Instruction: Gender - male Age - 54 Weight - 165lbs Height - 5'11So my father has been a heavy alcoholic and smoker for 40+ years but im concerned about his health. About 15 years ago he went to the doctors to get some tests done and his doctor literally said to him "I don't know how you are standing here in front of me", He also had a blood pressure of over 200 and his blood pressure is still at around that level today.But a few months ago he felt really dizzy to the point where He got a doctor's appointment, Then at the doctor's they did a ECG on his heart and said that he must of had a silent heart attack. They also took his blood pressure and it was 260/180.But my father still drinks and smokes like crazy, He did take tablets to lower blood pressure but he still doesn't care.Seriously, How the hell could he still be alive when he has been living with critical blood pressure of over 200 for at least 15 years? Cause apparently if you have a blood pressure of over 180/120 then you have a 80 percent chance of dying within 1 year.Now I love my father but I think he is a ticking time bomb and im worried

Output: The body can adapt to a lot of things, seems that your dad is lucky. Not sure what type of advice youre looking for, seems that you know the answers. He should stop drinking and smoking and take his blood pressure medication because youre right, he is a ticking time bomb, he could suffer a brain hemorrhage or a heart attack at any moment, or even start to develop symptoms of lungs, heart and liver conditions.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Gender - male Age - 54 Weight - 165lbs Height - 5'11So my father has been a heavy alcoholic and smoker for 40+ years but im concerned about his health. About 15 years ago he went to the doctors to get some tests done and his doctor literally said to him "I don't know how you are standing here in front of me", He also had a blood pressure of over 200 and his blood pressure is still at around that level today.But a few months ago he felt really dizzy to the point where He got a doctor's appointment, Then at the doctor's they did a ECG on his heart and said that he must of had a silent heart attack. They also took his blood pressure and it was 260/180.But my father still drinks and smokes like crazy, He did take tablets to lower blood pressure but he still doesn't care.Seriously, How the hell could he still be alive when he has been living with critical blood pressure of over 200 for at least 15 years? Cause apparently if you have a blood pressure of over 180/120 then you have a 80 percent chance of dying within 1 year.Now I love my father but I think he is a ticking time bomb and im worried. ### Response: The body can adapt to a lot of things, seems that your dad is lucky. Not sure what type of advice youre looking for, seems that you know the answers. He should stop drinking and smoking and take his blood pressure medication because youre right, he is a ticking time bomb, he could suffer a brain hemorrhage or a heart attack at any moment, or even start to develop symptoms of lungs, heart and liver conditions..


Instruction: He's also not vaccinated against covid although I think he caught covid a few months ago because he was pretty Ill (He just couldn't be bothered taking a test tho). He has also never got a vaccine in his life (Apparently) and he was offered to get his covid/flu vaccine but he just doesn't want tohe is a heavy smoker and alcoholic (Does it everyday), He also use to do alot of other drugs back in his early day (I.e coke, ketamin, Ecstasy etc) but even his doctor said to him 15 years ago that he should be dead.Now I know that things such as heart attacks, Strokes etc doesn't seem to run in my family luckily and both of my grandparents (his parents) are still alive, my great grandparents (His grandparents) also lived to thier late 90s so maybe genetics plays a role here but still, I thought him having that silent heart attack a few months ago would of motivated him into getting his shit together but it hasn'tAlso, The doctor's gave him folic acid tablets to treat his blood pressure (Which I don't really understand). He also went for a scan the other day on his heart but they lost his scan results

Output: Folic acid is known to help reduce the risk of having a stroke. It looks like you cant do much else if your dad doesnt want to help himself a bit. Genetics might be doing their part here, theres really no way of knowing for sure why he hasnt any other complications, but thats a good thing :)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: He's also not vaccinated against covid although I think he caught covid a few months ago because he was pretty Ill (He just couldn't be bothered taking a test tho). He has also never got a vaccine in his life (Apparently) and he was offered to get his covid/flu vaccine but he just doesn't want tohe is a heavy smoker and alcoholic (Does it everyday), He also use to do alot of other drugs back in his early day (I.e coke, ketamin, Ecstasy etc) but even his doctor said to him 15 years ago that he should be dead.Now I know that things such as heart attacks, Strokes etc doesn't seem to run in my family luckily and both of my grandparents (his parents) are still alive, my great grandparents (His grandparents) also lived to thier late 90s so maybe genetics plays a role here but still, I thought him having that silent heart attack a few months ago would of motivated him into getting his shit together but it hasn'tAlso, The doctor's gave him folic acid tablets to treat his blood pressure (Which I don't really understand). He also went for a scan the other day on his heart but they lost his scan results. ### Response: Folic acid is known to help reduce the risk of having a stroke. It looks like you cant do much else if your dad doesnt want to help himself a bit. Genetics might be doing their part here, theres really no way of knowing for sure why he hasnt any other complications, but thats a good thing :).


Instruction: (EDIT Below Original Post ) I kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many have responded, thank you again, It really means so much.I been staying with him for 99% of the time in the hospital. I went home for one day out of 35 days.He was having issues all of this year, mostly without not being able to eat. We went to ER early June and test results came back okay (or so we were told)He became really sick and malnourished so we took him to ER again in Sept and they performed a CAT Scan. They found a Mass.Biopsy of the Mass diagnosed it as Stage 4 Lung Cancer and now he's been in the hospital for over 5 weeks.He had a cardiac arrest which lead to him being put on life support but they carried on with doing radiation to treat the mass and shrink itHe has SVC Syndrome, Pleural effusion (chest tube) Gastrointestinal tube present (Possibly getting a G-J) , HCC Lung Cancer and AFIB ( Atrial Flutter)Medications: (TBE) He's been/are onFor Pain: Morphine , fentanyl , Versed,Blood Thinners: Heparin, Zerelto, LovenoxBlood Pressures: Levophed, MidodrineDiuretics: Lasiks (oral)Lasiks (IV) 10mg to 20mg back to 10mg.Spironolactone (current)I really don't know what to do. They want us to tour LTAC facilities and we're scheduled to meet Palliative Care later on today..Chemo is an option but he might be too weak to do so..Idk if we should transfer hospitals to get second opinions or what.there isn't much I can do besides this. Being supportive and smiling.. Reaching out to people for help/opinions...This feeling of uselessness is overwhelming..EDITED (Additional information): Thank you for all the replies and upvotes... It means a ton. He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing a lot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment. He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk several times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility. They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathing on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay. He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's a lot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest. I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all. https://i.imgur.com/rea1isQ.png

