Instruction: Im 34, female, 5 ft. And currently depending on the day between 209 and 223 lbs ( its weird, Ill get to that.)Day 1 Normal bp: 90/60. Weight 184 pounds 5/29/21.So back in June, I was working in a facility housing homeless individuals. During my shift, I smelled what I thought it was an electrical fire or fumes coming through or exhaust system. I discovered that folks were either cooking or smoking methamphetamine in the facility, but couldnt do more then create an incident report and narrow down where this happened.I coughed a bit, Had a headache, went outside to clear my head. Didnt think anything of it. By the end of my shift It felt weird to breathe. Like I was stuffed up. Within 48 hours I was wheezing coughing and very fatigued. COVID negative. Started azithromycin and prednisone 7 day taper.By day 4 post incident I could feel It wasnt helping. Went to the hospital. 02 was in the high 70s, I was coughing so hard. Confused. BP elevated for me 120/70s. Admitted for 4 days. 3 COVID tests (2 pcr, 1 rapid) negative. No fever this whole time. Nothing came up in sputum tests or blood work other than what they explained as inflammation.According to docs notes: patient was admitted to the hospital originally for suspicious of pneumonia based on the chest x-ray reading. In speaking to the patient, her symptom is more consistent with a asthma/COPD attack and lack the usual signs symptoms of infectious pneumonia including fever, productive cough, leukocytosis, and known sick contact. Instead, her symptom was brought about by inhaling smoke at her workplace. Patient has a history of childhood asthma for which she managed at home with rescue inhaler, patient did not have any asthma issues as an adult until exposure at her work.Therefore, after admission, she was treated for an asthma/COPD exacerbation. Antibiotics initiated on admission ( levaquin, azithromycin)to a more appropriate diagnosis. She responded well to bronchodilators, nebulizer, and oral steroid. So I finish the azithromycin, prednisone and have duoneb, and albuterol to help.CT scan showed glass opacities, right side of lungs was worse. 5th PCR test negative for COVID.06/13-I go back to the doctor 6/13. I feel worse. They tell me to give it time.06/24- return to work on light duty. No more than 4 hours a day of walking.07/03-7/23- doctors are still saying give it time. My lungs sound clear. I quit my job with the county to work from home.07/29- go into urgent care because I feel like I cant breathe. Exacerbation of symptoms. They talk about referral to pulmonologist but nothing yet. More prednisone dosepak7/30-8/15- using flutter, spirometer, albuterol and duoneb still as directed. Flutter/ spirometer every hour. Albuterol every 8 hours.Hospital admission 8/16-8/21 doctors notes*Called by nursing due to worsening hypoxia. Patient was admitted for presumed asthma exacerbation with high suspicion for COVID-19 infection. She was initially on room air with SPO2 of 90%. Since her admission, her oxygen needs has been gradually increasing. She is currently on 15 LPM oxygen mask with SPO2 95%. She is becoming more tachypneic with respiratory rate up to 36.Due to lactic acidosis of 3.9 on presentation, patient was started on normal saline at 125 mL/h. She was also started on dexamethasone for presumed asthma exacerbation with possible COVID-19 infection. She is on albuterol MDI inhaler every 4 hours and every 2 hours as needed.Vital signs: Temperature 98.7, pulse of 107, respiratory rate 36, blood pressure 114/74, SPO2 95% on oxymask.On physical exam, patient is alert and oriented. She shows signs of mild respiratory distress with increased work of breathing and tachypnea. She has decreased breath sounds with mild crackles expiratory right greater than the left. No active wheezing.Laboratory studies show white count of 18.3, hemoglobin 14.7, platelets 277. Chemistry panel within normal limits with potassium of 3.9. Magnesium low at 1.7. Lactic acid improving to 2.2 from 3.9. Procalcitonin less than 0.05. D-dimer 0.41.CTA with PE protocol per my review shows no filling defects consistent with pulmonary embolism. There are mild diffuse patchy interstitial bilaterally concerning for COVID-19 infection versus asthma related pneumonitis. No pleural effusions or focal consolidations.Acute hypoxemic respiratory failureLactic acidosisHigh suspicion for COVID-19 infection. Progressive worsening with administration of IV fluids. Improving lactic acid.Plan: -Discontinue IV fluids. -Furosemide 40 mg IV once. -Continue dexamethasone 6 mg by mouth daily for 10 days. -Continue albuterol scheduled and as needed. -Magnesium sulfate 4 g IV once to assist with treatment of possible asthma exacerbation. -Check ABG. -Continue levofloxacin. -Follow-up COVID-19 testing results. Continue precautions for now. -Escalate to high flow oxygen to decrease work of breathing.Patient is critically ill. The patient continues to have: Acute hypoxemic respiratory failure the vital organ system that is affected is the: Respiratory system If untreated there is a high chance of deterioration into: Respiratory failure, cardiac arrest, and eventually death. The critical care that I am providing today is: I performed an extensive data review and discussed care with patient. I have stopped IV fluids and started diuresis with furosemide 40 mg IV. I started magnesium sulfate IV for treatment of presumed asthma exacerbation. I have escalated oxygen needs to high flow oxygen.I get discharged from this hospital stay with 2L oxygen constantly. I get to see my doctor for follow up 9/8. They tell me again to get better first. Then well look at respiratory therapy and pulmonologist and physical therapy long term. I talk to them about my weight gain and my puffy face. They say its common with steroids. I can self monitor for oxygen use.9/17 develop vertigo, confusion, nausea and vomiting. Diagnosed with colitis. COVID negative. Urgent care visit. No longer on oxygen but still exhausted.9/25- diagnosis sinusitis, vertigo from left ear infection. Lungs clear. COVID negative10/5- vertigo doesnt go away. Given meclizine. COVID negative10/17- patient noted to have slightly elevated blood pressure likely circumstantial secondary to presenting complaint (152/90). Referred to primary care physician for further evaluation.Medical Decision Making: CT temporal bones show some fluid within the left mastoid. Slight elevation of white count. Patient also has an abnormal dilatation of the right lateral ventricle on CT of her head. This is concerning in light of her ongoing nausea vomiting and vertigo over the last several weeks. Discussed with pharmacy and placed on antibiotics to cover for possible mastoiditis and discussed with hospitalist for admission for further evaluation and treatment of this ongoing vertigo and abnormal CT head. Admitted in guarded condition.10/17- COVID positive. Test results received after discharge. 10/18. 10/21 tests negative for COVIDWeight gain from June to October 21 is from 184 pounds to 222.October 27- pcp follow up after quarantine. Currently 231 pounds. BP is 148/86.Doc notes History of Pneumonia, RecurrentRecurrent pneumonias with recurrent hospitalizations Exposure to methamphetamine at work at shelter - ended up with ground glass opacities on imaging. Tested multiple times for covid, negative at that time. Has had persistent fatigue, lightheadedness, loss of energy Positive for Covid 10 days agoWeight GainGained 30 pounds since September. Has had recurrent doses of steroids with recent infections. Orthopnea Has had decreased appetite and is not eating much at all. When she does eat a lot, feels need to vomit.HypoxiaDesaturations throughout hospitalizations, was discharged on home oxygen which she was able to wean down, but does still have hypoxia when she sleeps and exertion. Concerned for sleep apnea.VertigoRecurrent episodes of vertigo especially after recent illnesses Reports that she is occasionally awoken by vertigo and hot flash symptoms. Repeat evaluations for the same - does have history of CP, recent finding of R ventricle enlargement on MRI. Some benefit with Meclizine, but has had abnormal associated symptoms including confusion, word finding difficulty. Continued to say istory of pneumonia, recurrent Suspicion for initial covid infection with negative test causing initial ground glass opacities As these are consistent with many other etiologies and she has significant other symptoms (fatigue, weight gain, hair loss, vertigo with normal TSH) will consider other etiologies ANA, RF, anti-CCP for evaluationWeight gain TSH normal in the past, so has never reflexed to T4 and T3 - will measure these Autoimmune evaluation as elsewhereHypoxia Pulmonology evaluation,possible covid long-hauler symptoms, possible other causes of groundglass opacities Sleep study and general PFTsCurrently taking : Claritin albuterol Flonase every day. Meclizine as needed. I think they help.I KNOW THIS IS A LOT. I m sorry thank you for even reading this but I wanted to be thorough.How can I advocate for myself further? What can I ask about? Any additional testing you would suggest? I dont feel like a person anymore. If I eat, clean my kitchen and walk the kids to school it takes everything I have.

