Instruction: Leukocytes but no BacteriaAge: 34Sex : FemaleHeight: 511Weight: 170lbsDuration of complaint: 3 weeksLocation: USAny existing relevant medical issues: NoCurrent medications: None currently, just finished a round of macrobid.Hey guys, I posted something similar to this in a micro group but things have changed since then so Im just looking for further advice.Almost 3 weeks ago, during a routine exam i showed moderate leukocytes in urine with trace blood. Id had no regular uti symptoms at all other than some pressure after peeing like once. No burning, urgency etc. According to my blood work I was also dehydrated. My NP, who is also my boss & friend, gave me a prescription for Macrobid and sent off a culture. I took the antibiotics for 3 days then I got the call that my culture was negative and to stop the antibiotics. So I did. From there it was back and forth because although I was still asymptomatic I still had leukocytes in my urine. So another culture was sent off - same results 25 - 50k cfu mixed urogenital flora okay cool. So what do I do? NP tells me to just finish the antibiotics so I did. I did get a micro UA done as well and it showed 5-10 wbc with few bacteria, mucus and epithelial cells but none of my urine samples were clean catch.On Saturday after finishing my antibiotics completely I took one of those AZO uti strips after a shower and it had a small purple speck in the middle of the leukocyte pad after 2 minutes. I text my NP to let her know and she sent me in yet another prescription for antibiotics.My concern is that Im not one to take a lot of antibiotics. Actually, I havent taken antibiotics in several years so I feel uncomfortable just taking them with no identifiable bacteria present. I do have a referral to urology but its going to take some time and Im worried about getting a kidney infection. I also feel as though my concerns arent being addressed properly because of my NP being my friend, so she doesnt run the tests she would on a regular patient (IE I had to bug her for the culture and micro ua because she just immediately wanted to give me antibiotics and call it a day).Thanks in advance for any advice, I know its a long read.

Output: Asymptomatic leukocytes in urine, with no growth on a culture, from a sample that isn't a clean catch, is not a UTI and does not need antibiotics.Stop getting medical "care" from this person. Sounds incompetent. Get an actual PCP, preferably a physician.Urology is gonna be scratching their head on why they have this referral.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Leukocytes but no BacteriaAge: 34Sex : FemaleHeight: 511Weight: 170lbsDuration of complaint: 3 weeksLocation: USAny existing relevant medical issues: NoCurrent medications: None currently, just finished a round of macrobid.Hey guys, I posted something similar to this in a micro group but things have changed since then so Im just looking for further advice.Almost 3 weeks ago, during a routine exam i showed moderate leukocytes in urine with trace blood. Id had no regular uti symptoms at all other than some pressure after peeing like once. No burning, urgency etc. According to my blood work I was also dehydrated. My NP, who is also my boss & friend, gave me a prescription for Macrobid and sent off a culture. I took the antibiotics for 3 days then I got the call that my culture was negative and to stop the antibiotics. So I did. From there it was back and forth because although I was still asymptomatic I still had leukocytes in my urine. So another culture was sent off - same results 25 - 50k cfu mixed urogenital flora okay cool. So what do I do? NP tells me to just finish the antibiotics so I did. I did get a micro UA done as well and it showed 5-10 wbc with few bacteria, mucus and epithelial cells but none of my urine samples were clean catch.On Saturday after finishing my antibiotics completely I took one of those AZO uti strips after a shower and it had a small purple speck in the middle of the leukocyte pad after 2 minutes. I text my NP to let her know and she sent me in yet another prescription for antibiotics.My concern is that Im not one to take a lot of antibiotics. Actually, I havent taken antibiotics in several years so I feel uncomfortable just taking them with no identifiable bacteria present. I do have a referral to urology but its going to take some time and Im worried about getting a kidney infection. I also feel as though my concerns arent being addressed properly because of my NP being my friend, so she doesnt run the tests she would on a regular patient (IE I had to bug her for the culture and micro ua because she just immediately wanted to give me antibiotics and call it a day).Thanks in advance for any advice, I know its a long read.. ### Response: Asymptomatic leukocytes in urine, with no growth on a culture, from a sample that isn't a clean catch, is not a UTI and does not need antibiotics.Stop getting medical "care" from this person. Sounds incompetent. Get an actual PCP, preferably a physician.Urology is gonna be scratching their head on why they have this referral..


Instruction: Why are small kidney stones worse than my larger one?Female, 38yrs old, bilateral nephrocalcinosis, no other health concerns and only medications are acute pain relief (30mg codeine & 500mg paracetamol combined tablets at 2 per dose, Tramadol 100mg, Diclofenac suppository 100mg, Buscopan 10mg). Currently in absolute agony.8 weeks ago I passed a 4mm stone that was exceptionally painful. Worse than my unmedicated child birth. That pain started around 7am but by 5pm I had passed the stone. It was horrific, more intense pain than I currently have but at least over in less than 12hrs.I had a CT scan and a follow up call from a urology nurse informed me I only had very small stones, described as like gravel left. No treatment or management plan - just a follow CT in a year.Which would be fine but for the past 2 days I have been in agony in my right kidney. Im on maximum doses of all my home pain relief and Im getting breakthrough pain every 2.5-3hrs.I would love to understand why this is more drawn out than my bigger stone? Im drinking large amounts of water to flush it/them out but Im not passing much urine at a time and theres a lot of blood in there too. I think I could cope better if I knew why this was taking longer or if I could work out just how long this was going to go on for. Urology nurse was very terse and basically just said Theyll pass without intervention. Just take your pain relief.Grateful for any insight/ideas x

Output: Not a urologist, but we deal with similar issues in the bile duct. When it's a single stone, it is very easy to pop out because there's nothing else obstructing or limiting its dislodgement. However, when the bile duct is full of sludge and copious amounts of smaller stones, it's like trying to pull out a tube full of thick gravel or sand and extraction becomes a lot more tedious and prolonged. My guess is that it's just difficult for the gunk to move through your ureters because it's somewhat clogged up.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Why are small kidney stones worse than my larger one?Female, 38yrs old, bilateral nephrocalcinosis, no other health concerns and only medications are acute pain relief (30mg codeine & 500mg paracetamol combined tablets at 2 per dose, Tramadol 100mg, Diclofenac suppository 100mg, Buscopan 10mg). Currently in absolute agony.8 weeks ago I passed a 4mm stone that was exceptionally painful. Worse than my unmedicated child birth. That pain started around 7am but by 5pm I had passed the stone. It was horrific, more intense pain than I currently have but at least over in less than 12hrs.I had a CT scan and a follow up call from a urology nurse informed me I only had very small stones, described as like gravel left. No treatment or management plan - just a follow CT in a year.Which would be fine but for the past 2 days I have been in agony in my right kidney. Im on maximum doses of all my home pain relief and Im getting breakthrough pain every 2.5-3hrs.I would love to understand why this is more drawn out than my bigger stone? Im drinking large amounts of water to flush it/them out but Im not passing much urine at a time and theres a lot of blood in there too. I think I could cope better if I knew why this was taking longer or if I could work out just how long this was going to go on for. Urology nurse was very terse and basically just said Theyll pass without intervention. Just take your pain relief.Grateful for any insight/ideas x. ### Response: Not a urologist, but we deal with similar issues in the bile duct. When it's a single stone, it is very easy to pop out because there's nothing else obstructing or limiting its dislodgement. However, when the bile duct is full of sludge and copious amounts of smaller stones, it's like trying to pull out a tube full of thick gravel or sand and extraction becomes a lot more tedious and prolonged. My guess is that it's just difficult for the gunk to move through your ureters because it's somewhat clogged up..


