Instruction: Hi there. Female, 20yo with Panic Disorder, GAD, MDD, BPD, the works. Hate it.Anyways, I've had psychiatrists keep me on Prozac 40mg most of my life and it's been the most comfortable. A numbing experience, but it did the job. Years ago, I tried Wellbutrin but at the time I had COVID (which actually amped my anxiety) and thought my anxiety getting worse was due to Wellbutrin, so I was taken off. Back to prozac for 2 more years. Recently, I got off it again and got on Wellbutrin 150mg due to sexual side effects and hoping it'd help my anxiety.It did not. In fact, it made anxiety worse and I've had awful panic attacks, physical symptoms that have been cleared by my GP after tests showed nothing was physically wrong.Talked to the psych, and he said "Ok well I can cross taper you from Wellbutrin slowly back to Prozac.".I swear I keep hearing never to take those together, and even my past psych wanted me to be off prozac completely before getting on Wellbutrin years ago.Note I have horrible health anxiety and dread feeling any negative physical symptoms (to the point I annoy my GP about it) and it's starting to make me feel helpless. I'm constantly bothering people and terrified of dying, and just... Feel like a waste of time to my doctor, a waste of resources to my nearby hospital when a panic attack gets so unbearable it feels like I'm fucking dying, and a bother to my loved ones even though they try to be helpful and reassure me I'm not dying.Last night was possibly the worst panic attack since I've been on Wellbutrin, even worse than Prozac PAs. Basically I was eating soft stick candy, swallowed a whole piece because I have a bad habit of not chewing my food, felt like it was stuck in my throat, tried coughing/throwing it up, began to panic when my throat started feeling weird after trying to force myself to throw up, and panic ensued. Fiance checked, nothing was in my throat and turns out it was probably a phantom feeling in my throat.But anyways, about the medication.So... I've agreed to do a cross taper and lower to 100mg for 2 weeks before adding in Prozac 20mg if I felt ok.Is this ok?Also, secondary question.What do you think of patients who suffer from these things? I'll be completely honest... I genuinely feel like a horrible person for wasting the time of people who help others that really need it.I had gone to an Urgent care when I started experiencing really bad breathlessness and a nurse came in to talk to me, I told them what I was feeling and mentioned it felt worse than most of my panic attacks. She asked me if I had a history of anxiety, answered yes, and she did my vitals and left. Later a doctor came in to check on me, nurse pulled her back outside and I had heard her say "No no, she's having a Panic attack" and their voices became more muffled as they walked away.It just... Kinda confirmed what I was already feeling and connected with other experiences of having gone to hospitals feeling absolutely shitty, with doctors recognizing me and seeming annoyed, or seeing my GP look at me with.. I dunno, not really pity, but something else that just makes me feel like I'm disappointing him, and it's not his fault... It just sort of destroys me, because every time he clears me of any physical illness, he just reminds me to find a suitable therapist and combine it with my medications, despite me knowing and not telling him most therapists around me have a year long waiting list and the ones I tried that DID hear me out... Well, didn't help at all. One I tried recently missed appointments constantly, telling me to wait until next week... for 4 weeks straight. And when I finally saw her, I wanted nothing more than to just spill the beans and vent and try and work through recent trauma with just a really horrible and abusive friendship that I'd managed to cut off, and...She said that before that, we had paperwork to fill out for the next 2 sessions. Not homework or therapy paperwork, mind you, paperwork paperwork.It's just... A helpless feeling. I feel like a bother to most doctors having the anxiety I have. I want to get to a therapy asap to stop having these obsessive thoughts about my health, and in turn, let you guys do what you do best, y'know?I'm really sorry to bother you all here. I guess I want some insight? Validation? Criticism? Confirmation of whether or not it's a huge inconvenience/nuisance for you all? I'm not sure... Any answer on the second half is welcome. Thanks, and again, sorry.

Output: Physician - PsychiatryProzac and Wellbutrin are very often prescribed in combination and is perfectly safe.You need to chew before you swallow your food. Basic skills of life here. There's a reason we have teeth. Please use them.There's nothing inherently wrong with you seeking medical reassurance when you're anxious about something, but also understand that medical resources are limited and healthcare workers are burnt out and very overworked. If someone comes in for the 4th or 5th time with anxiety symptoms that are similar to the past 4-5 times, it's human nature for the doctors to automatically assume it's anxiety again, which is neither medically urgent nor emergent. It becomes harder and harder for the doctor to justify medical workups when the cause seems very obvious.Having experienced anxiety symptoms for so long and so often, you can learn to recognize when it's anxiety vs something new that would feel different. You can learn how to start taking an active part in recognizing triggers of your anxiety and learning to avoid triggers (i.e. CHEWING your food) or de-escalate your symptoms before they become severe. As a psychiatrist, I'm acutely aware of how difficult is to find a therapist who can take insurance within a reasonable wait list (you should still get on those wait lists, it'll be your turn eventually). In the meantime, you can look into online Cognitive Behavioral Therapy (CBT) courses you can do on your own from home. It's not as effective and personalized as working with your own therapist, but it can get you to start learning the basic skills and concepts and start practicing those skills while you're waiting for a therapist. Therapy will be essential for long-term control of your symptoms. Meds alone will never be enough.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hi there. Female, 20yo with Panic Disorder, GAD, MDD, BPD, the works. Hate it.Anyways, I've had psychiatrists keep me on Prozac 40mg most of my life and it's been the most comfortable. A numbing experience, but it did the job. Years ago, I tried Wellbutrin but at the time I had COVID (which actually amped my anxiety) and thought my anxiety getting worse was due to Wellbutrin, so I was taken off. Back to prozac for 2 more years. Recently, I got off it again and got on Wellbutrin 150mg due to sexual side effects and hoping it'd help my anxiety.It did not. In fact, it made anxiety worse and I've had awful panic attacks, physical symptoms that have been cleared by my GP after tests showed nothing was physically wrong.Talked to the psych, and he said "Ok well I can cross taper you from Wellbutrin slowly back to Prozac.".I swear I keep hearing never to take those together, and even my past psych wanted me to be off prozac completely before getting on Wellbutrin years ago.Note I have horrible health anxiety and dread feeling any negative physical symptoms (to the point I annoy my GP about it) and it's starting to make me feel helpless. I'm constantly bothering people and terrified of dying, and just... Feel like a waste of time to my doctor, a waste of resources to my nearby hospital when a panic attack gets so unbearable it feels like I'm fucking dying, and a bother to my loved ones even though they try to be helpful and reassure me I'm not dying.Last night was possibly the worst panic attack since I've been on Wellbutrin, even worse than Prozac PAs. Basically I was eating soft stick candy, swallowed a whole piece because I have a bad habit of not chewing my food, felt like it was stuck in my throat, tried coughing/throwing it up, began to panic when my throat started feeling weird after trying to force myself to throw up, and panic ensued. Fiance checked, nothing was in my throat and turns out it was probably a phantom feeling in my throat.But anyways, about the medication.So... I've agreed to do a cross taper and lower to 100mg for 2 weeks before adding in Prozac 20mg if I felt ok.Is this ok?Also, secondary question.What do you think of patients who suffer from these things? I'll be completely honest... I genuinely feel like a horrible person for wasting the time of people who help others that really need it.I had gone to an Urgent care when I started experiencing really bad breathlessness and a nurse came in to talk to me, I told them what I was feeling and mentioned it felt worse than most of my panic attacks. She asked me if I had a history of anxiety, answered yes, and she did my vitals and left. Later a doctor came in to check on me, nurse pulled her back outside and I had heard her say "No no, she's having a Panic attack" and their voices became more muffled as they walked away.It just... Kinda confirmed what I was already feeling and connected with other experiences of having gone to hospitals feeling absolutely shitty, with doctors recognizing me and seeming annoyed, or seeing my GP look at me with.. I dunno, not really pity, but something else that just makes me feel like I'm disappointing him, and it's not his fault... It just sort of destroys me, because every time he clears me of any physical illness, he just reminds me to find a suitable therapist and combine it with my medications, despite me knowing and not telling him most therapists around me have a year long waiting list and the ones I tried that DID hear me out... Well, didn't help at all. One I tried recently missed appointments constantly, telling me to wait until next week... for 4 weeks straight. And when I finally saw her, I wanted nothing more than to just spill the beans and vent and try and work through recent trauma with just a really horrible and abusive friendship that I'd managed to cut off, and...She said that before that, we had paperwork to fill out for the next 2 sessions. Not homework or therapy paperwork, mind you, paperwork paperwork.It's just... A helpless feeling. I feel like a bother to most doctors having the anxiety I have. I want to get to a therapy asap to stop having these obsessive thoughts about my health, and in turn, let you guys do what you do best, y'know?I'm really sorry to bother you all here. I guess I want some insight? Validation? Criticism? Confirmation of whether or not it's a huge inconvenience/nuisance for you all? I'm not sure... Any answer on the second half is welcome. Thanks, and again, sorry.. ### Response: Physician - PsychiatryProzac and Wellbutrin are very often prescribed in combination and is perfectly safe.You need to chew before you swallow your food. Basic skills of life here. There's a reason we have teeth. Please use them.There's nothing inherently wrong with you seeking medical reassurance when you're anxious about something, but also understand that medical resources are limited and healthcare workers are burnt out and very overworked. If someone comes in for the 4th or 5th time with anxiety symptoms that are similar to the past 4-5 times, it's human nature for the doctors to automatically assume it's anxiety again, which is neither medically urgent nor emergent. It becomes harder and harder for the doctor to justify medical workups when the cause seems very obvious.Having experienced anxiety symptoms for so long and so often, you can learn to recognize when it's anxiety vs something new that would feel different. You can learn how to start taking an active part in recognizing triggers of your anxiety and learning to avoid triggers (i.e. CHEWING your food) or de-escalate your symptoms before they become severe. As a psychiatrist, I'm acutely aware of how difficult is to find a therapist who can take insurance within a reasonable wait list (you should still get on those wait lists, it'll be your turn eventually). In the meantime, you can look into online Cognitive Behavioral Therapy (CBT) courses you can do on your own from home. It's not as effective and personalized as working with your own therapist, but it can get you to start learning the basic skills and concepts and start practicing those skills while you're waiting for a therapist. Therapy will be essential for long-term control of your symptoms. Meds alone will never be enough..