Output: This is a hell of a history. From the right ventricular dilatation, hypoxia, and continued GGOs on CT scan Id say that the cause is probably the lungs. The pulmonologist is going to be your best friend here. PFTs are going to be helpful

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im 34, female, 5 ft. And currently depending on the day between 209 and 223 lbs ( its weird, Ill get to that.)Day 1 Normal bp: 90/60. Weight 184 pounds 5/29/21.So back in June, I was working in a facility housing homeless individuals. During my shift, I smelled what I thought it was an electrical fire or fumes coming through or exhaust system. I discovered that folks were either cooking or smoking methamphetamine in the facility, but couldnt do more then create an incident report and narrow down where this happened.I coughed a bit, Had a headache, went outside to clear my head. Didnt think anything of it. By the end of my shift It felt weird to breathe. Like I was stuffed up. Within 48 hours I was wheezing coughing and very fatigued. COVID negative. Started azithromycin and prednisone 7 day taper.By day 4 post incident I could feel It wasnt helping. Went to the hospital. 02 was in the high 70s, I was coughing so hard. Confused. BP elevated for me 120/70s. Admitted for 4 days. 3 COVID tests (2 pcr, 1 rapid) negative. No fever this whole time. Nothing came up in sputum tests or blood work other than what they explained as inflammation.According to docs notes: patient was admitted to the hospital originally for suspicious of pneumonia based on the chest x-ray reading. In speaking to the patient, her symptom is more consistent with a asthma/COPD attack and lack the usual signs symptoms of infectious pneumonia including fever, productive cough, leukocytosis, and known sick contact. Instead, her symptom was brought about by inhaling smoke at her workplace. Patient has a history of childhood asthma for which she managed at home with rescue inhaler, patient did not have any asthma issues as an adult until exposure at her work.Therefore, after admission, she was treated for an asthma/COPD exacerbation. Antibiotics initiated on admission ( levaquin, azithromycin)to a more appropriate diagnosis. She responded well to bronchodilators, nebulizer, and oral steroid. So I finish the azithromycin, prednisone and have duoneb, and albuterol to help.CT scan showed glass opacities, right side of lungs was worse. 5th PCR test negative for COVID.06/13-I go back to the doctor 6/13. I feel worse. They tell me to give it time.06/24- return to work on light duty. No more than 4 hours a day of walking.07/03-7/23- doctors are still saying give it time. My lungs sound clear. I quit my job with the county to work from home.07/29- go into urgent care because I feel like I cant breathe. Exacerbation of symptoms. They talk about referral to pulmonologist but nothing yet. More prednisone dosepak7/30-8/15- using flutter, spirometer, albuterol and duoneb still as directed. Flutter/ spirometer every hour. Albuterol every 8 hours.Hospital admission 8/16-8/21 doctors notes*Called by nursing due to worsening hypoxia. Patient was admitted for presumed asthma exacerbation with high suspicion for COVID-19 infection. She was initially on room air with SPO2 of 90%. Since her admission, her oxygen needs has been gradually increasing. She is currently on 15 LPM oxygen mask with SPO2 95%. She is becoming more tachypneic with respiratory rate up to 36.Due to lactic acidosis of 3.9 on presentation, patient was started on normal saline at 125 mL/h. She was also started on dexamethasone for presumed asthma exacerbation with possible COVID-19 infection. She is on albuterol MDI inhaler every 4 hours and every 2 hours as needed.Vital signs: Temperature 98.7, pulse of 107, respiratory rate 36, blood pressure 114/74, SPO2 95% on oxymask.On physical exam, patient is alert and oriented. She shows signs of mild respiratory distress with increased work of breathing and tachypnea. She has decreased breath sounds with mild crackles expiratory right greater than the left. No active wheezing.Laboratory studies show white count of 18.3, hemoglobin 14.7, platelets 277. Chemistry panel within normal limits with potassium of 3.9. Magnesium low at 1.7. Lactic acid improving to 2.2 from 3.9. Procalcitonin less than 0.05. D-dimer 0.41.CTA with PE protocol per my review shows no filling defects consistent with pulmonary embolism. There are mild diffuse patchy interstitial bilaterally concerning for COVID-19 infection versus asthma related pneumonitis. No pleural effusions or focal consolidations.Acute hypoxemic respiratory failureLactic acidosisHigh suspicion for COVID-19 infection. Progressive worsening with administration of IV fluids. Improving lactic acid.Plan: -Discontinue IV fluids. -Furosemide 40 mg IV once. -Continue dexamethasone 6 mg by mouth daily for 10 days. -Continue albuterol scheduled and as needed. -Magnesium sulfate 4 g IV once to assist with treatment of possible asthma exacerbation. -Check ABG. -Continue levofloxacin. -Follow-up COVID-19 testing results. Continue precautions for now. -Escalate to high flow oxygen to decrease work of breathing.Patient is critically ill. The patient continues to have: Acute hypoxemic respiratory failure the vital organ system that is affected is the: Respiratory system If untreated there is a high chance of deterioration into: Respiratory failure, cardiac arrest, and eventually death. The critical care that I am providing today is: I performed an extensive data review and discussed care with patient. I have stopped IV fluids and started diuresis with furosemide 40 mg IV. I started magnesium sulfate IV for treatment of presumed asthma exacerbation. I have escalated oxygen needs to high flow oxygen.I get discharged from this hospital stay with 2L oxygen constantly. I get to see my doctor for follow up 9/8. They tell me again to get better first. Then well look at respiratory therapy and pulmonologist and physical therapy long term. I talk to them about my weight gain and my puffy face. They say its common with steroids. I can self monitor for oxygen use.9/17 develop vertigo, confusion, nausea and vomiting. Diagnosed with colitis. COVID negative. Urgent care visit. No longer on oxygen but still exhausted.9/25- diagnosis sinusitis, vertigo from left ear infection. Lungs clear. COVID negative10/5- vertigo doesnt go away. Given meclizine. COVID negative10/17- patient noted to have slightly elevated blood pressure likely circumstantial secondary to presenting complaint (152/90). Referred to primary care physician for further evaluation.Medical Decision Making: CT temporal bones show some fluid within the left mastoid. Slight elevation of white count. Patient also has an abnormal dilatation of the right lateral ventricle on CT of her head. This is concerning in light of her ongoing nausea vomiting and vertigo over the last several weeks. Discussed with pharmacy and placed on antibiotics to cover for possible mastoiditis and discussed with hospitalist for admission for further evaluation and treatment of this ongoing vertigo and abnormal CT head. Admitted in guarded condition.10/17- COVID positive. Test results received after discharge. 10/18. 10/21 tests negative for COVIDWeight gain from June to October 21 is from 184 pounds to 222.October 27- pcp follow up after quarantine. Currently 231 pounds. BP is 148/86.Doc notes History of Pneumonia, RecurrentRecurrent pneumonias with recurrent hospitalizations Exposure to methamphetamine at work at shelter - ended up with ground glass opacities on imaging. Tested multiple times for covid, negative at that time. Has had persistent fatigue, lightheadedness, loss of energy Positive for Covid 10 days agoWeight GainGained 30 pounds since September. Has had recurrent doses of steroids with recent infections. Orthopnea Has had decreased appetite and is not eating much at all. When she does eat a lot, feels need to vomit.HypoxiaDesaturations throughout hospitalizations, was discharged on home oxygen which she was able to wean down, but does still have hypoxia when she sleeps and exertion. Concerned for sleep apnea.VertigoRecurrent episodes of vertigo especially after recent illnesses Reports that she is occasionally awoken by vertigo and hot flash symptoms. Repeat evaluations for the same - does have history of CP, recent finding of R ventricle enlargement on MRI. Some benefit with Meclizine, but has had abnormal associated symptoms including confusion, word finding difficulty. Continued to say istory of pneumonia, recurrent Suspicion for initial covid infection with negative test causing initial ground glass opacities As these are consistent with many other etiologies and she has significant other symptoms (fatigue, weight gain, hair loss, vertigo with normal TSH) will consider other etiologies ANA, RF, anti-CCP for evaluationWeight gain TSH normal in the past, so has never reflexed to T4 and T3 - will measure these Autoimmune evaluation as elsewhereHypoxia Pulmonology evaluation,possible covid long-hauler symptoms, possible other causes of groundglass opacities Sleep study and general PFTsCurrently taking : Claritin albuterol Flonase every day. Meclizine as needed. I think they help.I KNOW THIS IS A LOT. I m sorry thank you for even reading this but I wanted to be thorough.How can I advocate for myself further? What can I ask about? Any additional testing you would suggest? I dont feel like a person anymore. If I eat, clean my kitchen and walk the kids to school it takes everything I have.. ### Response: This is a hell of a history. From the right ventricular dilatation, hypoxia, and continued GGOs on CT scan Id say that the cause is probably the lungs. The pulmonologist is going to be your best friend here. PFTs are going to be helpful.


Instruction: Ruptured calcaneofibular ligament and ?fracture of the anterior process of the calcaneus I am a little unsure of where that exactly is on the ankle after looking at multiple diagrams, doctors werent helpful enough in explaining it.- backstory if youre interested:Ill try and keep this short, history of ankle injuries in the past, never quite this bad on that ankle (other one has had reconstructive surgery).I am a 24yo Female who works in emergency as a critical care RN.Rolled the ankle after stepping on a hockey ball 2.5 weeks ago. First 3 days was horrendous, then the pain settled and all I needed was Panadol once a day.XR on day 1 said no fractures. Went home and played another game of hockey a week later (with some pain after of course).US at week 1 said fully ruptured ligament and small ossicle 2.8mm indicating a possible fracture. Recommended CT.CT at 2 weeks showed possible cortical fracture at anterior process of calcaneus.Now Ive had ligament damage in the past, on the other ankle, and this feels relatively minor in comparison.Im being told by an orthopaedic surgeon that I need to be in a moon boot. I am ambulating fine on flat ground with rigid strapping tape on to replace the broken ligament.Its relatively painless to poke around the ankle area. Im not sure I even understand exactly where this supposed fracture is.Im worried by going in a boot when Im coping so well, will hinder my recovery and extend the time itll take me to get back to sport.I can attach some paperwork in the comments.Whats your opinions? Is it possible theres no fracture?