Instruction: Cant stop peeing blood! Help!Hi everyone! Please let me know if theres any other/better places to ask this but I didnt know where else to go. I am going through hell and feel so embarrassed talking about my bloody pee online but I have gotten blown off more times than I can count. I am 22F 59 with no prior history of UTIs and I have been peeing blood for TWO WEEKS with extreme pain! It started out full and just generally lower abdominal pain, but now Im starting to feel occasional sharp stabbing pain in my side/back which is making me think its my kidneys. Heres a timeline of how all of this has gone:1/2/22- notice blood on the tissue when I wipe for the first time, freak out, schedule an appointment with my GP1/3/22- I go to my doctors appointment, she tests my urine and finds high white blood cell count (infection) prescribes me 5 days of macrobid1/6/22- bleeding gets heavier and abdominal pain gets worse1/8/22- finished my antibiotics, still extremely ill, more pain more blood, I start running a low grade fever and throw up1/10/22- I go to an urgent care, blood found in urine but no signs of infection, gave me a shot of ciprofloxacin and sent pill form home with me, told me if it gets worse to go the emergency room1/12/22- after never noticing a difference in pain or blood I go to the emergency room. They test my blood multiple times, take urine sample, and do a CT scan. My blood work shows elevated white blood cells and elevated high lactic acid levels. They send me in for a CT scan (no contrast) and dont see anything. I get sent home because nothing is in my CT scan and get told if the pain gets worse come backI am in a lot of pain and I dont know what to do. I am STILL peeing blood and having awful pain. I have a urology appointment tomorrow but I dont know if I should wait or go back to the emergency room. My back keeps having these painful twitches and I cant stop shaking. The nurse who discharged me said she thinks its interstitial cystitis and it is an infection that is curable that you treat with antibiotics. I looked it up and thats flat out not true. Other nurses had said all night it seemed like I had a kidney infection, and thats honestly what it feels like. What should I do?

Output: If they did basic blood work, urine tests, and you haven't had true fever, then you probably don't have a kidney infection.Did you original urine sample ever grow anything in the culture?Do you urine results show blood +? Do they say if they specifically see RBCs or not?Edit: include the actual lab info if you have it availableIt kind of upsets me that the CT A/P was done non con. I guess maybe they were looking for stones... But still. You cannot reliably comment on pyelonephritis on a non con CT.I'm sure they were hunting for stones. Shouldn't really need CT imaging to make pyelonephritis diagnosis.Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. This includes medical students.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Cant stop peeing blood! Help!Hi everyone! Please let me know if theres any other/better places to ask this but I didnt know where else to go. I am going through hell and feel so embarrassed talking about my bloody pee online but I have gotten blown off more times than I can count. I am 22F 59 with no prior history of UTIs and I have been peeing blood for TWO WEEKS with extreme pain! It started out full and just generally lower abdominal pain, but now Im starting to feel occasional sharp stabbing pain in my side/back which is making me think its my kidneys. Heres a timeline of how all of this has gone:1/2/22- notice blood on the tissue when I wipe for the first time, freak out, schedule an appointment with my GP1/3/22- I go to my doctors appointment, she tests my urine and finds high white blood cell count (infection) prescribes me 5 days of macrobid1/6/22- bleeding gets heavier and abdominal pain gets worse1/8/22- finished my antibiotics, still extremely ill, more pain more blood, I start running a low grade fever and throw up1/10/22- I go to an urgent care, blood found in urine but no signs of infection, gave me a shot of ciprofloxacin and sent pill form home with me, told me if it gets worse to go the emergency room1/12/22- after never noticing a difference in pain or blood I go to the emergency room. They test my blood multiple times, take urine sample, and do a CT scan. My blood work shows elevated white blood cells and elevated high lactic acid levels. They send me in for a CT scan (no contrast) and dont see anything. I get sent home because nothing is in my CT scan and get told if the pain gets worse come backI am in a lot of pain and I dont know what to do. I am STILL peeing blood and having awful pain. I have a urology appointment tomorrow but I dont know if I should wait or go back to the emergency room. My back keeps having these painful twitches and I cant stop shaking. The nurse who discharged me said she thinks its interstitial cystitis and it is an infection that is curable that you treat with antibiotics. I looked it up and thats flat out not true. Other nurses had said all night it seemed like I had a kidney infection, and thats honestly what it feels like. What should I do?. ### Response: If they did basic blood work, urine tests, and you haven't had true fever, then you probably don't have a kidney infection.Did you original urine sample ever grow anything in the culture?Do you urine results show blood +? Do they say if they specifically see RBCs or not?Edit: include the actual lab info if you have it availableIt kind of upsets me that the CT A/P was done non con. I guess maybe they were looking for stones... But still. You cannot reliably comment on pyelonephritis on a non con CT.I'm sure they were hunting for stones. Shouldn't really need CT imaging to make pyelonephritis diagnosis.Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. This includes medical students..


Instruction: How urgent is urinary problem?40F, 5'7, 205 lbs, Caucasian.Primary complaint: blood in urine, lower abdominal painHx: Neurogenic bladder from fall in 2009, Intermittent catheterization. Hx of kidney stones, UTIs. Partial loss of feeling due to nerve damage in abdomen. OA/DDD with SCS implant.Painful cath 4 days ago with strange pinkish red tissue string in toilet.3 days ago Pain in right flank/lower back attributed to too much dancing the night before.Yesterday, orangish tinted urine, blood suspected.Today, bright red blood in urine and a strange feeling in my lower abdomen, which I would describe as pain-like.I moved states and have yet to fully establish care locally. I have not seen my primary or urology. I did see a resident yesterday for medication refills, who ordered blood work and a UA for my primary care appointment next month. The blood work is to be done in a week or two to get me back to full strength on my lithium.My question is: should I do the UA today and wait a few days for results or should I go to urgent care?Medical issues: Osteoarthritis, SI joint dysfunction, neurogenic bladder, Bipolar 1 Disorder, anxiety, PTSD, migraines, recurrent Varicella zoster, IBS-DMeds: Lithium 900mg daily Levothyroxine 50mcg ac am Metformin 500 mg bid (for weight loss) Prazosin 6mg nightly Trazodone 200mg nightly Tizanidine 4mg 1 tab am, 2 tabs qhs Alosetron 1mg bid Voltaren gel CannabisSmoke 1 pack/week, drink 1-2 drinks couple times a month (including the 2 heavy drinks night this began), No street drugs.Any light shed on the urgency of this issue would be awesome! Thank you all!

Output: Sooner rather than later. Urgent care may not be that helpful unless you're pouring out blood or you're obstructed from a blood clot. You should do the UA soon. The only specific reason I'd go to urgent care is if you think it's a UTI which of course is possible given you intermittent cath.The bleeding could be trauma or a stone but the worst case scenario would be bladder cancer, especially since you have a smoking history. A work-up is definitely needed if the hematuria is persistent.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How urgent is urinary problem?40F, 5'7, 205 lbs, Caucasian.Primary complaint: blood in urine, lower abdominal painHx: Neurogenic bladder from fall in 2009, Intermittent catheterization. Hx of kidney stones, UTIs. Partial loss of feeling due to nerve damage in abdomen. OA/DDD with SCS implant.Painful cath 4 days ago with strange pinkish red tissue string in toilet.3 days ago Pain in right flank/lower back attributed to too much dancing the night before.Yesterday, orangish tinted urine, blood suspected.Today, bright red blood in urine and a strange feeling in my lower abdomen, which I would describe as pain-like.I moved states and have yet to fully establish care locally. I have not seen my primary or urology. I did see a resident yesterday for medication refills, who ordered blood work and a UA for my primary care appointment next month. The blood work is to be done in a week or two to get me back to full strength on my lithium.My question is: should I do the UA today and wait a few days for results or should I go to urgent care?Medical issues: Osteoarthritis, SI joint dysfunction, neurogenic bladder, Bipolar 1 Disorder, anxiety, PTSD, migraines, recurrent Varicella zoster, IBS-DMeds: Lithium 900mg daily Levothyroxine 50mcg ac am Metformin 500 mg bid (for weight loss) Prazosin 6mg nightly Trazodone 200mg nightly Tizanidine 4mg 1 tab am, 2 tabs qhs Alosetron 1mg bid Voltaren gel CannabisSmoke 1 pack/week, drink 1-2 drinks couple times a month (including the 2 heavy drinks night this began), No street drugs.Any light shed on the urgency of this issue would be awesome! Thank you all!. ### Response: Sooner rather than later. Urgent care may not be that helpful unless you're pouring out blood or you're obstructed from a blood clot. You should do the UA soon. The only specific reason I'd go to urgent care is if you think it's a UTI which of course is possible given you intermittent cath.The bleeding could be trauma or a stone but the worst case scenario would be bladder cancer, especially since you have a smoking history. A work-up is definitely needed if the hematuria is persistent..