Output: Sorry to hear.(HCC stands for hepatocellular carcinoma, a kind of liver cancer. It can metastasize to the lung, which can be a cause for confusion. Or perhaps he has a lung cancer and the acronym you were provided isnt quite right. Probably not of much consequence to the following discussion.)If there is talk of LTAC and he is on versed, I am guessing he is still requiring mechanical ventilation?One cannot be precise without seeing all the data but the typical prognosis with this general picture is very poor. If someone is ill enough to die while in the hospital while receiving optimal care, the odds of complete recovery after resuscitation are low (in the neighborhood of 10%). In those who go to LTAC on a chronic ventilator, only a minority ever come off the vent (~30%), and there is a high short-term mortality in these patients even when stage IV cancer isnt in the mix. Stage IV cancer of any kind, with very very rare exception (some testicular cancer, etc), is not curable.Meeting with palliative care seems like a very good next step. If they do not suggest it themselves, I would ask for a family meeting with the palliative care docs, ICU docs, oncology and radiation oncology docs all in the room together. This is often the best way to get a complete picture of the current medical issues.If he is not currently able to make decisions for himself, as I suspect from information provided he is not, the main question for you and your family is: what is the minimum quality of life he would accept? Some would say that unless current therapies have a good chance of returning them to independent living with intact cognition, they would not want to be maintained alive by machines or treatments. Some would say that if they can think but require complete assistance, that would be enough. Some would say even being maintained in a state in which they have no awareness of the outside world is acceptable.The main question for his doctors is: what are the chances his current treatments will get him to that minimum qualify of life, whatever it is for him? If the treatments and supports offered have little chance of returning him to a state he would find acceptable, then one could view his current therapies as prolonging a state of suffering.Sorry again for what your family is going through.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: (EDIT Below Original Post ) I kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many have responded, thank you again, It really means so much.I been staying with him for 99% of the time in the hospital. I went home for one day out of 35 days.He was having issues all of this year, mostly without not being able to eat. We went to ER early June and test results came back okay (or so we were told)He became really sick and malnourished so we took him to ER again in Sept and they performed a CAT Scan. They found a Mass.Biopsy of the Mass diagnosed it as Stage 4 Lung Cancer and now he's been in the hospital for over 5 weeks.He had a cardiac arrest which lead to him being put on life support but they carried on with doing radiation to treat the mass and shrink itHe has SVC Syndrome, Pleural effusion (chest tube) Gastrointestinal tube present (Possibly getting a G-J) , HCC Lung Cancer and AFIB ( Atrial Flutter)Medications: (TBE) He's been/are onFor Pain: Morphine , fentanyl , Versed,Blood Thinners: Heparin, Zerelto, LovenoxBlood Pressures: Levophed, MidodrineDiuretics: Lasiks (oral)Lasiks (IV) 10mg to 20mg back to 10mg.Spironolactone (current)I really don't know what to do. They want us to tour LTAC facilities and we're scheduled to meet Palliative Care later on today..Chemo is an option but he might be too weak to do so..Idk if we should transfer hospitals to get second opinions or what.there isn't much I can do besides this. Being supportive and smiling.. Reaching out to people for help/opinions...This feeling of uselessness is overwhelming..EDITED (Additional information): Thank you for all the replies and upvotes... It means a ton. He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing a lot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment. He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk several times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility. They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathing on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay. He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's a lot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest. I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all. https://i.imgur.com/rea1isQ.png. ### Response: Sorry to hear.(HCC stands for hepatocellular carcinoma, a kind of liver cancer. It can metastasize to the lung, which can be a cause for confusion. Or perhaps he has a lung cancer and the acronym you were provided isnt quite right. Probably not of much consequence to the following discussion.)If there is talk of LTAC and he is on versed, I am guessing he is still requiring mechanical ventilation?One cannot be precise without seeing all the data but the typical prognosis with this general picture is very poor. If someone is ill enough to die while in the hospital while receiving optimal care, the odds of complete recovery after resuscitation are low (in the neighborhood of 10%). In those who go to LTAC on a chronic ventilator, only a minority ever come off the vent (~30%), and there is a high short-term mortality in these patients even when stage IV cancer isnt in the mix. Stage IV cancer of any kind, with very very rare exception (some testicular cancer, etc), is not curable.Meeting with palliative care seems like a very good next step. If they do not suggest it themselves, I would ask for a family meeting with the palliative care docs, ICU docs, oncology and radiation oncology docs all in the room together. This is often the best way to get a complete picture of the current medical issues.If he is not currently able to make decisions for himself, as I suspect from information provided he is not, the main question for you and your family is: what is the minimum quality of life he would accept? Some would say that unless current therapies have a good chance of returning them to independent living with intact cognition, they would not want to be maintained alive by machines or treatments. Some would say that if they can think but require complete assistance, that would be enough. Some would say even being maintained in a state in which they have no awareness of the outside world is acceptable.The main question for his doctors is: what are the chances his current treatments will get him to that minimum qualify of life, whatever it is for him? If the treatments and supports offered have little chance of returning him to a state he would find acceptable, then one could view his current therapies as prolonging a state of suffering.Sorry again for what your family is going through..


Instruction: Very well said.I want add that if you look at the data for people who go to LTAC and are successfully liberated from the ventilator, and are alive and independent at 1 year... It's somewhere between 5-10 percent. It's a long road to get there, even without metastatic cancer.Something I'd like to add about the quality of life comment that I think is important to share with family members... Everyone has a quality of life minimum that they would accept. It's our jobs to tell the people we love what that minimum is while we are alive and healthy so that our love ones know what our wishes are. If (when) something happens to us, it's up to our love ones to state the decision we've previously made. There's always going to be emotions during this tough time, but guilt or regret should not be one of them.In Healthcare we commonly refer to the surrogate or next of kin as the "decision maker", but really the decision maker is always the patient. The surrogate is the party that speaks for the patient when they are unable to and brings the patients desires to light.

Output: HCC stands for hepatocellular carcinomaIn EPIC, a lot of diagnoses in the problem list are labeled with (HCC) after their name, like "Acute heart failure with reduced ejection fraction (HCC)". I have no idea what it means, but this is probably where OP got it from, and the pt probably doesn't have hepatocellular carcinoma.Edit: Just looked at OP's screenshot and you can see what I was talking about.Yes. Probably means the word salad pointed out by the other poster just before you. Never heard in a clinical context. Reason #649263 that epic sucks.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Very well said.I want add that if you look at the data for people who go to LTAC and are successfully liberated from the ventilator, and are alive and independent at 1 year... It's somewhere between 5-10 percent. It's a long road to get there, even without metastatic cancer.Something I'd like to add about the quality of life comment that I think is important to share with family members... Everyone has a quality of life minimum that they would accept. It's our jobs to tell the people we love what that minimum is while we are alive and healthy so that our love ones know what our wishes are. If (when) something happens to us, it's up to our love ones to state the decision we've previously made. There's always going to be emotions during this tough time, but guilt or regret should not be one of them.In Healthcare we commonly refer to the surrogate or next of kin as the "decision maker", but really the decision maker is always the patient. The surrogate is the party that speaks for the patient when they are unable to and brings the patients desires to light.. ### Response: HCC stands for hepatocellular carcinomaIn EPIC, a lot of diagnoses in the problem list are labeled with (HCC) after their name, like "Acute heart failure with reduced ejection fraction (HCC)". I have no idea what it means, but this is probably where OP got it from, and the pt probably doesn't have hepatocellular carcinoma.Edit: Just looked at OP's screenshot and you can see what I was talking about.Yes. Probably means the word salad pointed out by the other poster just before you. Never heard in a clinical context. Reason #649263 that epic sucks..


Instruction: HCCs are a method used in coding to show how "sick" a person is. It's used for Medicare reimbursement calculations for payers (insurance), incentive programs, etc. It's part of Risk Adjustment. Heirarchical condition code....or something like that. I can't even remember right now and I'm a certified Risk Adjustment coder.

Output: Is there any good reason that this stuff is exposed to actual healthcare workers?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: HCCs are a method used in coding to show how "sick" a person is. It's used for Medicare reimbursement calculations for payers (insurance), incentive programs, etc. It's part of Risk Adjustment. Heirarchical condition code....or something like that. I can't even remember right now and I'm a certified Risk Adjustment coder.. ### Response: Is there any good reason that this stuff is exposed to actual healthcare workers?.


Instruction: Another aspect to note is that patients who see palliative care earlier have a much better prognosis - longer survival times and higher quality of life scores.

