Instruction: Hi Docs & Medical Community -Coming to you all hear with some saddening news. It's been approximatley six weeks since my partner "attempted" suicide via hanging, and I have had extremely limited information on his current condition due to a variety of factors. These include being a non family-member, and his remaining family being very difficult to work with, less than caring of his current condition, and not being the ideal parents. The background for these are for another subreddit, but I'm happy to divulge any information if you all need more. I will try to be as analytical and non-emotional as I can in this post, as I'm only attempting to gather information from those directly involved in the field, as opposed to my resources of compiling random pages on the internet. Hope you all can help, and if you need any information please ping me.For security reasons, this is a throwaway, but I will be checking the post on my main account routinely and can log back in to answer any questions you all may have. Thank you very much for your help.I made an original post on r/TrueOffMyChest yesterday, that you can find here. It may have some information that may be relevant, although focuses more on my emotional state and less on the actual medical facts.---Patient Information: USA, 25M, 6'0", 192, White, Attempted Suicide Via Hanging - Hypoxic Brain Injury. No exisiting medical issues - daily workouts w/ weightlifting and cardio, very diet and food aware. Current medications include 20mg daily Wellbutrin, started 2-3wks before event happened. Prior to Wellbutrin, 20mg of Prozac daily. Casual smoker (vape-nicotine) and regular alcohol intake (2-3 drinks/mo). No recreational drugs. Past history of mild depression and anxiety, routine therapy. Zero previous suicide attempts or thoughts at self-harm.---The last several weeks have been quite stressful and devastating as you can imagine. There's a lot more to the information-specific side of the story, but the long story short is an abusive, neglectful, and incredibly religious mother, who has cut off her son. She is unwilling to call the hospital for daily updates, and obviously they can't release any information to myself or his friends, as we're not family. We have been able to get some limited information through friends of friends - my partner was a graduate school student in biology, and has many friends who know some individuals who work at the specific hospital he's at and were able to nail down some information. With the exception of yesterday's update, in which my partner's best friend drove to the hospital and used one of his friends there to squeeze some actual information (I'm not sure that's legal, but we are totally in the dark and the only person who has information will not share for her own greed), we know nothing concrete.The information yesterday was helpful in a way. For my full emotions, I can't say I'm any better, but from a purely medical standpoint I'd like some help deciphering it. Again, I understand this is a sticky situation involving HIPPA and legality, so want to be clear that I am not advocating for any unethical or illegal reporting standards. I fully understand the rationale and logistics behind HIPPA and it's protection laws. I hope, from a personal perspective, you all can see how we had to do what we did in order just to learn SOMETHING. I am not a judgemental person, but his mother is subjectively awful for her behavior in the past and now, withholding information and not even picking up half of the hospitals calls regarding updates about her own son. We just have to work with what we have.The reason I bring this up at all is due to the fact I want to stress the 'concrete' nature of the status update yesterday - while all of our other updates have had questionting validity due to them being passed through multiple sets of ears and open to interpetation, this one came directly from the source. Anyways, I will attempt to construe a timeline below:Mid-Feburary: Initial incident occured. I discovered my partner hanging by a constructed noose in his bedroom. While I don't know how long he was cut from oxygen, I know that it was >4min and <11min. If it was closer to 4, I'd assume he'd be awake by now. If it was closer to 11, I figured he may be confirmed brain dead and/or medically dead at this point.I called 911 and began CPR immediatley. 911 was quick response, and from call time to arrival was no more than 3-4 minutes. In this 3-4 minute period, I opened his airway and performed CPR while simeltaneously on the phone. I did not detect a pulse nor breathing, and once the EMTs arrived, they relocated me into another room for comfort & questioning while attending to him in the field. They shocked his heart back from AFIB, and I do not remember them confirming if they restarted his pulse.Late-Feburary: 13 days after event. I have no information. I am called by my attorney (who I called to be safe and attempt to find out more info) to see if he knows anyone who can get any contact update. I have contacted his mother by now who has expressed her disgust for her son and says he is an "unforgiveable sinner" and wishes not to be contacted by me anymore. When my attorney calls, he gives me no information other than "no brain activity." I immediatley assume brain death, and am disheartened (to say the least) at this news. I assume at this point that it is irreversible and he will not wake up.Early-March: Limbo period of no information update. My attorney can only guarentee me that he will have any information if she dies - in which case I will be informed.Through grapvine comprised of partner's close friends, limited information is listed that he has been transferred to a highly-rated neurosurgery hospital, and has been moved from "Critical" to "Critical-Stable". His body is improving, but no update on his brain status and activity. No one knows who authorized the transfer, or if it was done by the State or a hospital administration decision. His mother does not answer my request for comment. Brain activity has gone from "no brain activity" to "little to no brain activity" if that makes a difference - it did not to me, at least not at the time.Late-March/Present: Partner's best friend made the state-crossing drive to his current hospital, which as of yesterday, he is still at and not reported medically dead. Source-based information was relayed as follows: Still in "Critical-Stable" condition, with significant brainstem activity. They would not say if it was a persistent or permanent vegetative state, rather they listed it as a "medically-induced coma to allow the brain to heal." They implied that they COULD wake him up if he wanted, but they were holding off to see if he would have a better response. I'm unclear on what that means. They could not give him an exact date on when he was moved from one "level" of inactivity or trauma to the other, so I cannot confirm that. They said his OFFICIAL condition was "Stable, but Unresponsive" which could mean a number of things. I am optimistic that they have taken away the notion of a sudden brain death, but am trying not to a) get my hopes up, and b) speculate on anything that was not explicitly confirmed.In addition to those updates, they said his vitals were normal, and he had sleep/wake cycles, but no voluntary response to stimulation. Whether this is due to a brain injury or the medically-induced coma or some combination of the two is unknown. While he is still on a ventilator, it was reported that it is no longer breathing FOR him, simply assisting him in his breath. His heart was put on bypass, but is pumping on it's own at the moment. This is the last update I have.---So, here we are. This is a lot of words. I want to state - I don't know how to feel. I'm not writing this post for someone to sit here and tell me it's going to be okay. I know, logically, there is a very small percent change (<5%, if not smaller) of him ever waking up, and a fraction of that small chance of him being "normal" in the sense that he was.My intention with this post is to try and get some real life experience from those who have seen something similar or have an area of expertise in this field. I've read a LOT of things on the internet, some of which make sense, some of which don't, and some of which conflict each other.IF YOU HAVE ANY ADDITIONAL QUESTIONS OR NEED ANY MORE INFORMATION, PLEASE LET ME KNOW. WILL UPDATE AS SOON AS I CAN.---I'm not religious, but ask all of you to send some good thoughts his way. You never know. I know that there are a thousand possibilities of varying severity through this outcome. I'm hoping it's the one that he's happy with.