Instruction: How to talk to my daughter's pediatrician about a concernUPDATE: The appointment went as expected. The pediatrician wasn't too concerned because she was still able to eat and "looked fine". So I took matters into my own hands and gave her a total of 6 doses of Miralax starting on Thursday. She had MAJOR success yesterday afternoon and finally ate a whole meal.Hi docs, I need advice on how to talk to my daughter's pediatrician about an ongoing kidney & bladder infection without sounding like a crazy mom. She's 12, 52 inches, and now weighs 87 lbs (from 98 lbs).She first became sick on Aug 25th, with fever and vomiting. The first dr visit was diagnosed with a stomach bug and period cramps. Ended up at the ER a few hours later with a temp of 103.7. ER ran tests for hours. Urine came back good, bloodwork showed an infection. After several tests, the conclusion was a kidney infection. Sent home because there were no available beds. This went on for 4 more days, in and out of the ER. After 8 days of yucky, she returned to school.On Sep 20th, I got a call from the nurse to come and get her. Temp was 102.7, BP 90/49, HR 125 and she was vomiting brown. Took her immediately to the ER. ER put her in PICU to treat the kidney and bladder infection. She was in the PICU for 6 days and step down for 3.Went to her pediatrician for the follow-up. She did bloodwork and ordered ultrasounds. Bloodwork wasn't so great. I picked up the ultrasound report and the report stated there was a fecal impaction. I asked the pediatrician, she told me to give her Metamucil and sent me off to a urologist.We had the 2nd urology appointment on Tuesday. The fecal impaction was brought up again when she was going over her (the urologists') ultrasounds and cystography. I asked more questions about this impaction and was told to give her FiberCon or Metamucil. She still has kidney and bladder infections. Urologists put her back on antibiotics.I have an appointment with the pediatrician this week. I really need to seriously discuss this fecal impaction. I have been giving her both Metamucil & FiberCon for about 22 days now. And have given her Milk of Magnesia a few times. She has not had a bowel movement (a small amount) since Wednesday.I have picked up all lab and radiology reports from 2 hospitals and 3 different doctors. The CTs on Sept 1 and Sept 20th note the impaction. Ultrasounds on Sep 22 and Oct 7 also mention the impaction. And now, the urologist mentioned it on Oct 26.She is still not feeling well and not eating much anymore. This morning her temp was 96.9, BP 103/53, HR was 65, and she said she was extremely tired. I logged in to the portal this morning and received Friday's blood and urine labs, neither are great news, but there is some improvement.How do I approach the pediatrician with all this information without sounding like a crazy paranoid mom? Or maybe I am and this is not a major concern or issue? I have asked about this and feel like I was brushed off. I feel kind of crazy as it is because I went to all these places and got the records and put it all together. Thank you.

Output: First of all, don't ever worry about how you come across to a doctor when you're talking about literally the most important thing in your life - the health of your child. I have parents tell me all the time "OK, don't think I'm crazy." I never do. I go out of my way to tell them I don't think it's crazy and that the reason we're talking is to make sure we're all on the same page and we're both comfortable with the plan.Just express your concerns honestly and in a straightforward way. It is literally their job to help you navigate something that evokes a strong emotional response. If they can't do that, they aren't a good pediatrician. (But thankfully, most pediatrician, in my experience, are excellent at this).As far as the fecal impaction, Metamucil won't cut it. Rectal fecal impaction is a common cause of UTIs, especially in girls (who have shorter urethras than boys). I usually use the big guns - like a Miralax cleanout or a Mg citrate cleanout. Basically the same thing we would do before a scope. This usually helps you start over from ground zero and then you can work on keeping her poop soft with Metamucil or whatever else you think works for her on a daily basis (Miralax is still my favorite for this too).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How to talk to my daughter's pediatrician about a concernUPDATE: The appointment went as expected. The pediatrician wasn't too concerned because she was still able to eat and "looked fine". So I took matters into my own hands and gave her a total of 6 doses of Miralax starting on Thursday. She had MAJOR success yesterday afternoon and finally ate a whole meal.Hi docs, I need advice on how to talk to my daughter's pediatrician about an ongoing kidney & bladder infection without sounding like a crazy mom. She's 12, 52 inches, and now weighs 87 lbs (from 98 lbs).She first became sick on Aug 25th, with fever and vomiting. The first dr visit was diagnosed with a stomach bug and period cramps. Ended up at the ER a few hours later with a temp of 103.7. ER ran tests for hours. Urine came back good, bloodwork showed an infection. After several tests, the conclusion was a kidney infection. Sent home because there were no available beds. This went on for 4 more days, in and out of the ER. After 8 days of yucky, she returned to school.On Sep 20th, I got a call from the nurse to come and get her. Temp was 102.7, BP 90/49, HR 125 and she was vomiting brown. Took her immediately to the ER. ER put her in PICU to treat the kidney and bladder infection. She was in the PICU for 6 days and step down for 3.Went to her pediatrician for the follow-up. She did bloodwork and ordered ultrasounds. Bloodwork wasn't so great. I picked up the ultrasound report and the report stated there was a fecal impaction. I asked the pediatrician, she told me to give her Metamucil and sent me off to a urologist.We had the 2nd urology appointment on Tuesday. The fecal impaction was brought up again when she was going over her (the urologists') ultrasounds and cystography. I asked more questions about this impaction and was told to give her FiberCon or Metamucil. She still has kidney and bladder infections. Urologists put her back on antibiotics.I have an appointment with the pediatrician this week. I really need to seriously discuss this fecal impaction. I have been giving her both Metamucil & FiberCon for about 22 days now. And have given her Milk of Magnesia a few times. She has not had a bowel movement (a small amount) since Wednesday.I have picked up all lab and radiology reports from 2 hospitals and 3 different doctors. The CTs on Sept 1 and Sept 20th note the impaction. Ultrasounds on Sep 22 and Oct 7 also mention the impaction. And now, the urologist mentioned it on Oct 26.She is still not feeling well and not eating much anymore. This morning her temp was 96.9, BP 103/53, HR was 65, and she said she was extremely tired. I logged in to the portal this morning and received Friday's blood and urine labs, neither are great news, but there is some improvement.How do I approach the pediatrician with all this information without sounding like a crazy paranoid mom? Or maybe I am and this is not a major concern or issue? I have asked about this and feel like I was brushed off. I feel kind of crazy as it is because I went to all these places and got the records and put it all together. Thank you.. ### Response: First of all, don't ever worry about how you come across to a doctor when you're talking about literally the most important thing in your life - the health of your child. I have parents tell me all the time "OK, don't think I'm crazy." I never do. I go out of my way to tell them I don't think it's crazy and that the reason we're talking is to make sure we're all on the same page and we're both comfortable with the plan.Just express your concerns honestly and in a straightforward way. It is literally their job to help you navigate something that evokes a strong emotional response. If they can't do that, they aren't a good pediatrician. (But thankfully, most pediatrician, in my experience, are excellent at this).As far as the fecal impaction, Metamucil won't cut it. Rectal fecal impaction is a common cause of UTIs, especially in girls (who have shorter urethras than boys). I usually use the big guns - like a Miralax cleanout or a Mg citrate cleanout. Basically the same thing we would do before a scope. This usually helps you start over from ground zero and then you can work on keeping her poop soft with Metamucil or whatever else you think works for her on a daily basis (Miralax is still my favorite for this too)..


Instruction: Granma here, just wondering...no enemas, these days?

Output: Enemas work great, but dont go too far up. Cleanouts from above take care of the whole problem at once.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Granma here, just wondering...no enemas, these days?. ### Response: Enemas work great, but dont go too far up. Cleanouts from above take care of the whole problem at once..