Output: Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.The anterior process of the calcaneus is deep inside the foot, and thus fractures do not always produce tenderness, as you cannot palpate it directly. I assume that when you say "no bone pain", this is what you are talking about.Fractures of the anterior process can be occult, not seen on plain x-ray due to the overlap of bones in the area, and sometimes CT or MRI are needed to confirm.I am a little surprised at you posting here, as you are a registered nurse who has access to emergency physicians and have already seen an orthopedic specialist for consultation. The opinion of your orthopedic specialist is that you have a fracture, and the treatment recommended is immobilization. No one who has neither examined you nor had access to your imaging studies will be able to give you better advice.The rationale behind immobilization of such fractures is simple: the foot has many bones that articulate (touch and move) with each other. Broken bones that do not heal well will cause permanent pain and debility due to interruption of the way the bones can move in relation to each other.If you want a second opinion, then see another foot specialist, bring them all of the imaging tests on DVD (reports are of limited use in these situations).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Ruptured calcaneofibular ligament and ?fracture of the anterior process of the calcaneus I am a little unsure of where that exactly is on the ankle after looking at multiple diagrams, doctors werent helpful enough in explaining it.- backstory if youre interested:Ill try and keep this short, history of ankle injuries in the past, never quite this bad on that ankle (other one has had reconstructive surgery).I am a 24yo Female who works in emergency as a critical care RN.Rolled the ankle after stepping on a hockey ball 2.5 weeks ago. First 3 days was horrendous, then the pain settled and all I needed was Panadol once a day.XR on day 1 said no fractures. Went home and played another game of hockey a week later (with some pain after of course).US at week 1 said fully ruptured ligament and small ossicle 2.8mm indicating a possible fracture. Recommended CT.CT at 2 weeks showed possible cortical fracture at anterior process of calcaneus.Now Ive had ligament damage in the past, on the other ankle, and this feels relatively minor in comparison.Im being told by an orthopaedic surgeon that I need to be in a moon boot. I am ambulating fine on flat ground with rigid strapping tape on to replace the broken ligament.Its relatively painless to poke around the ankle area. Im not sure I even understand exactly where this supposed fracture is.Im worried by going in a boot when Im coping so well, will hinder my recovery and extend the time itll take me to get back to sport.I can attach some paperwork in the comments.Whats your opinions? Is it possible theres no fracture?. ### Response: Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.The anterior process of the calcaneus is deep inside the foot, and thus fractures do not always produce tenderness, as you cannot palpate it directly. I assume that when you say "no bone pain", this is what you are talking about.Fractures of the anterior process can be occult, not seen on plain x-ray due to the overlap of bones in the area, and sometimes CT or MRI are needed to confirm.I am a little surprised at you posting here, as you are a registered nurse who has access to emergency physicians and have already seen an orthopedic specialist for consultation. The opinion of your orthopedic specialist is that you have a fracture, and the treatment recommended is immobilization. No one who has neither examined you nor had access to your imaging studies will be able to give you better advice.The rationale behind immobilization of such fractures is simple: the foot has many bones that articulate (touch and move) with each other. Broken bones that do not heal well will cause permanent pain and debility due to interruption of the way the bones can move in relation to each other.If you want a second opinion, then see another foot specialist, bring them all of the imaging tests on DVD (reports are of limited use in these situations)..