Instruction: This is... An incredibly well thought out and insightful comment :')Yeah the chewing the food part was definitely my own fault, even my parents point out I eat way too fast and it's always been a terrible habit to break out of, something in my brain, whenever I try to chew, just says "Stop it, it's food, get it in before it's gone" so I'm genuinely trying to slow down but slip up like yesterday.The medical reassurance thing has sparked up pretty recently and I'll try my best to at least limit the urges to go. The problem is that even though I've had countless panic attacks, something new ALWAYS pops up. A different symptom that just freaks me out every time, jumps up out of nowhere, and automatically is flagged as "This is new. Panic, you're dying." Just when I get used to one symptom, another pops up. Like the breathlessness, which was never really a symptom until recently. Something I noticed after I'd gone to the doctor and got cleared was that trying to tell myself "You're fine, it's new, but nothing is wrong with your lungs and heart, just distract yourself." Tada, as soon as I'm not thinking about it, it goes away, and as soon as I think "Hey, look at that! It went away!" It comes right back because I focus on it, even if it's positive. But at least I got that down, trying to tell myself as long as I'm breathing and not unconscious I don't need to go to a hospital.About the CBT online courses, I had no idea that existed. Usually I'd only take DBT for years and not CBT even though I thought it would help more (but therapists kept saying "well you have BPD so let's focus on DBT" even though... I graduated it.)I usually assumed I NEEDED a person to have CBT therapy with, so is there a specific site you'd recommend? I'm genuinely kinda excited at the prospect of it being online.

Output: One suggestion I have is for your to start keeping a list of the symptoms you have when you have anxiety/panic, and also checking out descriptions of anxiety symptoms from REPUTABLE medical websites like WebMD, MDConsult, Stanford Health, Massachusetts General Hospital, Johns Hopkins Health, etc, and generate a master list. When you have a new symptom, check it against the master list to see if it's considered a common anxiety symptom, and if it isn't THEN go get a medical workup.You can do a Google search for online CBT classes (be aware these are not usually Free, and if they are, there's usually a catch). Here are a few with good reputations:https://cbtonline.com/https://www.beatingtheblues.co.uk/private-patients/https://cogbtherapy.com/free-online-cbt-workbook (this is free, no catch, but very basic)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This is... An incredibly well thought out and insightful comment :')Yeah the chewing the food part was definitely my own fault, even my parents point out I eat way too fast and it's always been a terrible habit to break out of, something in my brain, whenever I try to chew, just says "Stop it, it's food, get it in before it's gone" so I'm genuinely trying to slow down but slip up like yesterday.The medical reassurance thing has sparked up pretty recently and I'll try my best to at least limit the urges to go. The problem is that even though I've had countless panic attacks, something new ALWAYS pops up. A different symptom that just freaks me out every time, jumps up out of nowhere, and automatically is flagged as "This is new. Panic, you're dying." Just when I get used to one symptom, another pops up. Like the breathlessness, which was never really a symptom until recently. Something I noticed after I'd gone to the doctor and got cleared was that trying to tell myself "You're fine, it's new, but nothing is wrong with your lungs and heart, just distract yourself." Tada, as soon as I'm not thinking about it, it goes away, and as soon as I think "Hey, look at that! It went away!" It comes right back because I focus on it, even if it's positive. But at least I got that down, trying to tell myself as long as I'm breathing and not unconscious I don't need to go to a hospital.About the CBT online courses, I had no idea that existed. Usually I'd only take DBT for years and not CBT even though I thought it would help more (but therapists kept saying "well you have BPD so let's focus on DBT" even though... I graduated it.)I usually assumed I NEEDED a person to have CBT therapy with, so is there a specific site you'd recommend? I'm genuinely kinda excited at the prospect of it being online.. ### Response: One suggestion I have is for your to start keeping a list of the symptoms you have when you have anxiety/panic, and also checking out descriptions of anxiety symptoms from REPUTABLE medical websites like WebMD, MDConsult, Stanford Health, Massachusetts General Hospital, Johns Hopkins Health, etc, and generate a master list. When you have a new symptom, check it against the master list to see if it's considered a common anxiety symptom, and if it isn't THEN go get a medical workup.You can do a Google search for online CBT classes (be aware these are not usually Free, and if they are, there's usually a catch). Here are a few with good reputations:https://cbtonline.com/https://www.beatingtheblues.co.uk/private-patients/https://cogbtherapy.com/free-online-cbt-workbook (this is free, no catch, but very basic).


Instruction: This is amazing. I've never considered a master list and I'll get on that right away. I kinda wanna make a physical and digital one and make them both look nice, so it seems I've got a new art project :DAlso the free online CBT workbook seems best while I look for a CBT therapist or at least get into the therapy waiting list from the psychiatric hospital nearby I get medications from. I apologize for being a little difficult, but here's my question:Concerning symptoms in general, what if it's a new symptom that feels particularly severe or a general symptom from before that feels significantly more severe than usual?Usually I start to panic once let's say... I have dizziness, and suddenly that dizziness morphs into lightheadedness and a feeling faint sensation. Luckily I've been able to tell myself "just lie down, this is probably anxiety" but that was waaaay before, with my health anxiety ramping up again I'm afraid of just freaking out once something comes up and I forget in the moment.Although, I do guess that comes with the territory of learning my symptoms. But like I said, if a symptom is extremely severe, I should probably check with other things like accompaniment of other symptoms that are new and not anxiety related, or if something happened to spark the symptom right? I'm really sorry, I just wanna make sure I know when to panic and when not to, although I realize that's also something I'll need to work on, controlling panic.

Output: I encourage you to read up on Box Breathing techniques. When someone gets stressed or anxiety, its easy to start hyperventilating, and hyperventilating can induce anxiety symptoms. So learning how to control your breathing can go a long way towards getting anxiety and panic symptoms under control. As soon as you notice that youre feeling anxious, take yourself away from the trigger and go find a quiet private place, preferably dark, and take 5-10 minutes to do the Box Breathing technique. Most anxiety symptoms will go down by doing that and youll be able to better differentiate where youre having anxiety or an actual new concerning symptom.https://www.webmd.com/balance/what-is-box-breathingI also would suggest you find some guided progressive muscle relaxation videos on YouTube and start learning that skill. Its incredibly effective at calming anxiety attacks. If you can successfully complete a whole session, youre probably not going to feel much anxiety afterwards.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This is amazing. I've never considered a master list and I'll get on that right away. I kinda wanna make a physical and digital one and make them both look nice, so it seems I've got a new art project :DAlso the free online CBT workbook seems best while I look for a CBT therapist or at least get into the therapy waiting list from the psychiatric hospital nearby I get medications from. I apologize for being a little difficult, but here's my question:Concerning symptoms in general, what if it's a new symptom that feels particularly severe or a general symptom from before that feels significantly more severe than usual?Usually I start to panic once let's say... I have dizziness, and suddenly that dizziness morphs into lightheadedness and a feeling faint sensation. Luckily I've been able to tell myself "just lie down, this is probably anxiety" but that was waaaay before, with my health anxiety ramping up again I'm afraid of just freaking out once something comes up and I forget in the moment.Although, I do guess that comes with the territory of learning my symptoms. But like I said, if a symptom is extremely severe, I should probably check with other things like accompaniment of other symptoms that are new and not anxiety related, or if something happened to spark the symptom right? I'm really sorry, I just wanna make sure I know when to panic and when not to, although I realize that's also something I'll need to work on, controlling panic.. ### Response: I encourage you to read up on Box Breathing techniques. When someone gets stressed or anxiety, its easy to start hyperventilating, and hyperventilating can induce anxiety symptoms. So learning how to control your breathing can go a long way towards getting anxiety and panic symptoms under control. As soon as you notice that youre feeling anxious, take yourself away from the trigger and go find a quiet private place, preferably dark, and take 5-10 minutes to do the Box Breathing technique. Most anxiety symptoms will go down by doing that and youll be able to better differentiate where youre having anxiety or an actual new concerning symptom.https://www.webmd.com/balance/what-is-box-breathingI also would suggest you find some guided progressive muscle relaxation videos on YouTube and start learning that skill. Its incredibly effective at calming anxiety attacks. If you can successfully complete a whole session, youre probably not going to feel much anxiety afterwards..