Instruction: Alcohol Flush Response. If not allergy, what could it be?44M WhiteAbout 3-4 years ago I developed an alcohol reaction. I can have a single drop of alcohol on my tongue and end up with a bright red, itchy and hot face, and I would sweat. I do not get chest pain. Often, if I ignored then the issue would disappear quickly (10 mins). Often, I could continue drinking and be fine.Sometimes the same alcohol would not do this another time (e.g. same drink one week vs next).I have been tested (23&me) GG for alcohol flush syndrome and am fine.I saw a GP after seeing a post on reddit where someone said something similar and everyone told him it was lymphoma. The GP checked me and said I was fine. I have no weight loss, no night sweats, no obvious lymph node issues.I spoke with an allergist and they said:"These reactions are unlikely to be an allergy as it does not occur every time alcohol is taken and also disappears after the first initial reaction.It might be due to the histamine in the alcohol, or even the presence of sulphites, but if this were the case then the reaction would be maintained throughout the period that alcohol is consumed.We do see people who have had reactions to alcohol, to rule an allergy out, but rarely is an allergy the cause."I am currently on betahistines for something else, and have no reaction, so I don't think it can be histamine allergy, and I have tried some drinks which say "includes sulphites" and have no effect.Last year I have had some urology issues (difficulty peeing). They did not get to the end of it and told me I had 'shy bladder' - I disagree, but I was told I had an enlarged spleen after ultra sound, but later told I did not.So, what could this be if not lymphoma or allergy? My GP is not being very helpful, but it is really affecting my mental health and I am worried a sign of something else.I do not drink any longer. I am currently dealing with a new thing, vestibular migraine, and this is all swirling around in my head.

Output: A transient effect like this seems more likely to be an autonomic response, which would be very difficult to diagnose and there aren't any tests for it. This sort of thing usually goes away after a few minutes.You might still have an alcohol flush response, despite "normal" genetics from 23&me. There are more genes that have been described recently. The only way to know for sure is to do an acetaldehyde breath test, but this isn't very widely available.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Alcohol Flush Response. If not allergy, what could it be?44M WhiteAbout 3-4 years ago I developed an alcohol reaction. I can have a single drop of alcohol on my tongue and end up with a bright red, itchy and hot face, and I would sweat. I do not get chest pain. Often, if I ignored then the issue would disappear quickly (10 mins). Often, I could continue drinking and be fine.Sometimes the same alcohol would not do this another time (e.g. same drink one week vs next).I have been tested (23&me) GG for alcohol flush syndrome and am fine.I saw a GP after seeing a post on reddit where someone said something similar and everyone told him it was lymphoma. The GP checked me and said I was fine. I have no weight loss, no night sweats, no obvious lymph node issues.I spoke with an allergist and they said:"These reactions are unlikely to be an allergy as it does not occur every time alcohol is taken and also disappears after the first initial reaction.It might be due to the histamine in the alcohol, or even the presence of sulphites, but if this were the case then the reaction would be maintained throughout the period that alcohol is consumed.We do see people who have had reactions to alcohol, to rule an allergy out, but rarely is an allergy the cause."I am currently on betahistines for something else, and have no reaction, so I don't think it can be histamine allergy, and I have tried some drinks which say "includes sulphites" and have no effect.Last year I have had some urology issues (difficulty peeing). They did not get to the end of it and told me I had 'shy bladder' - I disagree, but I was told I had an enlarged spleen after ultra sound, but later told I did not.So, what could this be if not lymphoma or allergy? My GP is not being very helpful, but it is really affecting my mental health and I am worried a sign of something else.I do not drink any longer. I am currently dealing with a new thing, vestibular migraine, and this is all swirling around in my head.. ### Response: A transient effect like this seems more likely to be an autonomic response, which would be very difficult to diagnose and there aren't any tests for it. This sort of thing usually goes away after a few minutes.You might still have an alcohol flush response, despite "normal" genetics from 23&me. There are more genes that have been described recently. The only way to know for sure is to do an acetaldehyde breath test, but this isn't very widely available..


Instruction: Total loss of bladder controlWhat would cause a complete loss of bladder control in 17 year old with cerebral palsy. Yes he has cp and thats what his primary wants to relate it to, but hes been in control since age 8 and now suddenly, theres about a 2 second warning before he goes. Sometime he doesnt even know he went. Cp is non progressive. Last 2 months there has been 5 separate episodes of blood (not from urine) in his brief in the morning. After standing for sometime and then sits, he feels a slight pain in the groin area. Urine was cultured, no bacteria was found, only microscopic blood. Referred to nephrology and his kidneys are good but his compliment levels were low. Doc thinks from having COVID in November. Testing again in 2 months. Next step is urology. Thanks in advance for any insight....Edit: he is now being followed for increased hemoglobin and hematocrit in RBC

Output: How severe is his cerebral palsy? Is he ambulatory? Is he bed bound? in children with significant skeletal deformities or minimal ambulation, kidney stones are very common. These can cause blood in the urine and the urinary incontinence that you are describing. You need to go see a pediatric urologist for evaluation. First step should be checking for a urine infection, but after that imaging with an ultrasound or CT scan is likely the next step.Moderate spastic cp, wheelchair yes, but can walk with a walker short distances. He did have kidney and bladder ultrasound that was unremarkable. He also had a urine culture that was clear of bacteria. Thank you for your repl

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Total loss of bladder controlWhat would cause a complete loss of bladder control in 17 year old with cerebral palsy. Yes he has cp and thats what his primary wants to relate it to, but hes been in control since age 8 and now suddenly, theres about a 2 second warning before he goes. Sometime he doesnt even know he went. Cp is non progressive. Last 2 months there has been 5 separate episodes of blood (not from urine) in his brief in the morning. After standing for sometime and then sits, he feels a slight pain in the groin area. Urine was cultured, no bacteria was found, only microscopic blood. Referred to nephrology and his kidneys are good but his compliment levels were low. Doc thinks from having COVID in November. Testing again in 2 months. Next step is urology. Thanks in advance for any insight....Edit: he is now being followed for increased hemoglobin and hematocrit in RBC. ### Response: How severe is his cerebral palsy? Is he ambulatory? Is he bed bound? in children with significant skeletal deformities or minimal ambulation, kidney stones are very common. These can cause blood in the urine and the urinary incontinence that you are describing. You need to go see a pediatric urologist for evaluation. First step should be checking for a urine infection, but after that imaging with an ultrasound or CT scan is likely the next step.Moderate spastic cp, wheelchair yes, but can walk with a walker short distances. He did have kidney and bladder ultrasound that was unremarkable. He also had a urine culture that was clear of bacteria. Thank you for your repl.


Instruction: Can CT Scan without Contrast IV detect Pelvic/Abdominal Cancer22m, 220lbs, 5'6. No smoking or alcohol use.Got a CT scan from ER to look for kidney stones and they found none.Quote the patients case was ultimately discussed with urology who agreed with further evaluation with CT abdomen and pelvis to rule out renal and urethral calcinotic/renal pathology. The patient demonstrated no signs of acute intra-abdominal renal pathology. Urology advised to follow up with non-urgent cytoscopy"Im currently experiencing a lot of dull abdominal pain and worried about potentially having cancer in the pelvic region.For 3 months Ive had lower abdominal pain, frequency urinating, pain when urinating, urethral pain.I have no signs of kidney stones, leukocytes or blood in urine. Ive tested negative for bacterial STDs as well and even Hep B and C, Syphilis, HIV at 3 months.

Output: To answer your question, a non-contrast CT scan does not rule out cancer in the abdomen/pelvis, barring a huge mass or obvious metastases. In fact, even a contrast enhanced CT scan is not very sensitive for several types of cancer.You should discuss with your physician whether or not additional imaging would be warranted. I don't know much about your history but in general, it is exceedingly rare for a 22 year old to suddenly develop some sort of intra-abdominal malignancy.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can CT Scan without Contrast IV detect Pelvic/Abdominal Cancer22m, 220lbs, 5'6. No smoking or alcohol use.Got a CT scan from ER to look for kidney stones and they found none.Quote the patients case was ultimately discussed with urology who agreed with further evaluation with CT abdomen and pelvis to rule out renal and urethral calcinotic/renal pathology. The patient demonstrated no signs of acute intra-abdominal renal pathology. Urology advised to follow up with non-urgent cytoscopy"Im currently experiencing a lot of dull abdominal pain and worried about potentially having cancer in the pelvic region.For 3 months Ive had lower abdominal pain, frequency urinating, pain when urinating, urethral pain.I have no signs of kidney stones, leukocytes or blood in urine. Ive tested negative for bacterial STDs as well and even Hep B and C, Syphilis, HIV at 3 months.. ### Response: To answer your question, a non-contrast CT scan does not rule out cancer in the abdomen/pelvis, barring a huge mass or obvious metastases. In fact, even a contrast enhanced CT scan is not very sensitive for several types of cancer.You should discuss with your physician whether or not additional imaging would be warranted. I don't know much about your history but in general, it is exceedingly rare for a 22 year old to suddenly develop some sort of intra-abdominal malignancy..