Instruction: Height: 1.8m (5' 11")Weight: 64kg (141lbs)Race: CaucasianLocation: Seattle, WA, USA (German born, Berlin)Vices: occasional vaping with very weak nicotine content, no drinking, no illicit drugs, chronic pain patient (fentanyl patches, 50 microgram)Current physical conditions: pituitary macroadenoma, adrenal cortext carcinoma, and a ton of implants and artificial bones. I cannot afford treatment for either and my insurance, medicaid, will not pay for removal of either or even treatments since my treatment is HCG, which comes from only fertility clinic pharmacies, and medicaid doesn't cover and fertility treatments for menCurrent mental health conditions: PTSD, bipolar, BPD, ADHD, generalized anxiety, and recently depression. All are treated quite effectivelyMedications (total daily doses): 50microgram fentanyl patches, 6mg prazosin, 12mg tizanadine, 7.5mg mirtazipine, 2700mg gabapentin, 2mg clonidine, up to 150mg hydroxyzine, 80mg Latuda, 200mg Lamotrigine, 40mg viibryd, 10mg melatonin, 8mg ondansetronEmergency Usage Only Medications: Hospital only: 100mg dex, 20mg morphine, 4mg lorazepam all IV for cluster headaches; Personal use: 50mg IM dex for cluster headaches, epi-pen for food allergiesWARNING: This will be long. I deeply apologise, but I feel like I need to be very specific and include context to get an accurate answer, if one even exists.----------------------------------------------CONTEXT:I want to start this off by saying I don't particularly believe in homeopathy, certain Eastern medicine, religion (I'm agnostic, borderline atheist), or the paranormal. I do many things for work, taking whatever pays me, but I have spent the majority of my career as a data architect in medical research. I believe in what can be proven, but I also acknowledge we can't prove absolutely everything to be true or false and that the sciences are ever changing and ever growing. I would also note that my life have been a very challenging one and I seem to have the single worst luck of anyone I've ever personally met. I've been very stressed and it has gotten significantly worse of late, though I've been told that I'm handling it quite well. Of course, I also acknowledge that there's plenty of people who've lived much worse lives. I'm not trying to play the victim or be arrogant.----------------------------------------------IMPORTANT LEAD IN:I went to bed last night around 23:00. I woke up an hour or so later to the sounds of small booms outside the front of my house. I initially thought I'd imagined it, but I rolled over and say all 3 of my cats with their faces pressed against the window screen, ears perked up. The sounds actually happened. A few moments later, I heard out smartlock on the front door unlock followed by the door opening and closing. Aside from internal doors, the front door is the only "normal" door to the house. the others are sliding doors that were all locked and barred and sound completely different when opened and closed. My roommate was asleep in his room and had been for hours. Nobody else lives here. Once again, I thought I imagined it, but the cats had all left my room and run downstairs to the door, which is what they do when someone comes over or gets home from work, errands, or whatever. I then head a set of male and female voices coming from downstairs. I grabbed a replica Master Sword (from The Legend of Zelda game series my roommate gave me a few years back) and went to my roommate. I tried to wake him up repeatedly, but he just mumbled something inaudible and rolled away over and over. So I went downstairs quietly. I spent 15-20 minutes walking around the house, following the voices, but never found anything. One of my cats, Needles, kept running off towards the voices then coming back to yell at me to follow him to them, which is what he does whenever someone comes home and I don't instantly go see them, but I never could find them. He's an utter attention whore. After that, I gave up and went back upstairs. Within 5 minutes I heard the door open and close again and the voices stopped. I don't have the greatest hearing in the world and never got close enough to make out what they were saying. I checked my Nest doorbell camera and at no point did anyone walk past the door. It is always recording and saved online for 5 days and, with the way it's positioned, it couldn't possibly fail to see someone come in or leave. I checked my smart lock app to see how it was unlocked and it said it was unlocked using a key by a user named "error". To clarify, the account's username that opened it was not literally "error", but rather that the app produced an error trying to identify the user. There are no physical keys to our house. It's entirely electronic and only myself and my roommate have the access codes.I have no explanation for what happened. I was wide awake for it all. The cats saw it. My smartlock confirms it. It definitely happened.----------------------------------------------THE REAL ISSUE:After that all happened I went back to sleep. It generally takes me hours to fall asleep, however that's not what happened last night. I always fall asleep with the TV on for noise, but turned down. South Park is what I had on last night and throughout the course of the night, I could clearly identify the voices and episodes as they came and went, even during the "dreams" I'm about to talk about, but NOT during the dream at the end of my story. That's a VERY important thing to note. After maybe 30 minute I felt like I was asleep, but I wasn't. I could feel my sheets, feel my head and arms on the pillow, move around, and feel my cat against my leg. That said, I started "dreaming" as if I was asleep. I'd note now that I've only ever had 1 lucid dream before and it was right after my long-term secret fiance had left me. It was stressful cause I simply came home to an empty house one day. I hadn't heard a word from him all day and all that was left was a quit-claim, signed and notarized, leaving the house entirely to me and taking his name off it and a hand-written note saying "I'll always love you. I'm sorry". Never heard from him again. He was my world even though he wouldn't allow anyone to know we were together cause he desperately wanted to be "straight". I cried myself to sleep for quite literally years, though over time it became a silent cry. I've been told the stress caused the lucid dream. I have countless wonderful stories about him, but he did give me me a strong case of PTSD, which I already had to deal with from an extremely abusive father.Back to the story now. During this "dream" I found myself on a cement platform in a park with a table and two chairs in front of me, underneath a pavilion. There were lots of oak trees, azaleas, and camellias, like a park would look like where I grew up in New Orleans. A cup of my favourite tea was waiting for me. An middle-to-late aged woman was sitting at the table in a white pants-suit. She had blue eyes and gray hair. She introduced herself as "death" and asked me to sit and chat with her for a while. She discussed my life with me and asked me many questions. She knew things about me that I didn't even realize myself. My memory of it is hazy, however. The "dream" lasted 30-45 minutes. During the "dream" I was able to freely move my "sleeping" physical body. Movement would cause a strange type of interference with the dream that I cannot really describe, but as soon as I stopped moving it went back to being incredibly vivid. At one point I sat up entirely, walked to my desk, and scooped up one of my other cats, and brought him back to bed and wrapped my arms around him. I felt entirely real. I had fully control over my body and words through the entire "dream". At some point in the dream she asked me to stop moving around cause it made her "presence" more difficult and she insisted I trust her that it was real. Over the next 7 hours I had 7 more nearly identical "dreams". Each dream was roughly the same, but the scenery and other person changed. Each "person" I talked to presented themselves as some kind of aspect of life. The ones I remember were: Death, Joy, Lust, Love, Pain, and Plague. I'm struggling to recalled specifics about the conversations, but they all insisted it was real and that I was safe. Each discussion was different and revolved around the aspect of life they claimed to be.I woke up completely after that and was confused, scared, and for some reason, relieved. It felt like everything was going to be ok. I've only experienced that feeling one other time. In December 2016, I was run over, intentionally, by a woman in an SUV while I was crossing the road on my motorcycle. She ran her light with the goal of killing me cause she was enraged by the pride flag sticker on the back of my motorcycle. It's a long story that I've shared many times, but this is already long so I'll skip most of it. The force of the impact sent me flying 30 feet and I slammed into an oak tree and the majority of my body was either broken of entirely shattered and I damn well knew it. In relatively short order, I grew cold from my chest and it spread throughout my body and I knew what was happening. I was about to die. I suddenly felt this massive calming wave overtake me and felt like nothing could ever be wrong and everything is ok. I blacked out shortly later and when I woke up again, I was looking at EMTs and a nurse who'd been attempting to revive me. I had been dead for around 5 minutes and had been kept alive by the person who was driving behind me and just so happened to be an ER nurse heading to work at the hospital less than a mile away.Back to the story again, I was awake for around an hour after all those experiences and ended up falling back asleep. This time, however, I had a regular dream, technically a nightmare, which is normal for me. I suffer from night terrors that are truly horrible and take 6mg of prazosin at night to prevent them. I still get them from time to time, but the overwhelming majority of my dreams are standard issue nightmares. I rarely have any positive dreams.As a reminder, I'd mentioned earlier that I had South Park on throughout the night. During the bizarre "dreams", I could hear the voices and episode as they came and went and even laughed at a particularly funny scene and told the "aspect" I was currently talking to about it when it happened. In my last dream of the night, the standard-issue nightmare, I could NOT hear the TV, could NOT control my body, and was completely asleep. I'm not sure what that means overall, but I feel like it's a VERY important detail.----------------------------------------------THE QUESTION:Quite simply, what in the absolute hell happened to me last night?! I don't know what to make of any of it. As I said, I'm not spiritual or religious in any way, but this is causing extreme level of conflict and concern within me. Furthermore, I've been around a lot of dying people, I live with a doctor and dated him for the last 6 years (we broke up a few months back, but still live together), I've dated other doctors, I spend a ton of time at doc appointments and in hospitals, and I myself work as a data architect in medical research most of the time. I'm very aware that when people are nearing the end of their lives, most (60%, if I remember right) will hallucinate loved ones, angels, or even demons, and have long conversations with them over and over. In my experience, and to best of my knowledge, this usually happens within a few days preceding their death, but can happen as far as a few months in advance. Is that what I just experienced? I certainly have serious conditions, but I'm otherwise perfectly healthy. Other than my migraines, cluster headaches, and chronic pain I feel perfectly fine. I've had the migraines and clusters since I was a kid and the chronic pain since I was run over and nearly murdered. Nothing new has come up. I have been much more depressed and anxious about life lately as I've had awful dating experiences, am struggling horribly to land a new job, and the end of my lease is coming up soon and I will have nowhere to live, but I feel like I'm handling it well.I'm exceptionally worried about what happened last night. I want to see a doctor about it, but I have absolutely no clue who I'd go to. I know there's "doctors" who study dream analysis, but I talked to my ex about it, the doctor I live with, and we both feel like that's psuedo-science and doesn't carry any real validity. Because I'm currently laid off, aren't receiving unemployment, and am only earning money by doing freelance and contract work, I have to use medicaid for insurance. There's no available therapists or psychiatrists I can go to cause I can't afford their cash rates and the ones who accept medicaid are seriously booked up and have multi-year long wait lists. I'm on all of the wait lists, but I'm definitely not gonna hear back anytime soon. I can't afford cancer treatments either and medicaid won't pay for them.My mother insists all of it was a dream and I didn't wake up at any point through all of this. That's 100% false. I damn well know when I was awake and what I experienced. I have proof from the cats seeing and hearing what I did and the history on my door lock. I talked to a friend studying psych and he suggested I could be schizophrenic, but he's not a doctor or even a therapist and I was diagnosed as schizo year ago and treated for it, which worked, but when I moved to WA and found a much better psychiatrist, she vehemently disagreed, changed me to my current diagnosis and changed my medications which work far better, so I'm inclined to believe she was right. My psychiatrist in Louisiana was not on good terms with the board and was wildly aggressive with diagnosis and treatment for all her patients. Her results were remarkable, but her methods were HIGHLY questionable and she was quick to prescribe controlled meds. She had me on lorazepam and adderall while I was also on 50mg of Percoset daily from my neurologist. I absolutely never had any problems, complications, or side effects because of this and it was actually extremely helpful in helping me hold down a job and be a functional adult, but it's generally not appropriate to do. I desperately need my ADHD treated to hold down a job, but the state of WA will not allow you to be on more than 1 controlled medication at a time. I understand, but it makes life extremely difficult for me and I think it's completely unfair to make me choose between living in intense pain or being able to focus for more than 5 minutes at a time. Writing this post has taken me over 3 hours cause I keep walking away and doing other things.Anyway, any advice would be amazing. thank you for reading and I'm sorry for the length.TL;DRHad a series of "dreams" last night that didn't work like any dream I've ever had where I could freely move my physical body, which upset the "people" I was talking to in the "dreams". During the series of "dreams" I met personified aspects of life itself, like love, death, regret, plague, etc that held conversations with me about my life. A while after the series of "dreams" ended, I ended up going back to sleep and having a normal nightmare where I couldn't control my sleeping, physical body and things were normal. Now I'm wondering if that's my version of dying people hallucinating loved ones and I don't know what to do or what kind of doctor to see about it.That said, please, PLEASE read the full post. There's way more to this and the TLDR makes me sound like a lunatic. I spend a lot of time carefully writing it up and explaining everything, like the insanely critical context the TLDR is missing, please read it.