Instruction: Hey! Im a 33F. 59, 215lbs. Diagnosed with arthritis in my back in 2020. No daily medications normally. ER just started me on prednisone 60mg daily, metaxalone 800mg TID and diclofenac 75mg BID. I have had chronic back pain for years now. I work as a nurse and as you all know the constant pulling and lifting of patients is hard on the back. I did some dumb things as a new grad working short in long term care and ended up with lots of back pain. I went in 2020 to have it evaluated. My NP did an X-ray and it just showed arthritis. She ordered PT but at that time I was working a covid unit and they started mandatory extra shifts and I wasnt able to schedule the PT. About 6 months ago I started having issues where when I would go to stand up my back would catch and Id be stuck bent over for several minutes until it loosened up. I kept saying I was going to schedule an appointment but never did. (I know, I know. ) At work the other night my toes/foot went numb. I ended up going to the ED. They did a CT scan of my lumbar spine and told me I had bulging discs. When the ER NP came in, he told me I had 4 bulging discs in my lumbar spine and he felt they were causing nerve compression which was causing my numbness/tingling. He said I was at risk of herniating and put me on a 10 lb weight restriction until I follow up with primary care for a MRI. (They are a small ED and have no MRI available.) The CT report just came through on MyChart and it says I have bulges at L4-L5 and L5-S1. So am I understanding that that would only be 2 bulging discs? Im thinking my husband and I maybe just misunderstood him when he came in. This is a different side of nursing for me and Im not too sure about the risks and such with disc issues. Is the risk of herniating really high? My job wont put me on light duty because it didnt happen there and they just told me to ask for help with transfers/boosts. I work on a very heavy floor thats not considered ICU but they still call it critical care. Its lots of post ops and amputations. It tends to require a lot of lifting and pulling. Im just feeling really anxious about work and I guess am just looking for reassurance/ guidance. Interestingly enough two days before my foot went numb I was having nerve pain going across my shoulders and radiating down my arms. So Im sure Ive got stuff going on higher up as well. I was able to get a PCP follow up on Wednesday so Im hoping to get more information there.Also- is it common for the numbness tingling to come and go? Im assuming its the meds helping? Because at first it was continuous. Now sometimes it travels up my leg into my thigh but It wont last very long. Maybe an hour or so and then goes away.Sorry for the novel- thank you if youve gotten this far.

Output: I question everything this ER NP has told you. You're correct, if your report says L4-L5 and L5-S1 that's two discs. Not sure why they said that those disc bulges are causing the pain. It's well known that imaging findings in back pain, particularly minor and common findings of disc degeneration, do not correlate well with back pain. That is to say, imaging findings like yours are not necessarily the pain generator. Was a physical exam done with a lower extremity Neuro exam?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hey! Im a 33F. 59, 215lbs. Diagnosed with arthritis in my back in 2020. No daily medications normally. ER just started me on prednisone 60mg daily, metaxalone 800mg TID and diclofenac 75mg BID. I have had chronic back pain for years now. I work as a nurse and as you all know the constant pulling and lifting of patients is hard on the back. I did some dumb things as a new grad working short in long term care and ended up with lots of back pain. I went in 2020 to have it evaluated. My NP did an X-ray and it just showed arthritis. She ordered PT but at that time I was working a covid unit and they started mandatory extra shifts and I wasnt able to schedule the PT. About 6 months ago I started having issues where when I would go to stand up my back would catch and Id be stuck bent over for several minutes until it loosened up. I kept saying I was going to schedule an appointment but never did. (I know, I know. ) At work the other night my toes/foot went numb. I ended up going to the ED. They did a CT scan of my lumbar spine and told me I had bulging discs. When the ER NP came in, he told me I had 4 bulging discs in my lumbar spine and he felt they were causing nerve compression which was causing my numbness/tingling. He said I was at risk of herniating and put me on a 10 lb weight restriction until I follow up with primary care for a MRI. (They are a small ED and have no MRI available.) The CT report just came through on MyChart and it says I have bulges at L4-L5 and L5-S1. So am I understanding that that would only be 2 bulging discs? Im thinking my husband and I maybe just misunderstood him when he came in. This is a different side of nursing for me and Im not too sure about the risks and such with disc issues. Is the risk of herniating really high? My job wont put me on light duty because it didnt happen there and they just told me to ask for help with transfers/boosts. I work on a very heavy floor thats not considered ICU but they still call it critical care. Its lots of post ops and amputations. It tends to require a lot of lifting and pulling. Im just feeling really anxious about work and I guess am just looking for reassurance/ guidance. Interestingly enough two days before my foot went numb I was having nerve pain going across my shoulders and radiating down my arms. So Im sure Ive got stuff going on higher up as well. I was able to get a PCP follow up on Wednesday so Im hoping to get more information there.Also- is it common for the numbness tingling to come and go? Im assuming its the meds helping? Because at first it was continuous. Now sometimes it travels up my leg into my thigh but It wont last very long. Maybe an hour or so and then goes away.Sorry for the novel- thank you if youve gotten this far.. ### Response: I question everything this ER NP has told you. You're correct, if your report says L4-L5 and L5-S1 that's two discs. Not sure why they said that those disc bulges are causing the pain. It's well known that imaging findings in back pain, particularly minor and common findings of disc degeneration, do not correlate well with back pain. That is to say, imaging findings like yours are not necessarily the pain generator. Was a physical exam done with a lower extremity Neuro exam?.


Instruction: The NP, MD and nurse never once looked at my foot. I was at work when it started. Im a vascular nurse so I checked pulses and my other nurse friend did a very quick assessment for weakness but it was fine. At the ED they all just kept telling me it was sciatica, which Ive had before but its never made anything go numb. Then once the CT came back they said it was nerve compression from the bulging discs.

Output: Hopefully your primary care doc will actually do a physical exam.I'd caution you against recommending things based off of what you've seen. That's unsafe, inaccurate and bad practice.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: The NP, MD and nurse never once looked at my foot. I was at work when it started. Im a vascular nurse so I checked pulses and my other nurse friend did a very quick assessment for weakness but it was fine. At the ED they all just kept telling me it was sciatica, which Ive had before but its never made anything go numb. Then once the CT came back they said it was nerve compression from the bulging discs.. ### Response: Hopefully your primary care doc will actually do a physical exam.I'd caution you against recommending things based off of what you've seen. That's unsafe, inaccurate and bad practice..