Output: Thats a very sad and difficult situation, Im so sorry.Im not sure we can help a lot with all this second hand information.The fact that he has a wake/sleep rhythm and triggers the ventilator means that hes not brain dead. The first fact means hes probably moving to (at least) a persistent vegetative state.The chances that he recovers without important disability are slim. Its very hard to predict if this remains in the range of persistent vegetative state or if more consciousness will recover. A next step would be if meaningful communication would be possible.An MRI, EEG and the results of a neurological exam will help inform prognosis, but there still will be significant uncertainty.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hi Docs & Medical Community -Coming to you all hear with some saddening news. It's been approximatley six weeks since my partner "attempted" suicide via hanging, and I have had extremely limited information on his current condition due to a variety of factors. These include being a non family-member, and his remaining family being very difficult to work with, less than caring of his current condition, and not being the ideal parents. The background for these are for another subreddit, but I'm happy to divulge any information if you all need more. I will try to be as analytical and non-emotional as I can in this post, as I'm only attempting to gather information from those directly involved in the field, as opposed to my resources of compiling random pages on the internet. Hope you all can help, and if you need any information please ping me.For security reasons, this is a throwaway, but I will be checking the post on my main account routinely and can log back in to answer any questions you all may have. Thank you very much for your help.I made an original post on r/TrueOffMyChest yesterday, that you can find here. It may have some information that may be relevant, although focuses more on my emotional state and less on the actual medical facts.---Patient Information: USA, 25M, 6'0", 192, White, Attempted Suicide Via Hanging - Hypoxic Brain Injury. No exisiting medical issues - daily workouts w/ weightlifting and cardio, very diet and food aware. Current medications include 20mg daily Wellbutrin, started 2-3wks before event happened. Prior to Wellbutrin, 20mg of Prozac daily. Casual smoker (vape-nicotine) and regular alcohol intake (2-3 drinks/mo). No recreational drugs. Past history of mild depression and anxiety, routine therapy. Zero previous suicide attempts or thoughts at self-harm.---The last several weeks have been quite stressful and devastating as you can imagine. There's a lot more to the information-specific side of the story, but the long story short is an abusive, neglectful, and incredibly religious mother, who has cut off her son. She is unwilling to call the hospital for daily updates, and obviously they can't release any information to myself or his friends, as we're not family. We have been able to get some limited information through friends of friends - my partner was a graduate school student in biology, and has many friends who know some individuals who work at the specific hospital he's at and were able to nail down some information. With the exception of yesterday's update, in which my partner's best friend drove to the hospital and used one of his friends there to squeeze some actual information (I'm not sure that's legal, but we are totally in the dark and the only person who has information will not share for her own greed), we know nothing concrete.The information yesterday was helpful in a way. For my full emotions, I can't say I'm any better, but from a purely medical standpoint I'd like some help deciphering it. Again, I understand this is a sticky situation involving HIPPA and legality, so want to be clear that I am not advocating for any unethical or illegal reporting standards. I fully understand the rationale and logistics behind HIPPA and it's protection laws. I hope, from a personal perspective, you all can see how we had to do what we did in order just to learn SOMETHING. I am not a judgemental person, but his mother is subjectively awful for her behavior in the past and now, withholding information and not even picking up half of the hospitals calls regarding updates about her own son. We just have to work with what we have.The reason I bring this up at all is due to the fact I want to stress the 'concrete' nature of the status update yesterday - while all of our other updates have had questionting validity due to them being passed through multiple sets of ears and open to interpetation, this one came directly from the source. Anyways, I will attempt to construe a timeline below:Mid-Feburary: Initial incident occured. I discovered my partner hanging by a constructed noose in his bedroom. While I don't know how long he was cut from oxygen, I know that it was >4min and <11min. If it was closer to 4, I'd assume he'd be awake by now. If it was closer to 11, I figured he may be confirmed brain dead and/or medically dead at this point.I called 911 and began CPR immediatley. 911 was quick response, and from call time to arrival was no more than 3-4 minutes. In this 3-4 minute period, I opened his airway and performed CPR while simeltaneously on the phone. I did not detect a pulse nor breathing, and once the EMTs arrived, they relocated me into another room for comfort & questioning while attending to him in the field. They shocked his heart back from AFIB, and I do not remember them confirming if they restarted his pulse.Late-Feburary: 13 days after event. I have no information. I am called by my attorney (who I called to be safe and attempt to find out more info) to see if he knows anyone who can get any contact update. I have contacted his mother by now who has expressed her disgust for her son and says he is an "unforgiveable sinner" and wishes not to be contacted by me anymore. When my attorney calls, he gives me no information other than "no brain activity." I immediatley assume brain death, and am disheartened (to say the least) at this news. I assume at this point that it is irreversible and he will not wake up.Early-March: Limbo period of no information update. My attorney can only guarentee me that he will have any information if she dies - in which case I will be informed.Through grapvine comprised of partner's close friends, limited information is listed that he has been transferred to a highly-rated neurosurgery hospital, and has been moved from "Critical" to "Critical-Stable". His body is improving, but no update on his brain status and activity. No one knows who authorized the transfer, or if it was done by the State or a hospital administration decision. His mother does not answer my request for comment. Brain activity has gone from "no brain activity" to "little to no brain activity" if that makes a difference - it did not to me, at least not at the time.Late-March/Present: Partner's best friend made the state-crossing drive to his current hospital, which as of yesterday, he is still at and not reported medically dead. Source-based information was relayed as follows: Still in "Critical-Stable" condition, with significant brainstem activity. They would not say if it was a persistent or permanent vegetative state, rather they listed it as a "medically-induced coma to allow the brain to heal." They implied that they COULD wake him up if he wanted, but they were holding off to see if he would have a better response. I'm unclear on what that means. They could not give him an exact date on when he was moved from one "level" of inactivity or trauma to the other, so I cannot confirm that. They said his OFFICIAL condition was "Stable, but Unresponsive" which could mean a number of things. I am optimistic that they have taken away the notion of a sudden brain death, but am trying not to a) get my hopes up, and b) speculate on anything that was not explicitly confirmed.In addition to those updates, they said his vitals were normal, and he had sleep/wake cycles, but no voluntary response to stimulation. Whether this is due to a brain injury or the medically-induced coma or some combination of the two is unknown. While he is still on a ventilator, it was reported that it is no longer breathing FOR him, simply assisting him in his breath. His heart was put on bypass, but is pumping on it's own at the moment. This is the last update I have.---So, here we are. This is a lot of words. I want to state - I don't know how to feel. I'm not writing this post for someone to sit here and tell me it's going to be okay. I know, logically, there is a very small percent change (<5%, if not smaller) of him ever waking up, and a fraction of that small chance of him being "normal" in the sense that he was.My intention with this post is to try and get some real life experience from those who have seen something similar or have an area of expertise in this field. I've read a LOT of things on the internet, some of which make sense, some of which don't, and some of which conflict each other.IF YOU HAVE ANY ADDITIONAL QUESTIONS OR NEED ANY MORE INFORMATION, PLEASE LET ME KNOW. WILL UPDATE AS SOON AS I CAN.---I'm not religious, but ask all of you to send some good thoughts his way. You never know. I know that there are a thousand possibilities of varying severity through this outcome. I'm hoping it's the one that he's happy with.. ### Response: Thats a very sad and difficult situation, Im so sorry.Im not sure we can help a lot with all this second hand information.The fact that he has a wake/sleep rhythm and triggers the ventilator means that hes not brain dead. The first fact means hes probably moving to (at least) a persistent vegetative state.The chances that he recovers without important disability are slim. Its very hard to predict if this remains in the range of persistent vegetative state or if more consciousness will recover. A next step would be if meaningful communication would be possible.An MRI, EEG and the results of a neurological exam will help inform prognosis, but there still will be significant uncertainty..


Instruction: Age 40 Sex MHeight 6'1 Weight 190 Race W Duration of complaint Week Location Left index Any existing relevant medical issues PsA Current medications Biologic Include a photo if relevantLast weekend when planting a very large agave/century plant, I got three spines in my left index finger. Two I got out (but they hurt for days after -irritant/poisonous?). The third I felt a stick but didn't see a mark and couldn't find anything to remove. All week the finger has been warm, red, stiff, and a bit swollen. No change in a week, though now the first joint is a bit painful when pushing on it. I've got PSA, so used to having stiff hands, but this is a little different.I've held a very bright flashlight to it and cannot see any foreign body under the skin.For sure had DTAP 8yrs ago when my first was born. Not sure since.Go to the GP? Let it ride? If the doc, do they just throw oral antibiotics at it, or is there something more effective?

Output: Missing critical elements of history and no images. You may have an infection and you should seek care. Infections in the hand can be serious.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Age 40 Sex MHeight 6'1 Weight 190 Race W Duration of complaint Week Location Left index Any existing relevant medical issues PsA Current medications Biologic Include a photo if relevantLast weekend when planting a very large agave/century plant, I got three spines in my left index finger. Two I got out (but they hurt for days after -irritant/poisonous?). The third I felt a stick but didn't see a mark and couldn't find anything to remove. All week the finger has been warm, red, stiff, and a bit swollen. No change in a week, though now the first joint is a bit painful when pushing on it. I've got PSA, so used to having stiff hands, but this is a little different.I've held a very bright flashlight to it and cannot see any foreign body under the skin.For sure had DTAP 8yrs ago when my first was born. Not sure since.Go to the GP? Let it ride? If the doc, do they just throw oral antibiotics at it, or is there something more effective?. ### Response: Missing critical elements of history and no images. You may have an infection and you should seek care. Infections in the hand can be serious..


Instruction: 29F, 5'2, 80 something lbs, end stage liver failure etc.This one might be long, but I appreciate any kind of advice or input. I'm concerned my sister has been kind of pushed to the side since COVID19 and she's currently in critical, critical condition despite having been discharged. My family is confused on what to do, how to help her, especially since she's been denied a liver transplant. But anyways, here it goes:On March 5th my sister was found collapsed on her bathroom floor, she was completely yellow. Her boyfriend rushed her to the ER, where he was told to call family (us) because she wouldn't make it. From there she was transferred to a larger hospital, placed in surgical ICU and had a team immediately on her case. At this point her liver was failing, and she had an infection but they didn't know the source nor the bacteria causing it. She couldn't breathe on her own etc. Over the next week they threw all the antibiotics at her hoping something would stick, put a tube in her stomach to drain fluid that had built up around her bladder, put her on 24/7 dialysis since her kidneys began to fail, so many tests ran, I unfortunately can't recall all the details right now but if there are any specific questions I can likely answer.It was very touch and go for a while but her fever had gone away despite never finding out the source of infection. She was tolerating the dialysis and the last day I saw her she looked like she was doing a little bit better. Then COVID-19 hit my state and we were no longer allowed to visit her. Phone updates from the RN told us she was doing better, but they never had any specific information on what specific doctor's were saying, questions we had just weren't getting answered and my sister was unable to tell us what was going on. Within one week, we were told she was well enough to go down to general, despite previously being told she would go down to regular ICU first, and be in the hospital for at the very least a total of 6 weeks. She could breathe (not very well) on her own at this point and could communicate, so the hospital was no longer relaying information to us despite her not being in good enough condition to actually understand what was going on and couldn't remember what doctor's were saying to her. The next day we get a call that she's getting a port placed for out patient dialysis, and she was discharged that same day.We knew she wouldn't be 100% obviously but thought she would be better than she is. She comes home and can't walk, can't breathe very well at all, is completely yellow, is in constant pain and honestly looks like she won't be able to make it much longer. We don't know if she can survive with this liver, she was denied a transplant (whole 'nother story) and despite getting outpatient dialysis she looks worse and worse. She was told she was getting a home care nurse, they aren't coming now. She was supposed to originally be getting PT, they won't come out anymore (honestly don't think she's at that point now anyways). I'm trying to facilitate the care she needs and I'm trying to get her appointments set up but all doctors are only doing video call (completely understand). I'm just so scattered right now and have no idea why she was discharged. Should I take her back? Will they even be able to do anything? I don't understand and I'm just looking for any kind of advice I can get.Edit: The liver failure was precipitated by alcohol abuse and exasperated by the sepsis from her bladder infection. The last we had heard from the transplant team was that she was considered a good candidate (after 3 interviews) despite the alcohol abuse. We got a letter in the mail yesterday stating the denial. I am not trying to negate from the alcohol abuse, that was the reason her liver failed. Just that she also had a lot else going on that led to the condition she is in.