Output: Pulmonologist here. I am also the medical director of a hospice for the last 15 years. First, I am very sorry for the difficulty that you, your father, and your family are having to deal with. As a physician, and particularly in doing pulmonary/critical care as well as hospice, I have tried to help people through these tough situations for most of my career. Each case is individual and each patient is an individual with their own beliefs and values and dreams.Over the years, I've spoken to many dying patients and their families about their illness, and what I've tried to do is to give them the perspective of a physician in order that they can then use their own values and beliefs within the framework of a physician's perspective...using what we know and applying their own perspective.As a physician, my perspective on your father is that he is dying. Please don't take that as callous...it is not meant that way. Most people think of dying as a moment...and it certainly can be...car wreck, heart attack, massive stroke... those thinks can take a life in the blink of an eye. However, for many, if not most, people...dying is a process. It can be several hours or several weeks...or longer It begins when you know that nothing else can be done for the patient and all you are trying to do is maintain, and despite your best efforts, the trend is that the patient continues to decline. All patient's have good days and they have bad days, but for a dying patient, when you average it out, the trend is that they continue to worsen.It's at this point that I think it's important to find out what kind of death your father really wants. That can sound very brutal to some people...but remember, we're physicians and we experience this life and death everyday, and we see patients who die peacefully and comfortably and we see patient's who die alone and in horrible circumstances. With those experiences in mind and with our practicality, we begin to think about what we would want for ourselves. Ask any physician or nurse friend of yours...chances are they've thought about it a lot...far more than other people. They tend to know exactly how far they're willing to go before they just want comfort.From your post, you've spoken to your Dad about his care:He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.When he says "chance," what does he mean? Chance of a cure?...chance to go back home?...chance to get a little better and be off the ventilator? In other words, you need to know what his goals are. If his goal is cure, there is no chance. If his goal is going home to the way his life had been...there probably is little chance of that either, though there may be a chance to go home...I don't have enough information. But first, find out which of his goals are potentially achievable with his doctors. Once you know what goals are potentially achievable for your father, you and his doctors can talk about what would have to happen to achieve those goals.Eventually...at some point however, because of the nature of our existence, none of those goals will be achievable, and at that point it is reasonable to give your father permission to let go and to seek comfort in the final moments, days, or weeks of his life. I say that because many patients continue to fight because they think that's what they're suppose to do or because they think they'll be letting down their family if they let go. They endure unnecessary suffering because no one has offered them a path of comfort and acceptance or because they made a vow to fight on and they don't want to renege on a promise they made to someone.We all eventually die. Some of us will never know what hit us because it comes too quickly. For those of us who are struck with a terminal illness like cancer, the only benefit is that we may have enough time to get our personal affairs in order and make peace while having some control over the dying process. As a physician, I know how I'd want to die, however, I don't try to push that on any of my patients. There are definitely patients who don't want to do much at all and just want to enjoy what life they have left. There are other patients who can't die in peace without trying everything including investigational treatments. I respect them all but as a physician I have to make sure that they are making those decisions knowing all the facts and the possibilities and risks.Start by talking to your father about his goals and discussing those goals with your father and his doctors. Give your father permission to do what he wants whether it's letting go or fighting to his last breath. And make sure that in the end, his comfort and wishes guide what decisions you may have to make in his stead. I hope this helped a bit. As best as I can on a reddit post, I'd like to give you, your father, and your family a big hug and my wishes that you all will be comforted in the days ahead.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Another aspect to note is that patients who see palliative care earlier have a much better prognosis - longer survival times and higher quality of life scores.. ### Response: Pulmonologist here. I am also the medical director of a hospice for the last 15 years. First, I am very sorry for the difficulty that you, your father, and your family are having to deal with. As a physician, and particularly in doing pulmonary/critical care as well as hospice, I have tried to help people through these tough situations for most of my career. Each case is individual and each patient is an individual with their own beliefs and values and dreams.Over the years, I've spoken to many dying patients and their families about their illness, and what I've tried to do is to give them the perspective of a physician in order that they can then use their own values and beliefs within the framework of a physician's perspective...using what we know and applying their own perspective.As a physician, my perspective on your father is that he is dying. Please don't take that as callous...it is not meant that way. Most people think of dying as a moment...and it certainly can be...car wreck, heart attack, massive stroke... those thinks can take a life in the blink of an eye. However, for many, if not most, people...dying is a process. It can be several hours or several weeks...or longer It begins when you know that nothing else can be done for the patient and all you are trying to do is maintain, and despite your best efforts, the trend is that the patient continues to decline. All patient's have good days and they have bad days, but for a dying patient, when you average it out, the trend is that they continue to worsen.It's at this point that I think it's important to find out what kind of death your father really wants. That can sound very brutal to some people...but remember, we're physicians and we experience this life and death everyday, and we see patients who die peacefully and comfortably and we see patient's who die alone and in horrible circumstances. With those experiences in mind and with our practicality, we begin to think about what we would want for ourselves. Ask any physician or nurse friend of yours...chances are they've thought about it a lot...far more than other people. They tend to know exactly how far they're willing to go before they just want comfort.From your post, you've spoken to your Dad about his care:He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.When he says "chance," what does he mean? Chance of a cure?...chance to go back home?...chance to get a little better and be off the ventilator? In other words, you need to know what his goals are. If his goal is cure, there is no chance. If his goal is going home to the way his life had been...there probably is little chance of that either, though there may be a chance to go home...I don't have enough information. But first, find out which of his goals are potentially achievable with his doctors. Once you know what goals are potentially achievable for your father, you and his doctors can talk about what would have to happen to achieve those goals.Eventually...at some point however, because of the nature of our existence, none of those goals will be achievable, and at that point it is reasonable to give your father permission to let go and to seek comfort in the final moments, days, or weeks of his life. I say that because many patients continue to fight because they think that's what they're suppose to do or because they think they'll be letting down their family if they let go. They endure unnecessary suffering because no one has offered them a path of comfort and acceptance or because they made a vow to fight on and they don't want to renege on a promise they made to someone.We all eventually die. Some of us will never know what hit us because it comes too quickly. For those of us who are struck with a terminal illness like cancer, the only benefit is that we may have enough time to get our personal affairs in order and make peace while having some control over the dying process. As a physician, I know how I'd want to die, however, I don't try to push that on any of my patients. There are definitely patients who don't want to do much at all and just want to enjoy what life they have left. There are other patients who can't die in peace without trying everything including investigational treatments. I respect them all but as a physician I have to make sure that they are making those decisions knowing all the facts and the possibilities and risks.Start by talking to your father about his goals and discussing those goals with your father and his doctors. Give your father permission to do what he wants whether it's letting go or fighting to his last breath. And make sure that in the end, his comfort and wishes guide what decisions you may have to make in his stead. I hope this helped a bit. As best as I can on a reddit post, I'd like to give you, your father, and your family a big hug and my wishes that you all will be comforted in the days ahead..


Instruction: Thank you for the supportive information. I really appreciate the time you took to type this out.He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing alot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment.He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathe on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay.He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's alot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest.I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all.https://i.imgur.com/rea1isQ.pngI kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many over responded, thank you again, It really means so much.

Output: I'm sorry you are going through this.Your father is going to die. I'm no oncologist, but this seems like he won't get into a situation where he can be treated with chemo or other targeted therapy (I assume they looked at that through his biopsy).A second option can help informing treatment decisions and with accepting this terrible news, but looking how to make sure your father is comfortable for the coming period seems like a good idea.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for the supportive information. I really appreciate the time you took to type this out.He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing alot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment.He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathe on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay.He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's alot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest.I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all.https://i.imgur.com/rea1isQ.pngI kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many over responded, thank you again, It really means so much.. ### Response: I'm sorry you are going through this.Your father is going to die. I'm no oncologist, but this seems like he won't get into a situation where he can be treated with chemo or other targeted therapy (I assume they looked at that through his biopsy).A second option can help informing treatment decisions and with accepting this terrible news, but looking how to make sure your father is comfortable for the coming period seems like a good idea..