Instruction: What would be used to rule out cancer then?

Output: Again, I would recommend discussing this with your physician (either primary care or the urologist). We generally do not recommend blanket scanning everyone with CTs and MRIs for non-specific abdominal pain especially in young patients, unless the clinical history warrants further investigation (it's not because we mind the extra work; it would be comically easy to read a bunch of negative studies all day and charge for it).Laypeople and even people in the medical field tend to assume that imaging is a magic answer box, but it oftentimes is not and the potential benefits of imaging may not outweigh the risks/costs.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What would be used to rule out cancer then?. ### Response: Again, I would recommend discussing this with your physician (either primary care or the urologist). We generally do not recommend blanket scanning everyone with CTs and MRIs for non-specific abdominal pain especially in young patients, unless the clinical history warrants further investigation (it's not because we mind the extra work; it would be comically easy to read a bunch of negative studies all day and charge for it).Laypeople and even people in the medical field tend to assume that imaging is a magic answer box, but it oftentimes is not and the potential benefits of imaging may not outweigh the risks/costs..


Instruction: Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th.

Output: How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder/ureter/renal pelvis, rarely but possible with RCC or a urethral caruncle

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th.. ### Response: How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder/ureter/renal pelvis, rarely but possible with RCC or a urethral caruncle.


Instruction: Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.

Output: n a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.. ### Response: n a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues..


Instruction: Complex Cystic Mass 8.5 cm x 5.9 cm x 5.0 cm - Left KidneyYesterday I had an ultrasound of my abdomen as I have had intermittent pain on my right hand side by my gallbladder and liver. I did not expect this result, but now it makes a bit of sense as it is probably pushing things over to the right which is causing my pain.I am a 38 year old female.Symptoms: Tired a lot, Full easily, Nauseous oftenLEFT KIDNEY: Normal size. Normal echogenicity with no hydronephrosis. In the left mid kidney there is a complex cystic mass with several septations and which have internal vascularity and areas of mural nodularity. This cyst measures approximately 8.5 x 5.9 x 5.0 cm.I am having difficulty getting a Urology appointment soon as everywhere is booked up until March or April. I have reached out to my primary doctors as well, but I am curios about what my next steps should be.What should I be eating? What should I be doing while I wait for my appointment? What should I not be doing?What tests should I have?I am assuming due to the size it may need to be surgically removed. Is that generally the outcome?Thank you.

Output: Nothing really to do or not do in the meantime. You can expect that they'll want to do an MRI or multiphase CT to see if there are actually any nodular areas that enhance with intravenous contrast, because that would be suspicious for a cystic renal malignancy. If so, these things tend to be really slow-growing and amenable to just being surgically removed with curative intent.Regardless, I don't think the cyst is causing your abdominal pain and was probably just found incidentally.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Complex Cystic Mass 8.5 cm x 5.9 cm x 5.0 cm - Left KidneyYesterday I had an ultrasound of my abdomen as I have had intermittent pain on my right hand side by my gallbladder and liver. I did not expect this result, but now it makes a bit of sense as it is probably pushing things over to the right which is causing my pain.I am a 38 year old female.Symptoms: Tired a lot, Full easily, Nauseous oftenLEFT KIDNEY: Normal size. Normal echogenicity with no hydronephrosis. In the left mid kidney there is a complex cystic mass with several septations and which have internal vascularity and areas of mural nodularity. This cyst measures approximately 8.5 x 5.9 x 5.0 cm.I am having difficulty getting a Urology appointment soon as everywhere is booked up until March or April. I have reached out to my primary doctors as well, but I am curios about what my next steps should be.What should I be eating? What should I be doing while I wait for my appointment? What should I not be doing?What tests should I have?I am assuming due to the size it may need to be surgically removed. Is that generally the outcome?Thank you.. ### Response: Nothing really to do or not do in the meantime. You can expect that they'll want to do an MRI or multiphase CT to see if there are actually any nodular areas that enhance with intravenous contrast, because that would be suspicious for a cystic renal malignancy. If so, these things tend to be really slow-growing and amenable to just being surgically removed with curative intent.Regardless, I don't think the cyst is causing your abdominal pain and was probably just found incidentally..


Instruction: Low right side front abdomen and right lower back pain (kidney?)Age 43 Hawaii Male UsaSo 3 or 4 months ago after a scan someone out in a Urology referral with no other notes other than hidden away positive for nephrolithiasis.Ive had this pain right where my kidney is. It becomes moderately painful after doing moderate work and takes a couple days to settle down.Is this still potentially a stone or would it have passed because of the time frame?

Output: Stones that remain in the cavities of the kidney will grow and recede based on things like pH and ion concentration over time. They are relatively normal to find, particularly as we get up there in age. They almost never symptomatic, unless they break off and get lodged in the ureterat which point its very symptomatic. Its hard to say what the sensation that youre having is; sounds like its causing a pretty significant obstruction for you that would be worth seeing your PCP about to get it worked up.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Low right side front abdomen and right lower back pain (kidney?)Age 43 Hawaii Male UsaSo 3 or 4 months ago after a scan someone out in a Urology referral with no other notes other than hidden away positive for nephrolithiasis.Ive had this pain right where my kidney is. It becomes moderately painful after doing moderate work and takes a couple days to settle down.Is this still potentially a stone or would it have passed because of the time frame?. ### Response: Stones that remain in the cavities of the kidney will grow and recede based on things like pH and ion concentration over time. They are relatively normal to find, particularly as we get up there in age. They almost never symptomatic, unless they break off and get lodged in the ureterat which point its very symptomatic. Its hard to say what the sensation that youre having is; sounds like its causing a pretty significant obstruction for you that would be worth seeing your PCP about to get it worked up..


Instruction: Coughing up blood after surgeryHello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight.

Output: Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Coughing up blood after surgeryHello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight.. ### Response: Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED..


Instruction: 27Female unable to walk, urinary retention, gastroparesis27 year old female, weight:57kg, height164cm. Previously diagnosed with autism, pernicious anaemia, iron deficiency, epilepsy, POTS.Taking Wellbutrin, lamotrigine, clobozam, vitamin d, iron, vitamin b12 injection, pantoprozole, and now because of gastroparesis I am taking domperidone also gravol IVI have leg weakness and my legs feel heavy and like they will give out on me. I have diminished feeling in them but the EMG came back as completely normal.I had an MRI and an MRI with contrast and it showed a disk bulge effacing the anterior disk space and moderate to severe narrowing of both neural foremen on disk L5/S1Disk protrusion which is mildly protruding into the thecsl sac and causing mild stenosis and mild neural foramen narrowing on L4-5I have gastroparesis which was just diagnosed during this hospital stay. I was vomiting almost everything I ate (which wasnt much because I got full so quickly) and they did a gastric emptying study.I have urinary retention meaning that I am unable to start urinating and it caused me to retain over 2L of fluid. I am currently catheterized. A urologist wouldnt see me because they believed it was a neurological problem but neuro suggested I see urology.I have a lot of the symptoms of Ehlers danlos syndrome as well (hyper mobility type) such as hypermobile joints, hyper elastic skin, soft, easily bruised skin, dislocations and TMJ disorder (which have caused jaw to dislocate many times).I have not been diagnosed with this yet but could the leg weakness and other symptoms be caused by ehlers danlos or is there something else we (the doctors and I) should be looking at.I am doing Physio and am getting a bit better at walking but my weight is mostly in my arms and so my legs dont give out I have been using a chair for the majority of the time here and walking with Physio using a walker. Im really unsteady on my feet and have a hard time controlling where my feet go which is making it hard to walk so I can only do pivot transfers.I had an ultrasound done of my abdomen/pelvis and am not sure the results yetDoctor is referring me to an EDS clinic because no one here knows enough to diagnose me