Output: Sounds like lucid dreams. I dont want to Monday morning quarterback your doctors but thats a dizzying (literally) array of psychoactive medications you have all mixing together that probably played some role too.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Height: 1.8m (5' 11")Weight: 64kg (141lbs)Race: CaucasianLocation: Seattle, WA, USA (German born, Berlin)Vices: occasional vaping with very weak nicotine content, no drinking, no illicit drugs, chronic pain patient (fentanyl patches, 50 microgram)Current physical conditions: pituitary macroadenoma, adrenal cortext carcinoma, and a ton of implants and artificial bones. I cannot afford treatment for either and my insurance, medicaid, will not pay for removal of either or even treatments since my treatment is HCG, which comes from only fertility clinic pharmacies, and medicaid doesn't cover and fertility treatments for menCurrent mental health conditions: PTSD, bipolar, BPD, ADHD, generalized anxiety, and recently depression. All are treated quite effectivelyMedications (total daily doses): 50microgram fentanyl patches, 6mg prazosin, 12mg tizanadine, 7.5mg mirtazipine, 2700mg gabapentin, 2mg clonidine, up to 150mg hydroxyzine, 80mg Latuda, 200mg Lamotrigine, 40mg viibryd, 10mg melatonin, 8mg ondansetronEmergency Usage Only Medications: Hospital only: 100mg dex, 20mg morphine, 4mg lorazepam all IV for cluster headaches; Personal use: 50mg IM dex for cluster headaches, epi-pen for food allergiesWARNING: This will be long. I deeply apologise, but I feel like I need to be very specific and include context to get an accurate answer, if one even exists.----------------------------------------------CONTEXT:I want to start this off by saying I don't particularly believe in homeopathy, certain Eastern medicine, religion (I'm agnostic, borderline atheist), or the paranormal. I do many things for work, taking whatever pays me, but I have spent the majority of my career as a data architect in medical research. I believe in what can be proven, but I also acknowledge we can't prove absolutely everything to be true or false and that the sciences are ever changing and ever growing. I would also note that my life have been a very challenging one and I seem to have the single worst luck of anyone I've ever personally met. I've been very stressed and it has gotten significantly worse of late, though I've been told that I'm handling it quite well. Of course, I also acknowledge that there's plenty of people who've lived much worse lives. I'm not trying to play the victim or be arrogant.----------------------------------------------IMPORTANT LEAD IN:I went to bed last night around 23:00. I woke up an hour or so later to the sounds of small booms outside the front of my house. I initially thought I'd imagined it, but I rolled over and say all 3 of my cats with their faces pressed against the window screen, ears perked up. The sounds actually happened. A few moments later, I heard out smartlock on the front door unlock followed by the door opening and closing. Aside from internal doors, the front door is the only "normal" door to the house. the others are sliding doors that were all locked and barred and sound completely different when opened and closed. My roommate was asleep in his room and had been for hours. Nobody else lives here. Once again, I thought I imagined it, but the cats had all left my room and run downstairs to the door, which is what they do when someone comes over or gets home from work, errands, or whatever. I then head a set of male and female voices coming from downstairs. I grabbed a replica Master Sword (from The Legend of Zelda game series my roommate gave me a few years back) and went to my roommate. I tried to wake him up repeatedly, but he just mumbled something inaudible and rolled away over and over. So I went downstairs quietly. I spent 15-20 minutes walking around the house, following the voices, but never found anything. One of my cats, Needles, kept running off towards the voices then coming back to yell at me to follow him to them, which is what he does whenever someone comes home and I don't instantly go see them, but I never could find them. He's an utter attention whore. After that, I gave up and went back upstairs. Within 5 minutes I heard the door open and close again and the voices stopped. I don't have the greatest hearing in the world and never got close enough to make out what they were saying. I checked my Nest doorbell camera and at no point did anyone walk past the door. It is always recording and saved online for 5 days and, with the way it's positioned, it couldn't possibly fail to see someone come in or leave. I checked my smart lock app to see how it was unlocked and it said it was unlocked using a key by a user named "error". To clarify, the account's username that opened it was not literally "error", but rather that the app produced an error trying to identify the user. There are no physical keys to our house. It's entirely electronic and only myself and my roommate have the access codes.I have no explanation for what happened. I was wide awake for it all. The cats saw it. My smartlock confirms it. It definitely happened.----------------------------------------------THE REAL ISSUE:After that all happened I went back to sleep. It generally takes me hours to fall asleep, however that's not what happened last night. I always fall asleep with the TV on for noise, but turned down. South Park is what I had on last night and throughout the course of the night, I could clearly identify the voices and episodes as they came and went, even during the "dreams" I'm about to talk about, but NOT during the dream at the end of my story. That's a VERY important thing to note. After maybe 30 minute I felt like I was asleep, but I wasn't. I could feel my sheets, feel my head and arms on the pillow, move around, and feel my cat against my leg. That said, I started "dreaming" as if I was asleep. I'd note now that I've only ever had 1 lucid dream before and it was right after my long-term secret fiance had left me. It was stressful cause I simply came home to an empty house one day. I hadn't heard a word from him all day and all that was left was a quit-claim, signed and notarized, leaving the house entirely to me and taking his name off it and a hand-written note saying "I'll always love you. I'm sorry". Never heard from him again. He was my world even though he wouldn't allow anyone to know we were together cause he desperately wanted to be "straight". I cried myself to sleep for quite literally years, though over time it became a silent cry. I've been told the stress caused the lucid dream. I have countless wonderful stories about him, but he did give me me a strong case of PTSD, which I already had to deal with from an extremely abusive father.Back to the story now. During this "dream" I found myself on a cement platform in a park with a table and two chairs in front of me, underneath a pavilion. There were lots of oak trees, azaleas, and camellias, like a park would look like where I grew up in New Orleans. A cup of my favourite tea was waiting for me. An middle-to-late aged woman was sitting at the table in a white pants-suit. She had blue eyes and gray hair. She introduced herself as "death" and asked me to sit and chat with her for a while. She discussed my life with me and asked me many questions. She knew things about me that I didn't even realize myself. My memory of it is hazy, however. The "dream" lasted 30-45 minutes. During the "dream" I was able to freely move my "sleeping" physical body. Movement would cause a strange type of interference with the dream that I cannot really describe, but as soon as I stopped moving it went back to being incredibly vivid. At one point I sat up entirely, walked to my desk, and scooped up one of my other cats, and brought him back to bed and wrapped my arms around him. I felt entirely real. I had fully control over my body and words through the entire "dream". At some point in the dream she asked me to stop moving around cause it made her "presence" more difficult and she insisted I trust her that it was real. Over the next 7 hours I had 7 more nearly identical "dreams". Each dream was roughly the same, but the scenery and other person changed. Each "person" I talked to presented themselves as some kind of aspect of life. The ones I remember were: Death, Joy, Lust, Love, Pain, and Plague. I'm struggling to recalled specifics about the conversations, but they all insisted it was real and that I was safe. Each discussion was different and revolved around the aspect of life they claimed to be.I woke up completely after that and was confused, scared, and for some reason, relieved. It felt like everything was going to be ok. I've only experienced that feeling one other time. In December 2016, I was run over, intentionally, by a woman in an SUV while I was crossing the road on my motorcycle. She ran her light with the goal of killing me cause she was enraged by the pride flag sticker on the back of my motorcycle. It's a long story that I've shared many times, but this is already long so I'll skip most of it. The force of the impact sent me flying 30 feet and I slammed into an oak tree and the majority of my body was either broken of entirely shattered and I damn well knew it. In relatively short order, I grew cold from my chest and it spread throughout my body and I knew what was happening. I was about to die. I suddenly felt this massive calming wave overtake me and felt like nothing could ever be wrong and everything is ok. I blacked out shortly later and when I woke up again, I was looking at EMTs and a nurse who'd been attempting to revive me. I had been dead for around 5 minutes and had been kept alive by the person who was driving behind me and just so happened to be an ER nurse heading to work at the hospital less than a mile away.Back to the story again, I was awake for around an hour after all those experiences and ended up falling back asleep. This time, however, I had a regular dream, technically a nightmare, which is normal for me. I suffer from night terrors that are truly horrible and take 6mg of prazosin at night to prevent them. I still get them from time to time, but the overwhelming majority of my dreams are standard issue nightmares. I rarely have any positive dreams.As a reminder, I'd mentioned earlier that I had South Park on throughout the night. During the bizarre "dreams", I could hear the voices and episode as they came and went and even laughed at a particularly funny scene and told the "aspect" I was currently talking to about it when it happened. In my last dream of the night, the standard-issue nightmare, I could NOT hear the TV, could NOT control my body, and was completely asleep. I'm not sure what that means overall, but I feel like it's a VERY important detail.----------------------------------------------THE QUESTION:Quite simply, what in the absolute hell happened to me last night?! I don't know what to make of any of it. As I said, I'm not spiritual or religious in any way, but this is causing extreme level of conflict and concern within me. Furthermore, I've been around a lot of dying people, I live with a doctor and dated him for the last 6 years (we broke up a few months back, but still live together), I've dated other doctors, I spend a ton of time at doc appointments and in hospitals, and I myself work as a data architect in medical research most of the time. I'm very aware that when people are nearing the end of their lives, most (60%, if I remember right) will hallucinate loved ones, angels, or even demons, and have long conversations with them over and over. In my experience, and to best of my knowledge, this usually happens within a few days preceding their death, but can happen as far as a few months in advance. Is that what I just experienced? I certainly have serious conditions, but I'm otherwise perfectly healthy. Other than my migraines, cluster headaches, and chronic pain I feel perfectly fine. I've had the migraines and clusters since I was a kid and the chronic pain since I was run over and nearly murdered. Nothing new has come up. I have been much more depressed and anxious about life lately as I've had awful dating experiences, am struggling horribly to land a new job, and the end of my lease is coming up soon and I will have nowhere to live, but I feel like I'm handling it well.I'm exceptionally worried about what happened last night. I want to see a doctor about it, but I have absolutely no clue who I'd go to. I know there's "doctors" who study dream analysis, but I talked to my ex about it, the doctor I live with, and we both feel like that's psuedo-science and doesn't carry any real validity. Because I'm currently laid off, aren't receiving unemployment, and am only earning money by doing freelance and contract work, I have to use medicaid for insurance. There's no available therapists or psychiatrists I can go to cause I can't afford their cash rates and the ones who accept medicaid are seriously booked up and have multi-year long wait lists. I'm on all of the wait lists, but I'm definitely not gonna hear back anytime soon. I can't afford cancer treatments either and medicaid won't pay for them.My mother insists all of it was a dream and I didn't wake up at any point through all of this. That's 100% false. I damn well know when I was awake and what I experienced. I have proof from the cats seeing and hearing what I did and the history on my door lock. I talked to a friend studying psych and he suggested I could be schizophrenic, but he's not a doctor or even a therapist and I was diagnosed as schizo year ago and treated for it, which worked, but when I moved to WA and found a much better psychiatrist, she vehemently disagreed, changed me to my current diagnosis and changed my medications which work far better, so I'm inclined to believe she was right. My psychiatrist in Louisiana was not on good terms with the board and was wildly aggressive with diagnosis and treatment for all her patients. Her results were remarkable, but her methods were HIGHLY questionable and she was quick to prescribe controlled meds. She had me on lorazepam and adderall while I was also on 50mg of Percoset daily from my neurologist. I absolutely never had any problems, complications, or side effects because of this and it was actually extremely helpful in helping me hold down a job and be a functional adult, but it's generally not appropriate to do. I desperately need my ADHD treated to hold down a job, but the state of WA will not allow you to be on more than 1 controlled medication at a time. I understand, but it makes life extremely difficult for me and I think it's completely unfair to make me choose between living in intense pain or being able to focus for more than 5 minutes at a time. Writing this post has taken me over 3 hours cause I keep walking away and doing other things.Anyway, any advice would be amazing. thank you for reading and I'm sorry for the length.TL;DRHad a series of "dreams" last night that didn't work like any dream I've ever had where I could freely move my physical body, which upset the "people" I was talking to in the "dreams". During the series of "dreams" I met personified aspects of life itself, like love, death, regret, plague, etc that held conversations with me about my life. A while after the series of "dreams" ended, I ended up going back to sleep and having a normal nightmare where I couldn't control my sleeping, physical body and things were normal. Now I'm wondering if that's my version of dying people hallucinating loved ones and I don't know what to do or what kind of doctor to see about it.That said, please, PLEASE read the full post. There's way more to this and the TLDR makes me sound like a lunatic. I spend a lot of time carefully writing it up and explaining everything, like the insanely critical context the TLDR is missing, please read it.. ### Response: Sounds like lucid dreams. I dont want to Monday morning quarterback your doctors but thats a dizzying (literally) array of psychoactive medications you have all mixing together that probably played some role too..