Instruction: Hi all, I'm looking for some assistance for what my next steps are, as I'm just a grad student and not a medical professional.TLDR: 48/F with late stage liver failure and diabetes. Estimated 3-6 months to live. She suddenly is not lucid after stopping most treatment and starting an SSRI. I want to know if this sounds like encephalopathy, and if it does, can it be caused by these treatments?My mom (48/F/caucasian) is currently in the hospital for late stage liver failure. The current prognosis is that 10% is functioning, which is complicated by her diabetes. Last month she was in the hospital with 20% liver function, and had a second toe removed (the first was amputated in 2019).I brought her back in after my dad called complaining about how she can no longer stand, speak coherently, stop crying, and was in constant pain, which we were told was encephalopathy. Since she was removed from the ICU, a family member has been here for the entirety of visitation hours everyday to help her eat, get to the bathroom, etc, so we have witnessed this whole process. After a week or so of treatment with diuretics, she was lucid, starting walking, ate all of her food plus snacks, etc, though still in pain. She was able to verbalize that.Due to the IV teatments they were giving her, she accumulated 40 lbs of fluids in her legs and and abdomen, which they said couldn't drain due to her hemoglobin levels/blood pressure. It started weeping from her legs as a yellow liquid, and eventually she developed dozens of sores on her leg bandages and the legs swelled to 3x their regular size. She was in excruciating pain plus itching, which from what I've read to pretty standard. That all said, she was still able to verbalize this and was lucid.5 days ago, she was told by the hospitalist that there is nothing they can do, and instead of palliative care, she should now be in hospice care. She was incredibly upset by this, but was still lucid. At that time, the palliative care doctor prescribed her an SSRI (not sure which one, they would not tell me) and the hospitalist stopped all other treatment other than blood pressure medicine, insulin before meals, oxycodone upon request, and benedryl for itching upon request.The timeline since then is as follows:Friday, she started receiving the SSRI. She was still lucid, calling people, and complaining of pain.Saturday, she stopped eating, speaking, or drinking anything. She just lays in bed, and if you ask her a question she stares blankly at you. She will nod sometimes to questions. She ate very little, and only when urged to.Sunday, she was about the same. Barely ate and doesn't speak at all.Today, Monday 3/15: she is still the same, and hadn't had any sort of fluid since the previous family member left at 6p the day before and I arrived this morning. She has had no bowel movements in 24 hours. The palliative care representative prescribed ritalin to make her more alert, but it hasn't done anything. We are currently working on transferring her to a hospice care facility.She looks like someone on a heavy dose of oxycodone, but she hasn't had any in days. All she does is stare at us and occasionally eat a piece of candy when prompted. I asked the hospitalist what could cause this so suddenly, but he said there's nothing they can do, as it is not encephalopathy. He referred me to hospice and would give no other information.All of that long background is to say this: this doesn't look like how her encephalopathy manifested before (crying, pain, etc). Is it possible for it show up differently? The only new medication introduced last week was an SSRI, but since she only started it Friday, it seems weird that it would have an immediate effect like that, since I would think that it takes some time for it to get to the liver and metabolize (or not metabolize) and cause a rise in her toxin levels. I have also always been told that it takes weeks for SSRIs to be effective, but I don't know how that changes in cirrhosis patients. If this is not encephalopathy, but what is causing this sudden change?I want to make sure she is receiving proper care, as I'm not able to clean much from her doctors and she is not lucid. Thank you for any guidance on this situation!Here are the papers I read regarding this, in case that is important:2015, Issues in the endstage liver disease patient for which palliative care could be helpful2017, Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicityNote:I don't know her current numbers, as they messed up her labs this morning and apparently don't redo them when that happens.

Output: I imagine this is one of the toughest times you and your family have ever had to go through. Please don't neglect yourselves whilst looking after your mother and seek appropriate support, particularly psychological, as necessary.I am a psychiatrist, so I will try to answer your query regarding the SSRI. I'm afraid my internal medicine knowledge isn't up to date enough to help with much else here.All SSRIs are hepatically metabolised. They can therefore accumulate over long periods of time, so they must be used cautiously in liver impairment, and SSRIs with long half lives should be avoided. Of the SSRI family, citalopram / escitalopram have the least known effect on hepatic enzymes and are typically the SSRI of choice. Some specialists may prefer paroxetine, due to it having the shortest half life. Whichever is chosen, the general rule is to start low and go slow. I trust your mother's doctors have stuck with this rule. In which case, I suspect there has not been enough time for the new SSRI to accumulate to sufficient levels to be responsible for her acute deterioration, particularly if her deterioration began after just one or two doses.However, even if the SSRI isn't doing any harm, we need to ask ourselves, is it doing her any good? In the state that you have described her to be in, especially since the deterioration, I would struggle to justify continuing the SSRI. At this stage, I would argue the potential harm outweighs the potential benefits. And who knows, I might be wrong about the SSRI not being responsible; if it gets discontinued and your mother starts perking up, then all the better.Sorry to hear about this awful situation, do take care.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hi all, I'm looking for some assistance for what my next steps are, as I'm just a grad student and not a medical professional.TLDR: 48/F with late stage liver failure and diabetes. Estimated 3-6 months to live. She suddenly is not lucid after stopping most treatment and starting an SSRI. I want to know if this sounds like encephalopathy, and if it does, can it be caused by these treatments?My mom (48/F/caucasian) is currently in the hospital for late stage liver failure. The current prognosis is that 10% is functioning, which is complicated by her diabetes. Last month she was in the hospital with 20% liver function, and had a second toe removed (the first was amputated in 2019).I brought her back in after my dad called complaining about how she can no longer stand, speak coherently, stop crying, and was in constant pain, which we were told was encephalopathy. Since she was removed from the ICU, a family member has been here for the entirety of visitation hours everyday to help her eat, get to the bathroom, etc, so we have witnessed this whole process. After a week or so of treatment with diuretics, she was lucid, starting walking, ate all of her food plus snacks, etc, though still in pain. She was able to verbalize that.Due to the IV teatments they were giving her, she accumulated 40 lbs of fluids in her legs and and abdomen, which they said couldn't drain due to her hemoglobin levels/blood pressure. It started weeping from her legs as a yellow liquid, and eventually she developed dozens of sores on her leg bandages and the legs swelled to 3x their regular size. She was in excruciating pain plus itching, which from what I've read to pretty standard. That all said, she was still able to verbalize this and was lucid.5 days ago, she was told by the hospitalist that there is nothing they can do, and instead of palliative care, she should now be in hospice care. She was incredibly upset by this, but was still lucid. At that time, the palliative care doctor prescribed her an SSRI (not sure which one, they would not tell me) and the hospitalist stopped all other treatment other than blood pressure medicine, insulin before meals, oxycodone upon request, and benedryl for itching upon request.The timeline since then is as follows:Friday, she started receiving the SSRI. She was still lucid, calling people, and complaining of pain.Saturday, she stopped eating, speaking, or drinking anything. She just lays in bed, and if you ask her a question she stares blankly at you. She will nod sometimes to questions. She ate very little, and only when urged to.Sunday, she was about the same. Barely ate and doesn't speak at all.Today, Monday 3/15: she is still the same, and hadn't had any sort of fluid since the previous family member left at 6p the day before and I arrived this morning. She has had no bowel movements in 24 hours. The palliative care representative prescribed ritalin to make her more alert, but it hasn't done anything. We are currently working on transferring her to a hospice care facility.She looks like someone on a heavy dose of oxycodone, but she hasn't had any in days. All she does is stare at us and occasionally eat a piece of candy when prompted. I asked the hospitalist what could cause this so suddenly, but he said there's nothing they can do, as it is not encephalopathy. He referred me to hospice and would give no other information.All of that long background is to say this: this doesn't look like how her encephalopathy manifested before (crying, pain, etc). Is it possible for it show up differently? The only new medication introduced last week was an SSRI, but since she only started it Friday, it seems weird that it would have an immediate effect like that, since I would think that it takes some time for it to get to the liver and metabolize (or not metabolize) and cause a rise in her toxin levels. I have also always been told that it takes weeks for SSRIs to be effective, but I don't know how that changes in cirrhosis patients. If this is not encephalopathy, but what is causing this sudden change?I want to make sure she is receiving proper care, as I'm not able to clean much from her doctors and she is not lucid. Thank you for any guidance on this situation!Here are the papers I read regarding this, in case that is important:2015, Issues in the endstage liver disease patient for which palliative care could be helpful2017, Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicityNote:I don't know her current numbers, as they messed up her labs this morning and apparently don't redo them when that happens.. ### Response: I imagine this is one of the toughest times you and your family have ever had to go through. Please don't neglect yourselves whilst looking after your mother and seek appropriate support, particularly psychological, as necessary.I am a psychiatrist, so I will try to answer your query regarding the SSRI. I'm afraid my internal medicine knowledge isn't up to date enough to help with much else here.All SSRIs are hepatically metabolised. They can therefore accumulate over long periods of time, so they must be used cautiously in liver impairment, and SSRIs with long half lives should be avoided. Of the SSRI family, citalopram / escitalopram have the least known effect on hepatic enzymes and are typically the SSRI of choice. Some specialists may prefer paroxetine, due to it having the shortest half life. Whichever is chosen, the general rule is to start low and go slow. I trust your mother's doctors have stuck with this rule. In which case, I suspect there has not been enough time for the new SSRI to accumulate to sufficient levels to be responsible for her acute deterioration, particularly if her deterioration began after just one or two doses.However, even if the SSRI isn't doing any harm, we need to ask ourselves, is it doing her any good? In the state that you have described her to be in, especially since the deterioration, I would struggle to justify continuing the SSRI. At this stage, I would argue the potential harm outweighs the potential benefits. And who knows, I might be wrong about the SSRI not being responsible; if it gets discontinued and your mother starts perking up, then all the better.Sorry to hear about this awful situation, do take care..


