Instruction: My daughter ( F, 18 y/o, 5'5', 165lbs) has been feeling poorly for a 6-8 months. She had COVID a couple of months ago and symptoms have are much worse in the last month or so. Symptoms seem POTS-like. She feels light headed, breathless, dizzy, HR goes from ~65 lying down to ~155-160 on standing. Today she tells me HR has been around 170 all day and she feels really lousy. (She using an OTC pulse ox to measure.) She has a cardiology appt but not until March and a PCP appt but not until April since she's at school and it's a new provider. What to do? Is this a on call nurse sort of issue? Or a trip to the ED? Or wait till tomorrow and try for an early appt? Try a couple of Valsalvas? Wait it out until her cardio appt? Or? She's away at school if Boston, what to do? Thank you

Output: If she actually has a HR of 170 that is accurate, ongoing and persistent, she needs to be seen in the ED immediately.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My daughter ( F, 18 y/o, 5'5', 165lbs) has been feeling poorly for a 6-8 months. She had COVID a couple of months ago and symptoms have are much worse in the last month or so. Symptoms seem POTS-like. She feels light headed, breathless, dizzy, HR goes from ~65 lying down to ~155-160 on standing. Today she tells me HR has been around 170 all day and she feels really lousy. (She using an OTC pulse ox to measure.) She has a cardiology appt but not until March and a PCP appt but not until April since she's at school and it's a new provider. What to do? Is this a on call nurse sort of issue? Or a trip to the ED? Or wait till tomorrow and try for an early appt? Try a couple of Valsalvas? Wait it out until her cardio appt? Or? She's away at school if Boston, what to do? Thank you. ### Response: If she actually has a HR of 170 that is accurate, ongoing and persistent, she needs to be seen in the ED immediately..


Instruction: Im a 37 y.o. transgender man with pre-diabetes and high cholesterol/triglycerides. I had chest pain and dizziness several months ago and went to cardiology for tests. Stress echo was normal, though the symptoms were still made worse with the exercise. I was sent for a CT scan with contrast. No blockages or abnormalities. They did find a small hiatal hernia. I asked if that could cause chest pain and they reluctantly admitted that it could. I say reluctantly because despite my results being normal, she wanted to put me on a stronger statin. Ive been on statins for years and it has impaired my glucose tolerance. Rather than go on Metformin, I opted to go on strict low carb diet, monitor my glucose and lots of walking. Ive done that for two years and Im almost back in to anormal A1C. Ive worked very hard. I also switched from Simvastatin to Pravastatin. The latter has some preliminary findings suggesting it doesn't effect glucose tolerance as strongly. One of the worst statins for this...is Crestor. The cardiac nurse is convinced that I need to be on it. So I tried it for a month and surprise - my glucose is impaired again. (Morning was usually 160 at worst, two days ago it was 300. My diet has not changed.) I said no thanks to the Crestor and asked to be put back on Pravastatin. Nurse was really pushing back saying its still worth the risk because my cholesterol was too high on the Pravastin. I agreed to double my dose of it until we sort out this dispute. I get a call today from the cardiologist resident who was approached by the RN about my refusal to take Crestor. I get the same spiel about how its worth the risk. I explain patiently that A) I show no signs of heart disease. B)that my chest pain was very likely the hiatal hernia (which will be addressed separately)C) That although I understand their logic, I have worked very hard to keep my Diabetes controlled without Metformin. The common side effects of which (fecal incontinence and nausea) Ive seen with my sister and would very much like to avoid. Cardio Resident says she will "consult Endocrinology but they will likely say the same thing". Add to this that Im on Testosterone Cypionate , which she says can cause the triglycerides to read high. I told her to make sure she mentions this when she talks to the Endo. I feel like I am being forced onto a medication that I dont consent to. Here are my questions: 1) could Testosterone cypionate cause a false high reading of triglycerides on a blood test? 2) Am I being foolish in my refusal of the more aggressive statin? 3)Are there other options I am not seeing?

Output: How high is your cholesterol? Since youre only 37 and they are pushing statins pretty hard, I would assume that your cholesterol sucks and you almost certainly should be on atorvastatin or rosuvastatin if it is being recommended by two cardiology providers. Small hiatal hernias do not generally cause chest pain, and for sure do not cause dizziness. If your chest pain was worse with exercise, its concerning for micro vascular disease, with a normal CT.Overall while statins do increase glucose intolerance, they overall have a net benefit in decreasing risk of heart attack and stroke. While your glucose numbers may change, its less about the glucose numbers and more about reducing downstream effects.It is kind of silly frankly to avoid metformin without knowing if youll have GI side effects or not. You likely will unfortunately need metformin in the future, statin or not, and if you dont tolerate metformin there are other alternatives out there such as GLP-1 agonists and SGLT-2 inhibitors that also help with cardiovascular risk.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im a 37 y.o. transgender man with pre-diabetes and high cholesterol/triglycerides. I had chest pain and dizziness several months ago and went to cardiology for tests. Stress echo was normal, though the symptoms were still made worse with the exercise. I was sent for a CT scan with contrast. No blockages or abnormalities. They did find a small hiatal hernia. I asked if that could cause chest pain and they reluctantly admitted that it could. I say reluctantly because despite my results being normal, she wanted to put me on a stronger statin. Ive been on statins for years and it has impaired my glucose tolerance. Rather than go on Metformin, I opted to go on strict low carb diet, monitor my glucose and lots of walking. Ive done that for two years and Im almost back in to anormal A1C. Ive worked very hard. I also switched from Simvastatin to Pravastatin. The latter has some preliminary findings suggesting it doesn't effect glucose tolerance as strongly. One of the worst statins for this...is Crestor. The cardiac nurse is convinced that I need to be on it. So I tried it for a month and surprise - my glucose is impaired again. (Morning was usually 160 at worst, two days ago it was 300. My diet has not changed.) I said no thanks to the Crestor and asked to be put back on Pravastatin. Nurse was really pushing back saying its still worth the risk because my cholesterol was too high on the Pravastin. I agreed to double my dose of it until we sort out this dispute. I get a call today from the cardiologist resident who was approached by the RN about my refusal to take Crestor. I get the same spiel about how its worth the risk. I explain patiently that A) I show no signs of heart disease. B)that my chest pain was very likely the hiatal hernia (which will be addressed separately)C) That although I understand their logic, I have worked very hard to keep my Diabetes controlled without Metformin. The common side effects of which (fecal incontinence and nausea) Ive seen with my sister and would very much like to avoid. Cardio Resident says she will "consult Endocrinology but they will likely say the same thing". Add to this that Im on Testosterone Cypionate , which she says can cause the triglycerides to read high. I told her to make sure she mentions this when she talks to the Endo. I feel like I am being forced onto a medication that I dont consent to. Here are my questions: 1) could Testosterone cypionate cause a false high reading of triglycerides on a blood test? 2) Am I being foolish in my refusal of the more aggressive statin? 3)Are there other options I am not seeing?. ### Response: How high is your cholesterol? Since youre only 37 and they are pushing statins pretty hard, I would assume that your cholesterol sucks and you almost certainly should be on atorvastatin or rosuvastatin if it is being recommended by two cardiology providers. Small hiatal hernias do not generally cause chest pain, and for sure do not cause dizziness. If your chest pain was worse with exercise, its concerning for micro vascular disease, with a normal CT.Overall while statins do increase glucose intolerance, they overall have a net benefit in decreasing risk of heart attack and stroke. While your glucose numbers may change, its less about the glucose numbers and more about reducing downstream effects.It is kind of silly frankly to avoid metformin without knowing if youll have GI side effects or not. You likely will unfortunately need metformin in the future, statin or not, and if you dont tolerate metformin there are other alternatives out there such as GLP-1 agonists and SGLT-2 inhibitors that also help with cardiovascular risk..


Instruction: Male 35 physically active no issues before non smokerRecently my entire body swelled up like edema was in the hospital CK level super high but leveled out and started attacking itself over the last year I've gone to every doctor possible. My body is losing skeletal muscle mass and spams for the last year with no clear answers. I'm swimming in all my clothes and no matter what I do nothing helps. Excessive exhaustion and sweating as well.Went to cardiologist but she was vague on my test and scheduled a ct was wondering if anyone had suggestions after echo and ekg were negativeI've been to go a rheumatologist, neurologist, etc and no one has answers for what's going onThis is the latest from my cardiologist but if anyone else has ideas pleaseRAC sign is present, suggestive of anomalous coronary circulation with retroaortic course.

Output: Wish you the best,, really with this the only way anybody could provide any sort of advice would be a review of complete medical records and all lab findings

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Male 35 physically active no issues before non smokerRecently my entire body swelled up like edema was in the hospital CK level super high but leveled out and started attacking itself over the last year I've gone to every doctor possible. My body is losing skeletal muscle mass and spams for the last year with no clear answers. I'm swimming in all my clothes and no matter what I do nothing helps. Excessive exhaustion and sweating as well.Went to cardiologist but she was vague on my test and scheduled a ct was wondering if anyone had suggestions after echo and ekg were negativeI've been to go a rheumatologist, neurologist, etc and no one has answers for what's going onThis is the latest from my cardiologist but if anyone else has ideas pleaseRAC sign is present, suggestive of anomalous coronary circulation with retroaortic course.. ### Response: Wish you the best,, really with this the only way anybody could provide any sort of advice would be a review of complete medical records and all lab findings.


Instruction: Appreciate it al labs have come back completely negative only thing that's been consistently elevated but wasn't that much of a concern was CK levels everything else you could think of from any type of test normal

Output: again, really need complete work up and medical notes to provide any insight here

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Appreciate it al labs have come back completely negative only thing that's been consistently elevated but wasn't that much of a concern was CK levels everything else you could think of from any type of test normal. ### Response: again, really need complete work up and medical notes to provide any insight here.


