Instruction: I'm just a layperson, but I feel like if it was me I'd 100% rather random people/doctors think I'm crazy than my child feel like I don't hear them/don't care that they're complaining of pain or sickness.

Output: It's a very helpful matrix for cyclical vomiting syndrome. Though it's more relevant to the doctor treating the patient , I think it also provides good information to the patient or on your case parents.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm just a layperson, but I feel like if it was me I'd 100% rather random people/doctors think I'm crazy than my child feel like I don't hear them/don't care that they're complaining of pain or sickness.. ### Response: It's a very helpful matrix for cyclical vomiting syndrome. Though it's more relevant to the doctor treating the patient , I think it also provides good information to the patient or on your case parents..


Instruction: We were prescribed Topiramate, but I haven't had to use it since October 2022.

Output: Topiramate has a very good response in pediatric CVS.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: We were prescribed Topiramate, but I haven't had to use it since October 2022.. ### Response: Topiramate has a very good response in pediatric CVS..


Instruction: I have really appreciated your responses so far! Do you have any thoughts about the knee swelling/cyst and night pains?

Output: Night pains could be growing pains, or it could be the popliteal cyst or lymph node compressing a nerve. Usually, with an enlarged popliteal lymph node / cyst and neck ( cervical ) lymph node , I'll go for complete blood work and monospot test ( to detect mononucleosis/ Epstein Barr Virus ). Chronic bacterial and viral infection can lead to the enlargement of lymph nodes in kids ( also called lymphadenopathy ). It also happens in upper respiratory infection ( and if your pedi wants to explore further , I think they should go for a chest X-ray). Another thing that I'll always do will be the abdominal palpation to rule out enlarged spleen. In your kid's case , I'm still leaning towards the infection because he's otherwise healthy.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have really appreciated your responses so far! Do you have any thoughts about the knee swelling/cyst and night pains?. ### Response: Night pains could be growing pains, or it could be the popliteal cyst or lymph node compressing a nerve. Usually, with an enlarged popliteal lymph node / cyst and neck ( cervical ) lymph node , I'll go for complete blood work and monospot test ( to detect mononucleosis/ Epstein Barr Virus ). Chronic bacterial and viral infection can lead to the enlargement of lymph nodes in kids ( also called lymphadenopathy ). It also happens in upper respiratory infection ( and if your pedi wants to explore further , I think they should go for a chest X-ray). Another thing that I'll always do will be the abdominal palpation to rule out enlarged spleen. In your kid's case , I'm still leaning towards the infection because he's otherwise healthy..


Instruction: He was home for most of the covid lockdown years (we were in California and very restricted), so he was never sick or exposed to immune stressors for over two years. It seems like since he started daycare in late 2021 it's been nonstop illness. We've had head colds, stomach viruses, covid, flu, roseola, hand foot mouth, etc, you name it. Would this onslaught of viruses cause lymphadenopathy? Could it cause unexplained vomiting too? The vomiting occurred without fever and far enough from the stomach viruses and roseola to not be linked, I think.We decided to skip the ER and will see his pediatrician this week. I'll ask about the spleen/mono and push for more tests to explain the swelling nodes. Thank you so much for at least putting me at ease regarding worst case scenarios. Let me know if you'd like an update after we get results. I have no idea why you were so helpful to an internet stranger, but I sure do appreciate it!

Output: Thank you so much for your appreciation. As a physician , it is my duty to help a patient in any way I can. You are right about the non exposure of viruses during lock down, because kids didn't have the opportunity to develop any immunity to them, and hence, the flu is more severe than before. I'll definitely appreciate an update, and I hope everything will turn out alright.Different physician, but I am not concerned about the leg pain. The lymph nodes need to be investigated at some point soon, but not necessarily tonight. You relate reassuring characteristics about them.The big tell for leg pain is whether they want them rubbed or not. Pathologic leg pains don't get better with touch, and kids flinch away: tumors, fractures, arthritis, osteomyelitic infection, chronic inflammation, all of that is not something that gets better with being rubbed. I don't think I've ever seen something worrisome in the legs causing pain that was better with rubbing.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: He was home for most of the covid lockdown years (we were in California and very restricted), so he was never sick or exposed to immune stressors for over two years. It seems like since he started daycare in late 2021 it's been nonstop illness. We've had head colds, stomach viruses, covid, flu, roseola, hand foot mouth, etc, you name it. Would this onslaught of viruses cause lymphadenopathy? Could it cause unexplained vomiting too? The vomiting occurred without fever and far enough from the stomach viruses and roseola to not be linked, I think.We decided to skip the ER and will see his pediatrician this week. I'll ask about the spleen/mono and push for more tests to explain the swelling nodes. Thank you so much for at least putting me at ease regarding worst case scenarios. Let me know if you'd like an update after we get results. I have no idea why you were so helpful to an internet stranger, but I sure do appreciate it!. ### Response: Thank you so much for your appreciation. As a physician , it is my duty to help a patient in any way I can. You are right about the non exposure of viruses during lock down, because kids didn't have the opportunity to develop any immunity to them, and hence, the flu is more severe than before. I'll definitely appreciate an update, and I hope everything will turn out alright.Different physician, but I am not concerned about the leg pain. The lymph nodes need to be investigated at some point soon, but not necessarily tonight. You relate reassuring characteristics about them.The big tell for leg pain is whether they want them rubbed or not. Pathologic leg pains don't get better with touch, and kids flinch away: tumors, fractures, arthritis, osteomyelitic infection, chronic inflammation, all of that is not something that gets better with being rubbed. I don't think I've ever seen something worrisome in the legs causing pain that was better with rubbing..


Instruction: This is so very heartening to hear! I opted to skip the ER today. Will see pediatrician this week to re-examine the cough/lymph nodes. I'll wait for the ortho appointment this Friday. He definitely wants those legs rubbed!

Output: I will be thinking of you and hoping for the best. Please let us know how it works out.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This is so very heartening to hear! I opted to skip the ER today. Will see pediatrician this week to re-examine the cough/lymph nodes. I'll wait for the ortho appointment this Friday. He definitely wants those legs rubbed!. ### Response: I will be thinking of you and hoping for the best. Please let us know how it works out..


Instruction: Thank you, will do! Did you happen to see the comment above about Celiac Disease? My mother has it, I do not, but I do have issues with carbs in general. Would a sensitivity like that account for the leg pain and immune response? Vomiting and paleness?

Output: Celiac can certainly present in a variety of ways. We used to look for a very limited constellation of symptoms, but then it became recognized that -- for example -- it can come with constipation, not just diarrhea.My comment was intended to be reassuring about pathology in the legs themselves. I think what you related is reassuring from that perspective. Whether he could have cramping from an electrolyte imbalance or nutritional deficiency secondary to celiac disease? It should be possible. Thankfully there is relatively definitive testing to rule in or out.I hope you get some answers for your little tyke soon.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you, will do! Did you happen to see the comment above about Celiac Disease? My mother has it, I do not, but I do have issues with carbs in general. Would a sensitivity like that account for the leg pain and immune response? Vomiting and paleness?. ### Response: Celiac can certainly present in a variety of ways. We used to look for a very limited constellation of symptoms, but then it became recognized that -- for example -- it can come with constipation, not just diarrhea.My comment was intended to be reassuring about pathology in the legs themselves. I think what you related is reassuring from that perspective. Whether he could have cramping from an electrolyte imbalance or nutritional deficiency secondary to celiac disease? It should be possible. Thankfully there is relatively definitive testing to rule in or out.I hope you get some answers for your little tyke soon..


Instruction: ENT surgeons - would you do pediatric supraglottoplasty and/or remove adenoids?My baby is almost 5 months old, scheduled next week for endoscopy & bronchoscopy - the ent surgeon wants blanket consent going in for supraglottoplasty and removal of adenoids if indicated.On sleep study around 2.5 months ago, baby had a significant number of hypopneas (approx 27 times per hour) and 5 apneas (total) without a decline in O2 sats for either. Oxygen and carbon dioxide levels remained stable/good throughout duration of study. (Baby was not on supplemental oxygen during the study.)Baby has no noisy breathing, no feeding concerns (weight has gone from < 1 percentile at birth to currently 7th percentile) and is hitting all developmental milestones.Baby was IUGR, born at 5.5 lbs at 38 weeks. Released from hospital on day 3. Baby had trouble holding o2 sats at 2 weeks old, and was put on oxygen. Has remained on .5 liter since. A pulmonologist and the ENT doing the procedures both said the baby could come off of oxygen based on the sleep study, however the pulmonologist who initiated oxygen treatment in the hospital wants to continue until after the procedure.Since the study, baby is sometimes off of oxygen during the day and o2 levels hold stable. I also see significantly less startle during sleep. In my opinion, his condition is improving, and if I understand correctly a high number of babies outgrow apnea and laryngomalacia (what theyre looking for, not currently diagnosed).Looking for outside thoughts on this before deciding how to proceed.