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

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 29F, 5'2, 80 something lbs, end stage liver failure etc.This one might be long, but I appreciate any kind of advice or input. I'm concerned my sister has been kind of pushed to the side since COVID19 and she's currently in critical, critical condition despite having been discharged. My family is confused on what to do, how to help her, especially since she's been denied a liver transplant. But anyways, here it goes:On March 5th my sister was found collapsed on her bathroom floor, she was completely yellow. Her boyfriend rushed her to the ER, where he was told to call family (us) because she wouldn't make it. From there she was transferred to a larger hospital, placed in surgical ICU and had a team immediately on her case. At this point her liver was failing, and she had an infection but they didn't know the source nor the bacteria causing it. She couldn't breathe on her own etc. Over the next week they threw all the antibiotics at her hoping something would stick, put a tube in her stomach to drain fluid that had built up around her bladder, put her on 24/7 dialysis since her kidneys began to fail, so many tests ran, I unfortunately can't recall all the details right now but if there are any specific questions I can likely answer.It was very touch and go for a while but her fever had gone away despite never finding out the source of infection. She was tolerating the dialysis and the last day I saw her she looked like she was doing a little bit better. Then COVID-19 hit my state and we were no longer allowed to visit her. Phone updates from the RN told us she was doing better, but they never had any specific information on what specific doctor's were saying, questions we had just weren't getting answered and my sister was unable to tell us what was going on. Within one week, we were told she was well enough to go down to general, despite previously being told she would go down to regular ICU first, and be in the hospital for at the very least a total of 6 weeks. She could breathe (not very well) on her own at this point and could communicate, so the hospital was no longer relaying information to us despite her not being in good enough condition to actually understand what was going on and couldn't remember what doctor's were saying to her. The next day we get a call that she's getting a port placed for out patient dialysis, and she was discharged that same day.We knew she wouldn't be 100% obviously but thought she would be better than she is. She comes home and can't walk, can't breathe very well at all, is completely yellow, is in constant pain and honestly looks like she won't be able to make it much longer. We don't know if she can survive with this liver, she was denied a transplant (whole 'nother story) and despite getting outpatient dialysis she looks worse and worse. She was told she was getting a home care nurse, they aren't coming now. She was supposed to originally be getting PT, they won't come out anymore (honestly don't think she's at that point now anyways). I'm trying to facilitate the care she needs and I'm trying to get her appointments set up but all doctors are only doing video call (completely understand). I'm just so scattered right now and have no idea why she was discharged. Should I take her back? Will they even be able to do anything? I don't understand and I'm just looking for any kind of advice I can get.Edit: The liver failure was precipitated by alcohol abuse and exasperated by the sepsis from her bladder infection. The last we had heard from the transplant team was that she was considered a good candidate (after 3 interviews) despite the alcohol abuse. We got a letter in the mail yesterday stating the denial. I am not trying to negate from the alcohol abuse, that was the reason her liver failed. Just that she also had a lot else going on that led to the condition she is in.. ### Response: Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification..


Instruction: Ineligible? Its probably the alcohol. Transplant has very strict regulations. I cant believe any transplant team would say shes a good candidate if she lost her liver due to alcohol abuse. Just like with cigarette smokers. You have to quit and show at least 6 months to a year smoke free before you can even get on the list. Its a long process.I had to wait five years after my stomach cancer to get my transplant. So I did my best to follow my diet and restrictions set forth by my nephrologist and dialysis center.Im only speculating, about your situation. Im sorry if any of this sounds harsh.It took 3 years of waiting on the list and finally as my health took a turn for the worse, my ex donated his kidney to me 15 months ago.If she will not comply with the program, theres no reason to transplant a healthy organ in a person who wont stop those destructive behaviors. The restrictions/rules are there for a reason. I had So many moments of pure anger, crying, frustration and hopelessness. But thats normal considering the situation.I AGREE, she needs to be hospitalized. Her dialysis center should be advocating for her. Find out who is the social worker for her clinic and contact them ASAP.Also, did you know that for a liver - you can donate just a portion - it doesnt need to be the entire organ for a successful transplant. You (family) could still get tested while you work with the transplant team to make her eligible.My mom has cirrhosis of the liver & she too was ineligible because she was a heavy smoker and soda drinker. She wouldnt quit. Shes outlived all the doctors predictions. But shes suffered tremendously. I finally got her and my dad to quit about five years ago. Shes still too afraid to have transplant, shes set in her ways. So everyday is sheer hell at this point. Im terrified for her with COVID-19. One person has already died at her assisted facility living.Heres my take on part of the reason she was worse after she came home is most likely the dialysis. Its a new thing for her body. It has to adjust to it slowly over the next few months. Depends on how bad she is. It wrecks havoc on your body. You can have extreme lethargy, dizziness, headaches, nausea and cramping.She has End Stage Liver Disease. She is living with terminal illness. The only real thing besides humor & my kids that helped me cope was educating myself. About my disease, dialysis etc.I am so sorry this is happening. Wishing you both the best in the future to come.

Output: It's hard to tell you what's happening or what to do without more detailed info, although I completely understand that you do not have this information, and this is all exacerbated by the current isolation requirements. If I were you I would be focused on finding someone to talk to who can explain things better to you or her medical power of attorney (which, by the way she should definitely have at this point). Does she have a follow-up appointment with a liver doctor within the next week?What medical problems did your sister have prior to March 5th when she was found down in the bathroom? Do you understand what is the primary source of her liver failure? Most common things are alcohol abuse, hepatitis C, or toxicity from a Tylenol overdose... others have what's called "cryptogenic" liver disease which means "it's a mystery" but these cases usually don't present as rapidly and dramatically. Sometimes even young healthy patients just have really bad luck and get a bad viral hepatitis that leads to fulminant hepatic failure in a very short time span.Reasons for being denied a spot on the transplant list generally fall into one of three categories: 1 - not sick enough yet, 2 - too sick or has other serious other problems that mean even with a transplanted liver she would not survive long enough to benefit from the very scarce resource of a liver donation, and 3 - not eligible due to history of current or recent alcohol or drug abuse.From what you describe it sounds like she was reasonably healthy and has had a sudden dramatic decline in her health which included an ICU stay with multi-organ failure (liver, kidneys). Then at some point she had somewhat "stabilized" enough, although remained in overall poor health due to her illness. At this point she was discharged home with home health, outpatient dialysis, and PT for rehab, but given the current worldwide situation those services are not being very reliable. Pain, weakness, and some shortness of breath are honestly part of her disease and may not (by themselves) warrant re-admission to a hospital... depends on the severity and whether there is any intervention that could be done in a hospital setting to improve her. Perhaps she should have been discharged to a skilled nursing facility, but these have specific requirements which she may not have met. I can speculate all day but without detailed information it is hard to give good answers.I'm sorry for what you and your family are going through - both the fear of your sister's declining health as well as the uncertainty and confusion you are dealing with. I know it must be very frustrating. Like I said above, the most important thing is getting more info. And if she truly is getting sicker and looking worse at home them take her back to the hospital ER. They may or may not readmit her, but at least she would be evaluated and you'd have a chance to talk with someone about her situation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Ineligible? Its probably the alcohol. Transplant has very strict regulations. I cant believe any transplant team would say shes a good candidate if she lost her liver due to alcohol abuse. Just like with cigarette smokers. You have to quit and show at least 6 months to a year smoke free before you can even get on the list. Its a long process.I had to wait five years after my stomach cancer to get my transplant. So I did my best to follow my diet and restrictions set forth by my nephrologist and dialysis center.Im only speculating, about your situation. Im sorry if any of this sounds harsh.It took 3 years of waiting on the list and finally as my health took a turn for the worse, my ex donated his kidney to me 15 months ago.If she will not comply with the program, theres no reason to transplant a healthy organ in a person who wont stop those destructive behaviors. The restrictions/rules are there for a reason. I had So many moments of pure anger, crying, frustration and hopelessness. But thats normal considering the situation.I AGREE, she needs to be hospitalized. Her dialysis center should be advocating for her. Find out who is the social worker for her clinic and contact them ASAP.Also, did you know that for a liver - you can donate just a portion - it doesnt need to be the entire organ for a successful transplant. You (family) could still get tested while you work with the transplant team to make her eligible.My mom has cirrhosis of the liver & she too was ineligible because she was a heavy smoker and soda drinker. She wouldnt quit. Shes outlived all the doctors predictions. But shes suffered tremendously. I finally got her and my dad to quit about five years ago. Shes still too afraid to have transplant, shes set in her ways. So everyday is sheer hell at this point. Im terrified for her with COVID-19. One person has already died at her assisted facility living.Heres my take on part of the reason she was worse after she came home is most likely the dialysis. Its a new thing for her body. It has to adjust to it slowly over the next few months. Depends on how bad she is. It wrecks havoc on your body. You can have extreme lethargy, dizziness, headaches, nausea and cramping.She has End Stage Liver Disease. She is living with terminal illness. The only real thing besides humor & my kids that helped me cope was educating myself. About my disease, dialysis etc.I am so sorry this is happening. Wishing you both the best in the future to come.. ### Response: It's hard to tell you what's happening or what to do without more detailed info, although I completely understand that you do not have this information, and this is all exacerbated by the current isolation requirements. If I were you I would be focused on finding someone to talk to who can explain things better to you or her medical power of attorney (which, by the way she should definitely have at this point). Does she have a follow-up appointment with a liver doctor within the next week?What medical problems did your sister have prior to March 5th when she was found down in the bathroom? Do you understand what is the primary source of her liver failure? Most common things are alcohol abuse, hepatitis C, or toxicity from a Tylenol overdose... others have what's called "cryptogenic" liver disease which means "it's a mystery" but these cases usually don't present as rapidly and dramatically. Sometimes even young healthy patients just have really bad luck and get a bad viral hepatitis that leads to fulminant hepatic failure in a very short time span.Reasons for being denied a spot on the transplant list generally fall into one of three categories: 1 - not sick enough yet, 2 - too sick or has other serious other problems that mean even with a transplanted liver she would not survive long enough to benefit from the very scarce resource of a liver donation, and 3 - not eligible due to history of current or recent alcohol or drug abuse.From what you describe it sounds like she was reasonably healthy and has had a sudden dramatic decline in her health which included an ICU stay with multi-organ failure (liver, kidneys). Then at some point she had somewhat "stabilized" enough, although remained in overall poor health due to her illness. At this point she was discharged home with home health, outpatient dialysis, and PT for rehab, but given the current worldwide situation those services are not being very reliable. Pain, weakness, and some shortness of breath are honestly part of her disease and may not (by themselves) warrant re-admission to a hospital... depends on the severity and whether there is any intervention that could be done in a hospital setting to improve her. Perhaps she should have been discharged to a skilled nursing facility, but these have specific requirements which she may not have met. I can speculate all day but without detailed information it is hard to give good answers.I'm sorry for what you and your family are going through - both the fear of your sister's declining health as well as the uncertainty and confusion you are dealing with. I know it must be very frustrating. Like I said above, the most important thing is getting more info. And if she truly is getting sicker and looking worse at home them take her back to the hospital ER. They may or may not readmit her, but at least she would be evaluated and you'd have a chance to talk with someone about her situation..