Instruction: 32F, 130-140lbs, have asthma and history of postpartum preeclampsia. Former cigarette smoker, currently vapes nicotine.ECG in comments.Ive been feeling huge thumps in my chest, several times a minute. Called 911 a few days ago because I wasnt sure if I was going to keel over, have never felt this before, and was scared. EMT thought I was in AFIB. ER doctor says no, just PVCs and to reduce my stress, stop vaping and limit caffeine. That these are harmless and I dont need to worry.Sometimes I feel lightly dizzy when it happens. I notice them when Im falling asleep. I notice them just sitting here, and the last few minutes, Ive been feeling big thumps pretty much every 15-20 seconds. Theres no way thats normal right?Can someone tell me if I need to ask my PCP for a referral to cardiology? Or tell me what youre seeing? This is truthfully scary to me and so uncomfortable.

Output: Normal sinus rhythm with a PVC. Not concerning.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 32F, 130-140lbs, have asthma and history of postpartum preeclampsia. Former cigarette smoker, currently vapes nicotine.ECG in comments.Ive been feeling huge thumps in my chest, several times a minute. Called 911 a few days ago because I wasnt sure if I was going to keel over, have never felt this before, and was scared. EMT thought I was in AFIB. ER doctor says no, just PVCs and to reduce my stress, stop vaping and limit caffeine. That these are harmless and I dont need to worry.Sometimes I feel lightly dizzy when it happens. I notice them when Im falling asleep. I notice them just sitting here, and the last few minutes, Ive been feeling big thumps pretty much every 15-20 seconds. Theres no way thats normal right?Can someone tell me if I need to ask my PCP for a referral to cardiology? Or tell me what youre seeing? This is truthfully scary to me and so uncomfortable.. ### Response: Normal sinus rhythm with a PVC. Not concerning..


Instruction: 33F 144lb 55 ex-smoker x13yrs quit 2018 non-drinker Dx GPA with kidney/sinus/joint/skin involvement 2002, CKD2, chronic migraine with aura, SVT ablation 2017 dual AV node, sepsis 2018 from PID due to improperly placed IUD, dysautonomia (dx recently from tilt table test), Sjogrens, hospitalized in November for hypoglycaemia (glucose 2.7) still being worked up by endo but symptoms resolved after Rituxan so they are thinking autoimmune hypoglycaemia  Im not going to list everything because its just depressing and not relevant. Basically a big mix of autoimmune disorders and premature degenerative conditions related to treatment for GPA Currently taking ..Rituxan infusions every 6 months, next one in a couple of weeksPlaquenilLipitorZoloftWellbutrinGabapentinCyclobenzabrineEltroxinVyvanseZopicloneDomperidoneZofranTopiramateOxycodoneTriptans for migrainesSome PRNs Im forgettingSo I just want to know if this ECG is normal. Ive never gotten any alerts for Afib on my Apple Watch before and today during a particularly brutal migraine with lots of dry heaving, I got a few alerts (this ecg isnt of the Afib ones). If you move the sensor, you can get different lead ECG readings (according to my cardiology nurse). I placed the sensor over V2 (I had to look that up) to get this reading and the big dip after the QRS complex (also had to look that up) looks off to me when I compare it to the normal image on Google. Is this something I should be concerned about? Migraine has started to abate but I feel weird. Heart was pounding in throat the whole time, especially when on my side. Some shortness of breath. Mostly feeling better now.Thanks for your time, help (hopefully) putting my mind at ease and teaching me something in the process :)Edit - also, not sure if relevant but I got my 5th COVID vaccine (the bivalent Pfizer one) on Mondayhttps://i.imgur.com/mA1T0Vz.jpg

Output: EKG interpretation requires a very comprehensive understanding of cardiac electrophysiology, anatomy, and pathological processes, including the mechanisms that various arrhythmias, ischemia, and, in your particular case, previous procedures/ablations have on these functions. Without attempting to delve into the "why's and how's" of what these very complex squiggles mean, the short answer to your question is yes: inverted T waves in lead V2 can be completely normal in many individuals (that "dip" you're referring to after the QRS is the T-wave, and inverted just means that it's flipped upside down).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 33F 144lb 55 ex-smoker x13yrs quit 2018 non-drinker Dx GPA with kidney/sinus/joint/skin involvement 2002, CKD2, chronic migraine with aura, SVT ablation 2017 dual AV node, sepsis 2018 from PID due to improperly placed IUD, dysautonomia (dx recently from tilt table test), Sjogrens, hospitalized in November for hypoglycaemia (glucose 2.7) still being worked up by endo but symptoms resolved after Rituxan so they are thinking autoimmune hypoglycaemia  Im not going to list everything because its just depressing and not relevant. Basically a big mix of autoimmune disorders and premature degenerative conditions related to treatment for GPA Currently taking ..Rituxan infusions every 6 months, next one in a couple of weeksPlaquenilLipitorZoloftWellbutrinGabapentinCyclobenzabrineEltroxinVyvanseZopicloneDomperidoneZofranTopiramateOxycodoneTriptans for migrainesSome PRNs Im forgettingSo I just want to know if this ECG is normal. Ive never gotten any alerts for Afib on my Apple Watch before and today during a particularly brutal migraine with lots of dry heaving, I got a few alerts (this ecg isnt of the Afib ones). If you move the sensor, you can get different lead ECG readings (according to my cardiology nurse). I placed the sensor over V2 (I had to look that up) to get this reading and the big dip after the QRS complex (also had to look that up) looks off to me when I compare it to the normal image on Google. Is this something I should be concerned about? Migraine has started to abate but I feel weird. Heart was pounding in throat the whole time, especially when on my side. Some shortness of breath. Mostly feeling better now.Thanks for your time, help (hopefully) putting my mind at ease and teaching me something in the process :)Edit - also, not sure if relevant but I got my 5th COVID vaccine (the bivalent Pfizer one) on Mondayhttps://i.imgur.com/mA1T0Vz.jpg. ### Response: EKG interpretation requires a very comprehensive understanding of cardiac electrophysiology, anatomy, and pathological processes, including the mechanisms that various arrhythmias, ischemia, and, in your particular case, previous procedures/ablations have on these functions. Without attempting to delve into the "why's and how's" of what these very complex squiggles mean, the short answer to your question is yes: inverted T waves in lead V2 can be completely normal in many individuals (that "dip" you're referring to after the QRS is the T-wave, and inverted just means that it's flipped upside down)..


Instruction: Thank you so much for the education :)

Output: Did you place the back of the watch on your chest (in the V2 lead position) and then touch the crown with your finger to get this? If so, then the inverted T wave you are concerned about would not be a valid finding. The voltages in the precordial (V) leads in a 12 lead EKG are measured in relation to the average of the 4 limb leads, not just one arm which the watch is doing. EKG tracings from Apple Watches are good for determining heart rhythms but not much else.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much for the education :). ### Response: Did you place the back of the watch on your chest (in the V2 lead position) and then touch the crown with your finger to get this? If so, then the inverted T wave you are concerned about would not be a valid finding. The voltages in the precordial (V) leads in a 12 lead EKG are measured in relation to the average of the 4 limb leads, not just one arm which the watch is doing. EKG tracings from Apple Watches are good for determining heart rhythms but not much else..


Instruction: Thats exactly what I did. I was told you could use it on that area and even on the ankle to replicate different ECG (EKG?) leads. Thank you for the info!! Phew!

Output: It would be theoretically possible to get a tracing with accurate wave morphology between 2 limbs with an Apple Watch, but it could be inverted if the polarity is switched. Please dont try this though, it can only serve to stress you out more. As long as the watch says sinus rhythm, you are probably good. Ask your physician for a standard EKG is you are concerned.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thats exactly what I did. I was told you could use it on that area and even on the ankle to replicate different ECG (EKG?) leads. Thank you for the info!! Phew!. ### Response: It would be theoretically possible to get a tracing with accurate wave morphology between 2 limbs with an Apple Watch, but it could be inverted if the polarity is switched. Please dont try this though, it can only serve to stress you out more. As long as the watch says sinus rhythm, you are probably good. Ask your physician for a standard EKG is you are concerned..


Instruction: I appreciate you geeking out with me explaining the technology moreI find all of this stuff so fascinating. I got 6 Afib alerts today but I read there are a lot of false positives, especially with younger people. Will go get a full 12 lead to make sure. Thanks again!

Output: Did the watch say an EKG tracing you performed showed afib or was it from monitoring from the heart rate sensor?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I appreciate you geeking out with me explaining the technology moreI find all of this stuff so fascinating. I got 6 Afib alerts today but I read there are a lot of false positives, especially with younger people. Will go get a full 12 lead to make sure. Thanks again!. ### Response: Did the watch say an EKG tracing you performed showed afib or was it from monitoring from the heart rate sensor?.


Instruction: An EKG I performed while having palpitations showed Afib, which is why I started trying to get different lead readings  was trying to see if it was a fluke or not and get as much info for cardio if necessary (Holters suck). Didnt happen consistently when performing recordings back to backsome would say it detected Afib and others sinus.

Output: Thats a bit concerning. Be sure to show those EKG tracings to your cardiologist.Many of the medications you list can can affect heart rhythm and interact with each other. The Vyvanse particularly would not be good to take if there is a question of atrial fibrillation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: An EKG I performed while having palpitations showed Afib, which is why I started trying to get different lead readings  was trying to see if it was a fluke or not and get as much info for cardio if necessary (Holters suck). Didnt happen consistently when performing recordings back to backsome would say it detected Afib and others sinus.. ### Response: Thats a bit concerning. Be sure to show those EKG tracings to your cardiologist.Many of the medications you list can can affect heart rhythm and interact with each other. The Vyvanse particularly would not be good to take if there is a question of atrial fibrillation..