Instruction: This post is about my dad, who is about to leave the hospital after a 2 night stay.Age: 55Sex: MHeight: 5'8"Weight: ~180-200Race: whiteDuration of complaint: 5 daysLocation/issue: Esophageal tear, 4 stomach ulcersAny existing relevant medical issues: T2 diabetes, high BP, GERD, alcoholic for ~25-30 years, anxiety, compressed ulnar nerve due to bulging cervical discs - lots of back pain and numbness in armCurrent medications: metformin, no BP meds (had a bad rxn), alprazolam, venlafaxine, there are others I can't remember but they're not super relevant to my concernI'll be brief here, but can answer questions if needed. I don't live near my parents so I'm hearing everything from my mom.Wednesday: Dad isn't feeling great, but that's not uncommon due to the alcoholism-diabetes combo and current back pain. Mom and dad go to the gas station, dad goes to the bathroom, employee informs mom that dad has passed out in the bathroom. They call the ambulance, blood sugar is 54, he's given glucose, and feels better. Refuses to go to hospital, mom takes him home.They walk inside, he feels lightheaded again and vomits multiple times. Mom goes to get a towel and he then passes out and begins to aspirate vomit. Mom sits him up and slaps his back until he can breathe again. Brief comedy break- he says "wow! I feel better!" He goes to the bathroom and is bleeding a lot from his rectum. Refuses again to go to the hospital (he's an ornery fellow, but it's understandable because he doesn't have insurance).Thursday: He goes to his PCP Thursday morning and PCP says he has lost up to 1/3 of his blood and needs to go to the hospital. Dad refuses again. No major events occur the rest of the day.Friday: Dad tells mom he's feeling alright, he eats some food, seems normal. She goes to work. She returns and I'm not sure what exactly happened, but he begins bleeding profusely from the rectum again and goes to the hospital Friday evening.Drs can't identify the source of bleeding and are thinking diverticulitis. He continues to bleed and is given 5 pints of blood over the course of the evening/overnight. They prep him for colonoscopy in the morning. Drs tell mom situation is critical and to be prepared for the worst.Saturday: Dad doesn't respond well to the barium so they do endoscopy through the mouth instead and find an esophageal tear and 4 stomach ulcers. The esophageal tear finally resolves on its own so they didn't do any repair. Rectal bleeding largely subsides but there is still some with every BM. They plan to do a colonoscopy later. Hemoglobin was 9 at intake, now is 7.6. He's on a magnesium drip and gets another pint of blood for a total of 6 pints. Saturday night is not too eventful. Blood pressure is low despite typically high BP.Sunday: Bleeding has mostly subsided. Hemoglobin is still very low. BP still low. GI doctor no longer wants to do colonoscopy and says dad can go home. Floor Dr and nurse think he should stay. Dad is worried about medical bills and claims the hospital is "trying to kill him" so has opted to go home.I have two questions- should he really be going home?? And given he is a physically dependent alcoholic, should he be given alcohol or no? Mom says he was not given alcohol during his stay and did not have any seizures or severe withdrawal symptoms. Last time he had alcohol was probably sometime Friday morning or afternoon. I know quitting alcohol cold turkey is very dangerous so I'm surprised he has been mostly ok in that regard. He's anxious, irritable, and paranoid that the hospital is killing him, but otherwise not terrible. Is he over the hump after 2 days cold turkey? Should my family remove all alcohol from the house and keep him dry? Supervised small doses?I'm surprised he's allowed to discharge himself so soon after nearly dying, when his stats are still bad and his doctors don't even agree. My family hasn't been given much information and don't know how best to take care of him at home. He can be quite the asshole and doesn't listen to anyone (even his doctor) so restricting alcohol or anything else would be difficult.I'd appreciate any advice on home care, what to look out for, and especially what to do about alcohol. For reference his intake varies a lot but sometimes it's as high as a whole 750mL bottle of rum in one day. Supposedly it has been "less" lately due to acid reflux.Edit Sunday Aug 7th: his hemoglobin had gone up, but dropped back to 7.7 and there's a small amount of blood in his stool. So he's still at the hospital for now.

Output: Glad that he is staying in the hospital.He should strongly consider medications such as naltrexone (oral or intramuscular injections that last for 30 days) or acamprosate which can reduce alcohol cravings. This is the type of medication he should get a prescription for once he is discharged. Once he is home, remove any triggers he might have at home.Wish you and your dad the best

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This post is about my dad, who is about to leave the hospital after a 2 night stay.Age: 55Sex: MHeight: 5'8"Weight: ~180-200Race: whiteDuration of complaint: 5 daysLocation/issue: Esophageal tear, 4 stomach ulcersAny existing relevant medical issues: T2 diabetes, high BP, GERD, alcoholic for ~25-30 years, anxiety, compressed ulnar nerve due to bulging cervical discs - lots of back pain and numbness in armCurrent medications: metformin, no BP meds (had a bad rxn), alprazolam, venlafaxine, there are others I can't remember but they're not super relevant to my concernI'll be brief here, but can answer questions if needed. I don't live near my parents so I'm hearing everything from my mom.Wednesday: Dad isn't feeling great, but that's not uncommon due to the alcoholism-diabetes combo and current back pain. Mom and dad go to the gas station, dad goes to the bathroom, employee informs mom that dad has passed out in the bathroom. They call the ambulance, blood sugar is 54, he's given glucose, and feels better. Refuses to go to hospital, mom takes him home.They walk inside, he feels lightheaded again and vomits multiple times. Mom goes to get a towel and he then passes out and begins to aspirate vomit. Mom sits him up and slaps his back until he can breathe again. Brief comedy break- he says "wow! I feel better!" He goes to the bathroom and is bleeding a lot from his rectum. Refuses again to go to the hospital (he's an ornery fellow, but it's understandable because he doesn't have insurance).Thursday: He goes to his PCP Thursday morning and PCP says he has lost up to 1/3 of his blood and needs to go to the hospital. Dad refuses again. No major events occur the rest of the day.Friday: Dad tells mom he's feeling alright, he eats some food, seems normal. She goes to work. She returns and I'm not sure what exactly happened, but he begins bleeding profusely from the rectum again and goes to the hospital Friday evening.Drs can't identify the source of bleeding and are thinking diverticulitis. He continues to bleed and is given 5 pints of blood over the course of the evening/overnight. They prep him for colonoscopy in the morning. Drs tell mom situation is critical and to be prepared for the worst.Saturday: Dad doesn't respond well to the barium so they do endoscopy through the mouth instead and find an esophageal tear and 4 stomach ulcers. The esophageal tear finally resolves on its own so they didn't do any repair. Rectal bleeding largely subsides but there is still some with every BM. They plan to do a colonoscopy later. Hemoglobin was 9 at intake, now is 7.6. He's on a magnesium drip and gets another pint of blood for a total of 6 pints. Saturday night is not too eventful. Blood pressure is low despite typically high BP.Sunday: Bleeding has mostly subsided. Hemoglobin is still very low. BP still low. GI doctor no longer wants to do colonoscopy and says dad can go home. Floor Dr and nurse think he should stay. Dad is worried about medical bills and claims the hospital is "trying to kill him" so has opted to go home.I have two questions- should he really be going home?? And given he is a physically dependent alcoholic, should he be given alcohol or no? Mom says he was not given alcohol during his stay and did not have any seizures or severe withdrawal symptoms. Last time he had alcohol was probably sometime Friday morning or afternoon. I know quitting alcohol cold turkey is very dangerous so I'm surprised he has been mostly ok in that regard. He's anxious, irritable, and paranoid that the hospital is killing him, but otherwise not terrible. Is he over the hump after 2 days cold turkey? Should my family remove all alcohol from the house and keep him dry? Supervised small doses?I'm surprised he's allowed to discharge himself so soon after nearly dying, when his stats are still bad and his doctors don't even agree. My family hasn't been given much information and don't know how best to take care of him at home. He can be quite the asshole and doesn't listen to anyone (even his doctor) so restricting alcohol or anything else would be difficult.I'd appreciate any advice on home care, what to look out for, and especially what to do about alcohol. For reference his intake varies a lot but sometimes it's as high as a whole 750mL bottle of rum in one day. Supposedly it has been "less" lately due to acid reflux.Edit Sunday Aug 7th: his hemoglobin had gone up, but dropped back to 7.7 and there's a small amount of blood in his stool. So he's still at the hospital for now.. ### Response: Glad that he is staying in the hospital.He should strongly consider medications such as naltrexone (oral or intramuscular injections that last for 30 days) or acamprosate which can reduce alcohol cravings. This is the type of medication he should get a prescription for once he is discharged. Once he is home, remove any triggers he might have at home.Wish you and your dad the best.


Instruction: My son (19M) 6'1" 210lbs who lives approx. 2 hours away at university. No relevant health history besides depression. No routine meds. Doesn't smoke or drink. Yesterday, around 18:00 apparently, he took 50 500mg acetaminophen tablets in a suicide attempt. I was notified at around 02:00 this morning by my ex-wife. I immediately called 911 and notified them of the situation. Ultimately he was taken to the ER a little after 03:00. I have been unable to speak with him due to being Baker Acted. My ex-wife was able to find out that they'd given him something to induce vomiting. My question is roughly 9 hours after ingestion he should definitely be receiving Acetadote, right? I'm not saying that he he isn't, but it wasn't mentioned apparently. It has been quite sometime since I've worked in critical care (RN), but we would have definitely put him on Acetadote. Am I safe in assuming this is the case? Also, in an otherwise healthy young man, what, if any, longterm complications might we be looking at? Thanks in advance for any help.