Instruction: Thank you so much for this thoughtful reply, I'll try to clarify on some of the things you mentioned. I'll try to be as concise as possible.The cause for the liver failure is alcohol abuse, unfortunately.2 weeks prior to March 5th I saw my sister and she looked healthy. She had been complaining about UTI pain and she told me she saw a doctor and got antibiotics, I told her she needed to go back if she's in pain still since it could spread to her kidneys and she said she would. She never did either of those things, so that bladder infection I'm sure, is a result of a long standing infection. She didn't look jaundice two weeks prior, she has always been a drinker, however until this happened unfortunately I don't think anyone (in the family) knew just how bad it got. Apparently she was drinking very very heavily the week/2 weeks prior to collapsing. We didn't hear much from her the week prior to the hospital, her boyfriend told us she was trying to kick alcohol and wasn't feeling well. I honestly can't tell you exactly how things got to the point that they did, as she was living with her boyfriend at the time. I certainly have my own questions as to why it took her collapsing on the floor yellow as you wouldn't believe for him to get her to the hospital... But that's another story and something I'm trying to think about right now.I'm guessing her reason for not getting a spot on the transplant list is either due to your #2 or #3. We were assured when they first started speaking to us that alcoholics are eligible for liver transplants if they feel they are a good candidate, and they thought she was. We went through 3 separate interviews. We just got the news she was denied via letter in the mail just yesterday.She has a follow-up appointment via video call with a liver doctor on Wednesday.I've talked to my mom today about how we need to set up a POA. We didn't think she was going to make it while she was in the hospital/when we could still visit, so while my mom was acting as her advocate, nothing legal has been set up yet. I agree, that needs to be done asap.I forgot a couple things in my original post about how she was considered to have sepsis due to the infection, and she had aspiration pneumonia. Not sure if that's relevant at this point. I'm just taking with my mom rn were trying to make sure we're including as much info as we can remember.Your summary sounds very much on point, and that's kind of where I'm at. Do we take her to the ER? Do we wait until her video call on Wednesday? I can't figure out why she was discharged, and I don't feel like we were armed with enough information about her current condition before she was discharged and were confused on what to expect, what were working with, etc. She's currently in a lot of pain, she's not very alert today, she does have dialysis tomorrow. I'm just so confused lol.Thank you for your help, I'm trying to prepare for what my next move is going to be, everything has been so confusing having COVID19 thrown ontop of all of this. I do feel like this lack of communication wouldn't have happened before all of this, and it's just been confusing trying to figure it all out. She came back to us very very sick, and I just have so many questions.

Output: Sorry that you and your sister are in this situation, but for this extra information and the long standing alcohol dependency/usage, it sounds like she was denied on that basis. Yes, there are circumstances that can alcoholics can get listed but transplants are reserved for candidates that can make use of their own life and the life of the person whose liver is being transplanted. In other words, it isn't just her life that they are considering. The decision to offer or deny someone a transplant is not a light decision, it involves a whole committee that looks at all aspects of the patient being considered. They look at the usual age, sex and medical history, but also socioencomic history, psychiatric, social structure and support. They usually require a certain number of months of sobriety and vigorous compliance to AA, follow-ups, medications, etc before they can seriously consider any candidate as there is nothing worse than transplanting someone, and that person end up going back to old habits, get lost to follow-up and wasting a healthy transplant that could have gone to someone else. However, just because she was denied now, does not mean she cannot become eligible later.Long standing alcohol consumption can lead to eventual liver failure, and any binges on top of that can throw someone into fulminant hepatic failure and the resultant complications, which sounds like the situation your sister is going through.Unfortunately, she is very, very, very sick and her condition is unlikely to improve dramatically, and she will have more setbacks along the way or she may have an abrupt decline, even while waiting for a transplant. Failed livers have a very high chance of more bad things happening, even with the best therapies and intent. If she is not doing well, such as she is having increased confusion, or unable to be aroused, fevers, gastrointestinal bleeding, I would bring her back to the ER where they evaluated her for transplant (the large hospital, sounds like an academic hospital), if you can. If she cannot make it to the hospital where the transplant evaluation is possible, the closest ER will do, they can stabilize her and decide what to do once she is stable.Hoping for the best! Let us know if you have any more questions.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much for this thoughtful reply, I'll try to clarify on some of the things you mentioned. I'll try to be as concise as possible.The cause for the liver failure is alcohol abuse, unfortunately.2 weeks prior to March 5th I saw my sister and she looked healthy. She had been complaining about UTI pain and she told me she saw a doctor and got antibiotics, I told her she needed to go back if she's in pain still since it could spread to her kidneys and she said she would. She never did either of those things, so that bladder infection I'm sure, is a result of a long standing infection. She didn't look jaundice two weeks prior, she has always been a drinker, however until this happened unfortunately I don't think anyone (in the family) knew just how bad it got. Apparently she was drinking very very heavily the week/2 weeks prior to collapsing. We didn't hear much from her the week prior to the hospital, her boyfriend told us she was trying to kick alcohol and wasn't feeling well. I honestly can't tell you exactly how things got to the point that they did, as she was living with her boyfriend at the time. I certainly have my own questions as to why it took her collapsing on the floor yellow as you wouldn't believe for him to get her to the hospital... But that's another story and something I'm trying to think about right now.I'm guessing her reason for not getting a spot on the transplant list is either due to your #2 or #3. We were assured when they first started speaking to us that alcoholics are eligible for liver transplants if they feel they are a good candidate, and they thought she was. We went through 3 separate interviews. We just got the news she was denied via letter in the mail just yesterday.She has a follow-up appointment via video call with a liver doctor on Wednesday.I've talked to my mom today about how we need to set up a POA. We didn't think she was going to make it while she was in the hospital/when we could still visit, so while my mom was acting as her advocate, nothing legal has been set up yet. I agree, that needs to be done asap.I forgot a couple things in my original post about how she was considered to have sepsis due to the infection, and she had aspiration pneumonia. Not sure if that's relevant at this point. I'm just taking with my mom rn were trying to make sure we're including as much info as we can remember.Your summary sounds very much on point, and that's kind of where I'm at. Do we take her to the ER? Do we wait until her video call on Wednesday? I can't figure out why she was discharged, and I don't feel like we were armed with enough information about her current condition before she was discharged and were confused on what to expect, what were working with, etc. She's currently in a lot of pain, she's not very alert today, she does have dialysis tomorrow. I'm just so confused lol.Thank you for your help, I'm trying to prepare for what my next move is going to be, everything has been so confusing having COVID19 thrown ontop of all of this. I do feel like this lack of communication wouldn't have happened before all of this, and it's just been confusing trying to figure it all out. She came back to us very very sick, and I just have so many questions.. ### Response: Sorry that you and your sister are in this situation, but for this extra information and the long standing alcohol dependency/usage, it sounds like she was denied on that basis. Yes, there are circumstances that can alcoholics can get listed but transplants are reserved for candidates that can make use of their own life and the life of the person whose liver is being transplanted. In other words, it isn't just her life that they are considering. The decision to offer or deny someone a transplant is not a light decision, it involves a whole committee that looks at all aspects of the patient being considered. They look at the usual age, sex and medical history, but also socioencomic history, psychiatric, social structure and support. They usually require a certain number of months of sobriety and vigorous compliance to AA, follow-ups, medications, etc before they can seriously consider any candidate as there is nothing worse than transplanting someone, and that person end up going back to old habits, get lost to follow-up and wasting a healthy transplant that could have gone to someone else. However, just because she was denied now, does not mean she cannot become eligible later.Long standing alcohol consumption can lead to eventual liver failure, and any binges on top of that can throw someone into fulminant hepatic failure and the resultant complications, which sounds like the situation your sister is going through.Unfortunately, she is very, very, very sick and her condition is unlikely to improve dramatically, and she will have more setbacks along the way or she may have an abrupt decline, even while waiting for a transplant. Failed livers have a very high chance of more bad things happening, even with the best therapies and intent. If she is not doing well, such as she is having increased confusion, or unable to be aroused, fevers, gastrointestinal bleeding, I would bring her back to the ER where they evaluated her for transplant (the large hospital, sounds like an academic hospital), if you can. If she cannot make it to the hospital where the transplant evaluation is possible, the closest ER will do, they can stabilize her and decide what to do once she is stable.Hoping for the best! Let us know if you have any more questions..