Output: Really depends on what the neurological exam shows.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 27Female unable to walk, urinary retention, gastroparesis27 year old female, weight:57kg, height164cm. Previously diagnosed with autism, pernicious anaemia, iron deficiency, epilepsy, POTS.Taking Wellbutrin, lamotrigine, clobozam, vitamin d, iron, vitamin b12 injection, pantoprozole, and now because of gastroparesis I am taking domperidone also gravol IVI have leg weakness and my legs feel heavy and like they will give out on me. I have diminished feeling in them but the EMG came back as completely normal.I had an MRI and an MRI with contrast and it showed a disk bulge effacing the anterior disk space and moderate to severe narrowing of both neural foremen on disk L5/S1Disk protrusion which is mildly protruding into the thecsl sac and causing mild stenosis and mild neural foramen narrowing on L4-5I have gastroparesis which was just diagnosed during this hospital stay. I was vomiting almost everything I ate (which wasnt much because I got full so quickly) and they did a gastric emptying study.I have urinary retention meaning that I am unable to start urinating and it caused me to retain over 2L of fluid. I am currently catheterized. A urologist wouldnt see me because they believed it was a neurological problem but neuro suggested I see urology.I have a lot of the symptoms of Ehlers danlos syndrome as well (hyper mobility type) such as hypermobile joints, hyper elastic skin, soft, easily bruised skin, dislocations and TMJ disorder (which have caused jaw to dislocate many times).I have not been diagnosed with this yet but could the leg weakness and other symptoms be caused by ehlers danlos or is there something else we (the doctors and I) should be looking at.I am doing Physio and am getting a bit better at walking but my weight is mostly in my arms and so my legs dont give out I have been using a chair for the majority of the time here and walking with Physio using a walker. Im really unsteady on my feet and have a hard time controlling where my feet go which is making it hard to walk so I can only do pivot transfers.I had an ultrasound done of my abdomen/pelvis and am not sure the results yetDoctor is referring me to an EDS clinic because no one here knows enough to diagnose me. ### Response: Really depends on what the neurological exam shows..


Instruction: Made an appointment with a urology office to discuss getting a vasectomy, was told that the initial consults are with a nurse practitioner and not the actual doctor performing the procedure. Is this common practice?I'm assuming I won't even be meeting the doctor until the day of the procedure, which I think is kind of strange and makes me even more nervous than I already am. I know doctors are spread thin and minor procedures like vasectomies are probably low on their list, but I would at least like a few minutes of facetime with the guy that's going to be working on my junk...

Output: That's typical for many offices. If the doctor is meeting with everyone individually, then that's a lot fewer procedures they can do. Just the way healthcare works in the US.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Made an appointment with a urology office to discuss getting a vasectomy, was told that the initial consults are with a nurse practitioner and not the actual doctor performing the procedure. Is this common practice?I'm assuming I won't even be meeting the doctor until the day of the procedure, which I think is kind of strange and makes me even more nervous than I already am. I know doctors are spread thin and minor procedures like vasectomies are probably low on their list, but I would at least like a few minutes of facetime with the guy that's going to be working on my junk.... ### Response: That's typical for many offices. If the doctor is meeting with everyone individually, then that's a lot fewer procedures they can do. Just the way healthcare works in the US..


Instruction: 21M URGENT UROLOGY HELPI was masturbating excessively yesterday and during / right before ejaculation I lost all hardness and my penis became flaccid, stretchy, and curved to the left. My left testicle is also much more lower now and the right one doesnt doesnt move as smoothly. I basically cant really feel my penis anymore and its hanging very loosely downwards, as are my testicles. I saw a urologist right after it happened and he dismissed any fracture since there was no pain upon inspection and said everything was normal. My penis doesnt look, feel, move the same and i can no longer get a hard erection, the most i can get is a semi erection very loose penis with a 60 degree bend to the left side. What should i do? Had to add that my penis has become much more fatter maybe swollen?, and much more veiny, and has its flaccid size has increased, also scrotum shape is very weird and wrinkly.

Output: The only thing that sounds abnormal to me is the bend in the shaft of the penis. I'm not a urologist, but if you were unhappy with the urologist that you saw, I would recommend you seek a second opinion from another urologist.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 21M URGENT UROLOGY HELPI was masturbating excessively yesterday and during / right before ejaculation I lost all hardness and my penis became flaccid, stretchy, and curved to the left. My left testicle is also much more lower now and the right one doesnt doesnt move as smoothly. I basically cant really feel my penis anymore and its hanging very loosely downwards, as are my testicles. I saw a urologist right after it happened and he dismissed any fracture since there was no pain upon inspection and said everything was normal. My penis doesnt look, feel, move the same and i can no longer get a hard erection, the most i can get is a semi erection very loose penis with a 60 degree bend to the left side. What should i do? Had to add that my penis has become much more fatter maybe swollen?, and much more veiny, and has its flaccid size has increased, also scrotum shape is very weird and wrinkly.. ### Response: The only thing that sounds abnormal to me is the bend in the shaft of the penis. I'm not a urologist, but if you were unhappy with the urologist that you saw, I would recommend you seek a second opinion from another urologist..


Instruction: Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th.

Output: How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder/ureter/renal pelvis, rarely but possible with RCC or a urethral caruncle


Instruction: Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.

Output: In a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.. ### Response: In a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues..


Instruction: Urology vs. Nephrology28M, White, No drugs, Social drinker, no tobacco, 2 days kidney painIve had kidney pain for a couple of days. I went to urgent care this morning, but they unfortunately have no lab or imaging capability. They were able to dip my urine and detect blood. I have had no urinary symptoms. Theyre sending my urine for cultures (3 day turnaround) and also referring me to an outside facility for CT (unknown turnaround time).I am in need of a provider that is able to find the problem (and hopefully solution) sooner than later.My only question is, do I need to try and get an appointment with urology or nephrology?

Output: Urology

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Urology vs. Nephrology28M, White, No drugs, Social drinker, no tobacco, 2 days kidney painIve had kidney pain for a couple of days. I went to urgent care this morning, but they unfortunately have no lab or imaging capability. They were able to dip my urine and detect blood. I have had no urinary symptoms. Theyre sending my urine for cultures (3 day turnaround) and also referring me to an outside facility for CT (unknown turnaround time).I am in need of a provider that is able to find the problem (and hopefully solution) sooner than later.My only question is, do I need to try and get an appointment with urology or nephrology?. ### Response: Urology.


Instruction: Just got a worrying looking letter in the post following an ultrasound for varicocoele. Is there a urologist here that can help me translate this? (UK) Urology Cancer???Age 33Sex MHeight 6"1Weight 74kgHi All,Im based in UK. Just got this letter but I dunno what it means. Its from the Urologist to my GP that I've been CC'd on so it doesn't make a lot of sense to me. I could wait until I actually hear back from the Doctors but obviously I'm a bit worried now having read this so I hoped someone here could explain it to me. Here are the headlines:'His PSA is at 0.65''Ultrasound scrotum showed left scrotal varicocoele, bilateral mild hydrocoele and of note he had an ultrasound of the urinary tract which showed normal kidneys, a residual urine of 400ml and a soft tissue mobile non-shadowing focus within the bladder which is avascular on Doppler. This is unusual and I am going to review this in our MDT.''We will review him in our MDT urgently.'I have done an ETCI for a flexible cystoscopy'.Can someone please translate this for a layman? Many thanksI've just googled that the MDT is the 'Multi-Disciplinary Team (MDT) consists of a team with specialist training and experience of the diagnosis and management of Urology cancer'.

Output: You may have a funky mass in your bladder and theyre going to stick a camera up your penis to get a better look at it.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Just got a worrying looking letter in the post following an ultrasound for varicocoele. Is there a urologist here that can help me translate this? (UK) Urology Cancer???Age 33Sex MHeight 6"1Weight 74kgHi All,Im based in UK. Just got this letter but I dunno what it means. Its from the Urologist to my GP that I've been CC'd on so it doesn't make a lot of sense to me. I could wait until I actually hear back from the Doctors but obviously I'm a bit worried now having read this so I hoped someone here could explain it to me. Here are the headlines:'His PSA is at 0.65''Ultrasound scrotum showed left scrotal varicocoele, bilateral mild hydrocoele and of note he had an ultrasound of the urinary tract which showed normal kidneys, a residual urine of 400ml and a soft tissue mobile non-shadowing focus within the bladder which is avascular on Doppler. This is unusual and I am going to review this in our MDT.''We will review him in our MDT urgently.'I have done an ETCI for a flexible cystoscopy'.Can someone please translate this for a layman? Many thanksI've just googled that the MDT is the 'Multi-Disciplinary Team (MDT) consists of a team with specialist training and experience of the diagnosis and management of Urology cancer'.. ### Response: You may have a funky mass in your bladder and theyre going to stick a camera up your penis to get a better look at it..