Output: No long term complications if he recovers from this, which he should if the timing is correct. There's only 2 ways these go 1) liver failure or 2) complete recovery. He should be early enough in his overdose to be treated.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My son (19M) 6'1" 210lbs who lives approx. 2 hours away at university. No relevant health history besides depression. No routine meds. Doesn't smoke or drink. Yesterday, around 18:00 apparently, he took 50 500mg acetaminophen tablets in a suicide attempt. I was notified at around 02:00 this morning by my ex-wife. I immediately called 911 and notified them of the situation. Ultimately he was taken to the ER a little after 03:00. I have been unable to speak with him due to being Baker Acted. My ex-wife was able to find out that they'd given him something to induce vomiting. My question is roughly 9 hours after ingestion he should definitely be receiving Acetadote, right? I'm not saying that he he isn't, but it wasn't mentioned apparently. It has been quite sometime since I've worked in critical care (RN), but we would have definitely put him on Acetadote. Am I safe in assuming this is the case? Also, in an otherwise healthy young man, what, if any, longterm complications might we be looking at? Thanks in advance for any help.. ### Response: No long term complications if he recovers from this, which he should if the timing is correct. There's only 2 ways these go 1) liver failure or 2) complete recovery. He should be early enough in his overdose to be treated..


Instruction: My sister (30, Hispanic, 5'3", about 250 lbs) has several medical conditions and a long history of undiagnosed neurological symptoms.Two or three years ago, she started having numbness and weakness in her hands and feet and sometimes arms and legs that got much worse in the heat. She was having a couple of other symptoms at the time (can't remember, but I think one was having trouble seeing out of one eye) that made us wonder if she might need to be screened for M.S., but she didn't have insurance at the time and it resolved after a couple of months, so she never got it checked.Last year in June, she started having multiple grand mal and absence seizures per day, including episodes of stat ep, and an EEG confirmed temporal lobe epilepsy. She also had periods of disorientation with no obvious seizure activity. She tried several medications and they finally settled on max dose Depakote. She has not had a seizure in six months that she knows of.Two or three months ago she suddenly developed the inability to tell if her bladder was full and she also had sudden full releases of her bladder. This has been improved with medication.On June 8th, she went to the ER for a severe headache. She was diagnosed with cervicogenic headache caused by muscle spasms in her back and neck (new onset).On June 29th, the ER gave her a steroid injection (for asthma) in the front of her left thigh and her thigh immediately went numb. It remained numb until this past Monday, when she developed severe pain in her thigh with difficulty walking and bearing weight on that leg. There was no redness, swelling, or other obvious indication of infection or blood clot. Her PCP said it was likely femoral nerve entrapment as a result of the injection and that it would likely resolve over time.Last night (Thursday), just before 5 pm, she had a sudden onset of left sided numbness in her face, neck, left arm, and left leg. She could no longer feel the nerve pain in her thigh at all. She also had blurry vision in both eyes. The paramedics noticed slurred speech, word finding problems, and facial droop. She was able to make it to the stretcher with help. By the time that she got the ER (level 2 stroke center), her entire left side was paralyzed and she had zero sensation on that side. Whenever she tried to lift her left leg, visible muscle spasms were present in her thigh. She also could not feel her pubic region at all and had great difficulty urinating. At no point did she have a headache. She said she had no lapse in memory and does not believe she had a seizure (her SO was with her also). Her blood pressure and blood glucose were normal. Head CT and MRI did not show signs of either a hemorrhagic or ischemic stroke. After a couple of hours, she showed slight improvement - able to slightly lift her affected arm and leg, although she still has no sensation. The facial droop and slurred speech had mostly resolved, but she was still having word finding problems. She was told it was likely a TIA caused by her Nexplanon and that it would be completely resolved by morning. They said if it wasn't a TIA, it could either be an unusual presentation of a seizure or a psychiatric condition (she has depression, anxiety, PTSD, and ADHD, all controlled). She was admitted to the step down unit for observation. They said they could not give her any of her medications until the hospitalist approved them.This morning (Friday) my sister had recurrence of the left sided numbness and could no longer move her arm and leg. The hospitalist was surprised to find that the symptoms had not resolved. The hospitalist said it was likely not a TIA and that they would be looking for other causes, like M.S. The symptoms slowly began to improve again, then the numbness returned along with the paralysis. This has improved slightly again. She had a repeat head MRI and CT, an echo, and a carotid ultrasound, all normal. She was assessed by speech therapy (normal) and PT/OT, who found severe deficiencies and recommended inpatient rehab. At no point throughout the day was she given any of her regular medications, including her Depakote, which is critical for her. The nurse didn't answer any of her call lights all day, and she sat in her own urine for hours, tried desperately to hold her bowels because he was so irritated every time she called that she was afraid to use her call light.Her case worker informed her that both local inpatient rehabilitation centers denied her admission because she didn't meet the criteria based on the neurologist's diagnosis (which we had not yet been updated on). Finally the neurologist came and did a super quick assessment. My sister could lift her left arm about three inches off the bed and her left leg about two inches, and still had almost no sensation. She still could not walk or bear weight at all. The neurologist said that they had ruled out all emergent causes and that it was probably a manifestation of conversion disorder and that it would go away in a few weeks. She will be discharged tomorrow and given a referral for home health.After the neurologist left, my sister started crying. She felt dismissed and judged and crazy and she started wondering if she was faking the whole thing. I reassured her that what she was feeling was real and that I believed her 100%. I called the patient advocate, but they were gone for the weekend. I contacted the house supervisor and requested either a different neurologist or a transfer to another hospital. She said she would talk to the neurologist to see what he was thinking. After they talked, they basically denied both requests, as well as a request for inpatient rehab or PT, and said she would still be discharged tomorrow.There are stairs that lead up to her mobile home. Her SO is not strong enough to assist her with the at home care she needs until home health comes through and she will clearly need significant around the clock care. She will not be adequately cared for at home.I'm not sure if we should just do the best we can until she can contact her regular neurologist on Monday (there is no after hours emergency line), or if we should check her out tonight and take her to an academic hospital for a second opinion and further testing. Our closest major cities are Shreveport, LA (1 hr), Little Rock, AR (2.5 hr), and Dallas, TX (2.75 hr). Any advice would be extremely helpful.This is what I know about her medical history:Hard of hearing Temporal lobe epilepsy (June 2021), last known seizure 6 months ago Cervicogenic headache due to neck/back spasms (June 8) Asthma Unstable SVT (frequent episodes for awhile, but no episodes in a few years) Fibromyalgia Left leg - possible femoral nerve entrapment (June 29) Rectal abscess surgery (Feb 8) ADHD Depression Anxiety PTSD Chronic/frequent laryngitis? (sore throat, loss of voice, and fever every two to four weeks for at least a year, not diagnosed) Upper back pain/vomiting when eating (April) Severe sleep apnea - hasn't received CPAP machine yet Urinary incontinence Non-alcoholic fatty liver disease Chronic rib pain - both sides, since teenager Enlarged spleen (Dec 2020) Hypertension Hyperlipidemia COVID (2020) PCOS Acid refluxThese are the medications I'm aware of:Ozempic (for weight loss) Metformin (for weight loss) Cymbalta Depakote Albuterol Gabapentin Oxybutynin Indomethacin Trelegy Singulair NexplanonShe rarely drinks alcohol - causes back and shoulder pain. She does not smoke cigarettes. She has her medical marijuana card for epilepsy, but rarely used it until this week, when she began smoking frequently to try to control the leg pain.Please let me know if you have any questions.