Instruction: Not the OP but have seen plenty of cases of 'young' alcoholics with severe or fulminant liver failure. I've also seen plenty of much older alcoholics who don't develop any of the usually associated diseases. It's a bit unpredictable but generally someone who develops severe disease at a young age will have been drinking a very significant amount over a sustained period of time. And some people are particularly vulnerable to disease unfortunately.

Output: The degree of liver damage related to alcohol can definitely vary person to person, and probably has a genetic component to it. Just like some people can smoke their whole life and not get lung cancer, some people can drink and not develop cirrhosis (I don't recommend anyone try this). Those cases are the exception to the rule. Smoking and alcohol generally have a dose dependent insult to the respective organs.But definitely have seen early 20s in full liver failure and die, related to alcohol. Some might argue that the developing liver during childhood are more prone to alcohol-related damage.Wow you and your family are really having a terrible month. You seem very calm and reasoned despite the fear and chaos going on. In any family facing these kinds of ordeals it is always very helpful to have someone like you who can rationally absorb information and help others understand.Things that you should "go to the ER now" for would be an altered mental status to the point of near unconsciousness even when you try and speak to her, unbearable pain that is worsening, fevers, significant breathing difficulty (a very rapid respiratory rate like 30+ times per minute or otherwise looks like she is "getting tired" of breathing), a rapid expansion of her swollen belly, or if she cannot do simple tasks of daily living like drinking water or using the restroom on her own. If she is not quite that bad I think it is likely safe to take her to dialysis tomorrow. The dialysis nurses will have a keen eye for patients who are too sick to be at the outpatient center, if they don't seem particularly concerned about her and she tolerates dialysis well then I think she can go back home and await the hepatology appointment / video call on Wednesday. Hopefully you will have much more information after that and can then come up with a plan for the future.Patients with alcoholic liver disease do indeed received transplants all the time. Just because she was not a candidate once does not necessarily mean she never will be. For liver failure caused by alcohol or drug abuse, most donor networks will require abstinence for some period of time (usually several months at a minimum)... but it also sounds like she needs quite a bit of "medical optimization" before she would be well enough to undergo a liver transplant anyway. She needs to recuperate and heal from her infection more and keep taking all the liver failure medications they prescribe. They may also be waiting for her kidneys to hopefully recover some. Hopefully in another week or two she is feeling a bit better and stronger... once she is able to she should strongly consider some kind of addiction recovery program (there are many free ones as well as ones covered by most insurance companies).My very best to her and your family.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Not the OP but have seen plenty of cases of 'young' alcoholics with severe or fulminant liver failure. I've also seen plenty of much older alcoholics who don't develop any of the usually associated diseases. It's a bit unpredictable but generally someone who develops severe disease at a young age will have been drinking a very significant amount over a sustained period of time. And some people are particularly vulnerable to disease unfortunately.. ### Response: The degree of liver damage related to alcohol can definitely vary person to person, and probably has a genetic component to it. Just like some people can smoke their whole life and not get lung cancer, some people can drink and not develop cirrhosis (I don't recommend anyone try this). Those cases are the exception to the rule. Smoking and alcohol generally have a dose dependent insult to the respective organs.But definitely have seen early 20s in full liver failure and die, related to alcohol. Some might argue that the developing liver during childhood are more prone to alcohol-related damage.Wow you and your family are really having a terrible month. You seem very calm and reasoned despite the fear and chaos going on. In any family facing these kinds of ordeals it is always very helpful to have someone like you who can rationally absorb information and help others understand.Things that you should "go to the ER now" for would be an altered mental status to the point of near unconsciousness even when you try and speak to her, unbearable pain that is worsening, fevers, significant breathing difficulty (a very rapid respiratory rate like 30+ times per minute or otherwise looks like she is "getting tired" of breathing), a rapid expansion of her swollen belly, or if she cannot do simple tasks of daily living like drinking water or using the restroom on her own. If she is not quite that bad I think it is likely safe to take her to dialysis tomorrow. The dialysis nurses will have a keen eye for patients who are too sick to be at the outpatient center, if they don't seem particularly concerned about her and she tolerates dialysis well then I think she can go back home and await the hepatology appointment / video call on Wednesday. Hopefully you will have much more information after that and can then come up with a plan for the future.Patients with alcoholic liver disease do indeed received transplants all the time. Just because she was not a candidate once does not necessarily mean she never will be. For liver failure caused by alcohol or drug abuse, most donor networks will require abstinence for some period of time (usually several months at a minimum)... but it also sounds like she needs quite a bit of "medical optimization" before she would be well enough to undergo a liver transplant anyway. She needs to recuperate and heal from her infection more and keep taking all the liver failure medications they prescribe. They may also be waiting for her kidneys to hopefully recover some. Hopefully in another week or two she is feeling a bit better and stronger... once she is able to she should strongly consider some kind of addiction recovery program (there are many free ones as well as ones covered by most insurance companies).My very best to her and your family..


Instruction: Father, white male, 73 Approx 170, 58 Date of onset 2015My father is currently in a nursing home with the diagnosis of dementia. What is odd about this is that the dementia was sudden onset. The first thing that happened was that my father had an episode they called syncope in December of 2015. He fell down and according to my mother he appeared to seize up. My father is a poor historian since all this and my mother as well so I have to relay this as my memory serves and as she told me so some pieces are missing and some things may be confused.After the syncope episode he did go to the hospital. I am not sure what treatment he started at that time. I believe he had a work up for stroke and seizures and it was negative. In the subsequent months/years my father began to become obsessed with checking his blood pressure. BP readings were not abnormal at this time but he was convinced something was wrong with him. In the medical records it was documented that my father stated something is wrong. That was the last time my father was ever somewhat normal. He lost interest in his usual interests. He appeared quiet and withdrawn. I believe at this time he was taking medication for high blood pressure, prostate medication, cholesterols meds, and Zoloft.My father deteriorated badly enough that he was especially confused one night. My mother and I were concerned enough to take him to the ER. He had severe hyponatremia. I believe his sodium was in the critical range. He had a long hospital course. I believe the hospital corrected the hyponatremia carefully and slowly and I do not find fault with them over this. During the hospital stay my dads heart went bradycardic and he coded. He had to receive a pace maker.After they corrected the sodium my dad never came out of the confusion. He underwent so many work ups to see why he was experiencing the confusion. All the scans, PET scan, blood tests were negative for anything that would explain the confusion.My dad came home with the pacemaker and remained confused. He remained with a flat affect. Loss of interest in hobbies. Diagnosed with dementia at this point. The doctors couldnt explain why a sudden onset of dementia but said this wasnt the usual presentation.Sometime after this my dad had an episode of status epilepticus and went to the hospital. He was placed on a seizure medication at this time. I dont know which one but I can tell you that after he began seizure treatment his personality returned. He improved somewhat.After this he began to deteriorate to the point of not being able to use the restroom in his own. He started wearing diapers. He became bedridden. My mother decided to place him in a nursing home. He recognizes family but isnt oriented to time and space. I do know he began mirtazapine around this time. I was hopeful this would improve his condition if it were not truly dementia. I believe its been about a year since and my dad remains confused. Hes still wheelchair bound.I read promising studies regarding mirtazipine but as time goes on Im not hopeful he doesnt have dementia. Im posting this in hopes anyone can provide any insight over my dads case. My hopes are that he had pseudo dementia.Ill add that all of his care was provided by the VA. We never accused them of any wrong doing. His primary care doctor and neurologist no longer work at the hospital. They asked us repeatedly if my dad was an alcoholic. We would ask why he seemingly developed dementia overnight and they would ask us if he were an alcoholic. My dad was a heavy drinker at times but we didnt feel like alcohol contributed to anything so said no. I know from working in GI that if someone is an alcoholic its hard to hide from a proper work up. Its possible my dad drank more than I knew and its possible that he truly did have dementia but hid it. I guess my question is does this sound like true dementia? Is there anything else that can be ruled out?