Instruction: I think its long QT? Something QT? Pharmacist mentioned that I was on a lot that increased that risk so Ive been careful with the domperidone and zofran but I had to take both today. In your opinion, are there any meds you would cut? Other than the Oxycodone - I have a plan for that. I know you dont know my full medical history but I would love to eliminate some of these meds. Are there any redundant ones? Ones that work against another one? I wont take what you say as medical advice and discontinue meds or anything - just curious what another doctor would say. Appreciate it!Edit - and stopping Vyvanse for now until I talk to cardio is probably the best. I dont take it every day anyways

Output: No way I can address something this complex and nuanced in this forum. Please discuss this with your personal physician.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I think its long QT? Something QT? Pharmacist mentioned that I was on a lot that increased that risk so Ive been careful with the domperidone and zofran but I had to take both today. In your opinion, are there any meds you would cut? Other than the Oxycodone - I have a plan for that. I know you dont know my full medical history but I would love to eliminate some of these meds. Are there any redundant ones? Ones that work against another one? I wont take what you say as medical advice and discontinue meds or anything - just curious what another doctor would say. Appreciate it!Edit - and stopping Vyvanse for now until I talk to cardio is probably the best. I dont take it every day anyways. ### Response: No way I can address something this complex and nuanced in this forum. Please discuss this with your personal physician..


Instruction: Thank you for the advice! We havent thought about pheochromocytoma. It does seem to line up. How does that get diagnosed? The website I was reading just a minute ago said a 24-hour urine test which she did when her GI doctor wanted to test for carcinoid syndrome/neuroendocrine tumors with a 5-HIAA urine test. I think they were only testing 5-HIAA though and not anything else so not sure if thats what they test for when checking for pheochromocytoma. Shes also had a kidney ultrasound and two abdominal (including kidneys) CT scans with contrast. Would they have shown up on those or is it one of those things they have to be specifically looking for?Shes reached out for therapy. She actually is a counselor herself so we tend to think she had the proper coping skills herself but as time has gone on with this, she has reached out to former colleagues, specifically to try to schedule EMDR therapy which has been very helpful for her in the past.The tricky part with it being related to anything COVID-related is she's never actually tested positive for COVID. So we don't know that she's had it even though when she searches for others dealing with her symptoms on reddit, it often takes her to posts in the covid longhaulers subreddit.

Output: 5-HIAA testing is for carcinoid syndrome, not pheo

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for the advice! We havent thought about pheochromocytoma. It does seem to line up. How does that get diagnosed? The website I was reading just a minute ago said a 24-hour urine test which she did when her GI doctor wanted to test for carcinoid syndrome/neuroendocrine tumors with a 5-HIAA urine test. I think they were only testing 5-HIAA though and not anything else so not sure if thats what they test for when checking for pheochromocytoma. Shes also had a kidney ultrasound and two abdominal (including kidneys) CT scans with contrast. Would they have shown up on those or is it one of those things they have to be specifically looking for?Shes reached out for therapy. She actually is a counselor herself so we tend to think she had the proper coping skills herself but as time has gone on with this, she has reached out to former colleagues, specifically to try to schedule EMDR therapy which has been very helpful for her in the past.The tricky part with it being related to anything COVID-related is she's never actually tested positive for COVID. So we don't know that she's had it even though when she searches for others dealing with her symptoms on reddit, it often takes her to posts in the covid longhaulers subreddit.. ### Response: 5-HIAA testing is for carcinoid syndrome, not pheo.


Instruction: I would test Seum Copper levels and Zinc. Copper deficiency can cause peripheral neuropathy, histamine intolerance (copper is a cofactor of DAO), dysautonomia (copper is a cofactor of DBH, required to convert dopamine to norepinephrine), EKG abnormalities.Copper deficiency can be caused by zinc toxicity, and zinc has become a very popular supplement "to prevent" COVID. Too much zinc supplementation without Copper can lead to copper deficiency.We havent looked into that. She doesnt take any zinc supplements so were not sure what would cause her to have copper deficiency or zinc toxicity. Well write it down to mention to her PCP at her next appointment.She has been checked for carcinoid syndrome. Her GI doctor suggested it and she had both the CgA blood test and 24-hour urine 5-HIAA test that luckily both came back in normal range.

Output: I agree with another poster - she needs to have a PCP that can consolidate her information and testing to help you guide where to go next. I think you keeping this list is fantastic to help you advocate for yourselves.There are a few things here:The white plaques found on the colonoscopy Spring 2021 is of very high interest especially given that the cause was not determined. Was it ever biopsied? It may be worth another repeat C-scope because it sounds like the most recent direct visualization was an EGD. Low grade colitis from inflammatory bowel disease doesnt always show up on a CT scan.I also think her autoimmune workup is incomplete from the blood work listed. In addition to this, viral illnesses (such as the one she had in 2019 that may or may not have been COVID) often can trigger the beginning of an autoimmune condition. The blood work ANA and RF is by no means comprehensive. Why was an RF checked? Was she having joint pain as well? With a family history, autoimmune conditions are very high on my listnose symptoms, lung symptoms, microscopic hematuria, peripheral nervous system issues beings up differentials including: GPA (granulomatosis with polyangitis previously known as Wegeners Granulomatosis) and Anti-GBM (Goodpasture) Disease which are autoimmune vasculitisI would recommend checking for vasculitis: ESR, CRP, C3/4, ANCA, Anti-GBM, cryoglobulinsOther autoimmune conditions can manifest with GI issues too - there is a lot of overlap. Whether she has joint pain or not, I would check CCP, HLA B27, Sjogren panelSystemic scleroderma is a possibility too which would include Anti-Scl70 labsIf she has joint pain, a synovial ultrasound of the hands / feet may find active joint or tendon inflammation which would support an inflammatory condition as well.I hope this information can help bring your wife some answers and hopefully treatment

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I would test Seum Copper levels and Zinc. Copper deficiency can cause peripheral neuropathy, histamine intolerance (copper is a cofactor of DAO), dysautonomia (copper is a cofactor of DBH, required to convert dopamine to norepinephrine), EKG abnormalities.Copper deficiency can be caused by zinc toxicity, and zinc has become a very popular supplement "to prevent" COVID. Too much zinc supplementation without Copper can lead to copper deficiency.We havent looked into that. She doesnt take any zinc supplements so were not sure what would cause her to have copper deficiency or zinc toxicity. Well write it down to mention to her PCP at her next appointment.She has been checked for carcinoid syndrome. Her GI doctor suggested it and she had both the CgA blood test and 24-hour urine 5-HIAA test that luckily both came back in normal range.. ### Response: I agree with another poster - she needs to have a PCP that can consolidate her information and testing to help you guide where to go next. I think you keeping this list is fantastic to help you advocate for yourselves.There are a few things here:The white plaques found on the colonoscopy Spring 2021 is of very high interest especially given that the cause was not determined. Was it ever biopsied? It may be worth another repeat C-scope because it sounds like the most recent direct visualization was an EGD. Low grade colitis from inflammatory bowel disease doesnt always show up on a CT scan.I also think her autoimmune workup is incomplete from the blood work listed. In addition to this, viral illnesses (such as the one she had in 2019 that may or may not have been COVID) often can trigger the beginning of an autoimmune condition. The blood work ANA and RF is by no means comprehensive. Why was an RF checked? Was she having joint pain as well? With a family history, autoimmune conditions are very high on my listnose symptoms, lung symptoms, microscopic hematuria, peripheral nervous system issues beings up differentials including: GPA (granulomatosis with polyangitis previously known as Wegeners Granulomatosis) and Anti-GBM (Goodpasture) Disease which are autoimmune vasculitisI would recommend checking for vasculitis: ESR, CRP, C3/4, ANCA, Anti-GBM, cryoglobulinsOther autoimmune conditions can manifest with GI issues too - there is a lot of overlap. Whether she has joint pain or not, I would check CCP, HLA B27, Sjogren panelSystemic scleroderma is a possibility too which would include Anti-Scl70 labsIf she has joint pain, a synovial ultrasound of the hands / feet may find active joint or tendon inflammation which would support an inflammatory condition as well.I hope this information can help bring your wife some answers and hopefully treatment.


Instruction: I greatly appreciate this response as its extremely informative!The white plaques were never followed up on unfortunately. Her blood in her stool cleared up shortly after so she let it go.I definitely agree with you on the autoimmune thoughts. I had no idea there were so much more to test for. What kind of specialist would she see who would run those kinds of tests and how does she approach it with that doctor? Just tell them she wants to be tested for everything?

Output: A lot of those blood tests I mentioned any primary can order as well as the synovial ultrasound.Its hard to approach an MD about specific tests but I think its worth asking. It just depends on how you think your doctor is. I have patients ask me for specific tests pretty often and we just make a joint decision on if its worth it in shared decision making.As for which specialty? rheumatology and GI would be the ones in my opinion.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I greatly appreciate this response as its extremely informative!The white plaques were never followed up on unfortunately. Her blood in her stool cleared up shortly after so she let it go.I definitely agree with you on the autoimmune thoughts. I had no idea there were so much more to test for. What kind of specialist would she see who would run those kinds of tests and how does she approach it with that doctor? Just tell them she wants to be tested for everything?. ### Response: A lot of those blood tests I mentioned any primary can order as well as the synovial ultrasound.Its hard to approach an MD about specific tests but I think its worth asking. It just depends on how you think your doctor is. I have patients ask me for specific tests pretty often and we just make a joint decision on if its worth it in shared decision making.As for which specialty? rheumatology and GI would be the ones in my opinion..