Output: There's not enough information to definitively say what the correct course is, and we can't look at any further evaluation that has been done. Your child has severe sleep apnea based on the reported AHI, has an oxygen requirement, and by definition had failure to thrive while being <5th percentile for weight. One thing not commented on in this post at all is how feeding has been going, if there is tiring during feeding, desaturations during feeding, and how noisy the baby is when agitated and how noisy when sleeping. These can also all point to whether laryngomalacia is a potential cause.These all indicate at the very least that an evaluation of the airway is necessary, and it is reasonable if there are significant issues to correct those issues and minimize the need for further procedures.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: ENT surgeons - would you do pediatric supraglottoplasty and/or remove adenoids?My baby is almost 5 months old, scheduled next week for endoscopy & bronchoscopy - the ent surgeon wants blanket consent going in for supraglottoplasty and removal of adenoids if indicated.On sleep study around 2.5 months ago, baby had a significant number of hypopneas (approx 27 times per hour) and 5 apneas (total) without a decline in O2 sats for either. Oxygen and carbon dioxide levels remained stable/good throughout duration of study. (Baby was not on supplemental oxygen during the study.)Baby has no noisy breathing, no feeding concerns (weight has gone from < 1 percentile at birth to currently 7th percentile) and is hitting all developmental milestones.Baby was IUGR, born at 5.5 lbs at 38 weeks. Released from hospital on day 3. Baby had trouble holding o2 sats at 2 weeks old, and was put on oxygen. Has remained on .5 liter since. A pulmonologist and the ENT doing the procedures both said the baby could come off of oxygen based on the sleep study, however the pulmonologist who initiated oxygen treatment in the hospital wants to continue until after the procedure.Since the study, baby is sometimes off of oxygen during the day and o2 levels hold stable. I also see significantly less startle during sleep. In my opinion, his condition is improving, and if I understand correctly a high number of babies outgrow apnea and laryngomalacia (what theyre looking for, not currently diagnosed).Looking for outside thoughts on this before deciding how to proceed.. ### Response: There's not enough information to definitively say what the correct course is, and we can't look at any further evaluation that has been done. Your child has severe sleep apnea based on the reported AHI, has an oxygen requirement, and by definition had failure to thrive while being <5th percentile for weight. One thing not commented on in this post at all is how feeding has been going, if there is tiring during feeding, desaturations during feeding, and how noisy the baby is when agitated and how noisy when sleeping. These can also all point to whether laryngomalacia is a potential cause.These all indicate at the very least that an evaluation of the airway is necessary, and it is reasonable if there are significant issues to correct those issues and minimize the need for further procedures..


Instruction: Thank you for replying!I tried to address some of those things in my post. It sounds like I wasnt clear, so Ill try again.Ive been told by 2 different doctors that he no longer has an oxygen requirement, however the initial doctor who began the oxygen wants to keep him on it until the scopes.Baby is not failure to thrive. He was born less than 1 percentile due to IUGR. He is currently in the 7 percentile. He has been growing and gaining weight consistently along his curve. Weve seen GI and several nutritionists and feeding specialists (the specialists here see in co-managing groups) and everyone is very happy with how he is feeding and how he is gaining.He does not have, and has not had, any feeding issues. No tiring during feeds. No sweating. No desats during feeds. He has a bit of reflux, which GI said is normal and needs no treatment.There is no noisy breathing when agitated. He is not noisy during sleep.The impression Ive gotten is that laryngomalacia is being looked at as a possibility due to apnea. I also understand that typically oxygen drops during these events, and his did not. I think I was seeking some opinion on this in my post, though I wasnt clear. Can apnea be the only symptom of laryngomalacia requiring treatment?I absolutely think the scopes are necessary. Im totally on board with looking. I think this is why Im feeling challenged in giving blanket consent to cutting going in, though. To me, based on the research Ive done, it doesnt sound like he has other symptoms of laryngomalacia.I was hoping I might get additional insight here, and perhaps even find other pathways to research and explore. I appreciate you taking time to respond!

Output: Generally laryngomalacia is associated principally with noisy breathing and feeding difficulties. It is possible to have severe enough laryngomalacia that the loss of tone is resulting in the apneas/cessations of breathing, this would be called sleep-dependent laryngomalacia which is becoming increasingly recognized in the last few years.The true fact of the matter is there is a 5 month old with severe sleep apnea who is working on growing. Sleep apnea has significant impact on children and can impair development.It is also unclear if a scope examination has been done while the baby is awake (through the nose) to see if there is any evidence of laryngomalacia as this can often be apparent at bedside as well. The caveat to this would be sleep dependent laryngomalacia wouldn't be (because baby isn't asleep)When I was at a children's hospital and worked with some people that did blanket consents like that, it didn't always mean that the surgery would be performed, only if there were findings concerning enough to warrant the intervention. You have the option to talk to the surgeon and ask they call you before performing the procedure or discussing what they find. I've done that with plenty of folks. That being said, a supraglottoplasty is very well tolerated overall and those kids do tend to do much better.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for replying!I tried to address some of those things in my post. It sounds like I wasnt clear, so Ill try again.Ive been told by 2 different doctors that he no longer has an oxygen requirement, however the initial doctor who began the oxygen wants to keep him on it until the scopes.Baby is not failure to thrive. He was born less than 1 percentile due to IUGR. He is currently in the 7 percentile. He has been growing and gaining weight consistently along his curve. Weve seen GI and several nutritionists and feeding specialists (the specialists here see in co-managing groups) and everyone is very happy with how he is feeding and how he is gaining.He does not have, and has not had, any feeding issues. No tiring during feeds. No sweating. No desats during feeds. He has a bit of reflux, which GI said is normal and needs no treatment.There is no noisy breathing when agitated. He is not noisy during sleep.The impression Ive gotten is that laryngomalacia is being looked at as a possibility due to apnea. I also understand that typically oxygen drops during these events, and his did not. I think I was seeking some opinion on this in my post, though I wasnt clear. Can apnea be the only symptom of laryngomalacia requiring treatment?I absolutely think the scopes are necessary. Im totally on board with looking. I think this is why Im feeling challenged in giving blanket consent to cutting going in, though. To me, based on the research Ive done, it doesnt sound like he has other symptoms of laryngomalacia.I was hoping I might get additional insight here, and perhaps even find other pathways to research and explore. I appreciate you taking time to respond!. ### Response: Generally laryngomalacia is associated principally with noisy breathing and feeding difficulties. It is possible to have severe enough laryngomalacia that the loss of tone is resulting in the apneas/cessations of breathing, this would be called sleep-dependent laryngomalacia which is becoming increasingly recognized in the last few years.The true fact of the matter is there is a 5 month old with severe sleep apnea who is working on growing. Sleep apnea has significant impact on children and can impair development.It is also unclear if a scope examination has been done while the baby is awake (through the nose) to see if there is any evidence of laryngomalacia as this can often be apparent at bedside as well. The caveat to this would be sleep dependent laryngomalacia wouldn't be (because baby isn't asleep)When I was at a children's hospital and worked with some people that did blanket consents like that, it didn't always mean that the surgery would be performed, only if there were findings concerning enough to warrant the intervention. You have the option to talk to the surgeon and ask they call you before performing the procedure or discussing what they find. I've done that with plenty of folks. That being said, a supraglottoplasty is very well tolerated overall and those kids do tend to do much better..


Instruction: Dr.'s office is closed but I plan to call them tomorrow to verify... but I'm curious. My kiddo, 9F 29kg was prescribed pills instead of suspension because there is a shortage here, but it seems like she was prescribed an adult dose- 875mg every 12 hours, which works out to just over 60mg per kg per day. This seems to be roughly double the recommendation for children under 12.... source here: https://www.drugs.com/dosage/amoxicillin.html#Usual_Pediatric_Dose_for_Tonsillitis_PharyngitisThe diagnosis is scarlet fever, rapid strep test came back positive. I'm considering giving her half a pill tonight, or maybe just waiting until tomorrow when I can verify dosing with the doc. Do I have other options? Is there a better site for dosing information? I don't want to be the stereotypical "dr Google" but I know how EHR's work and I wonder if the system goofed when the med was switched from pediatric suspension to pill form, and I don't want to give my kid unnecessary diarrhea or whatever other nasty side effects might come from too strong a dose.

Output: They may have missed that we max out the dose of amoxicillin at 500mg twice daily or 1000mg once daily. I think it's fine for her to take a single dose of the 875mg tonight, then call them in the AM to see if you can get 500mg tablets instead.https://www.cdc.gov/groupastrep/diseases-hcp/scarlet-fever.html

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Dr.'s office is closed but I plan to call them tomorrow to verify... but I'm curious. My kiddo, 9F 29kg was prescribed pills instead of suspension because there is a shortage here, but it seems like she was prescribed an adult dose- 875mg every 12 hours, which works out to just over 60mg per kg per day. This seems to be roughly double the recommendation for children under 12.... source here: https://www.drugs.com/dosage/amoxicillin.html#Usual_Pediatric_Dose_for_Tonsillitis_PharyngitisThe diagnosis is scarlet fever, rapid strep test came back positive. I'm considering giving her half a pill tonight, or maybe just waiting until tomorrow when I can verify dosing with the doc. Do I have other options? Is there a better site for dosing information? I don't want to be the stereotypical "dr Google" but I know how EHR's work and I wonder if the system goofed when the med was switched from pediatric suspension to pill form, and I don't want to give my kid unnecessary diarrhea or whatever other nasty side effects might come from too strong a dose.. ### Response: They may have missed that we max out the dose of amoxicillin at 500mg twice daily or 1000mg once daily. I think it's fine for her to take a single dose of the 875mg tonight, then call them in the AM to see if you can get 500mg tablets instead.https://www.cdc.gov/groupastrep/diseases-hcp/scarlet-fever.html.