Output: You say sudden, but it sounds like this has been slowly progressive now for almost 6 years, not overnight. That's a fairly typical course for Alzheimer's disease, with initial loss of memory, later urinary incontinence and more global confusion, and later loss of mobility and total impairment. Pseudodementia has particular findings on assessment that indicate for or against; one element is depression. Your father has been on antidepressants, but it's not really clear, at least to me, what depressive symptoms he has had other apathy and loss of affect.But other things don't fit. Neither pseudodementia nor Alzheimer's dementia present with seizures. Severe hyponatremia can, but that would need a workup and cause. Sometimes the cause is brain injury causing syndrome of inappropriate antidiuretic hormone (SIADH), which lowers sodium, which can cause seizures, but it's still not obvious why the first episode of syncope. Eventually severe bradycardia requiring a pacemaker, but not initially?Timing and type of head imaging makes a difference. With the the triad of dementia, incontinence, and now loss of mobility, has there been any discussion of normal pressure hydrocephalus? It would usually be picked up, or at least suspicion identified on CT at some point, but it partially fits and should at least have been ruled out.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Father, white male, 73 Approx 170, 58 Date of onset 2015My father is currently in a nursing home with the diagnosis of dementia. What is odd about this is that the dementia was sudden onset. The first thing that happened was that my father had an episode they called syncope in December of 2015. He fell down and according to my mother he appeared to seize up. My father is a poor historian since all this and my mother as well so I have to relay this as my memory serves and as she told me so some pieces are missing and some things may be confused.After the syncope episode he did go to the hospital. I am not sure what treatment he started at that time. I believe he had a work up for stroke and seizures and it was negative. In the subsequent months/years my father began to become obsessed with checking his blood pressure. BP readings were not abnormal at this time but he was convinced something was wrong with him. In the medical records it was documented that my father stated something is wrong. That was the last time my father was ever somewhat normal. He lost interest in his usual interests. He appeared quiet and withdrawn. I believe at this time he was taking medication for high blood pressure, prostate medication, cholesterols meds, and Zoloft.My father deteriorated badly enough that he was especially confused one night. My mother and I were concerned enough to take him to the ER. He had severe hyponatremia. I believe his sodium was in the critical range. He had a long hospital course. I believe the hospital corrected the hyponatremia carefully and slowly and I do not find fault with them over this. During the hospital stay my dads heart went bradycardic and he coded. He had to receive a pace maker.After they corrected the sodium my dad never came out of the confusion. He underwent so many work ups to see why he was experiencing the confusion. All the scans, PET scan, blood tests were negative for anything that would explain the confusion.My dad came home with the pacemaker and remained confused. He remained with a flat affect. Loss of interest in hobbies. Diagnosed with dementia at this point. The doctors couldnt explain why a sudden onset of dementia but said this wasnt the usual presentation.Sometime after this my dad had an episode of status epilepticus and went to the hospital. He was placed on a seizure medication at this time. I dont know which one but I can tell you that after he began seizure treatment his personality returned. He improved somewhat.After this he began to deteriorate to the point of not being able to use the restroom in his own. He started wearing diapers. He became bedridden. My mother decided to place him in a nursing home. He recognizes family but isnt oriented to time and space. I do know he began mirtazapine around this time. I was hopeful this would improve his condition if it were not truly dementia. I believe its been about a year since and my dad remains confused. Hes still wheelchair bound.I read promising studies regarding mirtazipine but as time goes on Im not hopeful he doesnt have dementia. Im posting this in hopes anyone can provide any insight over my dads case. My hopes are that he had pseudo dementia.Ill add that all of his care was provided by the VA. We never accused them of any wrong doing. His primary care doctor and neurologist no longer work at the hospital. They asked us repeatedly if my dad was an alcoholic. We would ask why he seemingly developed dementia overnight and they would ask us if he were an alcoholic. My dad was a heavy drinker at times but we didnt feel like alcohol contributed to anything so said no. I know from working in GI that if someone is an alcoholic its hard to hide from a proper work up. Its possible my dad drank more than I knew and its possible that he truly did have dementia but hid it. I guess my question is does this sound like true dementia? Is there anything else that can be ruled out?. ### Response: You say sudden, but it sounds like this has been slowly progressive now for almost 6 years, not overnight. That's a fairly typical course for Alzheimer's disease, with initial loss of memory, later urinary incontinence and more global confusion, and later loss of mobility and total impairment. Pseudodementia has particular findings on assessment that indicate for or against; one element is depression. Your father has been on antidepressants, but it's not really clear, at least to me, what depressive symptoms he has had other apathy and loss of affect.But other things don't fit. Neither pseudodementia nor Alzheimer's dementia present with seizures. Severe hyponatremia can, but that would need a workup and cause. Sometimes the cause is brain injury causing syndrome of inappropriate antidiuretic hormone (SIADH), which lowers sodium, which can cause seizures, but it's still not obvious why the first episode of syncope. Eventually severe bradycardia requiring a pacemaker, but not initially?Timing and type of head imaging makes a difference. With the the triad of dementia, incontinence, and now loss of mobility, has there been any discussion of normal pressure hydrocephalus? It would usually be picked up, or at least suspicion identified on CT at some point, but it partially fits and should at least have been ruled out..


Instruction: Based on the history you give I would be very surprised if he had not had imaging of his head either CT or MRI and this would certainly have identified if normal pressure hydrocephalus was the cause of his symptoms and this is important to rule out as if identified early it is treatable.It does actually sound pretty good for a history of dementia and I was unclear from your history whether he had in fact had a stroke as this can sometimes lead to a form of dementia known as vascular dementia which is common but presents slightly differently to the more common Alzheimers dementia. In vascular dementia the progression of symptoms tends to be step wise with sudden deteriorations followed by a plateauing of symptoms and then further sudden decline. In Alzheimers the decline tends to be more of a slow and subtle deterioration. You can actually develop seizures with Alzheimers disease which can develop relatively early in the disease but they can be treated with anti epileptics.Dementia cannot explain the hyponatraemia though; however from the history there are 2 common causes for hyponatraemia. Firstly your father was being treated for hypertension and quite a few of the medications used to treat high blood pressure can cause hyponatraemia. This increases if people are on multiple agents to reduce blood pressure and diuretics tend to be the worst but ACEi and ARBs also cause it. Secondly there seems to be some suggestion of alcohol use and at times you say your father was a heavy drinker. Alcohol particularly if drinking over recommended safe limits can also cause hyponatraemia as well as seizures. It is also a risk factor for developing Alzheimers disease and can actually cause a rarer form of dementia known as wernicke-korsakoff syndrome; although from the description you give I suspect this is unlikely to be the cause.

Output: Its not uncommon for people to say what youre saying, which is they are shocked at how rapidly a person can deteriorate. I hear it all. The. Time. And its totally understandable.The reality is he was slowly deteriorating before that episode, and you didnt notice it. People with early dementia are good st hiding it. We as doctors get used to picking up on the small signs but family doesnt always realize it. Ask them to recall something very specific, and they cant. But they keep light happy conversation very well. And they always seem happy and they say things are going well. In reality they dont remember much.Then something happens. They get sick with whatever and family is shocked at how it becomes full blown dementia. This is classic presentation for a UTI in the elderly. Something that little can make them completely confused.I suspect that was going on for him. You said he had a heart attack, his brain may have not gotten enough oxygen for a short but also, and that can cause permanent damage. You touched on sodium, Im sure you know correcting that has potential downsides as well.Regardless of what caused it, it is what it is now. Outside of it being one of his medications causing it, I suspect theres nothing you can do. Theres some medications they use to treat it, Im not familiar with them.Sorry youre dealing with this. Its hard to watch someone slowly slip away. Make sure youre taking care of yourself, a therapist can help often. And reading up on how to deal with dementia patients is helpful also, theres lots of small things to do that make both of your time together better