Instruction: Hey. I am male 24 Height 5:10 and weigh 87 kg. I don't drink or smoke. For a few months i have been suffering from left sided chest pain that radiates to my left arm and back. I also suffer from shortness of breath at times. I decided to get my lipid profile done and my cholesterol levels came back very high. I then decided to get Echo Cardiogram and Exercise Tolerance Test and some other blood work. Can you take a look at my reports. Thankshttps://imgur.com/a/SiBOG1Phttps://imgur.com/a/yKBhqsFhttps://imgur.com/a/aK6RuWchttps://imgur.com/a/IWwMi1vhttps://imgur.com/a/UaEOvP2

Output: The point of getting testing like this done is to go over it with a medical professional who can then make recommendations. The echo and stress test are normal, your cholesterol is too high. I'd suggest that you find a primary care doctor.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hey. I am male 24 Height 5:10 and weigh 87 kg. I don't drink or smoke. For a few months i have been suffering from left sided chest pain that radiates to my left arm and back. I also suffer from shortness of breath at times. I decided to get my lipid profile done and my cholesterol levels came back very high. I then decided to get Echo Cardiogram and Exercise Tolerance Test and some other blood work. Can you take a look at my reports. Thankshttps://imgur.com/a/SiBOG1Phttps://imgur.com/a/yKBhqsFhttps://imgur.com/a/aK6RuWchttps://imgur.com/a/IWwMi1vhttps://imgur.com/a/UaEOvP2. ### Response: The point of getting testing like this done is to go over it with a medical professional who can then make recommendations. The echo and stress test are normal, your cholesterol is too high. I'd suggest that you find a primary care doctor..


Instruction: I did. Was recommended to start statins but i am yet to start those. I wan't to see if the levels could be brought down by lifestyle and diet changes first. I just can't figure out why im experiencing the chest pain.

Output: That's a good thing to talk to your PCP about. GERD is a common cause of non-cardiac chest pain.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I did. Was recommended to start statins but i am yet to start those. I wan't to see if the levels could be brought down by lifestyle and diet changes first. I just can't figure out why im experiencing the chest pain.. ### Response: That's a good thing to talk to your PCP about. GERD is a common cause of non-cardiac chest pain..


Instruction: 35 yo female 5'7" (170 cm) 180lbs (81.6kg) Caucasian and Native American I have previously had high blood pressure, but as of the last year or so my blood pressure has become very LOW for undetermined reasons, with my most recent reading being 101/60Primary symptoms: Decreasing general health for the past ~3 years, primarily presenting as severe fatigue, syncope + nausea when overheated or standing up too quickly, needing a minimum of 10-12 hours of sleep every night to feel rested, general malaise.I have asthma, ADD, MDD. Drink occasionally; previous occasional smoker but quit ~5 years ago. Same for recreational drugs -- on occasion when I was younger, but none for at least 5 years. I had previously been diagnosed with Rheumatic Fever in 2015, which seems VERY relevant here, but every doctor I've tried to discuss it with brushes it off when I mention it.So, last month I finally got a referral to a cardiologist, after years of trying to get one, and I was given a heart monitor to wear at home for two weeks, and then on Dec 23rd I had an echocardiogram ultrasound done. After trying and failing to get ahold of them by phone, Friday I FINALLY received a letter in the mail with my results. The front page of that letter states that all my tests were normal, and no follow-up is needed.THEN, that same letter goes on to detail in the next few pages that I have a small left ventricle, sinus tachycardia with an average heartbeat ranging from 90-150 bpm, paradoxical septal motion, mild pulmonary valve regurgitation, a thickened mitral valve, mild mitral valve regurgitation, trivial tricuspid valve regurgitation, and then it states that my "right ventricular systolic pressure could not be estimated due to inability to detect peak tricuspid regurgitation" and that my pulmonary valve stats were also inconclusive due to "poor visualization".The "inconclusives" I suppose could go either way, and I don't know if those are something I should try to get more testing for to clear up or not. But the rest definitely does not sound "normal" to me, and based on a quick Google search most of those things seem to be more common in someone who has had previous cardiac surgery, which I have not, and/or they usually go hand-in-hand with severe pulmonary hypertension, and as previously mentioned, my blood pressure has been consistently LOW, to the point of being almost abnormally so, for at least the past year.So, is there anyone who can confirm that all those abnormalities could be found, while still falling within the "normal" range of test results? Am I just reading too much into this, or am I right in thinking that my cardiologist didn't do his job properly, and a second opinion is needed?Update: Wow this really took off way more than I expected! I went to bed early last night, was busy with other stuff this morning, and then I'm American, so I have been thoroughly distracted by the absolute shitshow going on in DC ever since..., so I haven't logged on to Reddit to check back on responses until just now. Thank you to everyone for what looks like some very educated replies; I'm working my way through them and will try to respond more thoroughly tomorrow after a good night's (hopefully) sleep!

Output: Nearly all of the things youve described are seen on essentially every echo report. Trivial and trace and mild regurgitation are seen in one or more valves of (what I estimate to be) the vast majority of healthy people. The regurgitation is only really abnormal if its significant (moderate or severe). Its important to mention any at all, though, so the previous report can be compared to any future ones (among other reasons). The reason theres a lot of could not assess...poor visualization all over the report is because this was a transthoracic echo. If they need better visualization of those structures, they would need to do a transesophageal echo which is a really not-fun procedure which requires you to be sedated, and is usually reserved for people with high suspicion for infective endocarditis or severe cardiac disease involving the poorly visualized structures.The rest of the findings could be related to pulmonary arterial HTN, which youve already mentioned. PAH is not the same as hypertension in general. The lung circulation is separate from the systemic circulation (though obviously the two are connected) and PAH is usually due to changes in the lung structure or function. For example, COPD, pulmonary fibrosis (scarring in the lungs), or - my attendings personal favorite underdog in the world of heart/lung issues - sleep apnea.The full report of any diagnostic study, like an echo, is always going to have something that doesnt sound completely normal in it - the wonderful world of incidental findings. Thats why its important to go by what the cardiologist or other ordering physician interprets from the echo. Its also why every diagnostic report has a disclaimer along the lines of correlate with clinical findings. In the context of your presentation, the echo that you had done was essentially normal. Its what my own echo report said despite results that could have been used to diagnose someone with heart failure with reduced ejection fraction had they been a 68 year old with blood pressure of 155/100 for the past 25 years, extra heart sounds, and shortness of breath.Your echo was done, I presume, to look for rheumatic heart disease in the context of your clinical findings (which could be consistent with that, though its rare to get this from only having rheumatic fever once). These findings arent really consistent with RHD. The mitral valve is slightly thickened, which may be the result of the rheumatic fever, but the report does not show mitral stenosis (the expected consequence of RHD).What Id recommend doing is writing down the findings youve seen on the report, including your concerns about what they could mean, and other good questions youve asked in your post here (like about pulmonary artery hypertension, and the poor visualization of certain structures on the echo and how important these inconclusive findings would be to a diagnosis) and take them with you to the next appointment. Because your cardiologist has a more complete picture of your clinical presentation and other health info, they are the best person to help guide you through the report, why they do not feel this echo has shown the underlying problem, and the next steps to take.Best of luck to you, and thank you for the question! Echo reports are always confusing and concerning to many who arent aware that many of the abnormal findings are often normal variants, so this is a great post to discuss that with.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 35 yo female 5'7" (170 cm) 180lbs (81.6kg) Caucasian and Native American I have previously had high blood pressure, but as of the last year or so my blood pressure has become very LOW for undetermined reasons, with my most recent reading being 101/60Primary symptoms: Decreasing general health for the past ~3 years, primarily presenting as severe fatigue, syncope + nausea when overheated or standing up too quickly, needing a minimum of 10-12 hours of sleep every night to feel rested, general malaise.I have asthma, ADD, MDD. Drink occasionally; previous occasional smoker but quit ~5 years ago. Same for recreational drugs -- on occasion when I was younger, but none for at least 5 years. I had previously been diagnosed with Rheumatic Fever in 2015, which seems VERY relevant here, but every doctor I've tried to discuss it with brushes it off when I mention it.So, last month I finally got a referral to a cardiologist, after years of trying to get one, and I was given a heart monitor to wear at home for two weeks, and then on Dec 23rd I had an echocardiogram ultrasound done. After trying and failing to get ahold of them by phone, Friday I FINALLY received a letter in the mail with my results. The front page of that letter states that all my tests were normal, and no follow-up is needed.THEN, that same letter goes on to detail in the next few pages that I have a small left ventricle, sinus tachycardia with an average heartbeat ranging from 90-150 bpm, paradoxical septal motion, mild pulmonary valve regurgitation, a thickened mitral valve, mild mitral valve regurgitation, trivial tricuspid valve regurgitation, and then it states that my "right ventricular systolic pressure could not be estimated due to inability to detect peak tricuspid regurgitation" and that my pulmonary valve stats were also inconclusive due to "poor visualization".The "inconclusives" I suppose could go either way, and I don't know if those are something I should try to get more testing for to clear up or not. But the rest definitely does not sound "normal" to me, and based on a quick Google search most of those things seem to be more common in someone who has had previous cardiac surgery, which I have not, and/or they usually go hand-in-hand with severe pulmonary hypertension, and as previously mentioned, my blood pressure has been consistently LOW, to the point of being almost abnormally so, for at least the past year.So, is there anyone who can confirm that all those abnormalities could be found, while still falling within the "normal" range of test results? Am I just reading too much into this, or am I right in thinking that my cardiologist didn't do his job properly, and a second opinion is needed?Update: Wow this really took off way more than I expected! I went to bed early last night, was busy with other stuff this morning, and then I'm American, so I have been thoroughly distracted by the absolute shitshow going on in DC ever since..., so I haven't logged on to Reddit to check back on responses until just now. Thank you to everyone for what looks like some very educated replies; I'm working my way through them and will try to respond more thoroughly tomorrow after a good night's (hopefully) sleep!. ### Response: Nearly all of the things youve described are seen on essentially every echo report. Trivial and trace and mild regurgitation are seen in one or more valves of (what I estimate to be) the vast majority of healthy people. The regurgitation is only really abnormal if its significant (moderate or severe). Its important to mention any at all, though, so the previous report can be compared to any future ones (among other reasons). The reason theres a lot of could not assess...poor visualization all over the report is because this was a transthoracic echo. If they need better visualization of those structures, they would need to do a transesophageal echo which is a really not-fun procedure which requires you to be sedated, and is usually reserved for people with high suspicion for infective endocarditis or severe cardiac disease involving the poorly visualized structures.The rest of the findings could be related to pulmonary arterial HTN, which youve already mentioned. PAH is not the same as hypertension in general. The lung circulation is separate from the systemic circulation (though obviously the two are connected) and PAH is usually due to changes in the lung structure or function. For example, COPD, pulmonary fibrosis (scarring in the lungs), or - my attendings personal favorite underdog in the world of heart/lung issues - sleep apnea.The full report of any diagnostic study, like an echo, is always going to have something that doesnt sound completely normal in it - the wonderful world of incidental findings. Thats why its important to go by what the cardiologist or other ordering physician interprets from the echo. Its also why every diagnostic report has a disclaimer along the lines of correlate with clinical findings. In the context of your presentation, the echo that you had done was essentially normal. Its what my own echo report said despite results that could have been used to diagnose someone with heart failure with reduced ejection fraction had they been a 68 year old with blood pressure of 155/100 for the past 25 years, extra heart sounds, and shortness of breath.Your echo was done, I presume, to look for rheumatic heart disease in the context of your clinical findings (which could be consistent with that, though its rare to get this from only having rheumatic fever once). These findings arent really consistent with RHD. The mitral valve is slightly thickened, which may be the result of the rheumatic fever, but the report does not show mitral stenosis (the expected consequence of RHD).What Id recommend doing is writing down the findings youve seen on the report, including your concerns about what they could mean, and other good questions youve asked in your post here (like about pulmonary artery hypertension, and the poor visualization of certain structures on the echo and how important these inconclusive findings would be to a diagnosis) and take them with you to the next appointment. Because your cardiologist has a more complete picture of your clinical presentation and other health info, they are the best person to help guide you through the report, why they do not feel this echo has shown the underlying problem, and the next steps to take.Best of luck to you, and thank you for the question! Echo reports are always confusing and concerning to many who arent aware that many of the abnormal findings are often normal variants, so this is a great post to discuss that with..