Instruction: Please can anyone tell me what is in the predmed given before UK pediatric surgery -to help calm and sedate my 5yr old before GA. Thank youAgeSexHeightWeightRaceDuration of complaintLocationAny existing relevant medical issuesCurrent medicationsInclude a photo if relevant

Output: I'm not in the UK but in Germany, yet I doubt the colleagues use vastly different medicines.We typically use the short-acting benzodiazepine Midazolam, which is also available as a sirup (ideal for kids). Alternatively, Clonidin can be used.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Please can anyone tell me what is in the predmed given before UK pediatric surgery -to help calm and sedate my 5yr old before GA. Thank youAgeSexHeightWeightRaceDuration of complaintLocationAny existing relevant medical issuesCurrent medicationsInclude a photo if relevant. ### Response: I'm not in the UK but in Germany, yet I doubt the colleagues use vastly different medicines.We typically use the short-acting benzodiazepine Midazolam, which is also available as a sirup (ideal for kids). Alternatively, Clonidin can be used..


Instruction: Can I still visit a pediatric doctor although i am 2121F. Height: 159 cm. Weight: 47kgs. South Asian. Although i am 21 i literally look like a 12 year old. I look very skinny and petite. I almost always have been since age 7-8. I won't say i eat the healthiest diet in the sense i most of the time remove onions and tomatoes out, other than that I eat ample amount of food. I literally am not gaining any body mass other than my tummy lol. I have a very thin and petite body frame. I was thinking of approaching a pediatric doctor unless it didn't improve till 18/19 but then COVID hit, can I still visit one, or that won't be appropriate given I am 21 now. Or should I visit some other doctor?PS.: I also got my thyroid levels checked and it were normal. What could be the cause? Where do I start from

Output: If you have a pediatrician as your primary care doctor, they may continue to see you until some point. If you dont have one, setting up with a pediatrician makes no sense and most would decline to start with you. Size and appearance are not the distinction between pediatric and adult medicineas pediatricians are fond of saying, kids are not just small adults. You should see an internal medicine or family medicine doctor.Your BMI is within the healthy range. Are your parents and other relatives thin? If so, without any symptoms its very likely just genetics.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can I still visit a pediatric doctor although i am 2121F. Height: 159 cm. Weight: 47kgs. South Asian. Although i am 21 i literally look like a 12 year old. I look very skinny and petite. I almost always have been since age 7-8. I won't say i eat the healthiest diet in the sense i most of the time remove onions and tomatoes out, other than that I eat ample amount of food. I literally am not gaining any body mass other than my tummy lol. I have a very thin and petite body frame. I was thinking of approaching a pediatric doctor unless it didn't improve till 18/19 but then COVID hit, can I still visit one, or that won't be appropriate given I am 21 now. Or should I visit some other doctor?PS.: I also got my thyroid levels checked and it were normal. What could be the cause? Where do I start from. ### Response: If you have a pediatrician as your primary care doctor, they may continue to see you until some point. If you dont have one, setting up with a pediatrician makes no sense and most would decline to start with you. Size and appearance are not the distinction between pediatric and adult medicineas pediatricians are fond of saying, kids are not just small adults. You should see an internal medicine or family medicine doctor.Your BMI is within the healthy range. Are your parents and other relatives thin? If so, without any symptoms its very likely just genetics..


Instruction: Was I molested by my pediatrician? / Is this normal for a pediatric exam?This is going to be all over the place so I'm sorry for that.All I remember was being 14 and being at the pediatricians. I kept saying no. My Mom was in the room and kept saying yes. So my underwear was down and my knees were bent and I was sobbing and my male pediatrician spread my labia just to "look" (with his hands). I was sobbing and saying no and I was ignored.I've talked to various crisis types of hotlines including RAINN and personally found them of no help.

Output: An external genital exam is part of a normal physical exam in child. I seriously doubt your pediatrician was doing this exam for some sexual purpose. However, I wouldn't force an exam like this on a crying kid, particularly an older kid with a sense of agency, unless it was medically necessary.Many pediatricians will limit their external GU exam on older girls to simply looking externally at labia, to assess pubarche. Doing an external while spreading labia is less common a "check up", unless there's a specific complaint like discharge, itching, rash, whatever. On the other hand, boy will typically have their testicles palpated looking for masses, hernias, varicocele, and assessing normal testicular development.Nobody here can say if the specifics of what your pediatrician were definitely appropriate in the circumstances, but an external GU exam isn't uncommon, and isn't "molestation" in and of itself. But it's something where assent from a 14 y/o girl should be obtained.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Was I molested by my pediatrician? / Is this normal for a pediatric exam?This is going to be all over the place so I'm sorry for that.All I remember was being 14 and being at the pediatricians. I kept saying no. My Mom was in the room and kept saying yes. So my underwear was down and my knees were bent and I was sobbing and my male pediatrician spread my labia just to "look" (with his hands). I was sobbing and saying no and I was ignored.I've talked to various crisis types of hotlines including RAINN and personally found them of no help.. ### Response: An external genital exam is part of a normal physical exam in child. I seriously doubt your pediatrician was doing this exam for some sexual purpose. However, I wouldn't force an exam like this on a crying kid, particularly an older kid with a sense of agency, unless it was medically necessary.Many pediatricians will limit their external GU exam on older girls to simply looking externally at labia, to assess pubarche. Doing an external while spreading labia is less common a "check up", unless there's a specific complaint like discharge, itching, rash, whatever. On the other hand, boy will typically have their testicles palpated looking for masses, hernias, varicocele, and assessing normal testicular development.Nobody here can say if the specifics of what your pediatrician were definitely appropriate in the circumstances, but an external GU exam isn't uncommon, and isn't "molestation" in and of itself. But it's something where assent from a 14 y/o girl should be obtained..


Instruction: Sorry in advance for the long post!My 8 year old son has had significant trouble with bowel training since initiation of potty training in general. What I believe started as an aversion to pooping due to distraction or not wanting to miss out on anything exciting while he was on the toilet, evolved into chronic constipation and an aversion secondary to pain. This was initially treated with Miralax and pushing fluids. However, he continued to have various amounts of poop in his underwear on almost a daily basis, and struggled with having regular bowel movements, alternating between small pebbles to impossibly large logsBecause he spends half of his time with his father and half with myself, there have been some inconsistencies in addressing this. I recently had a long discussion with his father and we decided to give an impaction appropriate dose of Miralax to encourage complete emptying and then start on a consistent maintenance dose at both houses. Admittedly, we had both dropped the ball on this. My concern now is that my son has recently had a couple of episodes of full on incontinence while out running errands. When I talked to him about always letting me know he has to go so we can find a restroom, he explained that he does not feel and urge to go, and only realizes what has happened when he feels it in his pants. I recognize that prolonged constipation can decrease urge sensation and believe this is what has happened. I do think this is still a tiny bit related to not wanting to stop what hes doing and sit on the toilet for the appropriate amount of time to have a big poop. All of that background is basically to ask, should I seek out a pediatric GI specialist? Or is this something that can be solved by going back to the potty training basics (timed toileting and having him sit on the toilet for a while). Is Miralax an appropriate choice for his age/symptoms? Does this warrant a consult with a therapist? Of note, I am aware that some of these symptoms can be a trauma response, however I am very confident that is not the case with him. Despite our divorce, my ex remains a caring father to both of our children, and neither child is left in the care of any suspicious characters. Any guidance would be greatly appreciated!