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Based on the history you give I would be very surprised if he had not had imaging of his head either CT or MRI and this would certainly have identified if normal pressure hydrocephalus was the cause of his symptoms and this is important to rule out as if identified early it is treatable.It does actually sound pretty good for a history of dementia and I was unclear from your history whether he had in fact had a stroke as this can sometimes lead to a form of dementia known as vascular dementia which is common but presents slightly differently to the more common Alzheimers dementia. In vascular dementia the progression of symptoms tends to be step wise with sudden deteriorations followed by a plateauing of symptoms and then further sudden decline. In Alzheimers the decline tends to be more of a slow and subtle deterioration. You can actually develop seizures with Alzheimers disease which can develop relatively early in the disease but they can be treated with anti epileptics.Dementia cannot explain the hyponatraemia though; however from the history there are 2 common causes for hyponatraemia. Firstly your father was being treated for hypertension and quite a few of the medications used to treat high blood pressure can cause hyponatraemia. This increases if people are on multiple agents to reduce blood pressure and diuretics tend to be the worst but ACEi and ARBs also cause it. Secondly there seems to be some suggestion of alcohol use and at times you say your father was a heavy drinker. Alcohol particularly if drinking over recommended safe limits can also cause hyponatraemia as well as seizures. It is also a risk factor for developing Alzheimers disease and can actually cause a rarer form of dementia known as wernicke-korsakoff syndrome; although from the description you give I suspect this is unlikely to be the cause.. ### Response: Its not uncommon for people to say what youre saying, which is they are shocked at how rapidly a person can deteriorate. I hear it all. The. Time. And its totally understandable.The reality is he was slowly deteriorating before that episode, and you didnt notice it. People with early dementia are good st hiding it. We as doctors get used to picking up on the small signs but family doesnt always realize it. Ask them to recall something very specific, and they cant. But they keep light happy conversation very well. And they always seem happy and they say things are going well. In reality they dont remember much.Then something happens. They get sick with whatever and family is shocked at how it becomes full blown dementia. This is classic presentation for a UTI in the elderly. Something that little can make them completely confused.I suspect that was going on for him. You said he had a heart attack, his brain may have not gotten enough oxygen for a short but also, and that can cause permanent damage. You touched on sodium, Im sure you know correcting that has potential downsides as well.Regardless of what caused it, it is what it is now. Outside of it being one of his medications causing it, I suspect theres nothing you can do. Theres some medications they use to treat it, Im not familiar with them.Sorry youre dealing with this. Its hard to watch someone slowly slip away. Make sure youre taking care of yourself, a therapist can help often. And reading up on how to deal with dementia patients is helpful also, theres lots of small things to do that make both of your time together better.


Instruction: What are permanent treatments for sleep apnea? Due to the fact that obstructive sleep apnea is the result of anatomical characteristics, the question of a permanent cure is complicated to answer. You can definitely do a home sleep apnea test to be sure if you have it or not. Ongoing, sleep apnea may be treated by a CPAP machine or an oral appliance. A CPAP is worn nightly and works by opening up the airway with air pressure. CPAP is effective for the treatment of sleep apnea, but many patients find it difficult or impossible to tolerate. Continuous Positive Airway Pressure machines are machines in which doctors give the nasal mask to the patients that provides continuous air pressure, which opens the blockage in the passage that was causing obstructive sleep apnea. As a result, the patients can easily breathe, and they dont feel any breathing sensation or apnea. Due to this, the patient sleeps well with no snoring, and they wake up fresh in the morning. So this treatment is a very important treatment; however, patients first dont understand this, but once they start using it, they start noticing some changes. They feel active because earlier the sleep, which was not complete or used to be in fragments, you were waking up in between, and you were not aware of it, but now that sleep is complete, the patients feel much better. In addition, if people say that they will ignore it and say they dont need these machines, they will bring complications. Because if you are short of breath and there is less oxygen supply of blood to the organs of the body. There is the possibility of having a heart attack very much; if one has diabetes, then it may get uncontrolled; if someone has BP, then it may get uncontrolled, there is a chance of stroke. Also, the other life-threatening disease may get fatal because of obstructive sleep apnea. So it is very important to identify obstructive sleep apnea, get it diagnosed, get treatment, and, if needed, use a CPAP machine, which is very important for your life. So if you do these things along with lifestyle modification like early dinner. Few exercises can be done, such as walking, working on weight reduction and looking at your health benefits to reduce the use of CPAP machines. In this video, our SimpliHealth expert, Dr. Preeti Sharma Senior consultant Pulmonology and Critical Care at Apollo clinic Chandigarh explains the diagnosis and treatment of obstructive sleep apnea. https://www.youtube.com/watch?v=-GhgspGvrQY

Output: There isn't a permanent treatment for OSA. There are many treatments for OSA with various indications and various treatment success. CPAP is the most widely applicable with the most consistently positive outcomes. Oral appliances can improve symptoms and in some people normalize their overnight obstructive events, but doesn't have as good long term outcomes as CPAP. Some people may benefit from a surgery where their jaw is moved forward, but it only applies to certain people when their jaw is set very posteriorly. There are also hypoglossal nerve stimulators, but are effective in only certain instances of OSA in which the airway closes in a certain pattern.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What are permanent treatments for sleep apnea? Due to the fact that obstructive sleep apnea is the result of anatomical characteristics, the question of a permanent cure is complicated to answer. You can definitely do a home sleep apnea test to be sure if you have it or not. Ongoing, sleep apnea may be treated by a CPAP machine or an oral appliance. A CPAP is worn nightly and works by opening up the airway with air pressure. CPAP is effective for the treatment of sleep apnea, but many patients find it difficult or impossible to tolerate. Continuous Positive Airway Pressure machines are machines in which doctors give the nasal mask to the patients that provides continuous air pressure, which opens the blockage in the passage that was causing obstructive sleep apnea. As a result, the patients can easily breathe, and they dont feel any breathing sensation or apnea. Due to this, the patient sleeps well with no snoring, and they wake up fresh in the morning. So this treatment is a very important treatment; however, patients first dont understand this, but once they start using it, they start noticing some changes. They feel active because earlier the sleep, which was not complete or used to be in fragments, you were waking up in between, and you were not aware of it, but now that sleep is complete, the patients feel much better. In addition, if people say that they will ignore it and say they dont need these machines, they will bring complications. Because if you are short of breath and there is less oxygen supply of blood to the organs of the body. There is the possibility of having a heart attack very much; if one has diabetes, then it may get uncontrolled; if someone has BP, then it may get uncontrolled, there is a chance of stroke. Also, the other life-threatening disease may get fatal because of obstructive sleep apnea. So it is very important to identify obstructive sleep apnea, get it diagnosed, get treatment, and, if needed, use a CPAP machine, which is very important for your life. So if you do these things along with lifestyle modification like early dinner. Few exercises can be done, such as walking, working on weight reduction and looking at your health benefits to reduce the use of CPAP machines. In this video, our SimpliHealth expert, Dr. Preeti Sharma Senior consultant Pulmonology and Critical Care at Apollo clinic Chandigarh explains the diagnosis and treatment of obstructive sleep apnea. https://www.youtube.com/watch?v=-GhgspGvrQY. ### Response: There isn't a permanent treatment for OSA. There are many treatments for OSA with various indications and various treatment success. CPAP is the most widely applicable with the most consistently positive outcomes. Oral appliances can improve symptoms and in some people normalize their overnight obstructive events, but doesn't have as good long term outcomes as CPAP. Some people may benefit from a surgery where their jaw is moved forward, but it only applies to certain people when their jaw is set very posteriorly. There are also hypoglossal nerve stimulators, but are effective in only certain instances of OSA in which the airway closes in a certain pattern..


Instruction: My son is 5 weeks old, I am not sure of his height right now but he weighs 9lbs 4oz. his medical history is complex and I believe it is valuable information so I will start with that..When my son was exactly 1 week old we went to his first pediatrician appointment, they noticed he was looking a bit yellow so they did a bilirubin test the levels came back critically high (21). We were immediately brought back to the hospital and they started him on bili lights however they never tested his bilirubin before we discharged from the hospital I had him at, so we truly dont know how long his levels were that bad. We are RH incompatible so I am certain thats probably what caused the really high biliWhile hospitalized for the bilirubin, we quickly noticed our son was having problems breathing. He was holding his breath for pretty long periods of time. A nurse told us at one point that his respiration rate was only 14.. he was having desaturations and bradycardia with this so he was quickly life flighted to a hospital that was better equipped for this situation. Our son spent 1 night in the NICU and then 9 days in the special care unit. It took him EXACTLY 48 hours to have another breathing episode at this hospital. He was life flighted at 10 pm and then 48 hours later at exactly 10 pm he started having issues again. They did a 1 hour EEG and told us there was nothing substantial And that they didnt find it necessary to do a 24 hour EEG. they decided to try Pepcid 0.2mg because they started to think this was reflux related. At the same time they started the Pepcid he stopped having these breathing episodes. They did not run any further testing and just stated that he was having reflux and was holding his breath because of the acid coming up.My son is now 5 weeks old. We were home for less than 2 weeks and we are now hospitalized again. On Wednesday around 3:30pm our son had what looked to be seizures. His eyes were looking to the left, they were sort of vibrating rhythmically in small side to side movements (not across the entire eye. They stayed looking to the left but kind of vibrated??), and he was unresponsive. We snapped in his face and tapped on him, talked to him and everything and he just was not responsive. He ended up doing this 3 times back to back. Each episode would last about 30 seconds with a 1-3 minute break between each of them. We took a video of it and showed it to our pediatrician who immediately told us with certainty that our son was having seizures. He was admitted to the hospital that night.. they did blood work and did find his electrolytes slightly out of normal ranges, however just a few hours later when they repeated the labs he was back to a healthy range and I was told that couldve happened because of the IV fluids he was on..Once again, our pediatrician made the call to send him out to a better equipped hospital. They sent him to a childrens mercy he was there for 24 hours on an EEG which they did not find anything on.. they told me hes not having seizures and that this movement is normal Im sorry but I truly dont think this is normal. Ive never seen a baby do this and our pediatrician found it alarming enough to send him out to childrens.. our pediatrician has 30 years of experience. Hes a smart guyChildrens mercy discharged us with no answers. We begged them to run more tests or consult with a neonatologist and they refused we left that hospital and went to another one in the area that is well known for their high quality PICU & NICU. we went in and showed them the video.. the nurologist that watched the video said he also does not think this is seizures, however he doesnt think its normal.. right now the plan is to do an MRI tomorrow. In the past he has only had CT scans done, but nothing was found on them..I am absolutely desperate. Our kid is being life flighted twice in his first month of life, and hes spent nearly half of his life in the hospital at this point something is wrong, and no one knows what direction to point us in I asked about the eye movement possibly being related to a balance issue or an issue with his ears and they told me no.. Ive asked if reflux could cause it and theyve told me no Ive asked what could cause it and they give me broad answers I need a direction to go with this. Neurologists dont seem to be finding anything. Could this be a cardiac problem?? Does anyone have any advice on what to ask for if the MRI Comes back normal? Our son needs help. He is miserable. He doesnt sleep, hes not eating very well he gets hungry every two hours and I dont even think hes getting enough milk because he falls asleep every time hes eating and wakes up so upset because hes starving he doesnt let me put him down. I am not being dramatic when I say I have to hold him all day and all night. He will not sleep unless someone is holding him, and usually that someone has to be me. I need help something is wrong and I cant keep doing this. I dont have the energy in me to keep fighting with these doctors.. please help