Instruction: Sorry for such a late reply, but the past few days have been a bit busy for me. Thank you for such a detailed response!So, the echo actually wasn't done specifically to look for Rheumatic heart disease -- that's just something I thought might be relevant or related to the problems I've been having. It was primarily done because I've been having these periodic attacks of such severe fatigue I can barely get out of bed, and when I do manage to get myself upright, I get out of breath and heart-poundy with even the slightest exertion, and am just generally extremely weak and disoriented -- I can't lift my arm over my head for more than a couple seconds, can't stay standing very long without sitting or leaning heavily on something, etc... and if I try to fight it and actually KEEP myself upright and moving around for more than a minute or two -- ie, to take a shower -- it quickly progresses to my heart feeling like it's gonna pound out of my chest, then nausea + room violently spinning, very rapidly followed by syncope. I'm not sure if it's full or partial syncope because I'm not sure if only being "out" for a few seconds or so qualifies as full syncope or just partial -- but I definitely black out briefly and collapse, and then spend awhile feeling violently sick and dizzy and shaky (and cold-sweaty) after I come back to. These "attacks" (episodes? Not really sure what to call them) come and go, but when they happen, they generally last about a week (roughly 3-4 days of being really bad, then another 3-4 days of recovery before I'm relatively back to normal again.) I've figured out that my Adderall prescription seemed to be a primary trigger for these attacks, so I've recently quit taking that altogether, and I'm hoping that will drastically reduce the attacks... but they've definitely happened at other times even without any triggers that I've been able to pinpoint, so it's not the Adderall that was CAUSING it (also it didn't happen every time I took the Adderall, which is why it took awhile to pinpoint that being a huge trigger) -- there's something underlying that's going on, and the Adderall just seemed to trigger whatever that "something" is. But I'm not sure what it is that triggers them other times.So, my cardiology workup was primarily to try to figure out what the hell is going on with me as far as all that. I was honestly really hoping the answers here would be along the lines of "yes, something DEFINITELY got overlooked or mixed up, you need to call and insist on a follow-up appointment and let your doctor know he effed up and x, y, and z needs to be immediately looked into further". I mean I'm not looking for a malpractice suit or anything, I understand mistakes can happen... but I just really wanted to hear that it WAS a mistake, because I'm SO. FED. UP. with these goddamn symptoms.I have been in and out of doctor appointments CONSTANTLY for three years now. And I haven't been able to work for those three years because jobs just fire me for having to call in too often. And despite three years of endless appointments and efforts, I feel like I'm still no closer to having any answers... so I was REALLY hoping this would finally provide some. I would rather have an upsetting diagnosis at this point, than continue having NO diagnosis at all. Knowing what IS wrong would be so much more useful than just knowing one more thing that isn't -- once I know what IS wrong, I can actually get a treatment plan going for it, and maybe I can finally start getting my life back on track. I used to be super active -- worked full-time in a restaurant, on my feet running around 40 hours a week; spent my free time riding bikes, hiking, and gardening, as much as possible... and now I can barely do any of that. Very short hikes, small amounts of gardening... but none of the rest. I want my life back.Or worst case scenario, with a diagnosis I could at least apply for disability, if getting my life back isn't an option, and have some meager bit of income again, anyway. I could start processing the fact that getting my life back close to where it was before just isn't gonna happen, and deal with that, instead of holding out some hope of being able to be "fixed" -- at least somewhat -- once I finally know what's wrong. With answers, I could at least do SOMETHING. With no answers, my life just stays in this shitty limbo indefinitely. And I really, really thought this was going to be what finally gave me some answers. It 100% FEELS like it's my heart that's the root of my problems... and I was even about 2/3rds through one of the attack weeks when I had the echo done, so I thought for sure it would show something while I was right in the midst of it, especially. So I just can't wrap my head around how everything could be "basically normal."I suppose that all wasn't exactly clear in my "symptoms" summary -- I was just trying to rush through and get to the echo results, and didn't really feel like typing out the whole story -- so I just figured "fatigue/syncope/malaise" would cover the gist of it.I do really appreciate your response, though... I just wish it was what I actually wanted to hear. I just don't know how much more I can take of hearing "nothing seems to be wrong" when something is so obviously, seriously wrong. I know it's not psychosomatic; any doctor who tried to tell me it's "anxiety and/or depression" would probably find themself in possession of a brand new, shiny, second asshole by the time I was done with them... but this never-ending lack of answers does sometimes make me wonder if I'm going crazy. It feels like I'm being gaslit -- but by medical science, not by a person.

Output: Hello. I'm not a native English speaker so the terms "mild" or "moderate" got me a little confused at first. The medical student and the cardiologist gave a very good explanation as to why those are really normal findings, those are normal findings in my country as well. Still heart rate isn't normal, and symptoms persist so there is still a problem. Now we now it isn't in the heart. I also think that the rheumatoid fever isn't something to be worried of there was only one event, the echocardiogram findings demonstrate mitral valve thicken but not an stenosis, I agree with the rest and think that is not a problem. There are not-doctors that are thinking about POTS/dysautonomy, I came here to tell them they are not crazy, I also suspect that. However dysautonomy is diagnosed by discarding other illnesses, and with only the findings of an echocardiogram it cannot be diagnosed. I would ask with internal medicine for a second opinion and more tests, first you have to discard hypothyroidism (not likely), adrenal dysfunction and endocrine dysfunctions. The recommendations to better your symptoms are drinking more water, change positions slowly: if you are in crouch position stand up as slowly as you can, from laying down sit before you stand up. Try doing some non impact exercise (not a good idea: weight lifting, running, crossfit). Hope you get better and find some answers. Stay safe