Output: Probably appropriate to see a peds GI at this point. The starting outcome will likely be Miralax and timed toileting, but it's good to make sure nothing else is going missed.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry in advance for the long post!My 8 year old son has had significant trouble with bowel training since initiation of potty training in general. What I believe started as an aversion to pooping due to distraction or not wanting to miss out on anything exciting while he was on the toilet, evolved into chronic constipation and an aversion secondary to pain. This was initially treated with Miralax and pushing fluids. However, he continued to have various amounts of poop in his underwear on almost a daily basis, and struggled with having regular bowel movements, alternating between small pebbles to impossibly large logsBecause he spends half of his time with his father and half with myself, there have been some inconsistencies in addressing this. I recently had a long discussion with his father and we decided to give an impaction appropriate dose of Miralax to encourage complete emptying and then start on a consistent maintenance dose at both houses. Admittedly, we had both dropped the ball on this. My concern now is that my son has recently had a couple of episodes of full on incontinence while out running errands. When I talked to him about always letting me know he has to go so we can find a restroom, he explained that he does not feel and urge to go, and only realizes what has happened when he feels it in his pants. I recognize that prolonged constipation can decrease urge sensation and believe this is what has happened. I do think this is still a tiny bit related to not wanting to stop what hes doing and sit on the toilet for the appropriate amount of time to have a big poop. All of that background is basically to ask, should I seek out a pediatric GI specialist? Or is this something that can be solved by going back to the potty training basics (timed toileting and having him sit on the toilet for a while). Is Miralax an appropriate choice for his age/symptoms? Does this warrant a consult with a therapist? Of note, I am aware that some of these symptoms can be a trauma response, however I am very confident that is not the case with him. Despite our divorce, my ex remains a caring father to both of our children, and neither child is left in the care of any suspicious characters. Any guidance would be greatly appreciated!. ### Response: Probably appropriate to see a peds GI at this point. The starting outcome will likely be Miralax and timed toileting, but it's good to make sure nothing else is going missed..


Instruction: what to expect at pediatrics?16yo female. went to the doctors complaining about stomach issues, they took my bloods and done a checkup and nothing came back wrong.they made an appointment in the hospital for the pediatrician and im quite nervous.

Output: A talk with you and your parent, and a physical exam. Any particular thing youre worried about?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: what to expect at pediatrics?16yo female. went to the doctors complaining about stomach issues, they took my bloods and done a checkup and nothing came back wrong.they made an appointment in the hospital for the pediatrician and im quite nervous.. ### Response: A talk with you and your parent, and a physical exam. Any particular thing youre worried about?.


Instruction: Pediatric lower back painMy son broke his hip 4 months ago. He was non weight bearing for over 2 months. His doctor released him 2 weeks ago. His PT said his left side is super weak and lost muscle mass. He has a slight limp which the doctor said would get better with time. My question is, when he tries to run eventually his lower back starts to hurt. Could this be just from weak hip/ back muscles or some kind of muscle imbalance throwing things off? We are keeping a look out for hip AVN but OS told us that would cause hip pain and groin pain, not back pain. Any insight be help.Please

Output: Could certainly be the weakness in his leg altering his biomechanics. That said, how did he break his hip? If there is any concern for a back injury that went unnoticed, discuss with his doctor.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric lower back painMy son broke his hip 4 months ago. He was non weight bearing for over 2 months. His doctor released him 2 weeks ago. His PT said his left side is super weak and lost muscle mass. He has a slight limp which the doctor said would get better with time. My question is, when he tries to run eventually his lower back starts to hurt. Could this be just from weak hip/ back muscles or some kind of muscle imbalance throwing things off? We are keeping a look out for hip AVN but OS told us that would cause hip pain and groin pain, not back pain. Any insight be help.Please. ### Response: Could certainly be the weakness in his leg altering his biomechanics. That said, how did he break his hip? If there is any concern for a back injury that went unnoticed, discuss with his doctor..


Instruction: We had a sledding accident. Im pretty sure they did a full trauma work up at the hospital. All sorts of X-rays. Couldnt they have seen something then? It all started after he started trying to run and stuff, which is why it makes me think its muscular imbalance?

Output: Yes, I'd be very surprised if they didn't catch something more serious. The back pain should improve as his gait and running stride normalize, which PT can help with.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: We had a sledding accident. Im pretty sure they did a full trauma work up at the hospital. All sorts of X-rays. Couldnt they have seen something then? It all started after he started trying to run and stuff, which is why it makes me think its muscular imbalance?. ### Response: Yes, I'd be very surprised if they didn't catch something more serious. The back pain should improve as his gait and running stride normalize, which PT can help with..


Instruction: Good sub for pediatrics?The sub r/pediatrics isnt for medical questions. Im trying to find one thats appropriate.Ive got a sick four year old who has been fighting a sinus / ear infection for weeks, even after seeing four different doctors. So Im looking for a group with some potential SMEs or at least other parents who have been down this road.

Output: Yes, there are a number of pediatricians, peds-EM docs, and a neonatal NP active on this sub.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Good sub for pediatrics?The sub r/pediatrics isnt for medical questions. Im trying to find one thats appropriate.Ive got a sick four year old who has been fighting a sinus / ear infection for weeks, even after seeing four different doctors. So Im looking for a group with some potential SMEs or at least other parents who have been down this road.. ### Response: Yes, there are a number of pediatricians, peds-EM docs, and a neonatal NP active on this sub..


Instruction: Worried about my dads cardiac cath resultsMy father is a stubborn mule of a man, and I need to know if Im right in pushing this issue until he gets the care he needs. I am a pediatric ICU nurse, so adults are not my thing.My dads history: 63yo male, normal BMI, moderate physical activity 5 days a week, former smoker x 30+ years (quit in 2017 when my son was born). He takes Repatha, losartan, baby aspirin, and ambien (he works nightshift & sleeps during the day). Generally healthy and active, only pmhx is high cholesterol (we are Cuban and he eats a very high fat diet and a lot of red meat), and two stents placed in 2017. Extremely extensive family cardiac history as follows (this is tough to keep track of so bear with me):His father: quadruple bypass, 5 TIAs then full carotid blockage, heart attack = died in 10/2014His mother: quadruple bypass, years later had MI & stroke = died 4/28/2008Brother #1: quintuple bypass in his 40s... died of heart attack in his sleep 5/2019 @ age 58Brother #2: stent in his 40sSister: MI (widow maker) & triple bypass 4/2019Brother #3: 3/2023 bilateral carotid 90% blockages, persistent A-fib.And those are just his immediate family. That history extends to every branch of uncles & cousins as well. They should give us a discount for buy two get two bypass at this point.My dad recently went for his annual cardiac appt and failed his stress test (he was unable to complete it) so they had him go for a cath. That revealed 100% blockages in several areas (diagram drawn by his doc here: https://imgur.com/a/0adwYqA ) but they didnt perform any interventions. The doc said theyd have to compare this cath to the one he had in 2017 to see the changes and decide how to proceed, but that he felt ok just watching things for now. His next appt is in June, and my dad seems to think all is well. He said oh it went fine, they told me my body made other pathways for the blood to flow. Ugh.I am alarmed. Cardiac isnt my specialty, but wouldnt this warrant a double bypass? Isnt his personal and family history enough to be more proactive with intervention? I was very close with my uncle and he passed away in his sleep just months after a normal cardiac exam. I dont want the same to happen to my dad, and Im concerned that hes heading towards a major event. Any insight? Am I right to want to push him to follow up on this immediately? Thank you.

Output: So obviously your dad has significant coronary artery disease. The family history at this point (which is ridiculously extensive) doesn't really matter since we know his anatomy.It looks like his left main coronary artery and left anterior descending artery (LAD) are open. His right coronary artery is blocked but past this it presumably backfills from the LAD through enlarged (collateral) vessels that wrap around the apex of the heart. This is why he had a positive stress test - with enough exertion the oxygen demand is too high for the left side to keep up.Almost all of the benefit for a coronary bypass procedure is with patients who have significant narrowing of the left main coronary artery or both of the immediate downstream arteries. These feed a large portion of the heart muscle, and not just your dad but anyone does poorly if they are blocked.However when these are open, which is the case here, the benefit is less clear and this is doubly true in the absence of significant symptoms. A left sided graft may not even stay patent in this setting, since there is competitive flow down the LAD. We would not usually do a bypass just for right coronary disease, the benefits do not appear to outweigh the risks in this scenario.The other blockages are being backfilled by the open arteries, and unless he develops new symptoms then medical management is at least as effective and safer. It isn't that the blockages aren't a concern, it is whether bypassing them is beneficial. In this case if it were my dad I would prefer aggressive medical management and lifestyle changes as much as possible.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Worried about my dads cardiac cath resultsMy father is a stubborn mule of a man, and I need to know if Im right in pushing this issue until he gets the care he needs. I am a pediatric ICU nurse, so adults are not my thing.My dads history: 63yo male, normal BMI, moderate physical activity 5 days a week, former smoker x 30+ years (quit in 2017 when my son was born). He takes Repatha, losartan, baby aspirin, and ambien (he works nightshift & sleeps during the day). Generally healthy and active, only pmhx is high cholesterol (we are Cuban and he eats a very high fat diet and a lot of red meat), and two stents placed in 2017. Extremely extensive family cardiac history as follows (this is tough to keep track of so bear with me):His father: quadruple bypass, 5 TIAs then full carotid blockage, heart attack = died in 10/2014His mother: quadruple bypass, years later had MI & stroke = died 4/28/2008Brother #1: quintuple bypass in his 40s... died of heart attack in his sleep 5/2019 @ age 58Brother #2: stent in his 40sSister: MI (widow maker) & triple bypass 4/2019Brother #3: 3/2023 bilateral carotid 90% blockages, persistent A-fib.And those are just his immediate family. That history extends to every branch of uncles & cousins as well. They should give us a discount for buy two get two bypass at this point.My dad recently went for his annual cardiac appt and failed his stress test (he was unable to complete it) so they had him go for a cath. That revealed 100% blockages in several areas (diagram drawn by his doc here: https://imgur.com/a/0adwYqA ) but they didnt perform any interventions. The doc said theyd have to compare this cath to the one he had in 2017 to see the changes and decide how to proceed, but that he felt ok just watching things for now. His next appt is in June, and my dad seems to think all is well. He said oh it went fine, they told me my body made other pathways for the blood to flow. Ugh.I am alarmed. Cardiac isnt my specialty, but wouldnt this warrant a double bypass? Isnt his personal and family history enough to be more proactive with intervention? I was very close with my uncle and he passed away in his sleep just months after a normal cardiac exam. I dont want the same to happen to my dad, and Im concerned that hes heading towards a major event. Any insight? Am I right to want to push him to follow up on this immediately? Thank you.. ### Response: So obviously your dad has significant coronary artery disease. The family history at this point (which is ridiculously extensive) doesn't really matter since we know his anatomy.It looks like his left main coronary artery and left anterior descending artery (LAD) are open. His right coronary artery is blocked but past this it presumably backfills from the LAD through enlarged (collateral) vessels that wrap around the apex of the heart. This is why he had a positive stress test - with enough exertion the oxygen demand is too high for the left side to keep up.Almost all of the benefit for a coronary bypass procedure is with patients who have significant narrowing of the left main coronary artery or both of the immediate downstream arteries. These feed a large portion of the heart muscle, and not just your dad but anyone does poorly if they are blocked.However when these are open, which is the case here, the benefit is less clear and this is doubly true in the absence of significant symptoms. A left sided graft may not even stay patent in this setting, since there is competitive flow down the LAD. We would not usually do a bypass just for right coronary disease, the benefits do not appear to outweigh the risks in this scenario.The other blockages are being backfilled by the open arteries, and unless he develops new symptoms then medical management is at least as effective and safer. It isn't that the blockages aren't a concern, it is whether bypassing them is beneficial. In this case if it were my dad I would prefer aggressive medical management and lifestyle changes as much as possible..