Instruction: You seem to have knowledge about how SSRIs work, wondering if you'd take a look at my post, possibly had SSRI-related damage happen to me. https://www.reddit.com/r/antidepressants/comments/raqwkk/my_life_has_been_upended_and_i_dont_know_what_to/

Output: I'm sorry to hear you and your family are going through this. I agree with her physicians that unfortunately it does sound as though your mother is approaching the end of her life and palliative/hospice type care is appropriate.Given your description, I suspect that her current condition is likely caused by hepatic encephalopathy, where toxins like ammonia build up in the body as they are unable to be processed by the failing liver. The treatment for this is usually medications that promote frequent bowel movements, like lactulose or other laxatives, as the bowel is the only other route by which these toxins can be removed.Hospice care should be focused on your mother's values and what's important to her. If you feel that it would be important to your mother to be more awake and with it during this time, it would be reasonable to ask her physicians whether medications to treat encephalopathy could be restarted. However, the counter argument is that by being more awake, your mother may also be less comfortable, the avoidance of which is another goal of end of life care. It could be that this is why her physicians have felt that holding these medications to promote her being less aware is best for her at this time. This is a conversation you should have with her palliative care doctors and together figure out what is the best way to care for her. Again, I'm very sorry and hope this helps.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: You seem to have knowledge about how SSRIs work, wondering if you'd take a look at my post, possibly had SSRI-related damage happen to me. https://www.reddit.com/r/antidepressants/comments/raqwkk/my_life_has_been_upended_and_i_dont_know_what_to/. ### Response: I'm sorry to hear you and your family are going through this. I agree with her physicians that unfortunately it does sound as though your mother is approaching the end of her life and palliative/hospice type care is appropriate.Given your description, I suspect that her current condition is likely caused by hepatic encephalopathy, where toxins like ammonia build up in the body as they are unable to be processed by the failing liver. The treatment for this is usually medications that promote frequent bowel movements, like lactulose or other laxatives, as the bowel is the only other route by which these toxins can be removed.Hospice care should be focused on your mother's values and what's important to her. If you feel that it would be important to your mother to be more awake and with it during this time, it would be reasonable to ask her physicians whether medications to treat encephalopathy could be restarted. However, the counter argument is that by being more awake, your mother may also be less comfortable, the avoidance of which is another goal of end of life care. It could be that this is why her physicians have felt that holding these medications to promote her being less aware is best for her at this time. This is a conversation you should have with her palliative care doctors and together figure out what is the best way to care for her. Again, I'm very sorry and hope this helps..


Instruction: 9 weeks ago i got pain on my right side under my rib cage. shortly after that nausea, bloating, and indigestion started. then my bowl movements were unpredictable and of all different types (loose... dark... normal... soft... constipation...) then dry heaving started.i have had a hell of a time getting treatment because im not critical enough during this covid19 crap. through multiple urgent care visits i finally got one to take urine and blood samples. they also got me an ultrasound and a telemed appt with a gastroenterologist.the urine was normal, but i was slightly dehydrated. not surprising given i was so nauseous drinking water was difficult. blood test was also normal except for a slightly low RBC count/low iron. the ultrasound showed no evidence of gallbladder problem, but did reveal some potential (likely benign) tumors in my liver. those apparently are completely incidental, and not urgent to diagnose immediately, but i do need to get a CT scan on them once covid restrictions lighten up.this past weekend vomiting returned for a few hours. i also developed a mild fever, and then chills with low body temp. i was also salivating uncontrollably. i had to chew gum to get the salvation to stop. it was weird af.i can only eat small portions of easy to digest food. like grapes and cream of wheat. complex foods or larger portions usually throw me into severe nausea/belching/etc. I've lost around 6lbs this far.i'm waiting for a h. pylori stool sample test to come back in the next 48hrs. at this point im praying its positive so i can get an answer and some relief.is this normal? 9 weeks feels really long. every time i think im improving it hits me and gets bad again. do i sound like im describing an ulcer? and if so does it seem like the bacterial type? can it really take this long to heal? i called the gastroenterologist and im trying to get a follow up appt soon. i realize this is the internet and is not a substitute for true medical care. im just having lots of anxiety and would love some opinions. 9 weeks of constant nausea starts to fuck with your head.note - I've been on anti nausea and proton pump inhibitors for 4 weeks. i take no other meds including nsaids. there's also no history of cancer/ulcers im my family. im also a middle aged male (early 40s). i have no major health issues, injuries, or surgeries. im an avid fitness freak. seasonal allergies, mild rosacea, and depression are my only real health problems to date.any thoughts appreciated. im in hell. getting help during covid is slow. im miserable and have a hard time living daily life.

Output: Most people with changes in their stools between constipation and diarrhea have irritable bowel syndrome. There are related conditions like sphincter of Oddi dysfunction or biliary dyskinesia that also cause RUQ pain and can sometimes affect stool consistency.H. pylori would be unusual with your symptoms, but it can present in many different ways. It doesn't typically cause diarrhea or other stool changes (unless it bleeds, but that's usually pretty obvious). Furthermore, if you get a stool test for H. pylori, and it's positive, that doesn't mean it causes your symptoms. Many people are asymptomatic. It really takes an endoscopy that shows significant gastritis or an ulcer to make a clear association between your symptoms and the effect of the bacteria.Your liver findings are probably not related. We see incidental liver lesions on ultrasounds all the time. But sounds like your doctors aren't too worried. I agree a CT down the road is a good idea. These are usually benign things, like hemangiomas, but worth getting a more clear diagnosis for these just in case.Other things to consider with nausea / belching with higher calorie foods is gastroparesis, which is where your stomach doesn't empty properly.I know it will be hard to get much workup now, but that's really the only way to narrow this stuff down. The tests we typically do are things like endoscopy (probably of most importance in your case), gall bladder scans, and gastric emptying scans.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 9 weeks ago i got pain on my right side under my rib cage. shortly after that nausea, bloating, and indigestion started. then my bowl movements were unpredictable and of all different types (loose... dark... normal... soft... constipation...) then dry heaving started.i have had a hell of a time getting treatment because im not critical enough during this covid19 crap. through multiple urgent care visits i finally got one to take urine and blood samples. they also got me an ultrasound and a telemed appt with a gastroenterologist.the urine was normal, but i was slightly dehydrated. not surprising given i was so nauseous drinking water was difficult. blood test was also normal except for a slightly low RBC count/low iron. the ultrasound showed no evidence of gallbladder problem, but did reveal some potential (likely benign) tumors in my liver. those apparently are completely incidental, and not urgent to diagnose immediately, but i do need to get a CT scan on them once covid restrictions lighten up.this past weekend vomiting returned for a few hours. i also developed a mild fever, and then chills with low body temp. i was also salivating uncontrollably. i had to chew gum to get the salvation to stop. it was weird af.i can only eat small portions of easy to digest food. like grapes and cream of wheat. complex foods or larger portions usually throw me into severe nausea/belching/etc. I've lost around 6lbs this far.i'm waiting for a h. pylori stool sample test to come back in the next 48hrs. at this point im praying its positive so i can get an answer and some relief.is this normal? 9 weeks feels really long. every time i think im improving it hits me and gets bad again. do i sound like im describing an ulcer? and if so does it seem like the bacterial type? can it really take this long to heal? i called the gastroenterologist and im trying to get a follow up appt soon. i realize this is the internet and is not a substitute for true medical care. im just having lots of anxiety and would love some opinions. 9 weeks of constant nausea starts to fuck with your head.note - I've been on anti nausea and proton pump inhibitors for 4 weeks. i take no other meds including nsaids. there's also no history of cancer/ulcers im my family. im also a middle aged male (early 40s). i have no major health issues, injuries, or surgeries. im an avid fitness freak. seasonal allergies, mild rosacea, and depression are my only real health problems to date.any thoughts appreciated. im in hell. getting help during covid is slow. im miserable and have a hard time living daily life.. ### Response: Most people with changes in their stools between constipation and diarrhea have irritable bowel syndrome. There are related conditions like sphincter of Oddi dysfunction or biliary dyskinesia that also cause RUQ pain and can sometimes affect stool consistency.H. pylori would be unusual with your symptoms, but it can present in many different ways. It doesn't typically cause diarrhea or other stool changes (unless it bleeds, but that's usually pretty obvious). Furthermore, if you get a stool test for H. pylori, and it's positive, that doesn't mean it causes your symptoms. Many people are asymptomatic. It really takes an endoscopy that shows significant gastritis or an ulcer to make a clear association between your symptoms and the effect of the bacteria.Your liver findings are probably not related. We see incidental liver lesions on ultrasounds all the time. But sounds like your doctors aren't too worried. I agree a CT down the road is a good idea. These are usually benign things, like hemangiomas, but worth getting a more clear diagnosis for these just in case.Other things to consider with nausea / belching with higher calorie foods is gastroparesis, which is where your stomach doesn't empty properly.I know it will be hard to get much workup now, but that's really the only way to narrow this stuff down. The tests we typically do are things like endoscopy (probably of most importance in your case), gall bladder scans, and gastric emptying scans..