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry for such a late reply, but the past few days have been a bit busy for me. Thank you for such a detailed response!So, the echo actually wasn't done specifically to look for Rheumatic heart disease -- that's just something I thought might be relevant or related to the problems I've been having. It was primarily done because I've been having these periodic attacks of such severe fatigue I can barely get out of bed, and when I do manage to get myself upright, I get out of breath and heart-poundy with even the slightest exertion, and am just generally extremely weak and disoriented -- I can't lift my arm over my head for more than a couple seconds, can't stay standing very long without sitting or leaning heavily on something, etc... and if I try to fight it and actually KEEP myself upright and moving around for more than a minute or two -- ie, to take a shower -- it quickly progresses to my heart feeling like it's gonna pound out of my chest, then nausea + room violently spinning, very rapidly followed by syncope. I'm not sure if it's full or partial syncope because I'm not sure if only being "out" for a few seconds or so qualifies as full syncope or just partial -- but I definitely black out briefly and collapse, and then spend awhile feeling violently sick and dizzy and shaky (and cold-sweaty) after I come back to. These "attacks" (episodes? Not really sure what to call them) come and go, but when they happen, they generally last about a week (roughly 3-4 days of being really bad, then another 3-4 days of recovery before I'm relatively back to normal again.) I've figured out that my Adderall prescription seemed to be a primary trigger for these attacks, so I've recently quit taking that altogether, and I'm hoping that will drastically reduce the attacks... but they've definitely happened at other times even without any triggers that I've been able to pinpoint, so it's not the Adderall that was CAUSING it (also it didn't happen every time I took the Adderall, which is why it took awhile to pinpoint that being a huge trigger) -- there's something underlying that's going on, and the Adderall just seemed to trigger whatever that "something" is. But I'm not sure what it is that triggers them other times.So, my cardiology workup was primarily to try to figure out what the hell is going on with me as far as all that. I was honestly really hoping the answers here would be along the lines of "yes, something DEFINITELY got overlooked or mixed up, you need to call and insist on a follow-up appointment and let your doctor know he effed up and x, y, and z needs to be immediately looked into further". I mean I'm not looking for a malpractice suit or anything, I understand mistakes can happen... but I just really wanted to hear that it WAS a mistake, because I'm SO. FED. UP. with these goddamn symptoms.I have been in and out of doctor appointments CONSTANTLY for three years now. And I haven't been able to work for those three years because jobs just fire me for having to call in too often. And despite three years of endless appointments and efforts, I feel like I'm still no closer to having any answers... so I was REALLY hoping this would finally provide some. I would rather have an upsetting diagnosis at this point, than continue having NO diagnosis at all. Knowing what IS wrong would be so much more useful than just knowing one more thing that isn't -- once I know what IS wrong, I can actually get a treatment plan going for it, and maybe I can finally start getting my life back on track. I used to be super active -- worked full-time in a restaurant, on my feet running around 40 hours a week; spent my free time riding bikes, hiking, and gardening, as much as possible... and now I can barely do any of that. Very short hikes, small amounts of gardening... but none of the rest. I want my life back.Or worst case scenario, with a diagnosis I could at least apply for disability, if getting my life back isn't an option, and have some meager bit of income again, anyway. I could start processing the fact that getting my life back close to where it was before just isn't gonna happen, and deal with that, instead of holding out some hope of being able to be "fixed" -- at least somewhat -- once I finally know what's wrong. With answers, I could at least do SOMETHING. With no answers, my life just stays in this shitty limbo indefinitely. And I really, really thought this was going to be what finally gave me some answers. It 100% FEELS like it's my heart that's the root of my problems... and I was even about 2/3rds through one of the attack weeks when I had the echo done, so I thought for sure it would show something while I was right in the midst of it, especially. So I just can't wrap my head around how everything could be "basically normal."I suppose that all wasn't exactly clear in my "symptoms" summary -- I was just trying to rush through and get to the echo results, and didn't really feel like typing out the whole story -- so I just figured "fatigue/syncope/malaise" would cover the gist of it.I do really appreciate your response, though... I just wish it was what I actually wanted to hear. I just don't know how much more I can take of hearing "nothing seems to be wrong" when something is so obviously, seriously wrong. I know it's not psychosomatic; any doctor who tried to tell me it's "anxiety and/or depression" would probably find themself in possession of a brand new, shiny, second asshole by the time I was done with them... but this never-ending lack of answers does sometimes make me wonder if I'm going crazy. It feels like I'm being gaslit -- but by medical science, not by a person.. ### Response: Hello. I'm not a native English speaker so the terms "mild" or "moderate" got me a little confused at first. The medical student and the cardiologist gave a very good explanation as to why those are really normal findings, those are normal findings in my country as well. Still heart rate isn't normal, and symptoms persist so there is still a problem. Now we now it isn't in the heart. I also think that the rheumatoid fever isn't something to be worried of there was only one event, the echocardiogram findings demonstrate mitral valve thicken but not an stenosis, I agree with the rest and think that is not a problem. There are not-doctors that are thinking about POTS/dysautonomy, I came here to tell them they are not crazy, I also suspect that. However dysautonomy is diagnosed by discarding other illnesses, and with only the findings of an echocardiogram it cannot be diagnosed. I would ask with internal medicine for a second opinion and more tests, first you have to discard hypothyroidism (not likely), adrenal dysfunction and endocrine dysfunctions. The recommendations to better your symptoms are drinking more water, change positions slowly: if you are in crouch position stand up as slowly as you can, from laying down sit before you stand up. Try doing some non impact exercise (not a good idea: weight lifting, running, crossfit). Hope you get better and find some answers. Stay safe.


Instruction: 48 year old female 54 normal weight female. Went to the ER for chest pains on the left side that were consistent for about two months and have since subsided in the ER had a normal chest CAT scan with contrast. Low anion Gap. I was just looking back at bloodwork from ER visit in December and noticed Anion Gap was 1/mol/L but Albumin was normal 3.9 and total protein normal 7.2. The Dr didn't mention this to me. And just saw this now. So worried about Multiple Myeloma now. My sodium was low 131 and SGPT (ALT) was low 12. The only thing they mentioned was elevated Hgb 15.5 and Het 46.3% but said nothing to worry about. Can anyone give their opinion. Ive also been to the gastroenterologist and cardiologist, upper endoscopy and colonoscopy normal and all cardiology tests were clear just showed some palpitations upon exertion.

Output: Multiple myeloma usually has high calcium, kidney disease, anemia (low blood count) and bone disease. You mentioned none of those. Low anion gap is hardly used in the emergency setting, and usually will need retesting if blood to see if it was a one time occurrence.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 48 year old female 54 normal weight female. Went to the ER for chest pains on the left side that were consistent for about two months and have since subsided in the ER had a normal chest CAT scan with contrast. Low anion Gap. I was just looking back at bloodwork from ER visit in December and noticed Anion Gap was 1/mol/L but Albumin was normal 3.9 and total protein normal 7.2. The Dr didn't mention this to me. And just saw this now. So worried about Multiple Myeloma now. My sodium was low 131 and SGPT (ALT) was low 12. The only thing they mentioned was elevated Hgb 15.5 and Het 46.3% but said nothing to worry about. Can anyone give their opinion. Ive also been to the gastroenterologist and cardiologist, upper endoscopy and colonoscopy normal and all cardiology tests were clear just showed some palpitations upon exertion.. ### Response: Multiple myeloma usually has high calcium, kidney disease, anemia (low blood count) and bone disease. You mentioned none of those. Low anion gap is hardly used in the emergency setting, and usually will need retesting if blood to see if it was a one time occurrence..


Instruction: Thank you for the response. Several months ago I did have elevated calcium but have been retested two times and calcium was normal. I was taking a lot of gas x and alka seltzer for the chest pain that I had gone in for.Also had bloodwork three weeks prior and anion gap and albumin and globulin were normal. Would that change so fast?

Output: Anion gap is calculated by (sodium + potassium) - (bicarbonate and chloride). Most of the time when it is reported as low it is because there is slight variation in these factors from any random blood sample leading it to be falsely low. This is why they usually repeat it, and usually it normalizes.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for the response. Several months ago I did have elevated calcium but have been retested two times and calcium was normal. I was taking a lot of gas x and alka seltzer for the chest pain that I had gone in for.Also had bloodwork three weeks prior and anion gap and albumin and globulin were normal. Would that change so fast?. ### Response: Anion gap is calculated by (sodium + potassium) - (bicarbonate and chloride). Most of the time when it is reported as low it is because there is slight variation in these factors from any random blood sample leading it to be falsely low. This is why they usually repeat it, and usually it normalizes..


Instruction: 8F, 78lbs, no medication. She was in the hospital for a long time but they discharged her. She is still in pain, please help. I attached the notes of her discharge.The patient is an 8-year-old white female with five weeks of fever, rash, arthralgias. Last month, the patient noted foot pain involving both left and right feet, as well as a blotchy pink rash on the leg that proceeded to spread to the trunk and then arms and then face during that week. The patient had low-grade fevers with temps to a max of 101. This has progressed to the week prior to admission higher fevers with T-max of 103.5. The patient has endorsed muscle pain, particularly in the right leg and arm, and PMD had seen the patient this week noted right knee and right index finger swelling. There is no noted weight change over this time period. No noted diarrhea or swollen nodes. The rash the patient described the week prior had an acute abrupt onset and 5-10 minutes later would dissipate.Rheumatology was consulted on the patient from admission. Lab studies were sent to rule-out an infectious etiology for rash. Strep culture was negative. EKG was also performed to rule-out a prolonged PR interval. EKG was within normal limits. A DNase B antibody was 547 and an ASO titer was 300. While results were elevated, the patient did no meet clinical criteria for rheumatic fever and diagnosis that was most likely entertained was systemic JIA. Further lab work included an ANA which was negative, rheumatoid factor which was negative, a CRP on admission was 8.6 mg/dL with an ESR about 80. CK and aldolase were within normal limits. Ferritin was elevated at 663. LDH was within normal limits. CBC was reassuring with normal white counts, hemoglobin and platelets; findings nonsuggestive of leukemia. Hepatic panel within normal limits. A chest x-ray was done to rule-out mediastinal mass, and that was negative. From an infectious standpoint, Parvo, CMV, EBV were all negative. Clinically the patient was noted to have a salmon-colored transient rash that would come and go throughout the hospitalization lasting a matter of minutes. No definite arthritis on examination. Oncology was consulted given the history of arthritis and fevers. It was felt in the setting of normal cell lines in evaluating a smear, which revealed no blasts, no indication of hepatomegaly or splenomegaly and uric acid and LDH within normal limits and x-ray that was normal, they felt that further oncologic evaluation was not indicated and a bone marrow was not indicated at that time. Cardiology was also officially consulted because the patient had a 2/6 ejection murmur on the exam. Cardiology felt the murmur was a flow murmur and evaluated the EKG, which they read as within normal limits, and decided an echo was not indicated to rule-out valvular disease in the setting of the rash and arthritis in an attempt to workup acute rheumatic fever.