Output: I hate to be that physician but in the absence of any actual findings on multiple MRI, ECHOs, Carotid US, sometimes conversion disorder may be more likely than a rare esoteric disease. That being said, what led you away from conversion disorder?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My sister (30, Hispanic, 5'3", about 250 lbs) has several medical conditions and a long history of undiagnosed neurological symptoms.Two or three years ago, she started having numbness and weakness in her hands and feet and sometimes arms and legs that got much worse in the heat. She was having a couple of other symptoms at the time (can't remember, but I think one was having trouble seeing out of one eye) that made us wonder if she might need to be screened for M.S., but she didn't have insurance at the time and it resolved after a couple of months, so she never got it checked.Last year in June, she started having multiple grand mal and absence seizures per day, including episodes of stat ep, and an EEG confirmed temporal lobe epilepsy. She also had periods of disorientation with no obvious seizure activity. She tried several medications and they finally settled on max dose Depakote. She has not had a seizure in six months that she knows of.Two or three months ago she suddenly developed the inability to tell if her bladder was full and she also had sudden full releases of her bladder. This has been improved with medication.On June 8th, she went to the ER for a severe headache. She was diagnosed with cervicogenic headache caused by muscle spasms in her back and neck (new onset).On June 29th, the ER gave her a steroid injection (for asthma) in the front of her left thigh and her thigh immediately went numb. It remained numb until this past Monday, when she developed severe pain in her thigh with difficulty walking and bearing weight on that leg. There was no redness, swelling, or other obvious indication of infection or blood clot. Her PCP said it was likely femoral nerve entrapment as a result of the injection and that it would likely resolve over time.Last night (Thursday), just before 5 pm, she had a sudden onset of left sided numbness in her face, neck, left arm, and left leg. She could no longer feel the nerve pain in her thigh at all. She also had blurry vision in both eyes. The paramedics noticed slurred speech, word finding problems, and facial droop. She was able to make it to the stretcher with help. By the time that she got the ER (level 2 stroke center), her entire left side was paralyzed and she had zero sensation on that side. Whenever she tried to lift her left leg, visible muscle spasms were present in her thigh. She also could not feel her pubic region at all and had great difficulty urinating. At no point did she have a headache. She said she had no lapse in memory and does not believe she had a seizure (her SO was with her also). Her blood pressure and blood glucose were normal. Head CT and MRI did not show signs of either a hemorrhagic or ischemic stroke. After a couple of hours, she showed slight improvement - able to slightly lift her affected arm and leg, although she still has no sensation. The facial droop and slurred speech had mostly resolved, but she was still having word finding problems. She was told it was likely a TIA caused by her Nexplanon and that it would be completely resolved by morning. They said if it wasn't a TIA, it could either be an unusual presentation of a seizure or a psychiatric condition (she has depression, anxiety, PTSD, and ADHD, all controlled). She was admitted to the step down unit for observation. They said they could not give her any of her medications until the hospitalist approved them.This morning (Friday) my sister had recurrence of the left sided numbness and could no longer move her arm and leg. The hospitalist was surprised to find that the symptoms had not resolved. The hospitalist said it was likely not a TIA and that they would be looking for other causes, like M.S. The symptoms slowly began to improve again, then the numbness returned along with the paralysis. This has improved slightly again. She had a repeat head MRI and CT, an echo, and a carotid ultrasound, all normal. She was assessed by speech therapy (normal) and PT/OT, who found severe deficiencies and recommended inpatient rehab. At no point throughout the day was she given any of her regular medications, including her Depakote, which is critical for her. The nurse didn't answer any of her call lights all day, and she sat in her own urine for hours, tried desperately to hold her bowels because he was so irritated every time she called that she was afraid to use her call light.Her case worker informed her that both local inpatient rehabilitation centers denied her admission because she didn't meet the criteria based on the neurologist's diagnosis (which we had not yet been updated on). Finally the neurologist came and did a super quick assessment. My sister could lift her left arm about three inches off the bed and her left leg about two inches, and still had almost no sensation. She still could not walk or bear weight at all. The neurologist said that they had ruled out all emergent causes and that it was probably a manifestation of conversion disorder and that it would go away in a few weeks. She will be discharged tomorrow and given a referral for home health.After the neurologist left, my sister started crying. She felt dismissed and judged and crazy and she started wondering if she was faking the whole thing. I reassured her that what she was feeling was real and that I believed her 100%. I called the patient advocate, but they were gone for the weekend. I contacted the house supervisor and requested either a different neurologist or a transfer to another hospital. She said she would talk to the neurologist to see what he was thinking. After they talked, they basically denied both requests, as well as a request for inpatient rehab or PT, and said she would still be discharged tomorrow.There are stairs that lead up to her mobile home. Her SO is not strong enough to assist her with the at home care she needs until home health comes through and she will clearly need significant around the clock care. She will not be adequately cared for at home.I'm not sure if we should just do the best we can until she can contact her regular neurologist on Monday (there is no after hours emergency line), or if we should check her out tonight and take her to an academic hospital for a second opinion and further testing. Our closest major cities are Shreveport, LA (1 hr), Little Rock, AR (2.5 hr), and Dallas, TX (2.75 hr). Any advice would be extremely helpful.This is what I know about her medical history:Hard of hearing Temporal lobe epilepsy (June 2021), last known seizure 6 months ago Cervicogenic headache due to neck/back spasms (June 8) Asthma Unstable SVT (frequent episodes for awhile, but no episodes in a few years) Fibromyalgia Left leg - possible femoral nerve entrapment (June 29) Rectal abscess surgery (Feb 8) ADHD Depression Anxiety PTSD Chronic/frequent laryngitis? (sore throat, loss of voice, and fever every two to four weeks for at least a year, not diagnosed) Upper back pain/vomiting when eating (April) Severe sleep apnea - hasn't received CPAP machine yet Urinary incontinence Non-alcoholic fatty liver disease Chronic rib pain - both sides, since teenager Enlarged spleen (Dec 2020) Hypertension Hyperlipidemia COVID (2020) PCOS Acid refluxThese are the medications I'm aware of:Ozempic (for weight loss) Metformin (for weight loss) Cymbalta Depakote Albuterol Gabapentin Oxybutynin Indomethacin Trelegy Singulair NexplanonShe rarely drinks alcohol - causes back and shoulder pain. She does not smoke cigarettes. She has her medical marijuana card for epilepsy, but rarely used it until this week, when she began smoking frequently to try to control the leg pain.Please let me know if you have any questions.. ### Response: I hate to be that physician but in the absence of any actual findings on multiple MRI, ECHOs, Carotid US, sometimes conversion disorder may be more likely than a rare esoteric disease. That being said, what led you away from conversion disorder?.


Instruction: Thank you for responding. I thought that required a pretty significant stressor. The only thing that's come up in the past couple of weeks is the nerve injury. Nothing else has really been stressful lately and her mental health has been under control. The altered mental status and muscle spasms left me with the injection that it is medical in nature. Also her history of neurological issues presenting over the past three years. I was thinking Todd Paralysis or MS might be more likely. They didn't do a spinal MRI, a spinal tap, or nerve conduction studies. Not sure if it was necessary or not.

Output: Conversion disorder does not require a significant stressor to be present, although significant is a relative term in itself. That being said, an extensive work-up would include MRIs with/without contrast of brain, cervical spine, thoracic spine, lumbar spine +/- lumbar puncture. If this has all been done and negative, it is more likely conversion then a obscure neurological disease although the latter in itself is difficult to rule out.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for responding. I thought that required a pretty significant stressor. The only thing that's come up in the past couple of weeks is the nerve injury. Nothing else has really been stressful lately and her mental health has been under control. The altered mental status and muscle spasms left me with the injection that it is medical in nature. Also her history of neurological issues presenting over the past three years. I was thinking Todd Paralysis or MS might be more likely. They didn't do a spinal MRI, a spinal tap, or nerve conduction studies. Not sure if it was necessary or not.. ### Response: Conversion disorder does not require a significant stressor to be present, although significant is a relative term in itself. That being said, an extensive work-up would include MRIs with/without contrast of brain, cervical spine, thoracic spine, lumbar spine +/- lumbar puncture. If this has all been done and negative, it is more likely conversion then a obscure neurological disease although the latter in itself is difficult to rule out..


Instruction: Given the timeline Ive described, would it be reasonable to assume the relationship between Covid and these complications?Would it be reasonable to assume the relationship between MI and demand ischemia?Interestingly, the transfer hospital did not initiate treatment for COVID-19. Could this have changed the trajectory of the case?

Output: Sounds like the likely timeline is COVID infection --> demand ischemia, MI. Given the situation, it sounds like the transfer hospital and receiving hospital appropriately triaged the issues and treated the most life-threatening issue (the acute MI) first.This patient had a lot of risk factors for getting very sick with any infection, not just COVID. Going without clopidogrel likely also helped precipitate the MI, though no one will be able to say to what extent.I don't think that initiating COVID treatment at time of presentation would have made much difference.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Given the timeline Ive described, would it be reasonable to assume the relationship between Covid and these complications?Would it be reasonable to assume the relationship between MI and demand ischemia?Interestingly, the transfer hospital did not initiate treatment for COVID-19. Could this have changed the trajectory of the case?. ### Response: Sounds like the likely timeline is COVID infection --> demand ischemia, MI. Given the situation, it sounds like the transfer hospital and receiving hospital appropriately triaged the issues and treated the most life-threatening issue (the acute MI) first.This patient had a lot of risk factors for getting very sick with any infection, not just COVID. Going without clopidogrel likely also helped precipitate the MI, though no one will be able to say to what extent.I don't think that initiating COVID treatment at time of presentation would have made much difference..


Instruction: Hello all... I am a white 33yr old male, 5'9 180lbs no meds taken currently. This is the second time I have had cellulitis in two months. I was wondering if sea moss was beneficial in any way to help the healing process as well as make it faster it's extremely painful and I have it on both of my feet in lower legs I'm afraid to go to the hospital because of the area that I live in they are too quick to judge and stereotype you and I have extreme anxiety going to the hospital so is there anything that I can do to get this healed and taken care of as quickly as possible please any and all comments ideas and suggestions are welcome and will not be criticized or Taken the wrong way

Output: If on both legs not likely to be cellulitis.Please include one of preferably more of the pictures in your post as an imgur.com or imbb.com link. It makes it easier to help with something when it can be examined visually.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hello all... I am a white 33yr old male, 5'9 180lbs no meds taken currently. This is the second time I have had cellulitis in two months. I was wondering if sea moss was beneficial in any way to help the healing process as well as make it faster it's extremely painful and I have it on both of my feet in lower legs I'm afraid to go to the hospital because of the area that I live in they are too quick to judge and stereotype you and I have extreme anxiety going to the hospital so is there anything that I can do to get this healed and taken care of as quickly as possible please any and all comments ideas and suggestions are welcome and will not be criticized or Taken the wrong way. ### Response: If on both legs not likely to be cellulitis.Please include one of preferably more of the pictures in your post as an imgur.com or imbb.com link. It makes it easier to help with something when it can be examined visually..