Instruction: thanks for this reply. i should have been clearer. i have had "looser stool" than normal at times. but not diarrhea. i don't believe I've had diarrhea even once so far. not sure if that natters or not. my most recent one (sry this is so gross) was small and seemed to be covered in a whitish substance. maybe mucus from excess production in stomach?also thx for the heads up that a positive pylori test doesn't mean that's the cause. frustrating, but good to know nonetheless.

Output: Loose stools would lean towards IBS as well. But its a pretty nonspecific symptom and doesnt narrow things down a ton. :-(

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: thanks for this reply. i should have been clearer. i have had "looser stool" than normal at times. but not diarrhea. i don't believe I've had diarrhea even once so far. not sure if that natters or not. my most recent one (sry this is so gross) was small and seemed to be covered in a whitish substance. maybe mucus from excess production in stomach?also thx for the heads up that a positive pylori test doesn't mean that's the cause. frustrating, but good to know nonetheless.. ### Response: Loose stools would lean towards IBS as well. But its a pretty nonspecific symptom and doesnt narrow things down a ton. :-(.


Instruction: There are some parasites that can cause liver cysts and start giving you all sorts if weird symptoms. Did you travel anywhere before symptoms began where you walked barefoot on soil/sand or drank water from a source you dont usually drink from?

Output: People sure do love parasites around here. Unlikely the explanation for OP.From your comment below:Entamoeba - This causes colitis, which is bloody diarrhea, not alternating stools and RUQ pain like OP describes.Liver flukes - Almost always asymptomatic. But, easy to check for with a stool O&P like you suggest.Cystic echinococcus - OP had a liver ultrasound. CE would show a bunch of cysts, and should be apparent to the radiologist.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: There are some parasites that can cause liver cysts and start giving you all sorts if weird symptoms. Did you travel anywhere before symptoms began where you walked barefoot on soil/sand or drank water from a source you dont usually drink from?. ### Response: People sure do love parasites around here. Unlikely the explanation for OP.From your comment below:Entamoeba - This causes colitis, which is bloody diarrhea, not alternating stools and RUQ pain like OP describes.Liver flukes - Almost always asymptomatic. But, easy to check for with a stool O&P like you suggest.Cystic echinococcus - OP had a liver ultrasound. CE would show a bunch of cysts, and should be apparent to the radiologist..


Instruction: From what I've learned from House MD, it's definitely either sarcoidosis or lupus.Also, you get an upvote for your username.

Output: TuberculosarcoidolupusCANCER.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: From what I've learned from House MD, it's definitely either sarcoidosis or lupus.Also, you get an upvote for your username.. ### Response: TuberculosarcoidolupusCANCER..


Instruction: I was reading this tweet thread from Dr. Monica Gandhi about molnupiravirhttps://twitter.com/MonicaGandhi9/status/1415093950000422912Molnupiravir was not developed for SARS-CoV-2- originally thought of as a broad-spectrum antiviral because it is a "nucleoside analogs". We use those a lot in HIV but they basically inhibit the virus from replicating because this compound interrupts the process of copyingwhich led me to this article in Business Insiderhttps://www.bloomberg.com/news/features/2021-03-25/merck-mrk-molnupiravir-pill-could-change-the-fight-against-covidThe first antiviral approved in the U.S. was idoxuridine, a herpes treatment regulators green-lit in 1963, generations after the discovery of antibiotics. Its among a widely used class of drugs called nucleoside analoguessynthetic versions of nucleosides, critical building blocks of DNA and its counterpart, RNA, the messenger molecule that delivers instructions to a cells protein-making factories. Nucleoside analogues prevent viruses from replicating, or from replicating effectively, inside cells.When they do invest, they have much more incentive to focus on chronic diseases than acute ones, which entail inherently shorter treatmentand revenuewindows. If you look at what drugs have been developed against viruses, you have HIV, you have hep C, you have herpes. Those are all chronic infections. That means longer-term therapy,And so here I am, my High School Biology in mind, wondering how if day to day my cells are dividing and so need to replicate DNA, how providing a drug that inhibits replication is safe, especially for chronic diseases where the drug is taken on a daily basis for well, the long term.For the care and feeding of the automod:I am a 60 year old male, non-smoking, and this question has recurred off and on for a few years now, mostly in by frontal lobe I believe, though friends insist that that is located in my rectum

Output: Antivirals like acyclovir and similar nucleoside analogues act only on the cellular machinery within viruses, but not the cellular machinery in human cells. You are right that both viruses and human cells replicate DNA, but they do it in a different way. Some antivirals work on viral DNA polymerase, some work on viral reverse transcriptase, and some probably do something else that I don't know about.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I was reading this tweet thread from Dr. Monica Gandhi about molnupiravirhttps://twitter.com/MonicaGandhi9/status/1415093950000422912Molnupiravir was not developed for SARS-CoV-2- originally thought of as a broad-spectrum antiviral because it is a "nucleoside analogs". We use those a lot in HIV but they basically inhibit the virus from replicating because this compound interrupts the process of copyingwhich led me to this article in Business Insiderhttps://www.bloomberg.com/news/features/2021-03-25/merck-mrk-molnupiravir-pill-could-change-the-fight-against-covidThe first antiviral approved in the U.S. was idoxuridine, a herpes treatment regulators green-lit in 1963, generations after the discovery of antibiotics. Its among a widely used class of drugs called nucleoside analoguessynthetic versions of nucleosides, critical building blocks of DNA and its counterpart, RNA, the messenger molecule that delivers instructions to a cells protein-making factories. Nucleoside analogues prevent viruses from replicating, or from replicating effectively, inside cells.When they do invest, they have much more incentive to focus on chronic diseases than acute ones, which entail inherently shorter treatmentand revenuewindows. If you look at what drugs have been developed against viruses, you have HIV, you have hep C, you have herpes. Those are all chronic infections. That means longer-term therapy,And so here I am, my High School Biology in mind, wondering how if day to day my cells are dividing and so need to replicate DNA, how providing a drug that inhibits replication is safe, especially for chronic diseases where the drug is taken on a daily basis for well, the long term.For the care and feeding of the automod:I am a 60 year old male, non-smoking, and this question has recurred off and on for a few years now, mostly in by frontal lobe I believe, though friends insist that that is located in my rectum. ### Response: Antivirals like acyclovir and similar nucleoside analogues act only on the cellular machinery within viruses, but not the cellular machinery in human cells. You are right that both viruses and human cells replicate DNA, but they do it in a different way. Some antivirals work on viral DNA polymerase, some work on viral reverse transcriptase, and some probably do something else that I don't know about..