Output: Internal medicine doc here but in my differential is Adult Onset Stills Disease which can still present in children and Rocky Mountain Spotted Fever. The salmon colored rash lasting a few minutes is textbook for Adult Onset Stills Disease.I'm assuming she had blood cultures done at one or multiple points during her admission. Did she have a procalcitonin tested? Did she receive any antibiotics? Any steroids like solumedrol, prednisone etc? Does she still have joint pain? Does this rash show up only during febrile episodes? Any auto immune conditions in the family like lupus, rheumatoid arthritis, hashimotos?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 8F, 78lbs, no medication. She was in the hospital for a long time but they discharged her. She is still in pain, please help. I attached the notes of her discharge.The patient is an 8-year-old white female with five weeks of fever, rash, arthralgias. Last month, the patient noted foot pain involving both left and right feet, as well as a blotchy pink rash on the leg that proceeded to spread to the trunk and then arms and then face during that week. The patient had low-grade fevers with temps to a max of 101. This has progressed to the week prior to admission higher fevers with T-max of 103.5. The patient has endorsed muscle pain, particularly in the right leg and arm, and PMD had seen the patient this week noted right knee and right index finger swelling. There is no noted weight change over this time period. No noted diarrhea or swollen nodes. The rash the patient described the week prior had an acute abrupt onset and 5-10 minutes later would dissipate.Rheumatology was consulted on the patient from admission. Lab studies were sent to rule-out an infectious etiology for rash. Strep culture was negative. EKG was also performed to rule-out a prolonged PR interval. EKG was within normal limits. A DNase B antibody was 547 and an ASO titer was 300. While results were elevated, the patient did no meet clinical criteria for rheumatic fever and diagnosis that was most likely entertained was systemic JIA. Further lab work included an ANA which was negative, rheumatoid factor which was negative, a CRP on admission was 8.6 mg/dL with an ESR about 80. CK and aldolase were within normal limits. Ferritin was elevated at 663. LDH was within normal limits. CBC was reassuring with normal white counts, hemoglobin and platelets; findings nonsuggestive of leukemia. Hepatic panel within normal limits. A chest x-ray was done to rule-out mediastinal mass, and that was negative. From an infectious standpoint, Parvo, CMV, EBV were all negative. Clinically the patient was noted to have a salmon-colored transient rash that would come and go throughout the hospitalization lasting a matter of minutes. No definite arthritis on examination. Oncology was consulted given the history of arthritis and fevers. It was felt in the setting of normal cell lines in evaluating a smear, which revealed no blasts, no indication of hepatomegaly or splenomegaly and uric acid and LDH within normal limits and x-ray that was normal, they felt that further oncologic evaluation was not indicated and a bone marrow was not indicated at that time. Cardiology was also officially consulted because the patient had a 2/6 ejection murmur on the exam. Cardiology felt the murmur was a flow murmur and evaluated the EKG, which they read as within normal limits, and decided an echo was not indicated to rule-out valvular disease in the setting of the rash and arthritis in an attempt to workup acute rheumatic fever.. ### Response: Internal medicine doc here but in my differential is Adult Onset Stills Disease which can still present in children and Rocky Mountain Spotted Fever. The salmon colored rash lasting a few minutes is textbook for Adult Onset Stills Disease.I'm assuming she had blood cultures done at one or multiple points during her admission. Did she have a procalcitonin tested? Did she receive any antibiotics? Any steroids like solumedrol, prednisone etc? Does she still have joint pain? Does this rash show up only during febrile episodes? Any auto immune conditions in the family like lupus, rheumatoid arthritis, hashimotos?.


Instruction: NAD. My son has Adult onset stills disease, also considered SJIA when in a child under 16. His symptoms were rash (with fever) that could disappear when the fever went down. Muscle aches, joint pain. Enlarged spleen, liver. Elevated CRP, ESR, ASO, and Ferritin. Liver enzymes elevated from the swelling. He is on high dose prednisone and biologic injections. Hospitalized for 3 weeks.Its rare op, but your sisters case seems so similar. It needs aggressive treatment early on for the best chance of success/possible remission

Output: Yes, the evanescent nature of the rash in this context twigged me to Still's as well. There is a known juvenile onset form that falls under "SoJIA" (Systemic-onset Juvenile Idiopathic Arthritis), considered a version of Still's.OP, this sounds exactly like a form of arthritis to a clinician who takes care of children. I agree that what comes to mind for your mother as "arthritis" is likely too limited, and that definition might need to be expanded in her mind. Could you look at this, and maybe share it with her? https://www.arthritis.org/diseases/systemic-juvenile-idiopathic-arthritisAbout a third of the way down that page is the SYMPTOMS section, with subsections on Fever, Rash, and Joint Pain. Please read it and see if it rings a bell. Best wishes.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: NAD. My son has Adult onset stills disease, also considered SJIA when in a child under 16. His symptoms were rash (with fever) that could disappear when the fever went down. Muscle aches, joint pain. Enlarged spleen, liver. Elevated CRP, ESR, ASO, and Ferritin. Liver enzymes elevated from the swelling. He is on high dose prednisone and biologic injections. Hospitalized for 3 weeks.Its rare op, but your sisters case seems so similar. It needs aggressive treatment early on for the best chance of success/possible remission. ### Response: Yes, the evanescent nature of the rash in this context twigged me to Still's as well. There is a known juvenile onset form that falls under "SoJIA" (Systemic-onset Juvenile Idiopathic Arthritis), considered a version of Still's.OP, this sounds exactly like a form of arthritis to a clinician who takes care of children. I agree that what comes to mind for your mother as "arthritis" is likely too limited, and that definition might need to be expanded in her mind. Could you look at this, and maybe share it with her? https://www.arthritis.org/diseases/systemic-juvenile-idiopathic-arthritisAbout a third of the way down that page is the SYMPTOMS section, with subsections on Fever, Rash, and Joint Pain. Please read it and see if it rings a bell. Best wishes..


Instruction: 27, female, 5ft 8, 190lbs, folic acid & vitamin D supplement medications.I am 16 weeks pregnant and have Wolff Parkinson White syndrome. I was diagnosed in 2012 but have been asymptomatic for around 8 years now. Today I was at maternity and was checked by cardiology where WPW presented itself again on my ECG. I had an 2 ablation attempts in 2012 & 2013 where they werent able to get the extra pathway.How will this affect my pregnancy and delivery options?

Output: It depends on if you have arrhythmias. Have you ever had atrial fibrillation? Did they ever do an exercise stress test?Most of the time it won't effect pregnancy but if you have ever had atrial fibrillation the risk of degrading to a ventricular arrhythmia will be increased in pregnancy.Talk with your cardiologist, it may be beneficial to start a beta blocker depending on your history.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 27, female, 5ft 8, 190lbs, folic acid & vitamin D supplement medications.I am 16 weeks pregnant and have Wolff Parkinson White syndrome. I was diagnosed in 2012 but have been asymptomatic for around 8 years now. Today I was at maternity and was checked by cardiology where WPW presented itself again on my ECG. I had an 2 ablation attempts in 2012 & 2013 where they werent able to get the extra pathway.How will this affect my pregnancy and delivery options?. ### Response: It depends on if you have arrhythmias. Have you ever had atrial fibrillation? Did they ever do an exercise stress test?Most of the time it won't effect pregnancy but if you have ever had atrial fibrillation the risk of degrading to a ventricular arrhythmia will be increased in pregnancy.Talk with your cardiologist, it may be beneficial to start a beta blocker depending on your history..


Instruction: I'm not sure what details are most important here, so I'll try to sum things up clearly. I need to determine if I should pay for a private autopsy, the problem is money is tight. However, if it's likely someone messed up, I want to take action. This hospital has something of a reputation when it comes to problems with infections, and previously they messed up on a friend of mine, their mistake nearly led to the amputation of her arm. Luckily that time they caught their mistake, and the $250,000 medical bill wasn't placed on my friend.Male665'10"215 lbhad been on 5mg oxycontin for a bruised rib, took something like 30mg total a dayRough timeline:Day 1 he went to the ER for an infected toe. They referred him to another ER because the infection had spread to the bone and they needed to amputate. His GP said he had no diabetes. He may have had a case of bronchitis.Day 2 he's dealing with bad conditions at the hospital where his surgery will take place due to overcrowding in the non-covid section of the hospital while they give him antibiotics prior to surgery.Day 3 surgery takes place, surgeon reports everything went quickly and smoothly. Dad texts me after, saying everything went well. I talked with him and he sounded tired, but didn't seem out of the ordinary post-op.~14 hours later, a nurse says he was talking with my dad, he was joking with the nurse and the nurse "got his pain level down" and continued his rounds. An hour after this, my dad starts to gasp for breath, starts coding and they move him to the cardiology section where he passed.Some possible weirdness:The surgeon led me to believe there would be an autopsy, though he never directly stated there would be one, as he said my dad was relatively young and the surgeon didn't know what could have gone wrong. However, the surgeon had either already signed off on no-autopsy or did shortly thereafter. Going back to our conversation, the surgeon never said "there will be an autopsy" he just said "the coroner will have to tell us what happened" or something along those lines.I waited for a couple of days to hear back the results, but the hospital then lost my dad and the stuff he had brought in with him, they lost him for something like 4 or 5 days, with us calling every day after the 2nd day after his passing trying to find him and his phone so we could get his contacts and notify people. We still don't have his phone, so we haven't been able to notify all of his friends as the majority of their contact info is in his phone and we don't have it yet.