Instruction: Hi docs! Im currently in the neurology critical care unit with an aunt (78F) who was flown from our local hospital to this one. We knew that it was a smaller bleed, but not much else. Im the one that will be asking questions on behalf of her children (who are with me) so that we can fully understand whats going on. What are the questions that I should ask in order to get the most explanation all around?

Output: I'm so sorry your family is going through this. I'm board-certified in both emergency medicine as well as critical care. Going to need a little more information in order to help tailor the appropriate questions to ask. What information have you received so far about your aunt's current situation, and what is her current condition (e.g. is she on a ventilator, acting appropriately, etc.)? Have the docs given any updates on her prognosis and/or next steps, medically?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hi docs! Im currently in the neurology critical care unit with an aunt (78F) who was flown from our local hospital to this one. We knew that it was a smaller bleed, but not much else. Im the one that will be asking questions on behalf of her children (who are with me) so that we can fully understand whats going on. What are the questions that I should ask in order to get the most explanation all around?. ### Response: I'm so sorry your family is going through this. I'm board-certified in both emergency medicine as well as critical care. Going to need a little more information in order to help tailor the appropriate questions to ask. What information have you received so far about your aunt's current situation, and what is her current condition (e.g. is she on a ventilator, acting appropriately, etc.)? Have the docs given any updates on her prognosis and/or next steps, medically?.


Instruction: Thank you so much. No information other than that she was resting and that the bleed was small. They said that they would try their best, but wouldnt guarantee anything. Thats all the doctor told her son. :/

Output: Well, that's certainly not very helpful or enlightening at all :/ Idk your aunt's medical history, how the bleed occurred, or what intervention's her medical team has already performed so far. However, it's reassuring that the bleed is reportedly small. Important things that would be good to ask would be:-What interventions have been performed so far, and why? Also, which interventions/procedures can be expected in the future? -How severe is the bleed, and what deficits can be expected following recovery vs. what are the chances of a full recovery (note, they likely won't commit to a specific answer to this question, because there's no good way to predict patient outcome, but notifies the care team that you're actively involved in the patient's care and want to be kept in the loop)? -What does the recovery time/process look like if/when her bleed improves? -Are there any additional co-complications going on? -is there any specialized care that is going to be required following recovery? -How often can we expect patient updates from the doc in the future? -Does the providing physician have any specific concerns of their own that we should be aware of?Additionally, it's probably worth asking what support is provided by the hospital that's available for friends/family of the patient. If you have any additional information to share, please post here so that specific questions can be appropriately addressed.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much. No information other than that she was resting and that the bleed was small. They said that they would try their best, but wouldnt guarantee anything. Thats all the doctor told her son. :/. ### Response: Well, that's certainly not very helpful or enlightening at all :/ Idk your aunt's medical history, how the bleed occurred, or what intervention's her medical team has already performed so far. However, it's reassuring that the bleed is reportedly small. Important things that would be good to ask would be:-What interventions have been performed so far, and why? Also, which interventions/procedures can be expected in the future? -How severe is the bleed, and what deficits can be expected following recovery vs. what are the chances of a full recovery (note, they likely won't commit to a specific answer to this question, because there's no good way to predict patient outcome, but notifies the care team that you're actively involved in the patient's care and want to be kept in the loop)? -What does the recovery time/process look like if/when her bleed improves? -Are there any additional co-complications going on? -is there any specialized care that is going to be required following recovery? -How often can we expect patient updates from the doc in the future? -Does the providing physician have any specific concerns of their own that we should be aware of?Additionally, it's probably worth asking what support is provided by the hospital that's available for friends/family of the patient. If you have any additional information to share, please post here so that specific questions can be appropriately addressed..


Instruction: I chose his CRNP because I was having chest pains and I already knew that I was hypertensive. I'm an advanced EMT and although my scope is nowhere near a CRNP, I can still diagnose myself for what is critical and what is not.This woman is under half of my age. I'm not comfortable with someone fresh out of medical school. She told me that I had to go to the ER. I paid $140 for an office visit for her to tell me that I had to go to the ER, after taking my blood pressure. I already knew that I was hypertensive and they told me over the phone to come in to get some kind of high blood pressure medicine.I told her that and she told me that I needed an EKG and a CBC workup. She told me they could do that at on-site, but without insurance, it would run me around $1,400... and it had to be paid, NOW. Words fail me here. All of this could have been told to me on the phone.I told her that I couldn't afford that out of pocket. She told me that I was going to be sent home... without any medicine. I said, "Let's review here... It's such an emergency that I have to go to the ER or pay for tests now, but you can send me home without medicince???" Unbelievable. I left, had to pay my $140, and went home with no medicine. I got home, at square one again, and was $140 poorer.The social worker called me later that day and she was also an EMT. I told her what I just typed. She emailed the doctor and a few hours later, I was prescribed some amlodipine that could be picked up immediately at my pharmacy.I received better care from a social worker that I paid nothing, than from a CRNP that I had to pay for... amazing. The CRNP obviously didn't even go to the doctor for consult.

Output: I'm not comfortable with someone fresh out of medical school.NPs do not go to medical school. They are knowledgeable and can treat common illnesses, but they are not medical doctors.Are you located in the US? Do you not have insurance?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I chose his CRNP because I was having chest pains and I already knew that I was hypertensive. I'm an advanced EMT and although my scope is nowhere near a CRNP, I can still diagnose myself for what is critical and what is not.This woman is under half of my age. I'm not comfortable with someone fresh out of medical school. She told me that I had to go to the ER. I paid $140 for an office visit for her to tell me that I had to go to the ER, after taking my blood pressure. I already knew that I was hypertensive and they told me over the phone to come in to get some kind of high blood pressure medicine.I told her that and she told me that I needed an EKG and a CBC workup. She told me they could do that at on-site, but without insurance, it would run me around $1,400... and it had to be paid, NOW. Words fail me here. All of this could have been told to me on the phone.I told her that I couldn't afford that out of pocket. She told me that I was going to be sent home... without any medicine. I said, "Let's review here... It's such an emergency that I have to go to the ER or pay for tests now, but you can send me home without medicince???" Unbelievable. I left, had to pay my $140, and went home with no medicine. I got home, at square one again, and was $140 poorer.The social worker called me later that day and she was also an EMT. I told her what I just typed. She emailed the doctor and a few hours later, I was prescribed some amlodipine that could be picked up immediately at my pharmacy.I received better care from a social worker that I paid nothing, than from a CRNP that I had to pay for... amazing. The CRNP obviously didn't even go to the doctor for consult.. ### Response: I'm not comfortable with someone fresh out of medical school.NPs do not go to medical school. They are knowledgeable and can treat common illnesses, but they are not medical doctors.Are you located in the US? Do you not have insurance?.


Instruction: What kind of school do they go to, then? I assumed that they went to some kind of medical school, since their scope is higher than a registered nurse.I am in the US and I just got insurance.

Output: What exactly is your question? Any given decision to see an MD vs an APP is a balance of complexity and access.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What kind of school do they go to, then? I assumed that they went to some kind of medical school, since their scope is higher than a registered nurse.I am in the US and I just got insurance.. ### Response: What exactly is your question? Any given decision to see an MD vs an APP is a balance of complexity and access..


Instruction: 31F, went to the ER due to stomach pain and uncontrollable shivering. She was admitted to the ICU and had extremely low blood sugar, hypothermia, hyperkalemia, blood in the stool, gram positive cocci in pairs and chains, anemia, and she had been previously diagnosed with endometriosis. They found cysts in the liver, hypodensity in the left side of the brain and have been taking several tests. ER gave her 3 blood transfusions for the anemia and she now has a swollen back, legs, hands, and feet. She is still anemic even after the 3 blood transfusions. She has undergone multiple MRI, ultrasounds, CAT scans, and blood works but they aren't sure what is causing everything.Her vitals at admission were:K 5.9Hgb 5.5Glucose 17Temp 94.5WBC 5700She started antibiotics yesterday morning and her second ecg was normal. She was taking oxycodone for pain but is now on morphine and lidocaine. Doctors said that she had a reaction to her 3rd blood transfusion and her heart rate went up and blood pressure went down. She is now on medication for that. She has not been allowed any food or water today after the reaction. An MRI found that she has lesions in her brain but the nuero surgery consultant said they were not going to do any procedure.Has anyone had experience with something similar and what was the diagnosis?