Instruction: Mobile means its moving around, which is a good sign in general (means its probably not growing from your bladder). The most likely culprit in these scenarios is a bladder stone. The fact that its nonshadowing makes it unusual because most bladder stones have calcifications that shadow. In any case one has to go in with a camera to take a look at it and do something with it.

Output: By "mobile" I'm not sure whether they mean like rolling all around the bladder (which in this case sounds like it would be a blood clot, not a stone), or an actual soft tissue mass that is swinging in the breeze but attached to the wall by a stalk.MDTs are used for anything complicated or unusual, not just for cancer.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Mobile means its moving around, which is a good sign in general (means its probably not growing from your bladder). The most likely culprit in these scenarios is a bladder stone. The fact that its nonshadowing makes it unusual because most bladder stones have calcifications that shadow. In any case one has to go in with a camera to take a look at it and do something with it.. ### Response: By "mobile" I'm not sure whether they mean like rolling all around the bladder (which in this case sounds like it would be a blood clot, not a stone), or an actual soft tissue mass that is swinging in the breeze but attached to the wall by a stalk.MDTs are used for anything complicated or unusual, not just for cancer..


Instruction: Who published the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease?

Output: Arnett et al

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Who published the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease?. ### Response: Arnett et al.


Instruction: What is the name of the guideline published by the American College of Cardiology?

Output: Guideline on the Primary Prevention of Cardiovascular DiseaseCirculation

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the name of the guideline published by the American College of Cardiology?. ### Response: Guideline on the Primary Prevention of Cardiovascular DiseaseCirculation.


Instruction: When was the last date of publication for the ACC and AHA guideline?

Output: September 10, 2019

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: When was the last date of publication for the ACC and AHA guideline?. ### Response: September 10, 2019.


Instruction: What is a community guide systematic review of?

Output: Team-based care and improved blood pressure control

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is a community guide systematic review of?. ### Response: Team-based care and improved blood pressure control.


Instruction: What is the name of the systematic review that focuses on pharmacist-physician medication-therapy management?

Output: community guide

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the name of the systematic review that focuses on pharmacist-physician medication-therapy management?. ### Response: community guide.


Instruction: What is a primary care-based, pharmacist-physician collaborative medication-therapy management of?

Output: hyper -tension

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is a primary care-based, pharmacist-physician collaborative medication-therapy management of?. ### Response: hyper -tension.


Instruction: What is the name of the randomized controlled trial of team-based care?

Output: S2.1-9

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the name of the randomized controlled trial of team-based care?. ### Response: S2.1-9.


Instruction: When was the J Gen Intern Med published?

Output: 2011

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: When was the J Gen Intern Med published?. ### Response: 2011.


Instruction: What is the name of the study that evaluated pharmacists' work in a physician-pharmacist collaborative model for the manage-ment of hypertension?

Output: Pharmacotherapy

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the name of the study that evaluated pharmacists' work in a physician-pharmacist collaborative model for the manage-ment of hypertension?. ### Response: Pharmacotherapy.


Instruction: What year did Pharmacotherapy issue 36:374–84?

Output: 2016

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What year did Pharmacotherapy issue 36:374–84?. ### Response: 2016.


Instruction: What does SCRIP-HTN stand for?

Output: pharmacists-hypertension

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What does SCRIP-HTN stand for?. ### Response: pharmacists-hypertension.


Instruction: What is the name of the study of cardiovascular risk intervention by pharmacists-hypertension?

Output: SCRIP-HTN

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the name of the study of cardiovascular risk intervention by pharmacists-hypertension?. ### Response: SCRIP-HTN.


Instruction: What is the cost-effectiveness of a physi-cian-pharmacist collaboration intervention to improve?

Output: blood pres-sure control

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the cost-effectiveness of a physi-cian-pharmacist collaboration intervention to improve?. ### Response: blood pres-sure control.


Instruction: Hypertension. 2015;66:1145–51.

Output: S2.1-12

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hypertension. 2015;66:1145–51.. ### Response: S2.1-12.


Instruction: What model is used to improve chronic care in an academic primary care practice?

Output: Teamlet Model

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What model is used to improve chronic care in an academic primary care practice?. ### Response: Teamlet Model.


Instruction: What is the name of the Multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus?

Output: RAMP-DM

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the name of the Multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus?. ### Response: RAMP-DM.


Instruction: What is RAMP-DM?

Output: Multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is RAMP-DM?. ### Response: Multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus.


Instruction: What is the acronym for Management Programme-Diabetes Mellitus?

Output: RAMP-DM

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the acronym for Management Programme-Diabetes Mellitus?. ### Response: RAMP-DM.


Instruction: What does RAMP-DM stand for?

Output: Multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What does RAMP-DM stand for?. ### Response: Multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus.


Instruction: How many people were enrolled in the 2018 Diabetes Care study?

Output: 41:49–59

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How many people were enrolled in the 2018 Diabetes Care study?. ### Response: 41:49–59.


Instruction: Informed shared decision-mak-ing on the prevention of myocardial infarction in type 2 diabetes: a randomised controlled trial?

Output: Buhse S

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Informed shared decision-mak-ing on the prevention of myocardial infarction in type 2 diabetes: a randomised controlled trial?. ### Response: Buhse S.


Instruction: What type of diabetes: a randomised controlled trial?

Output: type 2 diabetes

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What type of diabetes: a randomised controlled trial?. ### Response: type 2 diabetes.


Instruction: What is the name of the randomized controlled trial to improve patient-centered care in underserved pri-mary care patients?

Output: Cooper LA, Roter DL, Carson KA, et al. A randomized trial

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the name of the randomized controlled trial to improve patient-centered care in underserved pri-mary care patients?. ### Response: Cooper LA, Roter DL, Carson KA, et al. A randomized trial.


Instruction: What does Office-GAP stand for?

Output: Office-Guidelines Applied to Practice

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What does Office-GAP stand for?. ### Response: Office-Guidelines Applied to Practice.


Instruction: What is the name of the quasi-experimental design study used to implement shared deci-sion making?

Output: Office-Guidelines Applied to Practice (Office-GAP) program

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the name of the quasi-experimental design study used to implement shared deci-sion making?. ### Response: Office-Guidelines Applied to Practice (Office-GAP) program.


Instruction: What are beta-blockers used for in chronic heart failure and concomitant atrial fibrillation?

Output: significant hepa tic or renal dysfunction

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What are beta-blockers used for in chronic heart failure and concomitant atrial fibrillation?. ### Response: significant hepa tic or renal dysfunction.


Instruction: What is the name of the study that was excluded from NICE 2018?

Output: 2005119

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the name of the study that was excluded from NICE 2018?. ### Response: 2005119.


Instruction: What was the exclusion criteria for Placebo?

Output: Exclusion criteria

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What was the exclusion criteria for Placebo?. ### Response: Exclusion criteria.


Instruction: How many SENIORS were excluded from the inclusion criteria?

Output: 1061

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How many SENIORS were excluded from the inclusion criteria?. ### Response: 1061.


Instruction: Where was the placebo excluded from?

Output: the study

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Where was the placebo excluded from?. ### Response: the study.


Instruction: What percentage of the previous 6 months had heart failure within the 6 weeks prior to randomization?

Output: 35%

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What percentage of the previous 6 months had heart failure within the 6 weeks prior to randomization?. ### Response: 35%.


Instruction: What was a change in cardiovascular drug therapy in the 2 weeks before randomization in heart failure?

Output:  a change in cardiovascular drug therapy in the 2 weeks prior to randomization   heart failure due primarily to uncorrected valvular heart disease

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What was a change in cardiovascular drug therapy in the 2 weeks before randomization in heart failure?. ### Response:  a change in cardiovascular drug therapy in the 2 weeks prior to randomization   heart failure due primarily to uncorrected valvular heart disease.


Instruction: Heart failure due primarily to uncorrected what?

Output: valvular heart disease

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Heart failure due primarily to uncorrected what?. ### Response: valvular heart disease.


Instruction: What is the primary cause of heart failure?

Output: uncorrected valvular heart disease

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the primary cause of heart failure?. ### Response: uncorrected valvular heart disease.


Instruction: What is a contraindication or previous intolerance to beta -blockers?

Output: heart failure

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is a contraindication or previous intolerance to beta -blockers?. ### Response: heart failure.