Instruction: I 34(F) have been seeing a dermatologist over the course of several years, unfortunately Im in a healthcare system that is hit and miss with varying levels of doctors. Its also a healthcare system with a different first language to mine.I have been diagnosed with rosacea and seborrheic dermatitis. My skin goes from angry inflamed redness to dry and flakey.Initially I was advised to use steroids on the redness inflamed areas and to moisturise 2-3 times a day. To be honest, this doesnt work. Im using steroids weekly. I saw a good dermatologist who prescribed elidel cream which is ok, though it has not really worked well enough to prevent flare ups.Since then I was prescribed skinoren (which burns), told to wear sunscreen with multiple application daily and to start tacrolimus ointment. Avoid stress (Im a mum of 2 very small children and a critical care practitioner, so easier said than done).One dermatologist told me to stop steroids on my face as I had ?lines as a result of long term use. So should I completely stop?I cannot start tetralysal as Im breastfeeding.Are my options limited without oral medication? Will the results be worth me weaning?Im feeling pretty miserable as a woman when I can no longer wear make up without significant flare up and people asking what happened to your face?Advice is conflicting, often superficial and although I understand its chronic, will I ever have good enough skin to feel my normal self again? I only developed this in the past 6-8 years.Obligatory: BMI 20, non smoker, enjoy a glass of wine regularly. No other medical conditions or medication.

Output: Topical corticosteroids are inappropriate for long-term use. Pimecrolimus is much safer for long-term use and tacrolimus is more potent than pimecrolimus. Many who use azelaic acid use too much quantity and get irritation. Much smaller quantities are appropriate. Adding additional agents such as topical ivermectin and metronidazole may additionally help for rosacea, as could imidazole antifungal agents and similar for seborrheic dermatitis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I 34(F) have been seeing a dermatologist over the course of several years, unfortunately Im in a healthcare system that is hit and miss with varying levels of doctors. Its also a healthcare system with a different first language to mine.I have been diagnosed with rosacea and seborrheic dermatitis. My skin goes from angry inflamed redness to dry and flakey.Initially I was advised to use steroids on the redness inflamed areas and to moisturise 2-3 times a day. To be honest, this doesnt work. Im using steroids weekly. I saw a good dermatologist who prescribed elidel cream which is ok, though it has not really worked well enough to prevent flare ups.Since then I was prescribed skinoren (which burns), told to wear sunscreen with multiple application daily and to start tacrolimus ointment. Avoid stress (Im a mum of 2 very small children and a critical care practitioner, so easier said than done).One dermatologist told me to stop steroids on my face as I had ?lines as a result of long term use. So should I completely stop?I cannot start tetralysal as Im breastfeeding.Are my options limited without oral medication? Will the results be worth me weaning?Im feeling pretty miserable as a woman when I can no longer wear make up without significant flare up and people asking what happened to your face?Advice is conflicting, often superficial and although I understand its chronic, will I ever have good enough skin to feel my normal self again? I only developed this in the past 6-8 years.Obligatory: BMI 20, non smoker, enjoy a glass of wine regularly. No other medical conditions or medication.. ### Response: Topical corticosteroids are inappropriate for long-term use. Pimecrolimus is much safer for long-term use and tacrolimus is more potent than pimecrolimus. Many who use azelaic acid use too much quantity and get irritation. Much smaller quantities are appropriate. Adding additional agents such as topical ivermectin and metronidazole may additionally help for rosacea, as could imidazole antifungal agents and similar for seborrheic dermatitis..


Instruction: 33F, recently diagnosed with PCOS / insulin resistance, high TST, low cortisol.Im at a pretty critical point in getting my hormones fixed and after my appointment today I was notified that if I want to continue seeing the doctor that I see, there is a $100 fee per month to continue under her care. I see her three times a year but they want $1200 to ensure a spot to see her. They were very clear this was not insurance related and would be my responsibility...seems shady?? Hoping some medical professionals can explain it to me if its legitimate since, as it stands, it sounds very questionable. I want to understand.

Output: A physician can charge out of pocket whatever they want, not shady. Billing insurance is totally separate. This is a concierge model of healthcare that typically gives a patient more reliable access to their doctor (and is typically more expensive than other doctors). I suggest you find a different doctor that fits you situation better.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 33F, recently diagnosed with PCOS / insulin resistance, high TST, low cortisol.Im at a pretty critical point in getting my hormones fixed and after my appointment today I was notified that if I want to continue seeing the doctor that I see, there is a $100 fee per month to continue under her care. I see her three times a year but they want $1200 to ensure a spot to see her. They were very clear this was not insurance related and would be my responsibility...seems shady?? Hoping some medical professionals can explain it to me if its legitimate since, as it stands, it sounds very questionable. I want to understand.. ### Response: A physician can charge out of pocket whatever they want, not shady. Billing insurance is totally separate. This is a concierge model of healthcare that typically gives a patient more reliable access to their doctor (and is typically more expensive than other doctors). I suggest you find a different doctor that fits you situation better..


Instruction: 26F 56 120 lb No medications Non smoker No known medical issues Migraine symptoms approximately 1x/week for the last 4 weeksSo I did an MRA on Friday afternoon and the technicians gave me the results in a CD without any explanation. I didnt have a chance to speak with my neurologist. My boyfriend, who is a senior neuroscience biomedical engineering PhD student and has seen many brain scans before, immediately pointed out a strange deformity in my MRA. On the saggital view in the top middle of the brain close to the motor area there is a bump. His first thought was subdural meningioma. It was dark in the MRA image so he thinks it may not be a tumor because it isnt highly vascularized. Could it be a chat? Could it be a meningjoma covered by a subdural hematoma?Background - about 4 weeks ago I started having migraine symptoms basically for the first time. Nausea, dizziness, feeling out of breath while exercising even though I am a relatively fit person...and I had 3 episodes of mild throbbing pain on the side of my head. So I went to see a neurologist who recommended a MRA/MRI.He tried to book it before Id be set to go out of the country on holiday for 3 weeks - all the way from US to a beach in Thailand with possibly limited access to medical care. We only booked the MRA because the most urgent goal was to make sure it was not an aneurysm.I had yet another episode today - lots of nausea and feeling sort of dizzy and hard to balance at times. And I have my flight tomorrow early morning ... 30+ hours!The main question here is - how likely would it be for my situation to be dangerous enough that I should not get on a 30+ hour multi-flight trip? Any counter-indications towards flying that I may want to be aware of given my symptoms and this MRA result? The problem is that I cant speak to my neurologist until Monday morning - by then Id already be in Thailand (or sick / critically unwell due to the flight?).Any help would be greatly appreciated!! Im ok with flying as long as I can be reasonably sure that I am not putting myself at risk by doing so.

Output: Unfortunately, Without the images or report, it would be impossible for anyone to give advice here. Can you call your doctor or the doctor on call before you leave?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 26F 56 120 lb No medications Non smoker No known medical issues Migraine symptoms approximately 1x/week for the last 4 weeksSo I did an MRA on Friday afternoon and the technicians gave me the results in a CD without any explanation. I didnt have a chance to speak with my neurologist. My boyfriend, who is a senior neuroscience biomedical engineering PhD student and has seen many brain scans before, immediately pointed out a strange deformity in my MRA. On the saggital view in the top middle of the brain close to the motor area there is a bump. His first thought was subdural meningioma. It was dark in the MRA image so he thinks it may not be a tumor because it isnt highly vascularized. Could it be a chat? Could it be a meningjoma covered by a subdural hematoma?Background - about 4 weeks ago I started having migraine symptoms basically for the first time. Nausea, dizziness, feeling out of breath while exercising even though I am a relatively fit person...and I had 3 episodes of mild throbbing pain on the side of my head. So I went to see a neurologist who recommended a MRA/MRI.He tried to book it before Id be set to go out of the country on holiday for 3 weeks - all the way from US to a beach in Thailand with possibly limited access to medical care. We only booked the MRA because the most urgent goal was to make sure it was not an aneurysm.I had yet another episode today - lots of nausea and feeling sort of dizzy and hard to balance at times. And I have my flight tomorrow early morning ... 30+ hours!The main question here is - how likely would it be for my situation to be dangerous enough that I should not get on a 30+ hour multi-flight trip? Any counter-indications towards flying that I may want to be aware of given my symptoms and this MRA result? The problem is that I cant speak to my neurologist until Monday morning - by then Id already be in Thailand (or sick / critically unwell due to the flight?).Any help would be greatly appreciated!! Im ok with flying as long as I can be reasonably sure that I am not putting myself at risk by doing so.. ### Response: Unfortunately, Without the images or report, it would be impossible for anyone to give advice here. Can you call your doctor or the doctor on call before you leave?.