Instruction: This is an incredibly thorough reply, thank you for taking the time to explain all of that. My clinical brain cant function because all I can think about is getting another phone call and it being about him.So if Im understanding correctly, it sounds like the collateral vessels are more effective than I assumed. Hes a pretty active guy, is there danger if the left side cant meet the metabolic demands of the heart during exertion? Any risk of right sided ischemia?Ill be joining him at his appointment to take notes and make sure hes compliant with those lifestyle changes. He still thinks this is all routine and not a big deal. Your reply is helping me catch my breath a bit, so thank you again.

Output: Yes the collaterals are presumably well-developed. The danger from over exerting himself through exercise isnt of much concern, he would be symptom limited well before there was irreversible damage. Other issues like sepsis could put some strain on the heart but unlikely to cause any sizable infarct.He needs to really maximize the medical management - strict risk factor control with high-intensity lipid lowering therapy (doesnt matter if cholesterol is high) and tight monitoring of blood pressure. If there is a hint of diabetes one of the newer agents also would be good.The medicines actually work quite well combined with lifestyle changes. CABG and stent are more bailout procedures if a lot of heart muscle is threatened by very narrow arteries, which is not the case here.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This is an incredibly thorough reply, thank you for taking the time to explain all of that. My clinical brain cant function because all I can think about is getting another phone call and it being about him.So if Im understanding correctly, it sounds like the collateral vessels are more effective than I assumed. Hes a pretty active guy, is there danger if the left side cant meet the metabolic demands of the heart during exertion? Any risk of right sided ischemia?Ill be joining him at his appointment to take notes and make sure hes compliant with those lifestyle changes. He still thinks this is all routine and not a big deal. Your reply is helping me catch my breath a bit, so thank you again.. ### Response: Yes the collaterals are presumably well-developed. The danger from over exerting himself through exercise isnt of much concern, he would be symptom limited well before there was irreversible damage. Other issues like sepsis could put some strain on the heart but unlikely to cause any sizable infarct.He needs to really maximize the medical management - strict risk factor control with high-intensity lipid lowering therapy (doesnt matter if cholesterol is high) and tight monitoring of blood pressure. If there is a hint of diabetes one of the newer agents also would be good.The medicines actually work quite well combined with lifestyle changes. CABG and stent are more bailout procedures if a lot of heart muscle is threatened by very narrow arteries, which is not the case here..


Instruction: Pediatric low Creat level - Doctor ignoringMy 3 year old daughter went in for her check up/blood work, and has a .3 level of Creat and and 240 alphosi test results. The doctor is entirely unconcerned about this, but what Im reading on line makes me worried. Should I be concerned? If yes, what are immediate next steps I can take.Thank you in advance, Worried Parent

Output: I cannot think of a situation in which a low creatinine in an otherwise healthy child would worry me.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric low Creat level - Doctor ignoringMy 3 year old daughter went in for her check up/blood work, and has a .3 level of Creat and and 240 alphosi test results. The doctor is entirely unconcerned about this, but what Im reading on line makes me worried. Should I be concerned? If yes, what are immediate next steps I can take.Thank you in advance, Worried Parent. ### Response: I cannot think of a situation in which a low creatinine in an otherwise healthy child would worry me..


Instruction: Is there anything to be concerned about with the high level of the alkphosi?

Output: Probably not, but thats something to ask the pediatrician

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is there anything to be concerned about with the high level of the alkphosi?. ### Response: Probably not, but thats something to ask the pediatrician.


Instruction: NAD but I understand that higher alkphos in children is considered normal because of bone growth. Could be the kiddo just had a growth spurt. Alkphos is an enzyme found in bones, liver,kidneys, digestive tract. Def talk to your pediatrician so they can ease your worries.

Output: Those are both normal results for a patient her age. The doctor is ignoring them because your lab likely has a reference range that's for adults, not kidsThe creatinine level roughly reflects the muscle mass. Normal for kids is always low. If it's "normal" for a kid, I look twice and think about things.High alk phos (alkaline phosphatase) level in kids is almost invariably correlated with a low Vitamin D level. It's more typical these days to have a low Vitamin D than not, at least for kids. Maybe it's all the sunscreen plus much less non-screen time. Fewer sunburns but lower sunshine. I don't know that we have good guidelines for what to do with vitamin D levels these days, but if you wanted to pursue something, that would be it. Or give her a multivitamin with at least 400 IU of Vitamin D and consider rechecking in the spring.I'm curious, though -- we usually don't check these labs as part of routine blood work. There's the CBC or hemoglobin level, and lead, and then lipids and diabetes (but only for children at particularly high risk). Do you know what the physician was looking for, or why they were checking extra things?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: NAD but I understand that higher alkphos in children is considered normal because of bone growth. Could be the kiddo just had a growth spurt. Alkphos is an enzyme found in bones, liver,kidneys, digestive tract. Def talk to your pediatrician so they can ease your worries.. ### Response: Those are both normal results for a patient her age. The doctor is ignoring them because your lab likely has a reference range that's for adults, not kidsThe creatinine level roughly reflects the muscle mass. Normal for kids is always low. If it's "normal" for a kid, I look twice and think about things.High alk phos (alkaline phosphatase) level in kids is almost invariably correlated with a low Vitamin D level. It's more typical these days to have a low Vitamin D than not, at least for kids. Maybe it's all the sunscreen plus much less non-screen time. Fewer sunburns but lower sunshine. I don't know that we have good guidelines for what to do with vitamin D levels these days, but if you wanted to pursue something, that would be it. Or give her a multivitamin with at least 400 IU of Vitamin D and consider rechecking in the spring.I'm curious, though -- we usually don't check these labs as part of routine blood work. There's the CBC or hemoglobin level, and lead, and then lipids and diabetes (but only for children at particularly high risk). Do you know what the physician was looking for, or why they were checking extra things?.


Instruction: Dont worry- I totally believe in them and support vaccination.Im an infant/toddler nanny, and have been working with them for over 20 years. Today I encountered something new.The Little One I take care of (18 month F) got a couple of shots today. The pediatrician advised her parents not to use Motrin or Tylenol for fever or discomfort unless her temp goes over 103.5 or she absolutely cant sleep. The reason given was having a fever and letting it do its thing means she will have a greater immune response from the vaccines. (These were standard 18 month shots- not the COVID vax, for what its worth. She has gotten the first 2 COVID shots- waiting on the 3rd next month.)I have never heard this before. Can anyone weigh in on this? Sounds crazy to me, but Im not a doc.