Instruction: My dad (52M, no prior health issues except mildly high blood pressure, on a blood pressure med) is currently hospitalized for a pneumothorax after an injury. He broke several ribs, and one of them pierced his lung. The pneumothorax was small, so we assumed hed heal fine on his own, but yesterday he had to be transferred to the critical care unit because he had developed AFib in his sleep. Once his heart rate was stabilized, they put in a chest tube, because X-rays showed air and fluid. Hes been draining a lot of blood and fluids from the tube.They arent sure if the AFib was caused by the collapsed lung, but he has no history of irregular heartbeat or heart problems. Is this common after a pneumothorax?

Output: Essentially, anyone can develop atrial fibrillation at any time for numerous reasons including you and I. That being said, the stressors on his body could have induced a state conducive to this, or it is possible that these are 2 separate problems that happen to occur around the same time, ie a person with a stroke who also has a UTI. One would not have necessarily induced the other in this case.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My dad (52M, no prior health issues except mildly high blood pressure, on a blood pressure med) is currently hospitalized for a pneumothorax after an injury. He broke several ribs, and one of them pierced his lung. The pneumothorax was small, so we assumed hed heal fine on his own, but yesterday he had to be transferred to the critical care unit because he had developed AFib in his sleep. Once his heart rate was stabilized, they put in a chest tube, because X-rays showed air and fluid. Hes been draining a lot of blood and fluids from the tube.They arent sure if the AFib was caused by the collapsed lung, but he has no history of irregular heartbeat or heart problems. Is this common after a pneumothorax?. ### Response: Essentially, anyone can develop atrial fibrillation at any time for numerous reasons including you and I. That being said, the stressors on his body could have induced a state conducive to this, or it is possible that these are 2 separate problems that happen to occur around the same time, ie a person with a stroke who also has a UTI. One would not have necessarily induced the other in this case..


Instruction: Please take the time to read this. I am extremely sick and not sure if I am going to survive much longer.31M. 5'8"; 125LB; Caucasian; trouble breathing/abdominal pressure; 7 year duration; condition undiagnosed - separate diagnosis of reactive hypoglycemia; current medication (Acarbose 50mg every meal); ZERO drugs/drinking/smoking/vaping/caffeine;My name is Jason Otto. I've been so sick for so long I don't care about online anonymity anymore. Here's a pic of me to prove I'm not making this up:https://ibb.co/1vHzn3xI am extremely messed up. I have been unable to work for the last 8 years and savings have nearly run out. I am now homeless (living out of my car). I have traveled the United States in search of help and I am currently at Harvard. I thought I would get help here but it's more of the same: condescending doctors who take very little time to even talk to the patient and figure out what's wrong. I don't know where else to turn.I am currently looking for a doctor that gives a shit about his/her patients. I'm looking with someone with integrity. I am willing to travel anywhere in the country and can be there within 24 hours. Most dismiss me after the usual 20 minute appointment and tell me nothing else can be done. There is no brainstorming, no critical thinking, no followup, nothing. I don't think that these people understand how serious this situation is. I cannot work, I can barely get out of bed (now my car-seat) in the morning, my cognition is in the toilet and I am unable to function in daily life. I am a vegetable.My problems began in April 2013. I had been having gastritis for a good 6 months and was treated unsuccessfully by several GI docs and their PPIs and H2 blockers. Out of desperation, I went to a chiropractor at the recommendation of a friend. He said he sees all sorts of weird stuff and he will ACTUALLY LISTEN TO YOU. Sold.I see this guy and he thinks my gastritis is due to a hiatal hernia. I now know that this can be seen on an xray and that he was completely full of shit, but I was desperate so just told him to "fix me please". Desperation breeds bad decision making, and without family support I didn't think twice about it.He said he could manipulate it back into place and laid me down on the table, stuck his fingers in exceptionally hard, deep into my abdomen, just under my ribs, about an inch below my xiphoid process, and pushed in and pulled down toward my naval very forcefully.I feel like he moved something out of place.Since then I have had trouble breathing, eating, and feel like I'm constantly being hit in the stomach. I feel like the life is being sucked out of me. It's hard for me to move, it's hard for me to think, refreshing sleep is next to impossible, and I feel like I'm stuck in overdrive all the time because I am so uncomfortable that I cannot calm down. Something feels out of place in my abdomen, almost like it was shifted downward, and no one can seem to tell me what it is or how to treat it.I've had CTs, MRIs, xrays, and many other tests. GI has been ruled out with extensive testing (EGD, barium swallow studies, gastric emptying scans, etc.) It feels like it is outside of my GI tract, almost as if my liver has been displaced. When you go to a doctor and say you are having problems in the epigastric area, you are referred to a GI. GI has been ruled out, and there is nothing wrong. It feels like it's some sort of organ or something else that has been forcefully moved. I feel like I'm in hell in my own body.I struggle to focus because I feel the need to constantly lay down. It's like being hit in the stomach and needing to sit there for a moment to just relax and catch your breath, but the feeling is constant and never goes away. This has crippled me and I cannot do simple things like reading books.If anyone has any idea on what this could be, or has any recommendation on where to go or who to see, PLEASE let me know. I'm someone who always repays the favor, and if you can point me in the right direction or help me in any way, I will more than make it up to you.I used to be a somebody, and now I'm rotting away in my vehicle. I've lost 40 pounds because the thought of food makes me sick, and I cannot find relief.Thank you.-MAlso, THERE IS NO PAIN. I need to make that clear. It's pressure/tension that is constant and I do not feel pain with this at all.I also feel a beating heartbeat in the area, like my heart is pushing against it. The heartbeat is pronounced.Here is a link to an image I uploaded showing the area (under xiphoid process, near liver and diaphragm): https://ibb.co/ByrJ4xSScan list:CT chest, abdomen; MRI chest, pelvis, abdomen; xray chest, pelvis, abdomen; Abdominal ultrasound; Echo, stress test; Tons of blood workEGD; Barium Swallow Study; Colonoscopy; Gastric Emptying Scan; Capsule Endoscopy; Pillcam

Output: This is now getting filled with bad advice and advertising. I think good suggestions that will come up have come up, and the discussion is over.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Please take the time to read this. I am extremely sick and not sure if I am going to survive much longer.31M. 5'8"; 125LB; Caucasian; trouble breathing/abdominal pressure; 7 year duration; condition undiagnosed - separate diagnosis of reactive hypoglycemia; current medication (Acarbose 50mg every meal); ZERO drugs/drinking/smoking/vaping/caffeine;My name is Jason Otto. I've been so sick for so long I don't care about online anonymity anymore. Here's a pic of me to prove I'm not making this up:https://ibb.co/1vHzn3xI am extremely messed up. I have been unable to work for the last 8 years and savings have nearly run out. I am now homeless (living out of my car). I have traveled the United States in search of help and I am currently at Harvard. I thought I would get help here but it's more of the same: condescending doctors who take very little time to even talk to the patient and figure out what's wrong. I don't know where else to turn.I am currently looking for a doctor that gives a shit about his/her patients. I'm looking with someone with integrity. I am willing to travel anywhere in the country and can be there within 24 hours. Most dismiss me after the usual 20 minute appointment and tell me nothing else can be done. There is no brainstorming, no critical thinking, no followup, nothing. I don't think that these people understand how serious this situation is. I cannot work, I can barely get out of bed (now my car-seat) in the morning, my cognition is in the toilet and I am unable to function in daily life. I am a vegetable.My problems began in April 2013. I had been having gastritis for a good 6 months and was treated unsuccessfully by several GI docs and their PPIs and H2 blockers. Out of desperation, I went to a chiropractor at the recommendation of a friend. He said he sees all sorts of weird stuff and he will ACTUALLY LISTEN TO YOU. Sold.I see this guy and he thinks my gastritis is due to a hiatal hernia. I now know that this can be seen on an xray and that he was completely full of shit, but I was desperate so just told him to "fix me please". Desperation breeds bad decision making, and without family support I didn't think twice about it.He said he could manipulate it back into place and laid me down on the table, stuck his fingers in exceptionally hard, deep into my abdomen, just under my ribs, about an inch below my xiphoid process, and pushed in and pulled down toward my naval very forcefully.I feel like he moved something out of place.Since then I have had trouble breathing, eating, and feel like I'm constantly being hit in the stomach. I feel like the life is being sucked out of me. It's hard for me to move, it's hard for me to think, refreshing sleep is next to impossible, and I feel like I'm stuck in overdrive all the time because I am so uncomfortable that I cannot calm down. Something feels out of place in my abdomen, almost like it was shifted downward, and no one can seem to tell me what it is or how to treat it.I've had CTs, MRIs, xrays, and many other tests. GI has been ruled out with extensive testing (EGD, barium swallow studies, gastric emptying scans, etc.) It feels like it is outside of my GI tract, almost as if my liver has been displaced. When you go to a doctor and say you are having problems in the epigastric area, you are referred to a GI. GI has been ruled out, and there is nothing wrong. It feels like it's some sort of organ or something else that has been forcefully moved. I feel like I'm in hell in my own body.I struggle to focus because I feel the need to constantly lay down. It's like being hit in the stomach and needing to sit there for a moment to just relax and catch your breath, but the feeling is constant and never goes away. This has crippled me and I cannot do simple things like reading books.If anyone has any idea on what this could be, or has any recommendation on where to go or who to see, PLEASE let me know. I'm someone who always repays the favor, and if you can point me in the right direction or help me in any way, I will more than make it up to you.I used to be a somebody, and now I'm rotting away in my vehicle. I've lost 40 pounds because the thought of food makes me sick, and I cannot find relief.Thank you.-MAlso, THERE IS NO PAIN. I need to make that clear. It's pressure/tension that is constant and I do not feel pain with this at all.I also feel a beating heartbeat in the area, like my heart is pushing against it. The heartbeat is pronounced.Here is a link to an image I uploaded showing the area (under xiphoid process, near liver and diaphragm): https://ibb.co/ByrJ4xSScan list:CT chest, abdomen; MRI chest, pelvis, abdomen; xray chest, pelvis, abdomen; Abdominal ultrasound; Echo, stress test; Tons of blood workEGD; Barium Swallow Study; Colonoscopy; Gastric Emptying Scan; Capsule Endoscopy; Pillcam. ### Response: This is now getting filled with bad advice and advertising. I think good suggestions that will come up have come up, and the discussion is over..