Output: First off, let me say I am very sorry for your loss.All the following assumes you live in the US:I believe the specifics varies by state/county, but any unexpected death (with or without surgery) is by default a coroner's case. This means, someone at the hospital (doctor or nurse) is legally obligated to call the county coroner and report the death. The coroner has the discretion to order an autopsy, i.e. say yes or no they believe one should be done. In this situation, I would think they definitely would, and the body would be transferred to the coroner's office to do it. Even if the coroner says no, they don't require one, the attending doc of the patient can request an autopsy (to be done by the hospital.)I guess in your shoes I would do the following:Contact the surgeon and ask if the case was reported to the coroner. If not, why not. If they did call, what did they say about an autopsy.Then ask how you go about arranging a private autopsy. The surgeon might not know, but should be able to get you in contact with people in the hospital who can help you find out.Any respectable surgeon would want to know what happened just as much as you do. If you find him being evasive on the subject or refusing to return your calls, contact the hospital administration. Admins know medical legal risk and this is absolutely a red flag in that regard.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm not sure what details are most important here, so I'll try to sum things up clearly. I need to determine if I should pay for a private autopsy, the problem is money is tight. However, if it's likely someone messed up, I want to take action. This hospital has something of a reputation when it comes to problems with infections, and previously they messed up on a friend of mine, their mistake nearly led to the amputation of her arm. Luckily that time they caught their mistake, and the $250,000 medical bill wasn't placed on my friend.Male665'10"215 lbhad been on 5mg oxycontin for a bruised rib, took something like 30mg total a dayRough timeline:Day 1 he went to the ER for an infected toe. They referred him to another ER because the infection had spread to the bone and they needed to amputate. His GP said he had no diabetes. He may have had a case of bronchitis.Day 2 he's dealing with bad conditions at the hospital where his surgery will take place due to overcrowding in the non-covid section of the hospital while they give him antibiotics prior to surgery.Day 3 surgery takes place, surgeon reports everything went quickly and smoothly. Dad texts me after, saying everything went well. I talked with him and he sounded tired, but didn't seem out of the ordinary post-op.~14 hours later, a nurse says he was talking with my dad, he was joking with the nurse and the nurse "got his pain level down" and continued his rounds. An hour after this, my dad starts to gasp for breath, starts coding and they move him to the cardiology section where he passed.Some possible weirdness:The surgeon led me to believe there would be an autopsy, though he never directly stated there would be one, as he said my dad was relatively young and the surgeon didn't know what could have gone wrong. However, the surgeon had either already signed off on no-autopsy or did shortly thereafter. Going back to our conversation, the surgeon never said "there will be an autopsy" he just said "the coroner will have to tell us what happened" or something along those lines.I waited for a couple of days to hear back the results, but the hospital then lost my dad and the stuff he had brought in with him, they lost him for something like 4 or 5 days, with us calling every day after the 2nd day after his passing trying to find him and his phone so we could get his contacts and notify people. We still don't have his phone, so we haven't been able to notify all of his friends as the majority of their contact info is in his phone and we don't have it yet.. ### Response: First off, let me say I am very sorry for your loss.All the following assumes you live in the US:I believe the specifics varies by state/county, but any unexpected death (with or without surgery) is by default a coroner's case. This means, someone at the hospital (doctor or nurse) is legally obligated to call the county coroner and report the death. The coroner has the discretion to order an autopsy, i.e. say yes or no they believe one should be done. In this situation, I would think they definitely would, and the body would be transferred to the coroner's office to do it. Even if the coroner says no, they don't require one, the attending doc of the patient can request an autopsy (to be done by the hospital.)I guess in your shoes I would do the following:Contact the surgeon and ask if the case was reported to the coroner. If not, why not. If they did call, what did they say about an autopsy.Then ask how you go about arranging a private autopsy. The surgeon might not know, but should be able to get you in contact with people in the hospital who can help you find out.Any respectable surgeon would want to know what happened just as much as you do. If you find him being evasive on the subject or refusing to return your calls, contact the hospital administration. Admins know medical legal risk and this is absolutely a red flag in that regard..


Instruction: I have had an experience in a hospital like this, as the mom of a patient. The procedure was absolutely botched and we did not find out til later from a nurse who didnt realize they hadnt told us the entire truth. It changed the procedure for pyxis picks in our local hospital, because they picked the wrong medication and it went through two nurses and a pediatrician and was administered to my newborn, premature son.Every business is going to protect its own interests, and I consider doctors a business entity as well as the practices and hospitals. Mistakes are understandable but for a mistake to make it through 3 medical professionals and not be caught til hours after the fact is inexcusable.All this to say, mistakes happen and even on a big scale. I wouldnt think it uncommon for this sort of thing to happen.

Output: Interesting assuming your flair is correct and you are not in medicine it seems more likely there was a miscommunication. I've seen bad outcomes but i have never seen or been involved in a "coverup." In PACU Im on the phone with the family/proxy immediately informing them of even relatively mild complications like blood loss requiring transfusion (1-2 units not MTP).At least in general surgery, the patient/their PCP will see what was done on post-op imaging. You can't hide from radiology!

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have had an experience in a hospital like this, as the mom of a patient. The procedure was absolutely botched and we did not find out til later from a nurse who didnt realize they hadnt told us the entire truth. It changed the procedure for pyxis picks in our local hospital, because they picked the wrong medication and it went through two nurses and a pediatrician and was administered to my newborn, premature son.Every business is going to protect its own interests, and I consider doctors a business entity as well as the practices and hospitals. Mistakes are understandable but for a mistake to make it through 3 medical professionals and not be caught til hours after the fact is inexcusable.All this to say, mistakes happen and even on a big scale. I wouldnt think it uncommon for this sort of thing to happen.. ### Response: Interesting assuming your flair is correct and you are not in medicine it seems more likely there was a miscommunication. I've seen bad outcomes but i have never seen or been involved in a "coverup." In PACU Im on the phone with the family/proxy immediately informing them of even relatively mild complications like blood loss requiring transfusion (1-2 units not MTP).At least in general surgery, the patient/their PCP will see what was done on post-op imaging. You can't hide from radiology!.


Instruction: irst off, I know the pain of losing a parent and Im terribly sorry.Second, NAD, but my field of work happens to be in medical malpractice, specifically investigating licensed medical professionals.Malpractice is generally defined as medical negligence, but this comes in many forms.What I would do is request any and all medical records IF you can legally. Or whoever can, they need to and are allowed under HIPAA. The records we see from doctors are very general, they are required to log and note just about everything and a lot of detailed notes youll never see unless requested.It appears if any negligence happened it was after his passing. The fact that they lost him is NOT ok.Id also be curious to see what medication he received after surgery or in the hours before his passing. Incorrect dosage or medication is a lot more common than people think.Anyway a malpractice attorney may not be the best route yetThey would have a coroner examine the body and can sometimes determine cause of death without an autopsy hasnt a cause of death been given to your family yet?If they cannot determine cause an autopsy would be performed and the family has to consent.The family also has every right to request one, but you may have to pay for it.I would gather that information for sure and any and all medical records

Output: This very sudden event does not sound like a surgical complication. It sounds more like a pulmonary embolus or heart attack, possibly an acute allergic reaction. WITHOUT RECORDS I CANNOT CLAIM THIS AS FACT. Edit: I just noticed you mentioned they moved him to the cardiology floor. A cardiac event seems more likely.You can request a copy of his medical records if you want to know more.Pulmonary embolism was my first thought as well, but of course its my first thought regardless of the situation because, well, gotta CT somethin.Sorry for your loss OP. I hope you are able to find peace within all of this.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: irst off, I know the pain of losing a parent and Im terribly sorry.Second, NAD, but my field of work happens to be in medical malpractice, specifically investigating licensed medical professionals.Malpractice is generally defined as medical negligence, but this comes in many forms.What I would do is request any and all medical records IF you can legally. Or whoever can, they need to and are allowed under HIPAA. The records we see from doctors are very general, they are required to log and note just about everything and a lot of detailed notes youll never see unless requested.It appears if any negligence happened it was after his passing. The fact that they lost him is NOT ok.Id also be curious to see what medication he received after surgery or in the hours before his passing. Incorrect dosage or medication is a lot more common than people think.Anyway a malpractice attorney may not be the best route yetThey would have a coroner examine the body and can sometimes determine cause of death without an autopsy hasnt a cause of death been given to your family yet?If they cannot determine cause an autopsy would be performed and the family has to consent.The family also has every right to request one, but you may have to pay for it.I would gather that information for sure and any and all medical records. ### Response: This very sudden event does not sound like a surgical complication. It sounds more like a pulmonary embolus or heart attack, possibly an acute allergic reaction. WITHOUT RECORDS I CANNOT CLAIM THIS AS FACT. Edit: I just noticed you mentioned they moved him to the cardiology floor. A cardiac event seems more likely.You can request a copy of his medical records if you want to know more.Pulmonary embolism was my first thought as well, but of course its my first thought regardless of the situation because, well, gotta CT somethin.Sorry for your loss OP. I hope you are able to find peace within all of this..


Instruction: In my hospital, the surgeon has no decision making in a coroners case. A mandatory coroners case is if a patient dies within 24 hours of admission. Furthermore, if any patient dies in my hospital, the charge RN or patients RN calls 1) the coroners office. 2) organ donation. 3). The family, and 4) the funeral home or cremation. The surgeon has nothing to do with the decision of a coroners case, the coroner decides. If the coroner decides no autopsy is warranted, the family may have there own independent autopsy completed at their own expense. Your fathers surgeon signed off because your father was no longer his patient. I hope this helps, and I am truly sorry about your father.

Output: Saying that hospital staff killed your dad is a bit of a stretch, but you do deserve an autopsy like you asked for.Reaching out to get records from the hospital and getting a lawyer could help. You could also reach out to the medical examiners office and see if theyre even aware of this case, if they havent heard of it, or if they rejected it.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: In my hospital, the surgeon has no decision making in a coroners case. A mandatory coroners case is if a patient dies within 24 hours of admission. Furthermore, if any patient dies in my hospital, the charge RN or patients RN calls 1) the coroners office. 2) organ donation. 3). The family, and 4) the funeral home or cremation. The surgeon has nothing to do with the decision of a coroners case, the coroner decides. If the coroner decides no autopsy is warranted, the family may have there own independent autopsy completed at their own expense. Your fathers surgeon signed off because your father was no longer his patient. I hope this helps, and I am truly sorry about your father.. ### Response: Saying that hospital staff killed your dad is a bit of a stretch, but you do deserve an autopsy like you asked for.Reaching out to get records from the hospital and getting a lawyer could help. You could also reach out to the medical examiners office and see if theyre even aware of this case, if they havent heard of it, or if they rejected it..