Output: Current data is a bit conflicting from studies Ive read, but I generally caution against prophylactic use of antipyretics because there is some evidence that it blunts the immune response.Use of antipyretics about 4-6 hours post-vaccine have shown mixed results in terms of immune response but generally patients still gain immunity. Id rather have a happy patient and family that returns for all vaccines than tell them not to give Tylenol/ibuprofen. I try to make sure they wait 4-6 hours though before the first dose if it is needed. We have multiple doses of most childhood vaccines, so its likely there wont be an issue with immunity, even with Tylenol/ibuprofen post vaccine.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Dont worry- I totally believe in them and support vaccination.Im an infant/toddler nanny, and have been working with them for over 20 years. Today I encountered something new.The Little One I take care of (18 month F) got a couple of shots today. The pediatrician advised her parents not to use Motrin or Tylenol for fever or discomfort unless her temp goes over 103.5 or she absolutely cant sleep. The reason given was having a fever and letting it do its thing means she will have a greater immune response from the vaccines. (These were standard 18 month shots- not the COVID vax, for what its worth. She has gotten the first 2 COVID shots- waiting on the 3rd next month.)I have never heard this before. Can anyone weigh in on this? Sounds crazy to me, but Im not a doc.. ### Response: Current data is a bit conflicting from studies Ive read, but I generally caution against prophylactic use of antipyretics because there is some evidence that it blunts the immune response.Use of antipyretics about 4-6 hours post-vaccine have shown mixed results in terms of immune response but generally patients still gain immunity. Id rather have a happy patient and family that returns for all vaccines than tell them not to give Tylenol/ibuprofen. I try to make sure they wait 4-6 hours though before the first dose if it is needed. We have multiple doses of most childhood vaccines, so its likely there wont be an issue with immunity, even with Tylenol/ibuprofen post vaccine..


Instruction: Thank you so much. Ive just never heard this before, and Im always open to learning! We obviously want her to get the best results she can from them, but we also dont want her to be needlessly uncomfortable. She made it through to nap time comforted with snuggles and her favorite lunch, and we plan on letting her play in the tub this afternoon to soak the bandaids off her legs.Thats another question- is there a legit reason to put bandaids on after shots? Ive never seen more than the tiniest drop of blood on a bandaid after a child gets a vaccine, but they are so hard on their legs. They stick super hard, and she tends to get little welts where the bandaids were. She also cries now anytime she sees bandaids bc they hurt so much to take off.Are they needed? Is it to prevent infection? To put pressure on the injection site? We would MUCH rather just have the tiny drop of blood on her pants than go through this every time- but if theres a legit reason Id love to know about it.Thanks for taking the time to give an answer. Its much appreciated!

Output: No, no good reason for the bandaids other than the drop of blood and to prevent them from messing with the area immediately after.It's not evidence based. https://journals.lww.com/ebp/Fulltext/2021/03000/Does_premedication_with_ibuprofen_affect_the.19.aspxThose meds can reduce immune response but not uniformly and the immune response is still enough to be protective at minimum. There's no basis for that fever number that she picked. Delayed acetaminophen or ibuprofen given after the vaccine rather than with the vaccine appear to have a lesser effect.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much. Ive just never heard this before, and Im always open to learning! We obviously want her to get the best results she can from them, but we also dont want her to be needlessly uncomfortable. She made it through to nap time comforted with snuggles and her favorite lunch, and we plan on letting her play in the tub this afternoon to soak the bandaids off her legs.Thats another question- is there a legit reason to put bandaids on after shots? Ive never seen more than the tiniest drop of blood on a bandaid after a child gets a vaccine, but they are so hard on their legs. They stick super hard, and she tends to get little welts where the bandaids were. She also cries now anytime she sees bandaids bc they hurt so much to take off.Are they needed? Is it to prevent infection? To put pressure on the injection site? We would MUCH rather just have the tiny drop of blood on her pants than go through this every time- but if theres a legit reason Id love to know about it.Thanks for taking the time to give an answer. Its much appreciated!. ### Response: No, no good reason for the bandaids other than the drop of blood and to prevent them from messing with the area immediately after.It's not evidence based. https://journals.lww.com/ebp/Fulltext/2021/03000/Does_premedication_with_ibuprofen_affect_the.19.aspxThose meds can reduce immune response but not uniformly and the immune response is still enough to be protective at minimum. There's no basis for that fever number that she picked. Delayed acetaminophen or ibuprofen given after the vaccine rather than with the vaccine appear to have a lesser effect..


Instruction: Just to clarify your last sentence- does delaying the dose lessen the effect of the med I terms of comfort/fever reduction? Or lessen the effect of how the vaccine impacts the immune system?We try to use other methods of soothing her in general when we can, but sometimes shes uncomfortable enough that it seems warranted. (We went with her favorite lunch and lots of snuggles between the shots and nap, and are planning on letting her play in a warm bath after nap if she wants.)Thank you for weighing in. I appreciate it!

Output: I think there was a trend to lessening the effect on the immune response, but again, the immune response was still adequate regardless. I'd give my kid the tylenol after a vaccine. In my local children's hospital they do as well. I find the evidence saying not to give it is weak and mostly refers to giving it at the time of vaccination

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Just to clarify your last sentence- does delaying the dose lessen the effect of the med I terms of comfort/fever reduction? Or lessen the effect of how the vaccine impacts the immune system?We try to use other methods of soothing her in general when we can, but sometimes shes uncomfortable enough that it seems warranted. (We went with her favorite lunch and lots of snuggles between the shots and nap, and are planning on letting her play in a warm bath after nap if she wants.)Thank you for weighing in. I appreciate it!. ### Response: I think there was a trend to lessening the effect on the immune response, but again, the immune response was still adequate regardless. I'd give my kid the tylenol after a vaccine. In my local children's hospital they do as well. I find the evidence saying not to give it is weak and mostly refers to giving it at the time of vaccination.


Instruction: Thanks!Edit: added question to the top.

Output: Benzoyl peroxide is a rare allergen but a common irritant and can cause irritant contact dermatitis. As long as the latter does not occur, it is an excellent biocide.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks!Edit: added question to the top.. ### Response: Benzoyl peroxide is a rare allergen but a common irritant and can cause irritant contact dermatitis. As long as the latter does not occur, it is an excellent biocide..


Instruction: Thank you. Would you have insight into how often benzoyl peroxide wash would typically be used in a situation like ours?

Output: No examination details or images included, so no comment appropriate.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you. Would you have insight into how often benzoyl peroxide wash would typically be used in a situation like ours?. ### Response: No examination details or images included, so no comment appropriate..


Instruction: I hope this works for photos. Ive never used Imgur or posted a photo on Reddit before. The labeled photos are from tonight when the dots have pretty much dried up and are the best they get after a bleach bath. The other two are of times when the folliculitis is more flared up. Let me know if there is anything else for a physical exam you would want. Thanks!Edit: looks like the photos require being over 18 to view. Two are of his bottom, this is probably why, though I censored what was necessary.

Output: Mild folliculitis present. Using the benzoyl peroxide wash a few times a week may maximize efficacy and minimize irritation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I hope this works for photos. Ive never used Imgur or posted a photo on Reddit before. The labeled photos are from tonight when the dots have pretty much dried up and are the best they get after a bleach bath. The other two are of times when the folliculitis is more flared up. Let me know if there is anything else for a physical exam you would want. Thanks!Edit: looks like the photos require being over 18 to view. Two are of his bottom, this is probably why, though I censored what was necessary.. ### Response: Mild folliculitis present. Using the benzoyl peroxide wash a few times a week may maximize efficacy and minimize irritation..


Instruction: Would you indulge another question? Just curious if selsun blue would be a viable option as an occasional body wash for my sons situation given its anti-fungal properties. (Im thinking the benzoyl peroxide will be sufficient, but just curious.)

Output: Selenium sulfide is an antifungal agent but does not have antibacterial activity as far as I know. Not a good choice.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Would you indulge another question? Just curious if selsun blue would be a viable option as an occasional body wash for my sons situation given its anti-fungal properties. (Im thinking the benzoyl peroxide will be sufficient, but just curious.). ### Response: Selenium sulfide is an antifungal agent but does not have antibacterial activity as far as I know. Not a good choice..


Instruction: 3 months later, doctors hypothesize TTPm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help!

Output: It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 3 months later, doctors hypothesize TTPm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help!. ### Response: It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis.


Instruction: 6 year old re-cauterized day 5 post tonsillectomyMy 6 year old had her tonsils and adenoids taken out on April 6th, she was what I thought, healing well. In good spirits, never complaining of anything more than  a little pain . Popsicles nonstop, ice cream too. Tuesday night, after a full 5 days post operation, she wakes up and starts vomiting blood. We panic, call 911, go the nearest pediatric hospital. They tell us well have to recauterize. Cue second round of fear for the night. I couldnt imagine putting her through anesthesia again in less than a week. Thankfully it went well, and the left side had active bleeding in one spot which they cauterized and the right side had some tiny vessels that the doctor recauterized too. They kept her for another 8 hours for observation and she was doing well. I guess now were all so traumatized, including her, that it could happen again. She hates the taste of Tylenol but pediatrician warned about Motrin possibly triggering the bleeding. Of course, she prefers Motrin. Im writing this terrified of it recurring and praying it wont.Im so terrified of her hemorrhaging again and I dont know how to calm myself. I was told it would be rare to happen again but it was rare to even happen the first time. Were officially 7 days post initial procedure and Im wondering at how many days post op can i be confident that shes healed?Any possible words of encouragement or advice would be so very appreciated.

