doctor and she'd be leaving at the end of November. I then was forced to see a male doctor in the practice instead of the other female due to scheduling conflicts and bad weather. I felt very uncomfortable with the doctors bedside manner, the way he implied that I somehow forced a surgeon to take my thyroid out instead of trying medications first, didn't let me talk and explain that I was experiencing bad side effects from the chemo and also experiencing pain. This all happened and came to a head in March.He basically said that I was seeking drugs and that he wouldn't make any changes to my treatment (which was Bosulif 400mg/once a day). I was given a prescription and 5 refills. I then tried to speak to the director about being switched back to the female doctor and she said that the male Dr wouldn't sign off on that and if I was unhappy with the decision I can seek treatment elsewhere.I got my last refill in February and so have been off chemo since Feb 22nd. I tried to get into another oncology office but after the previous cancer center sent over my records, I've been told 4 times now that they have the referral and will contact me by end of day or the next day, for the last 3ish weeks.I can feel the pain in my thighs, hip/pelvic bone is growing and starting to get to effecting my daily routine.Does anyone have any advice on what I can do from here?Edit in case it's relevant: I also have Addisons and Graves Disease (well I had my thyroid taken out last June), Idiopathic Intracranial Hypertension, Thyroid Eye Disease, Ulcers, Gastritis, and gastroperisis.. ### Response: So what you have been taking is a -tinib drug which inhibits/blocks a growth hormone receptor (called tyrosine kinase). It really isn't classified as chemotherapy. That said, I would see a primary care doctor for now, to have the prescription renewed, while you wait to establish with a new oncologist..


Instruction: Ah, okay, was oddly explained to me in the beginning.But, I have gone to my primary care and they basically said that they can't prescribe the medication or treat the leukemia and that I need to try to work with the cancer center to find a new oncologist office. I've reached out to a few and had my referrals sent over but the days are just passing and no calls though a few have confirmed receiving the referrals.

Output: This is odd. I fail to see why a MD/DO would not prescribe at least 30 days of this medication. It isn't really a chemo drug and most physicians learn about it in medical school.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Ah, okay, was oddly explained to me in the beginning.But, I have gone to my primary care and they basically said that they can't prescribe the medication or treat the leukemia and that I need to try to work with the cancer center to find a new oncologist office. I've reached out to a few and had my referrals sent over but the days are just passing and no calls though a few have confirmed receiving the referrals.. ### Response: This is odd. I fail to see why a MD/DO would not prescribe at least 30 days of this medication. It isn't really a chemo drug and most physicians learn about it in medical school..


Instruction: Donating Blood with Fatty Liver / NASH42 White Male, 510, 181 PoundsMedications: Wellbutrin, Pepcid, Prilosec, AdderallI currently have Fatty Liver / NASH with F2 Fibrosis. I keep seeing things asking for blood donors due to a current shortage, but my local blood bank lists "Liver Disease" as a disqualifying condition.Over the past 7 months, I've lost 50 pounds due to diet and daily exercise. At my last hematology visit, all of my liver blood tests were in the "normal" range. So is there really a reason that I shouldn't give blood? Or do they really mean that cirrhosis is the disqualifier for blood donation?

Output: Fatty liver is not an exclusion to blood donation. When they list "liver disease", they mean problems that can be transmitted via the donated blood products. That means viruses, like hepatitis B or C. Cirrhosis does not exclude anyone from donating blood, but the person may be taking medications or have abnormal blood counts or have abnormal vital signs that would prevent the donation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Donating Blood with Fatty Liver / NASH42 White Male, 510, 181 PoundsMedications: Wellbutrin, Pepcid, Prilosec, AdderallI currently have Fatty Liver / NASH with F2 Fibrosis. I keep seeing things asking for blood donors due to a current shortage, but my local blood bank lists "Liver Disease" as a disqualifying condition.Over the past 7 months, I've lost 50 pounds due to diet and daily exercise. At my last hematology visit, all of my liver blood tests were in the "normal" range. So is there really a reason that I shouldn't give blood? Or do they really mean that cirrhosis is the disqualifier for blood donation?. ### Response: Fatty liver is not an exclusion to blood donation. When they list "liver disease", they mean problems that can be transmitted via the donated blood products. That means viruses, like hepatitis B or C. Cirrhosis does not exclude anyone from donating blood, but the person may be taking medications or have abnormal blood counts or have abnormal vital signs that would prevent the donation..


Instruction: Juvenile Xanthogranuloma22m with two skin lesions that were biopsied and turned out to be "Juvenile Xanthogranuloma" (adult type).The PA who did the biopsy didn't seem too concerned. I'm a little confused as it seems that it normally happens to infants and I can't find much other information about this online except in medical journals.Some research says it's rare, while other research says as many as 1% of children can be affected and that it's usually underdiagnosed. One study says the average dermatologist sees 1-2 cases per year, which doesn't seem too rare to me. It seems that 10-20% of cases occur in the third decade of life (people my age).I am also slightly concerned about an association between multiple juvenile xanthogranuloma and "hematologic malignancies."What has been your experience with this as a dermatologist/GP/etc.? Is this rare? Do you ever see it in adults in their early 20s or teenagers? Would having two lesions count as "multiple JXG"? Do I need to be getting bloodwork done? It's been months since they first appeared and no other ones have appeared.These developed after I got the COVID vax's. Apparently JXG results from a "proliferation of histiocytes". Could this be due to the immune response caused by the vax? I have not found anything about this link in VAERS.

Output: 2=multipleThese are very uncommon in adults. Feel free to have a thorough investigation if you feel it is needed. The yield is very low.Your theory on pathogenesis is interesting and unprovable.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Juvenile Xanthogranuloma22m with two skin lesions that were biopsied and turned out to be "Juvenile Xanthogranuloma" (adult type).The PA who did the biopsy didn't seem too concerned. I'm a little confused as it seems that it normally happens to infants and I can't find much other information about this online except in medical journals.Some research says it's rare, while other research says as many as 1% of children can be affected and that it's usually underdiagnosed. One study says the average dermatologist sees 1-2 cases per year, which doesn't seem too rare to me. It seems that 10-20% of cases occur in the third decade of life (people my age).I am also slightly concerned about an association between multiple juvenile xanthogranuloma and "hematologic malignancies."What has been your experience with this as a dermatologist/GP/etc.? Is this rare? Do you ever see it in adults in their early 20s or teenagers? Would having two lesions count as "multiple JXG"? Do I need to be getting bloodwork done? It's been months since they first appeared and no other ones have appeared.These developed after I got the COVID vax's. Apparently JXG results from a "proliferation of histiocytes". Could this be due to the immune response caused by the vax? I have not found anything about this link in VAERS.. ### Response: 2=multipleThese are very uncommon in adults. Feel free to have a thorough investigation if you feel it is needed. The yield is very low.Your theory on pathogenesis is interesting and unprovable..