Instruction: Definitely call the Dr on call now.

Output: Your symptoms would not match anything you described may or may not be on your MRA images. That being said besides vascular anomalies nothing else can be commented on in an MRA. So seeing dark or light things outside of the vessels does not mean anything, that's what the MRI is for.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Definitely call the Dr on call now.. ### Response: Your symptoms would not match anything you described may or may not be on your MRA images. That being said besides vascular anomalies nothing else can be commented on in an MRA. So seeing dark or light things outside of the vessels does not mean anything, that's what the MRI is for..


Instruction: My mom was diagnosed with Diverticulitis/Ischemic colitis on Saturday. I picked up an Rx for her and it said take every 6 hours.Yesterday, I called urgent care to see if taking it every 8 hours was a possibility, as my mother has moderate dementia and it's difficult to get her up in the middle of the night. They said no...has to be 6 hours, but I don't have to wake her up in the middle of the night.This makes no sense to me; if it's not allowed to switch to 8 hours, then it means it's critical to take it every 6...which means I have to wake her.I already have sleep issues, and waking her at 3am every night is going to be a whole ordeal and struggle. Sure, I'd love for her to sleep through the night, but I don't see how they can say I don't have to wake her. It doesn't make sense.I just want to do the right thing. Can someone give me guidance? Thanks!!Edit: I actually called the pharmacy first, before reaching out to the urgent care: they said they could not provide guidance.

Output: It is rarely necessary to dose flagyl more than every 8-12 hours, this is sufficient for the large majority of indications as it maintains adequate blood levels. I don't typically give it more frequently than this and work in an ICU with very sick patients. Every 8 hours is a reasonable compromise. There is another medicine called augmentin that is used for diverticulitis and is twice a day.The general push recently has been to not use antibiotics for diverticulitis, though with your mother's age it is still appropriate to prescribe these. But in any event wouldn't get overly concerned about the flagyl dosing interval provided she is getting it more often than every 8 to 12 hours.Remember I do not know your mother's specific situation, so this is not meant to supplant the information from your providers, just that without any other details a less frequent dose of flagyl is adequate.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My mom was diagnosed with Diverticulitis/Ischemic colitis on Saturday. I picked up an Rx for her and it said take every 6 hours.Yesterday, I called urgent care to see if taking it every 8 hours was a possibility, as my mother has moderate dementia and it's difficult to get her up in the middle of the night. They said no...has to be 6 hours, but I don't have to wake her up in the middle of the night.This makes no sense to me; if it's not allowed to switch to 8 hours, then it means it's critical to take it every 6...which means I have to wake her.I already have sleep issues, and waking her at 3am every night is going to be a whole ordeal and struggle. Sure, I'd love for her to sleep through the night, but I don't see how they can say I don't have to wake her. It doesn't make sense.I just want to do the right thing. Can someone give me guidance? Thanks!!Edit: I actually called the pharmacy first, before reaching out to the urgent care: they said they could not provide guidance.. ### Response: It is rarely necessary to dose flagyl more than every 8-12 hours, this is sufficient for the large majority of indications as it maintains adequate blood levels. I don't typically give it more frequently than this and work in an ICU with very sick patients. Every 8 hours is a reasonable compromise. There is another medicine called augmentin that is used for diverticulitis and is twice a day.The general push recently has been to not use antibiotics for diverticulitis, though with your mother's age it is still appropriate to prescribe these. But in any event wouldn't get overly concerned about the flagyl dosing interval provided she is getting it more often than every 8 to 12 hours.Remember I do not know your mother's specific situation, so this is not meant to supplant the information from your providers, just that without any other details a less frequent dose of flagyl is adequate..


Instruction: Thanks so much for this. I called her doctor and we'll see them on Friday. Thanks to your prompting, I asked if they would like to make any changes. They haven't yet...maybe because she already started...? Thanks again!!!This was an urgent care so she probably was not seen by an actual physician.

Output: I think interrupting the night sleep of an elderly infected woman seems a bit of an odd choice even in the hospital.Give her one dose right when she wakes up, and one dose right when goes to sleep. Then space the others as evenly during the day as possible. (So for example, she goes to sleep at around 21:00 and awakes at 7:00 her doses should be at: 7:00-11:30-16:30-21:00).On the other hand, the active metabolite of metronidazole (flagyl) has a half-life of 9-19 hours. So taking it more than thrice daily is also odd.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks so much for this. I called her doctor and we'll see them on Friday. Thanks to your prompting, I asked if they would like to make any changes. They haven't yet...maybe because she already started...? Thanks again!!!This was an urgent care so she probably was not seen by an actual physician.. ### Response: I think interrupting the night sleep of an elderly infected woman seems a bit of an odd choice even in the hospital.Give her one dose right when she wakes up, and one dose right when goes to sleep. Then space the others as evenly during the day as possible. (So for example, she goes to sleep at around 21:00 and awakes at 7:00 her doses should be at: 7:00-11:30-16:30-21:00).On the other hand, the active metabolite of metronidazole (flagyl) has a half-life of 9-19 hours. So taking it more than thrice daily is also odd..


Instruction: Thank you much. It's 250mg. I called her GI doc to update them and to see if they want to do any changes, and they scheduled to see her on Friday She was seen in an urgent care so probably these were not prescribed by a physician

Output: Fair enough, in my country every antibiotic has to be run through an MD (we don't really have DOs), so I assumed the same.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you much. It's 250mg. I called her GI doc to update them and to see if they want to do any changes, and they scheduled to see her on Friday She was seen in an urgent care so probably these were not prescribed by a physician. ### Response: Fair enough, in my country every antibiotic has to be run through an MD (we don't really have DOs), so I assumed the same..


Instruction: [16M] So 2 days ago i felt pain on my right eyelid, the pain is like bruise, I don't really care about it. The next day the pain wasn't gone, so I checked "Inside" of my eyelid and it's more red than the left side, now i am worried about this. My current hospital only accepts critical/emergency cases so I can't go there for now. What should I do about it? Is it bleeding inside?Edit : Nearby pharmacist says it's an infection/allergy and gave me eyedrop "DexOph", could this help me?

Output: Ophthalmologist here. The picture isnt great, but it looks pretty normal to me. I wouldnt just use Dexoph without seeing an ophthalmologist. Dexoph is dexamethasone which is a steroid. Unregulated use of steroid eye drops can lead to both premature cataracts and glaucoma.You should go see an ophthalmologist.Edit: can you upload a higher pixel picture of the affected eye along with a picture of the normal eye for comparison?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: [16M] So 2 days ago i felt pain on my right eyelid, the pain is like bruise, I don't really care about it. The next day the pain wasn't gone, so I checked "Inside" of my eyelid and it's more red than the left side, now i am worried about this. My current hospital only accepts critical/emergency cases so I can't go there for now. What should I do about it? Is it bleeding inside?Edit : Nearby pharmacist says it's an infection/allergy and gave me eyedrop "DexOph", could this help me?. ### Response: Ophthalmologist here. The picture isnt great, but it looks pretty normal to me. I wouldnt just use Dexoph without seeing an ophthalmologist. Dexoph is dexamethasone which is a steroid. Unregulated use of steroid eye drops can lead to both premature cataracts and glaucoma.You should go see an ophthalmologist.Edit: can you upload a higher pixel picture of the affected eye along with a picture of the normal eye for comparison?.