Output: Its not that uncommon after tonsillectomy actually, I agree unlikely to recur and should be ok. Did they check her blood counts to know how much she had bled?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 6 year old re-cauterized day 5 post tonsillectomyMy 6 year old had her tonsils and adenoids taken out on April 6th, she was what I thought, healing well. In good spirits, never complaining of anything more than  a little pain . Popsicles nonstop, ice cream too. Tuesday night, after a full 5 days post operation, she wakes up and starts vomiting blood. We panic, call 911, go the nearest pediatric hospital. They tell us well have to recauterize. Cue second round of fear for the night. I couldnt imagine putting her through anesthesia again in less than a week. Thankfully it went well, and the left side had active bleeding in one spot which they cauterized and the right side had some tiny vessels that the doctor recauterized too. They kept her for another 8 hours for observation and she was doing well. I guess now were all so traumatized, including her, that it could happen again. She hates the taste of Tylenol but pediatrician warned about Motrin possibly triggering the bleeding. Of course, she prefers Motrin. Im writing this terrified of it recurring and praying it wont.Im so terrified of her hemorrhaging again and I dont know how to calm myself. I was told it would be rare to happen again but it was rare to even happen the first time. Were officially 7 days post initial procedure and Im wondering at how many days post op can i be confident that shes healed?Any possible words of encouragement or advice would be so very appreciated.. ### Response: Its not that uncommon after tonsillectomy actually, I agree unlikely to recur and should be ok. Did they check her blood counts to know how much she had bled?.


Instruction: Ive got her lab results with me but unsure of what its telling me.

Output: Fairly common , frankly not a big deal that is just bad luck. Rate of postoperative bleed is 1%, so chance it happens again very rare.You can get a rebleed at 7-10 days but rare. After that it becomes extremely unlikely

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Ive got her lab results with me but unsure of what its telling me.. ### Response: Fairly common , frankly not a big deal that is just bad luck. Rate of postoperative bleed is 1%, so chance it happens again very rare.You can get a rebleed at 7-10 days but rare. After that it becomes extremely unlikely.


Instruction: Thanks for your comment. The pediatricians drilled it in our heads that it was rare that it happened in the first place, even at 5 days. But I cant help but shake the feeling that even though its rare to happen again, we were already one of the rare ones it happened to the first time around. They made it seem as its way more unlikely for it to happen to children and more common in adults. When we saw her vomiting fresh blood we thought we were going to lose her.Will the recauterization of the spot where they found her active bleeding (noted as left superior tonsillar fossa) reset the clock on healing the whole area? Diffuse oozing in the right, clots bilaterally were also listed on our discharge papers.

Output: In 25 years of practicing ENT Ive only seen one re-bleed.The cautery sets the clock back just in that one specific spot. Theres no evidence postop bleeding is more common in adults, thats an old wives tale.Big picture here, this was a small setback your child will be fine.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks for your comment. The pediatricians drilled it in our heads that it was rare that it happened in the first place, even at 5 days. But I cant help but shake the feeling that even though its rare to happen again, we were already one of the rare ones it happened to the first time around. They made it seem as its way more unlikely for it to happen to children and more common in adults. When we saw her vomiting fresh blood we thought we were going to lose her.Will the recauterization of the spot where they found her active bleeding (noted as left superior tonsillar fossa) reset the clock on healing the whole area? Diffuse oozing in the right, clots bilaterally were also listed on our discharge papers.. ### Response: In 25 years of practicing ENT Ive only seen one re-bleed.The cautery sets the clock back just in that one specific spot. Theres no evidence postop bleeding is more common in adults, thats an old wives tale.Big picture here, this was a small setback your child will be fine..


Instruction: 11 month old with fatty liver11 month Male Multivitamin with iron 6 weeks premature Uncircumcised 29 inches 24.5 lbsOn March 30 he woke up with a fever. We headed to urgent care and they diagnosed him with UTI. Got a call from them a week later saying to follow up with his pediatrician. While there she said his bacteria numbers werent high enough to indicate a UTI but its possible we just caught it super early. She said she was going to do research and possibly want further testing. She ended ordering a renal ultrasound. The findings of the ultrasound indicated that his renal system is unremarkable! But his liver is showing echogenicity and fatty infiltration of the liver. What could cause this? Should I be worried about it?

Output: Some infants have fatty liver on US or CT scans done for other reasons, as in your case. There's no consensus on what to do in this situation, but I tend to just follow it, because it often goes away. We think it's often a consequence of fetal environment, and has some association with maternal obesity, maternal gestational diabetes, and also seems to happen more often to preterm babies. But overall, the problem hasn't been well studied. In the setting of a recent infection, there's also a decent chance it's a consequence of the immune response (although it's usually from a gastroenteritis with things like adenovirus, not a UTI).These cases come to my clinic every now and then and most of the time it resolves. I usually do two things: repeat the ultrasound in a few months, and get a blood test (called a CMP) to look at the liver numbers.We don't know how this relates to long term risk for fatty liver, which has more significant health consequences. Some people have genetic causes for fatty liver, and it can start at a young age, but this is fairly rare, and not the cause of fatty liver in infants in most cases. Either way, it's worth keeping tabs on it to see if it goes away over time.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 11 month old with fatty liver11 month Male Multivitamin with iron 6 weeks premature Uncircumcised 29 inches 24.5 lbsOn March 30 he woke up with a fever. We headed to urgent care and they diagnosed him with UTI. Got a call from them a week later saying to follow up with his pediatrician. While there she said his bacteria numbers werent high enough to indicate a UTI but its possible we just caught it super early. She said she was going to do research and possibly want further testing. She ended ordering a renal ultrasound. The findings of the ultrasound indicated that his renal system is unremarkable! But his liver is showing echogenicity and fatty infiltration of the liver. What could cause this? Should I be worried about it?. ### Response: Some infants have fatty liver on US or CT scans done for other reasons, as in your case. There's no consensus on what to do in this situation, but I tend to just follow it, because it often goes away. We think it's often a consequence of fetal environment, and has some association with maternal obesity, maternal gestational diabetes, and also seems to happen more often to preterm babies. But overall, the problem hasn't been well studied. In the setting of a recent infection, there's also a decent chance it's a consequence of the immune response (although it's usually from a gastroenteritis with things like adenovirus, not a UTI).These cases come to my clinic every now and then and most of the time it resolves. I usually do two things: repeat the ultrasound in a few months, and get a blood test (called a CMP) to look at the liver numbers.We don't know how this relates to long term risk for fatty liver, which has more significant health consequences. Some people have genetic causes for fatty liver, and it can start at a young age, but this is fairly rare, and not the cause of fatty liver in infants in most cases. Either way, it's worth keeping tabs on it to see if it goes away over time..


Instruction: Should I look into dietary changes? He breastfeeds 5+ times a day and has a meal 3x a day. The meals typically consist of a protein, fruit/veggie and some form of starch (sweet potato, wild rice, veggie pasta). He drinks probably 1 cup of water a day.

Output: Likely not necessary in the short term. But I would still discuss with a pediatric gastroenterologist.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Should I look into dietary changes? He breastfeeds 5+ times a day and has a meal 3x a day. The meals typically consist of a protein, fruit/veggie and some form of starch (sweet potato, wild rice, veggie pasta). He drinks probably 1 cup of water a day.. ### Response: Likely not necessary in the short term. But I would still discuss with a pediatric gastroenterologist..


Instruction: Please help me understand this. Scared19, Male, 60, 180 lbs, Usually healthy, Works-out 5 days a weekHi there, I went to hematology for a low WBC count and while there I mentioned to them that I have had palpable lymph-nodes in my neck for 3.5 years and I have already been checked previously by 4 doctors including a pediatric oncologist and had multiple ultrasounds which suggest its non-concerning. However, she took an ACE level test and it came back elevated and she said something along the lines Youre ACE levels came back elevated and it could suggest sarcoidosis and if youre concerned go to a GP and get it measured again  ANYWAYS! I didnt think much of it and let it be for 6 months & I went to a Nurse Practitioner to repeat my CBC out of curiosity which showed everything was normal and my WBC was 5.6 which was great. I also asked for the ACE level test to be re-measured and they didnt know what that even was. They had me come back after they researched it and then they took a small vile of blood. They sent it off and it came back high at a 135 and cut off for that lab was 80. I am freaking out because he contacted the hematologist doc and they said I should go to a pulmonologist. I feel perfectly healthy and better than I ever have. I am freaking out because google keeps saying ACE levels being high indicates: Lymphoma, Multiple Myeloma AND Lung cancer. I am absolutely plummeting right now and nothing makes sense to me. Please give me some advice OR knowledge. Its hard to find stuff online speaking about ACE levels.