Output: While I have lots of experience with patients like her, I dont think theres much that can be said over the internet to help. She has a severe critical illness with what sounds like septic shock. The best people to answer your questions is the team of doctor taking care of your sister.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 31F, went to the ER due to stomach pain and uncontrollable shivering. She was admitted to the ICU and had extremely low blood sugar, hypothermia, hyperkalemia, blood in the stool, gram positive cocci in pairs and chains, anemia, and she had been previously diagnosed with endometriosis. They found cysts in the liver, hypodensity in the left side of the brain and have been taking several tests. ER gave her 3 blood transfusions for the anemia and she now has a swollen back, legs, hands, and feet. She is still anemic even after the 3 blood transfusions. She has undergone multiple MRI, ultrasounds, CAT scans, and blood works but they aren't sure what is causing everything.Her vitals at admission were:K 5.9Hgb 5.5Glucose 17Temp 94.5WBC 5700She started antibiotics yesterday morning and her second ecg was normal. She was taking oxycodone for pain but is now on morphine and lidocaine. Doctors said that she had a reaction to her 3rd blood transfusion and her heart rate went up and blood pressure went down. She is now on medication for that. She has not been allowed any food or water today after the reaction. An MRI found that she has lesions in her brain but the nuero surgery consultant said they were not going to do any procedure.Has anyone had experience with something similar and what was the diagnosis?. ### Response: While I have lots of experience with patients like her, I dont think theres much that can be said over the internet to help. She has a severe critical illness with what sounds like septic shock. The best people to answer your questions is the team of doctor taking care of your sister..


Instruction: Im 30 years old and after a very long and defeating search for a doctor willing to listen, I was finally diagnosed with Nutcracker Syndrome. I have surgery in 1 month, but I am in debilitating pain. Im a critical care nurse of 8 years and no stranger to the difficulties with pain management faced and felt by both physicians and patients. What I was baffled by was the extreme amount of gaslighting I faced as I tried to get this syndrome ruled in/out. Ive fought for months to NOT end up in this position (stuck in pain) by advocating for myself yet listening to each physicians advice, and trying to be a good patient and human being.I was in pain management but left the clinic because the doctor wasnt willing to work with me in any way. I was given Meloxicam, Gabapentin, and one 5mg Norco per day. Only the Norco would do much of anything. I had an appointment set up with a new clinic before I left, but its not till Dec. 12th and my pain has gotten MUCH worse even in the last week. I will also still have to wait the 2 weeks to actually get any medication (as far as i understand).My surgeon cannot prescribe me anything, and I see a PCP who uses holistic and traditional medicene (basically started me on tons of supplements) and really seemed to help me, its pricey but worth it as they are also more available. BUT, they cannot prescribe pain medication as they are a cash pay direct care practice. Ive called other pain clinics and they cant get me in until even later dates, Ive texted every doctor Ive worked with and their leads have fallen through. Meanwhile, the pain is so horrible I can hardly eat or move, and getting worse by the day. I went to the ED out of desperation a couple days ago and the doctor was kind and gave me 14 Norco 5s which help the pain a bit for about 2-3 hours. But I desperately need something stronger and more permanent (obviously).As far as options, My surgeon suggested going back to the ER for more pain meds (which was weird) or my PCP though he knows they cant prescribe those meds. The ER doctor suggested a new PCP which Im considering but Ive had good support with my current one and feel they are far more accessible, especially considering something new happens each week it seems like (strep B UTIs, hypothyroidism, gallbladder and liver issues, you name it). Plus idk if anyone would feel comfortable writing me opiates on a new patient visit.Is it even worth trying a new PCP? Would it be pointless to keep both my current PCP and see a new traditional PCP that could help with pain ? Or should I switch altogether? When my current pain meds run out I WILL have to go back to the ED because it gets that bad and Im no wimp. Its a solid 7-8/10 WITH the Norco on board. Would a second ED physician even consider writing Another script?Should I try and speak to the actual doctor I will be seeing Dec 12 about my hopeless situation or insist that the nurse tell him about it?Im really at a loss, Im in Indiana so medical marijuana isnt an option. I would appreciate any advice, leads, anything. I feel like Ive been failed for a year straight, and I was hoping I would be taken more seriously as someone whose also in healthcare, but its sadly not been the case. TIA

Output: I'm sorry OP, this is awful. Not familiar with the health care system where you live and why your PCP can't prescribe opioids, but can you see them for help navigating how to have this addressed? I agree it looks bad if you start seeing a new PCP or go back to ED but perhaps letters from your current PCP explaining the situation would be helpful?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im 30 years old and after a very long and defeating search for a doctor willing to listen, I was finally diagnosed with Nutcracker Syndrome. I have surgery in 1 month, but I am in debilitating pain. Im a critical care nurse of 8 years and no stranger to the difficulties with pain management faced and felt by both physicians and patients. What I was baffled by was the extreme amount of gaslighting I faced as I tried to get this syndrome ruled in/out. Ive fought for months to NOT end up in this position (stuck in pain) by advocating for myself yet listening to each physicians advice, and trying to be a good patient and human being.I was in pain management but left the clinic because the doctor wasnt willing to work with me in any way. I was given Meloxicam, Gabapentin, and one 5mg Norco per day. Only the Norco would do much of anything. I had an appointment set up with a new clinic before I left, but its not till Dec. 12th and my pain has gotten MUCH worse even in the last week. I will also still have to wait the 2 weeks to actually get any medication (as far as i understand).My surgeon cannot prescribe me anything, and I see a PCP who uses holistic and traditional medicene (basically started me on tons of supplements) and really seemed to help me, its pricey but worth it as they are also more available. BUT, they cannot prescribe pain medication as they are a cash pay direct care practice. Ive called other pain clinics and they cant get me in until even later dates, Ive texted every doctor Ive worked with and their leads have fallen through. Meanwhile, the pain is so horrible I can hardly eat or move, and getting worse by the day. I went to the ED out of desperation a couple days ago and the doctor was kind and gave me 14 Norco 5s which help the pain a bit for about 2-3 hours. But I desperately need something stronger and more permanent (obviously).As far as options, My surgeon suggested going back to the ER for more pain meds (which was weird) or my PCP though he knows they cant prescribe those meds. The ER doctor suggested a new PCP which Im considering but Ive had good support with my current one and feel they are far more accessible, especially considering something new happens each week it seems like (strep B UTIs, hypothyroidism, gallbladder and liver issues, you name it). Plus idk if anyone would feel comfortable writing me opiates on a new patient visit.Is it even worth trying a new PCP? Would it be pointless to keep both my current PCP and see a new traditional PCP that could help with pain ? Or should I switch altogether? When my current pain meds run out I WILL have to go back to the ED because it gets that bad and Im no wimp. Its a solid 7-8/10 WITH the Norco on board. Would a second ED physician even consider writing Another script?Should I try and speak to the actual doctor I will be seeing Dec 12 about my hopeless situation or insist that the nurse tell him about it?Im really at a loss, Im in Indiana so medical marijuana isnt an option. I would appreciate any advice, leads, anything. I feel like Ive been failed for a year straight, and I was hoping I would be taken more seriously as someone whose also in healthcare, but its sadly not been the case. TIA. ### Response: I'm sorry OP, this is awful. Not familiar with the health care system where you live and why your PCP can't prescribe opioids, but can you see them for help navigating how to have this addressed? I agree it looks bad if you start seeing a new PCP or go back to ED but perhaps letters from your current PCP explaining the situation would be helpful?.


Instruction: Thats a good thought, I have asked them to call the pain management place I have an appointment at the attempt to get me in sooner. I will see if they will do that as well :) Nothing can hurt at this point. And thanks for the validation because honestly, Ive started questioning if its really all that bad (though I know it is).Its crazy what a year of being chronically ill can do to the mind, even someone familiar with the healthcare system (Im in the U.S.). A lot of doctors here would love to be able to help me out but legally cant, or if they can would have to fear for their license (presumably).The ED giving me the small script they did was even kinda going out on a limb. It all comes down to the fact that not many doctors arent familiar with nutcracker syndrome because its rare, and the extreme pain isnt a well known fact about it. So it makes me seem as if Im drug seeking, but one look at my background and its clear theres not history of anything whatsoever.I mean i worked in ICU for 8 years around every narcotic imaginable, and still could be if I wasnt this sick. And I was charge nurse of a high acuity unit. The doctors Ive worked with have helped me alot in this process but their hands are tied on the opiate thing.

Output: I'm not familiar with the syndrome but it's not hard to look it up. It's very sad that because of the opioid abuse pandemic we've gone so far the other way that people can't get adequate pain relief for appropriate indications.Good luck, and I hope the surgery is effective!

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thats a good thought, I have asked them to call the pain management place I have an appointment at the attempt to get me in sooner. I will see if they will do that as well :) Nothing can hurt at this point. And thanks for the validation because honestly, Ive started questioning if its really all that bad (though I know it is).Its crazy what a year of being chronically ill can do to the mind, even someone familiar with the healthcare system (Im in the U.S.). A lot of doctors here would love to be able to help me out but legally cant, or if they can would have to fear for their license (presumably).The ED giving me the small script they did was even kinda going out on a limb. It all comes down to the fact that not many doctors arent familiar with nutcracker syndrome because its rare, and the extreme pain isnt a well known fact about it. So it makes me seem as if Im drug seeking, but one look at my background and its clear theres not history of anything whatsoever.I mean i worked in ICU for 8 years around every narcotic imaginable, and still could be if I wasnt this sick. And I was charge nurse of a high acuity unit. The doctors Ive worked with have helped me alot in this process but their hands are tied on the opiate thing.. ### Response: I'm not familiar with the syndrome but it's not hard to look it up. It's very sad that because of the opioid abuse pandemic we've gone so far the other way that people can't get adequate pain relief for appropriate indications.Good luck, and I hope the surgery is effective!.