Instruction: Since you're already in the neighborhood, have you tried this group? https://undiagnosed.hms.harvard.edu/

Output: UDN is a good thought, and I think worth looking into. I hope this suggestion gets upvoted more. They have great success stories and are run by great people. It also illustrates that "I am at Harvard for medical care" can mean a bunch of different hospitals, clinics, and doctors, who all have varying expertise and areas of focus.However, a couple things to point out:It's a research study, so not the same as "having a doctor." You also need a study recommendation letter from a health care provider."We cannot accept all applicants." Eligible participants "have at least one objective finding." I honestly don't know how they define that, e.g. is weight loss objective enough?"After all of the necessary information is received... it typically takes 6-8 weeks... to decide whether to accept...."They have about 12 clinical sites across the US, not just Boston.Not trying to dissuade OP. If it were me, I would absolutely be looking at UDN. Let them decide whether you're eligible or not. I'm just trying to provide perspective about what to expect.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Since you're already in the neighborhood, have you tried this group? https://undiagnosed.hms.harvard.edu/. ### Response: UDN is a good thought, and I think worth looking into. I hope this suggestion gets upvoted more. They have great success stories and are run by great people. It also illustrates that "I am at Harvard for medical care" can mean a bunch of different hospitals, clinics, and doctors, who all have varying expertise and areas of focus.However, a couple things to point out:It's a research study, so not the same as "having a doctor." You also need a study recommendation letter from a health care provider."We cannot accept all applicants." Eligible participants "have at least one objective finding." I honestly don't know how they define that, e.g. is weight loss objective enough?"After all of the necessary information is received... it typically takes 6-8 weeks... to decide whether to accept...."They have about 12 clinical sites across the US, not just Boston.Not trying to dissuade OP. If it were me, I would absolutely be looking at UDN. Let them decide whether you're eligible or not. I'm just trying to provide perspective about what to expect..


Instruction: Thanks!It does seem structural but I'm having a hard time getting anyone to believe me. Most docs don't even want to hear my history of how this happened. They're on auto-pilot and seem to just want to know what the symptoms are.I'll look into sympathetic nerve damage.

Output: Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks!It does seem structural but I'm having a hard time getting anyone to believe me. Most docs don't even want to hear my history of how this happened. They're on auto-pilot and seem to just want to know what the symptoms are.I'll look into sympathetic nerve damage.. ### Response: Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification..


Instruction: Thanks I added that to my list of things to look into and will be following up with someone on Monday to hopefully evaluate it. I have a list of everything that everyone on here has said and I'm going to bring it to the attention of the next doctor I find.

Output: To be honest I wonder if you had some traumatic injury to the celiac plexus. This sounds like a neuropathic pain secondary to the chiropractic manipulation. This is a very unusual story you give, so I can't say I have a strong hunch what is going on, but this seems like a reasonable thought. I'm sorry you've ended up in this predicament. You may consider seeing a pain specialist for discussion about a very particular procedure of a type of nerve block.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks I added that to my list of things to look into and will be following up with someone on Monday to hopefully evaluate it. I have a list of everything that everyone on here has said and I'm going to bring it to the attention of the next doctor I find.. ### Response: To be honest I wonder if you had some traumatic injury to the celiac plexus. This sounds like a neuropathic pain secondary to the chiropractic manipulation. This is a very unusual story you give, so I can't say I have a strong hunch what is going on, but this seems like a reasonable thought. I'm sorry you've ended up in this predicament. You may consider seeing a pain specialist for discussion about a very particular procedure of a type of nerve block..


Instruction: I've been thinking the same, and am trying to find out how to know for sure. I'm told that x-rays show the diaphragm, as well as CT scans, but nothing is ever mentioned. I've had an ultrasound of the abdomen as well which I was told would show something if there was a problem, but nothing is coming up.

Output: Just so you know, x-rays show the diaphragm so-so, but not great. CT would certainly show more detail. Earlier you stated a hiatal hernia "can be seen on an xray," which is true in the sense that an obvious one would show up, but not all would show up.Likewise, an ultrasound of the abdomen could in theory show some diaphragm abnormalities, but that's not often what the sonographer and radiologist will be looking at most closely.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I've been thinking the same, and am trying to find out how to know for sure. I'm told that x-rays show the diaphragm, as well as CT scans, but nothing is ever mentioned. I've had an ultrasound of the abdomen as well which I was told would show something if there was a problem, but nothing is coming up.. ### Response: Just so you know, x-rays show the diaphragm so-so, but not great. CT would certainly show more detail. Earlier you stated a hiatal hernia "can be seen on an xray," which is true in the sense that an obvious one would show up, but not all would show up.Likewise, an ultrasound of the abdomen could in theory show some diaphragm abnormalities, but that's not often what the sonographer and radiologist will be looking at most closely..


Instruction: t that's not often what the sonographer and radioloThank you.I have had a lot of imaging, including CTs, over the past several years. Do you think a second opinion from a radiologist would be a good idea? Usually you get an order from a doctor and the radiologist does and reads the scan, but are there options for people who just want a radiologist to look over old testing? Can I pay someone to look at old tests?

Output: In general, radiologists definitely look at old scans, and that could be considered a second opinion. This pretty much means the patient has to bring the images on CDs.However, when this happens, it involves a "front line" non-radiology doctor (medicine, ortho, neuro, etc.) who sees the patient and usually is ordering a new scan and wants to know how today's MRI of the hip compares to the 2015 scan from Far Across The Country Clinic, LLC. Rarely the front line doc might have old scans only and just want his/her local radiologist to take a look as a courtesy.I have never run across exactly the 2nd part of what you're suggesting: patient directly sees/pays a radiologist to review stuff (with no front line doc involved). This probably exists somewhere in the world, but it has a sort of "boutique" feel to it.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: t that's not often what the sonographer and radioloThank you.I have had a lot of imaging, including CTs, over the past several years. Do you think a second opinion from a radiologist would be a good idea? Usually you get an order from a doctor and the radiologist does and reads the scan, but are there options for people who just want a radiologist to look over old testing? Can I pay someone to look at old tests?. ### Response: In general, radiologists definitely look at old scans, and that could be considered a second opinion. This pretty much means the patient has to bring the images on CDs.However, when this happens, it involves a "front line" non-radiology doctor (medicine, ortho, neuro, etc.) who sees the patient and usually is ordering a new scan and wants to know how today's MRI of the hip compares to the 2015 scan from Far Across The Country Clinic, LLC. Rarely the front line doc might have old scans only and just want his/her local radiologist to take a look as a courtesy.I have never run across exactly the 2nd part of what you're suggesting: patient directly sees/pays a radiologist to review stuff (with no front line doc involved). This probably exists somewhere in the world, but it has a sort of "boutique" feel to it..