Output: ACE level is a very nonspecific test. It is not recommended for exactly this reason. Positive tests have <25% chance of having sarcoid, especially if they aren't sent for a good reason.I would followup to make sure but this is a good example of why we don't just send off a bunch of tests for no good reason - you end up with anxiety and chasing down a number of things that are not real.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Please help me understand this. Scared19, Male, 60, 180 lbs, Usually healthy, Works-out 5 days a weekHi there, I went to hematology for a low WBC count and while there I mentioned to them that I have had palpable lymph-nodes in my neck for 3.5 years and I have already been checked previously by 4 doctors including a pediatric oncologist and had multiple ultrasounds which suggest its non-concerning. However, she took an ACE level test and it came back elevated and she said something along the lines Youre ACE levels came back elevated and it could suggest sarcoidosis and if youre concerned go to a GP and get it measured again  ANYWAYS! I didnt think much of it and let it be for 6 months & I went to a Nurse Practitioner to repeat my CBC out of curiosity which showed everything was normal and my WBC was 5.6 which was great. I also asked for the ACE level test to be re-measured and they didnt know what that even was. They had me come back after they researched it and then they took a small vile of blood. They sent it off and it came back high at a 135 and cut off for that lab was 80. I am freaking out because he contacted the hematologist doc and they said I should go to a pulmonologist. I feel perfectly healthy and better than I ever have. I am freaking out because google keeps saying ACE levels being high indicates: Lymphoma, Multiple Myeloma AND Lung cancer. I am absolutely plummeting right now and nothing makes sense to me. Please give me some advice OR knowledge. Its hard to find stuff online speaking about ACE levels.. ### Response: ACE level is a very nonspecific test. It is not recommended for exactly this reason. Positive tests have <25% chance of having sarcoid, especially if they aren't sent for a good reason.I would followup to make sure but this is a good example of why we don't just send off a bunch of tests for no good reason - you end up with anxiety and chasing down a number of things that are not real..


Instruction: okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this?

Output: Very unlikely. We dont use it as a test to look for malignancy.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: okay thanks. ill meet up with a pulmonologist most likely. how likely would something malignant cause this?. ### Response: Very unlikely. We dont use it as a test to look for malignancy..


Instruction: okay thanks for the responses. my NP i seen doesnt even know what the ACE levels mean and has no knowledge on it. think i should go back and see my actual GP? or is this something i can just let be elevated

Output: I would be hard-pressed to know how to deal with this nonspecific test without seeing you and your lab records and getting a full medical history. So again I would followup. Depending on the level of suspicion a chest x-ray, chest CT or even biopsy might be warranted.It is generally more productive to wait until there are some symptoms but I can't reassure you that you definitely don't have sarcoid or a different autoimmune disease. It does not seem like you have cancer based on the lymph node surveillance

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: okay thanks for the responses. my NP i seen doesnt even know what the ACE levels mean and has no knowledge on it. think i should go back and see my actual GP? or is this something i can just let be elevated. ### Response: I would be hard-pressed to know how to deal with this nonspecific test without seeing you and your lab records and getting a full medical history. So again I would followup. Depending on the level of suspicion a chest x-ray, chest CT or even biopsy might be warranted.It is generally more productive to wait until there are some symptoms but I can't reassure you that you definitely don't have sarcoid or a different autoimmune disease. It does not seem like you have cancer based on the lymph node surveillance.


Instruction: what is this rash on my toddler1.5 year old, male, 24 pounds,I just noticed this rash on both my sons feet legs and bum. theres been no change in detergent, or soap. Hes recently been on antibiotics for an ear infection but broke out in a full body rash on day three of amoxicillin. so they switched him to azithromycin and same thing happened. hes been on cipro/ dex. drops since wednesday. what the heck is going on. why is he covered in rashes? he doesnt seem to notice. acting fine, no fever, not itching. Any ideas? Picsedit: sorry the pic kind of sucks but 1. hes a toddler and does not sit still 2. the flash dulls the color of the rash

Output: Does this rash cover his whole body? It looks like Roseola to me, which is a very common viral infection in pediatric patients.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: what is this rash on my toddler1.5 year old, male, 24 pounds,I just noticed this rash on both my sons feet legs and bum. theres been no change in detergent, or soap. Hes recently been on antibiotics for an ear infection but broke out in a full body rash on day three of amoxicillin. so they switched him to azithromycin and same thing happened. hes been on cipro/ dex. drops since wednesday. what the heck is going on. why is he covered in rashes? he doesnt seem to notice. acting fine, no fever, not itching. Any ideas? Picsedit: sorry the pic kind of sucks but 1. hes a toddler and does not sit still 2. the flash dulls the color of the rash. ### Response: Does this rash cover his whole body? It looks like Roseola to me, which is a very common viral infection in pediatric patients..


Instruction: no not this time. but the other 2 times it did. googling roseola - thats exactly what his rashes have looked like.i had brought him in to ER with a fever of 39.7 (went to 40.5) and lethargy, which is when they said he had quite a bad ear infection (membrane retracted with ++ pus) he hasnt been tugging on his ear or anything. could that have been an accidental finding and the fever was actually the roseola? i understand its hard to say over the internet but thought id ask

Output: Exactly. We see this in the ER all the time. Roseola is infamous for making the ear drums look infected when they're actually not. I suspect his fever was from the Roseola, and he was falsely diagnosed with an ear infection at that time given his constellation of symptoms. The rash infamously comes after the fever breaks. It's not itchy or uncomfortable for the child.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: no not this time. but the other 2 times it did. googling roseola - thats exactly what his rashes have looked like.i had brought him in to ER with a fever of 39.7 (went to 40.5) and lethargy, which is when they said he had quite a bad ear infection (membrane retracted with ++ pus) he hasnt been tugging on his ear or anything. could that have been an accidental finding and the fever was actually the roseola? i understand its hard to say over the internet but thought id ask. ### Response: Exactly. We see this in the ER all the time. Roseola is infamous for making the ear drums look infected when they're actually not. I suspect his fever was from the Roseola, and he was falsely diagnosed with an ear infection at that time given his constellation of symptoms. The rash infamously comes after the fever breaks. It's not itchy or uncomfortable for the child..


Instruction: that is so interesting!!! a coworker actually suggested this but i basically brushed it off, but it makes sense! so maybe hes not allergic to penicillin and azithro after all.its been about a week with on and off rashes. is that normal? i keep taking him back to the doctor thinking its the meds

Output: I highly doubt he's truly allergic to either :)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: that is so interesting!!! a coworker actually suggested this but i basically brushed it off, but it makes sense! so maybe hes not allergic to penicillin and azithro after all.its been about a week with on and off rashes. is that normal? i keep taking him back to the doctor thinking its the meds. ### Response: I highly doubt he's truly allergic to either :).


Instruction: Good to know!! he doesnt seem bothered by the rash at all! He does still have a bit of a rash though and its been like 7 days since it first showed up. its kind of comes and goes tho is that normal for roseola?

Output: Hand foot mouth is a possibility too.As an ER pediatrician, I ignore whatever urgent care diagnosis was given regarding ears. They usually suck at examining them, and think every flushed ear drum in a kid with fever/crying is infected. That, or frequently find that they're outright liars, and couldn't have possibly seen the TM, because of the enormous amount of wax (or even foreign bodies) that is in the way. The people doing these evaluations and making these diagnoses are almost never pediatricians, and usually aren't even physicians.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Good to know!! he doesnt seem bothered by the rash at all! He does still have a bit of a rash though and its been like 7 days since it first showed up. its kind of comes and goes tho is that normal for roseola?. ### Response: Hand foot mouth is a possibility too.As an ER pediatrician, I ignore whatever urgent care diagnosis was given regarding ears. They usually suck at examining them, and think every flushed ear drum in a kid with fever/crying is infected. That, or frequently find that they're outright liars, and couldn't have possibly seen the TM, because of the enormous amount of wax (or even foreign bodies) that is in the way. The people doing these evaluations and making these diagnoses are almost never pediatricians, and usually aren't even physicians..


Instruction: Advised by nurse line to give my 3 month old a glycerin suppository?Male. 3 months. 15 pounds.possibly milk dairy allergy. He usually goes 1 to 2 times a day but hasnt gone in 4 days. He is exclusively breastfeed. I started a probiotic 5 days ago that I discontinued since he hasnt gone. He has been having diarrhea for weeks everyday so this is a big change. Hes been passing gas and fussy starting today whenever he passes gas.I called our pediatrician hotline and was told to use 1/4th if a suppository for him. Im a little hesitant but cant get in touch with his doctor until Monday.

Output: Exclusively breastfed infants can go up to 9 days between poos. If he is eating, not vomiting and passing wind I dont know why you would give him a suppository

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Advised by nurse line to give my 3 month old a glycerin suppository?Male. 3 months. 15 pounds.possibly milk dairy allergy. He usually goes 1 to 2 times a day but hasnt gone in 4 days. He is exclusively breastfeed. I started a probiotic 5 days ago that I discontinued since he hasnt gone. He has been having diarrhea for weeks everyday so this is a big change. Hes been passing gas and fussy starting today whenever he passes gas.I called our pediatrician hotline and was told to use 1/4th if a suppository for him. Im a little hesitant but cant get in touch with his doctor until Monday.. ### Response: Exclusively breastfed infants can go up to 9 days between poos. If he is eating, not vomiting and passing wind I dont know why you would give him a suppository.