Instruction: I had an awful IUD experience, involving vomiting and fainting as a result of the pain level. I would rate my IUD insertion worse than passing a kidney stone or breaking bones. Im not alone with this experience. If you search IUD on TikTok or other female-dominated subreddits, youll see an abundance of women/ teenage girls who have also described the IUD pain as the worst pain in their life. Ive noticed a trend of increased pain particularly among nulliparous women.The Intensity of pain doesnt seem to be acknowledged by many medical providers though, as many patients are told it will be a slight pinch and arent properly informed about the pain involved. As a result, many of us did not properly prepare for the persisting pain by arranging a ride home from the appointment, a day off from work/school, or mental preparation for pain. Many providers both seem to acknowledge that extreme reactions to the insertion are normal, but the pain isnt enough to warrant preparation or pain medicationsI played rugby, basketball, football, and softball. Ive had many broken bones and torn ACLs. Ive also passed kidney stone. The IUD insertion pain was by far worse and longer than any of the aforementioned pain events. If I was offered pain medicine for all those events, why is nothing given for IUD insertions to reduce the associated pain and discomfort? Is there a specific reason?Edit- I should mention Im directing this question to medical professionals in the US.Edit 2- Ill admit I havent looked into any of the studies about this. We had one doctor chime in that studies show that extreme pain is not the norm, but the trend Im seeing in person and across social media appears contradictory to those findings. Would any medical professionals be willing to share the specific studies that are being referenced for care? Im a PhD student in a different area of public health research, but I wouldnt mind doing some critical review of the publications while I have the time. Update: so far I've only found a few relevant articles in my Uni's database. Most are about a decade or older and have really small sample sizes, like n=40 or less. The more recent articles are recognizing the pain of insertion as an issue, but I'm not finding a lot of resources so far. If anyone has a specific research study they reference when learning, I'd be thrilled to look at it.Edit 3 -I started to search for articles. This is the first abstract I found:"Concerns about pain during IUD insertion are a major barrier to use of IUDs among adolescent and young adult patients who may otherwise be interested in this method. Although few studies of pain control options have been conducted in this population, available data suggest that several pharmacologic interventions discussed in this chapter may be beneficial. Pre-procedure naproxen, ketorolac, or tramadol can help to reduce post-procedure discomfort. Paracervical nerve blockage with lidocaine-based anesthetics, topical lidocaine spray, or EMLA cream also appears to reduce pain with IUD insertion. Intravaginal 2% lidocaine gel may reduce pain with tenaculum and speculum placement. This chapter will discuss the complex nature of pain in gynecological procedures, including IUD placement, and the impact of anxiety and fear on pain perception. It will also review clinical guidelines to assist with pain control during procedures and describe evidence-based pharmacological pain control modalities that can be used during IUD procedures." Optimizing IUD Delivery for Adolescents and Young AdultsTho I don't have full access to the text, this abstract is making it apparent that pain management is a valid concern and there are options. Can doctors weigh in more on those options? If it is indeed a recognized problem in the medical community, why aren't these options considered?Update 4: I have 26 peer-reviewed articles to review. Slamming a coffee and Ill get you my quick-and-dirty lit review asap.

Output: I don't do IUD insertions, but pain management should be discussed and offered.I don't care what the studies say. Sometimes you just need to be a human and empathize with other humans. Medicine is as much an art as it is science.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I had an awful IUD experience, involving vomiting and fainting as a result of the pain level. I would rate my IUD insertion worse than passing a kidney stone or breaking bones. Im not alone with this experience. If you search IUD on TikTok or other female-dominated subreddits, youll see an abundance of women/ teenage girls who have also described the IUD pain as the worst pain in their life. Ive noticed a trend of increased pain particularly among nulliparous women.The Intensity of pain doesnt seem to be acknowledged by many medical providers though, as many patients are told it will be a slight pinch and arent properly informed about the pain involved. As a result, many of us did not properly prepare for the persisting pain by arranging a ride home from the appointment, a day off from work/school, or mental preparation for pain. Many providers both seem to acknowledge that extreme reactions to the insertion are normal, but the pain isnt enough to warrant preparation or pain medicationsI played rugby, basketball, football, and softball. Ive had many broken bones and torn ACLs. Ive also passed kidney stone. The IUD insertion pain was by far worse and longer than any of the aforementioned pain events. If I was offered pain medicine for all those events, why is nothing given for IUD insertions to reduce the associated pain and discomfort? Is there a specific reason?Edit- I should mention Im directing this question to medical professionals in the US.Edit 2- Ill admit I havent looked into any of the studies about this. We had one doctor chime in that studies show that extreme pain is not the norm, but the trend Im seeing in person and across social media appears contradictory to those findings. Would any medical professionals be willing to share the specific studies that are being referenced for care? Im a PhD student in a different area of public health research, but I wouldnt mind doing some critical review of the publications while I have the time. Update: so far I've only found a few relevant articles in my Uni's database. Most are about a decade or older and have really small sample sizes, like n=40 or less. The more recent articles are recognizing the pain of insertion as an issue, but I'm not finding a lot of resources so far. If anyone has a specific research study they reference when learning, I'd be thrilled to look at it.Edit 3 -I started to search for articles. This is the first abstract I found:"Concerns about pain during IUD insertion are a major barrier to use of IUDs among adolescent and young adult patients who may otherwise be interested in this method. Although few studies of pain control options have been conducted in this population, available data suggest that several pharmacologic interventions discussed in this chapter may be beneficial. Pre-procedure naproxen, ketorolac, or tramadol can help to reduce post-procedure discomfort. Paracervical nerve blockage with lidocaine-based anesthetics, topical lidocaine spray, or EMLA cream also appears to reduce pain with IUD insertion. Intravaginal 2% lidocaine gel may reduce pain with tenaculum and speculum placement. This chapter will discuss the complex nature of pain in gynecological procedures, including IUD placement, and the impact of anxiety and fear on pain perception. It will also review clinical guidelines to assist with pain control during procedures and describe evidence-based pharmacological pain control modalities that can be used during IUD procedures." Optimizing IUD Delivery for Adolescents and Young AdultsTho I don't have full access to the text, this abstract is making it apparent that pain management is a valid concern and there are options. Can doctors weigh in more on those options? If it is indeed a recognized problem in the medical community, why aren't these options considered?Update 4: I have 26 peer-reviewed articles to review. Slamming a coffee and Ill get you my quick-and-dirty lit review asap.. ### Response: I don't do IUD insertions, but pain management should be discussed and offered.I don't care what the studies say. Sometimes you just need to be a human and empathize with other humans. Medicine is as much an art as it is science..


Instruction: Im a 26F, 173lbs, 57 I have SLE Lupus, Ehlers Danlos Syndrome, and Idiopathic inter cranial hydrocephalus.I just had a CT W/O of the brain and neck yesterday. Reason for this was because Ive been having terrible headaches lately. I received a message today stating THIS REPORT CONTAINS FINDINGS THAT MAY BE CRITICAL TO PATIENT CARE.Impressions:Hyperdensity seen in the right frontal along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage. Sorry for the all caps I just copied and paste. What does this mean? Thank you for your help

Output: Physician, Emergency Medicine | ModeratorAgree 100% with /u/sspwnage. Closing this thread as there is no other message that needs to be said other than call 911 or go immediately to the ER (and tell them your CT scan yesterday showed bleeding in the brain). I am a little surprised no physician called to tell you about this which I assume is just an oversight.PhysicianYou need to go to the emergency room ASAP. That CT is showing you are having bleeding in the brain. This is probably the cause of your headaches but they will need to run more tests. Seriously drop what you are doing and go, brain bleeds need to be monitored and seen by a neurosurgeon ASAP.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im a 26F, 173lbs, 57 I have SLE Lupus, Ehlers Danlos Syndrome, and Idiopathic inter cranial hydrocephalus.I just had a CT W/O of the brain and neck yesterday. Reason for this was because Ive been having terrible headaches lately. I received a message today stating THIS REPORT CONTAINS FINDINGS THAT MAY BE CRITICAL TO PATIENT CARE.Impressions:Hyperdensity seen in the right frontal along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage. Sorry for the all caps I just copied and paste. What does this mean? Thank you for your help. ### Response: Physician, Emergency Medicine | ModeratorAgree 100% with /u/sspwnage. Closing this thread as there is no other message that needs to be said other than call 911 or go immediately to the ER (and tell them your CT scan yesterday showed bleeding in the brain). I am a little surprised no physician called to tell you about this which I assume is just an oversight.PhysicianYou need to go to the emergency room ASAP. That CT is showing you are having bleeding in the brain. This is probably the cause of your headaches but they will need to run more tests. Seriously drop what you are doing and go, brain bleeds need to be monitored and seen by a neurosurgeon ASAP..