Output: Were seizure like episodes actually captured on EEG? Did he do the weird stuff while the leads were actually on? It's possible to have seizures, but have a normal EEG if you're not actively seizing.However, not all abnormal movements are seizures.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My son is 5 weeks old, I am not sure of his height right now but he weighs 9lbs 4oz. his medical history is complex and I believe it is valuable information so I will start with that..When my son was exactly 1 week old we went to his first pediatrician appointment, they noticed he was looking a bit yellow so they did a bilirubin test the levels came back critically high (21). We were immediately brought back to the hospital and they started him on bili lights however they never tested his bilirubin before we discharged from the hospital I had him at, so we truly dont know how long his levels were that bad. We are RH incompatible so I am certain thats probably what caused the really high biliWhile hospitalized for the bilirubin, we quickly noticed our son was having problems breathing. He was holding his breath for pretty long periods of time. A nurse told us at one point that his respiration rate was only 14.. he was having desaturations and bradycardia with this so he was quickly life flighted to a hospital that was better equipped for this situation. Our son spent 1 night in the NICU and then 9 days in the special care unit. It took him EXACTLY 48 hours to have another breathing episode at this hospital. He was life flighted at 10 pm and then 48 hours later at exactly 10 pm he started having issues again. They did a 1 hour EEG and told us there was nothing substantial And that they didnt find it necessary to do a 24 hour EEG. they decided to try Pepcid 0.2mg because they started to think this was reflux related. At the same time they started the Pepcid he stopped having these breathing episodes. They did not run any further testing and just stated that he was having reflux and was holding his breath because of the acid coming up.My son is now 5 weeks old. We were home for less than 2 weeks and we are now hospitalized again. On Wednesday around 3:30pm our son had what looked to be seizures. His eyes were looking to the left, they were sort of vibrating rhythmically in small side to side movements (not across the entire eye. They stayed looking to the left but kind of vibrated??), and he was unresponsive. We snapped in his face and tapped on him, talked to him and everything and he just was not responsive. He ended up doing this 3 times back to back. Each episode would last about 30 seconds with a 1-3 minute break between each of them. We took a video of it and showed it to our pediatrician who immediately told us with certainty that our son was having seizures. He was admitted to the hospital that night.. they did blood work and did find his electrolytes slightly out of normal ranges, however just a few hours later when they repeated the labs he was back to a healthy range and I was told that couldve happened because of the IV fluids he was on..Once again, our pediatrician made the call to send him out to a better equipped hospital. They sent him to a childrens mercy he was there for 24 hours on an EEG which they did not find anything on.. they told me hes not having seizures and that this movement is normal Im sorry but I truly dont think this is normal. Ive never seen a baby do this and our pediatrician found it alarming enough to send him out to childrens.. our pediatrician has 30 years of experience. Hes a smart guyChildrens mercy discharged us with no answers. We begged them to run more tests or consult with a neonatologist and they refused we left that hospital and went to another one in the area that is well known for their high quality PICU & NICU. we went in and showed them the video.. the nurologist that watched the video said he also does not think this is seizures, however he doesnt think its normal.. right now the plan is to do an MRI tomorrow. In the past he has only had CT scans done, but nothing was found on them..I am absolutely desperate. Our kid is being life flighted twice in his first month of life, and hes spent nearly half of his life in the hospital at this point something is wrong, and no one knows what direction to point us in I asked about the eye movement possibly being related to a balance issue or an issue with his ears and they told me no.. Ive asked if reflux could cause it and theyve told me no Ive asked what could cause it and they give me broad answers I need a direction to go with this. Neurologists dont seem to be finding anything. Could this be a cardiac problem?? Does anyone have any advice on what to ask for if the MRI Comes back normal? Our son needs help. He is miserable. He doesnt sleep, hes not eating very well he gets hungry every two hours and I dont even think hes getting enough milk because he falls asleep every time hes eating and wakes up so upset because hes starving he doesnt let me put him down. I am not being dramatic when I say I have to hold him all day and all night. He will not sleep unless someone is holding him, and usually that someone has to be me. I need help something is wrong and I cant keep doing this. I dont have the energy in me to keep fighting with these doctors.. please help. ### Response: Were seizure like episodes actually captured on EEG? Did he do the weird stuff while the leads were actually on? It's possible to have seizures, but have a normal EEG if you're not actively seizing.However, not all abnormal movements are seizures..


Instruction: 24F 57, 190lbs Meds: Lexapro, Buspar, Zyxal, Allegra, Pepcid, metoprolol tartrate, NuvaringPMH: postural orthostatic tachycardia syndrome, mast cell activation syndrome, hypermobile Ehler Danlos syndrome, and Celiac diseaseOther background: moved to NYC over the summer, works in cardiac surgery and critical careBefore the past few weeks, I had symptoms well under control with meds and lifestyle.3 weeks ago, I woke up out of the blue with itchy, raised hives all over my entire body. I went to urgent care and got a 5 day run of prednisone and steroid cream. Hives continued to fade and pop up all over. A week later, I went to my allergist. She gave me hydroxyzine to manage itching. A few days before it started, I had gotten my flu shot and COVID booster (Pfizer). She said maybe it was a hypersensitivity reaction to one of the vaccines, and that wouldnt last more than a few weeks. We couldnt come up with another trigger other than maybe environmental due to the apartments heat kicking in or the weather changing to cold.After seeing her, things worsened. The hives have been terrible still. Ive been getting pain, hives, and swelling in my small joints (fingers, wrists, ankles). Today, my face started swelling too. I have no idea if its still a vaccine reaction, a new allergen, or something else. Its getting harder to manage and no new ideas from my drs. Any ideas?

Output: If you have urticaria, this is acute urticaria. They can both be managed the same way.Finding a "cause" for most urticaria in most patients is not a reasonable expectation. Laboratory and other evaluation is not evidence based. Following the evidence-based treatment approach in Figure 2 will greatly improve most patients: https://onlinelibrary.wiley.com/doi/10.1111/all.13397

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 24F 57, 190lbs Meds: Lexapro, Buspar, Zyxal, Allegra, Pepcid, metoprolol tartrate, NuvaringPMH: postural orthostatic tachycardia syndrome, mast cell activation syndrome, hypermobile Ehler Danlos syndrome, and Celiac diseaseOther background: moved to NYC over the summer, works in cardiac surgery and critical careBefore the past few weeks, I had symptoms well under control with meds and lifestyle.3 weeks ago, I woke up out of the blue with itchy, raised hives all over my entire body. I went to urgent care and got a 5 day run of prednisone and steroid cream. Hives continued to fade and pop up all over. A week later, I went to my allergist. She gave me hydroxyzine to manage itching. A few days before it started, I had gotten my flu shot and COVID booster (Pfizer). She said maybe it was a hypersensitivity reaction to one of the vaccines, and that wouldnt last more than a few weeks. We couldnt come up with another trigger other than maybe environmental due to the apartments heat kicking in or the weather changing to cold.After seeing her, things worsened. The hives have been terrible still. Ive been getting pain, hives, and swelling in my small joints (fingers, wrists, ankles). Today, my face started swelling too. I have no idea if its still a vaccine reaction, a new allergen, or something else. Its getting harder to manage and no new ideas from my drs. Any ideas?. ### Response: If you have urticaria, this is acute urticaria. They can both be managed the same way.Finding a "cause" for most urticaria in most patients is not a reasonable expectation. Laboratory and other evaluation is not evidence based. Following the evidence-based treatment approach in Figure 2 will greatly improve most patients: https://onlinelibrary.wiley.com/doi/10.1111/all.13397.