Instruction: What is a major medical condition that may have reduced survival during the period of the stud y Packer?

Output: heart failure

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is a major medical condition that may have reduced survival during the period of the stud y Packer?. ### Response: heart failure.


Instruction: How long have you been on a waiting list for percutaneous coronary intervention?

Output: 3 months

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How long have you been on a waiting list for percutaneous coronary intervention?. ### Response: 3 months.


Instruction: How long did it take for a patient to develop heart failure?

Output: three months

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How long did it take for a patient to develop heart failure?. ### Response: three months.


Instruction: What was the ejection fraction of patients with heart failure for at least three months?

Output: ≤ 35%

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What was the ejection fraction of patients with heart failure for at least three months?. ### Response: ≤ 35%.


Instruction: What is the ejection fraction  35%?

Output: ≤ 35%

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the ejection fraction  35%?. ### Response: ≤ 35%.


Instruction: How many months of treatment with diuretics and an ACE are needed?

Output: two

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How many months of treatment with diuretics and an ACE are needed?. ### Response: two.


Instruction: A major cardiovascular event or a major surgical procedure must occur within three months of entry into the study?

Output: cerebrovascular accidents

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: A major cardiovascular event or a major surgical procedure must occur within three months of entry into the study?. ### Response: cerebrovascular accidents.


Instruction: What is not controlled by antiarrhythmic intervention or a pacemaker?

Output: sustained ventricular tachycardia or advanced heart block

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is not controlled by antiarrhythmic intervention or a pacemaker?. ### Response: sustained ventricular tachycardia or advanced heart block.


Instruction: What is systolic blood pressure of more than 160 or less than 85 mm Hg?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is systolic blood pressure of more than 160 or less than 85 mm Hg?. ### Response: .


Instruction: What is the heart rate of a person with less than 68 beats per minute?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the heart rate of a person with less than 68 beats per minute?. ### Response: .


Instruction: What is a condition other than heart failure that could limit exercise?

Output: clinically important hepatic or renal disease; or any condition other than heart failure that could limit exercise  or survival

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is a condition other than heart failure that could limit exercise?. ### Response: clinically important hepatic or renal disease; or any condition other than heart failure that could limit exercise  or survival.


Instruction: What type of heart failure could limit exercise or survival?

Output: heart failure

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What type of heart failure could limit exercise or survival?. ### Response: heart failure.


Instruction: People receiving calcium -channel blockers,  or - adrenergic agonists or class IC drugs?

Output: α - or β

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: People receiving calcium -channel blockers,  or - adrenergic agonists or class IC drugs?. ### Response: α - or β.


Instruction: What was the endpoint of cardiovascular death or HF hospitalization significantly, by 20%?

Output: 138

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What was the endpoint of cardiovascular death or HF hospitalization significantly, by 20%?. ### Response: 138.


Instruction: The benefit was seen to a similar extent for both death and what other type of hospitalization?

Output: HF

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: The benefit was seen to a similar extent for both death and what other type of hospitalization?. ### Response: HF.


Instruction: What may lead to angioedema?

Output: ACE inhibitors

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What may lead to angioedema?. ### Response: ACE inhibitors.


Instruction: What is the benefit of ACE inhibitors for patients with prior or current symptoms of chronic HFrEF?

Output: reduce morbidity and mortality

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is the benefit of ACE inhibitors for patients with prior or current symptoms of chronic HFrEF?. ### Response: reduce morbidity and mortality.


Instruction: What has been shown in large RCTs to reduce morbidity and mortality in patients with HFrEF with mild, moderate, or severe symptoms of HF, with or without coronary artery disease?

Output: ACE inhibitors

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What has been shown in large RCTs to reduce morbidity and mortality in patients with HFrEF with mild, moderate, or severe symptoms of HF, with or without coronary artery disease?. ### Response: ACE inhibitors.


Instruction: Data suggest that there are no differences among available ACE inhibitors in what?

Output: their effects on symptoms or survival

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Data suggest that there are no differences among available ACE inhibitors in what?. ### Response: their effects on symptoms or survival.


Instruction: What is one of the effects of ACE inhibitors on symptoms or survival?

Output: clinical deterioration

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is one of the effects of ACE inhibitors on symptoms or survival?. ### Response: clinical deterioration.


Instruction: What should be started at low doses and titrated upward to doses shown to reduce the risk of cardiovascular events in clinical trials?

Output: ACE inhibitors

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What should be started at low doses and titrated upward to doses shown to reduce the risk of cardiovascular events in clinical trials?. ### Response: ACE inhibitors.


Instruction: What should be given with caution to patients with low systemic blood pressures, renal insufficiency, or elevated serum potassium?

Output: ACE inhibitors

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What should be given with caution to patients with low systemic blood pressures, renal insufficiency, or elevated serum potassium?. ### Response: ACE inhibitors.


Instruction: What occurs in 1% of patients who take an ACE inhibitor but more frequently in blacks and women?

Output: Angioedema

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What occurs in 1% of patients who take an ACE inhibitor but more frequently in blacks and women?. ### Response: Angioedema.


Instruction: What should patients not be given if they are pregnant or plan to become pregnant?

Output: ACE inhibitors

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What should patients not be given if they are pregnant or plan to become pregnant?. ### Response: ACE inhibitors.


Instruction: What inhibits kininase and increases levels of bradykinin?

Output: ACE inhibitors

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What inhibits kininase and increases levels of bradykinin?. ### Response: ACE inhibitors.


Instruction: Can ACE inhibitors induce cough in up to 20% of patients?

Output: ACE inhibitors also inhibit kininase and increase levels of bradykinin

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can ACE inhibitors induce cough in up to 20% of patients?. ### Response: ACE inhibitors also inhibit kininase and increase levels of bradykinin.


Instruction: What should be tried if maximal doses are not tolerated?

Output: intermediate doses

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What should be tried if maximal doses are not tolerated?. ### Response: intermediate doses.


Instruction: What can abrupt withdrawal of ACE inhibition lead to?

Output: clinical deterioration

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What can abrupt withdrawal of ACE inhibition lead to?. ### Response: clinical deterioration.


Instruction: What has been found to be superior to HFrEF?

Output: use of an ARNI

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What has been found to be superior to HFrEF?. ### Response: use of an ARNI.


Instruction: What remains strongly advised for patients for whom ARNI is not appropriate?

Output: continued use of an ACE inhibitor

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What remains strongly advised for patients for whom ARNI is not appropriate?. ### Response: continued use of an ACE inhibitor.


Instruction: What is recommended in patients with prior or current symptoms of chronic HFrEF who are intolerant to ACE inhibitors because of cough or angioedema?

Output: ARBs

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What is recommended in patients with prior or current symptoms of chronic HFrEF who are intolerant to ACE inhibitors because of cough or angioedema?. ### Response: ARBs.


Instruction: What has been shown to reduce mortality and HF hospitalizations?

Output: ARBs

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What has been shown to reduce mortality and HF hospitalizations?. ### Response: ARBs.


Instruction: How many hospitalizations are there in patients with HFr EF in large RCTs?

Output: 134–137

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How many hospitalizations are there in patients with HFr EF in large RCTs?. ### Response: 134–137.


Instruction: What does long-term therapy with ARBs produce?

Output: hemodynamic, neurohormonal, and clinical effects

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What does long-term therapy with ARBs produce?. ### Response: hemodynamic, neurohormonal, and clinical effects.


Instruction: Unlike ACE inhibitors, what does not inhibit kininase?

Output: ARBs

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Unlike ACE inhibitors, what does not inhibit kininase?. ### Response: ARBs.


Instruction: What are ACE inhibitors associated with a much lower incidence of?

Output: blacks and women

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What are ACE inhibitors associated with a much lower incidence of?. ### Response: blacks and women.


Instruction: What may produce beneficial vasodilatory effects?

Output: kininase inhibition by ACE inhibitors

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What may produce beneficial vasodilatory effects?. ### Response: kininase inhibition by ACE inhibitors.


Instruction: Patients intolerant to what should be started on ARBs?

Output: ACE inhibitors

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Patients intolerant to what should be started on ARBs?. ### Response: ACE inhibitors.


Instruction: How is hypertension treated in patients with CAD 1403124?

Output: Rosendorff

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How is hypertension treated in patients with CAD 1403124?. ### Response: Rosendorff.