Instruction: why does everything feel fake?history: im 16M, have no existing medical issues, nor am i using any medications, and i dont smoke, drink, or do drugs.occurrences: this has been getting progressively worse the past month, at first it was only something i could notice but it never really bothered me, but now it makes taking tests, reading (even this), and programming really difficult without full concentration. it kindof comes in waves where i can read whole chapters with no problem to having to re read a sentence multiple times to understand it (this happened in my ism test where i got stuck on a really easy problem because it felt like whenever i read one part of it, part before it disappeared). sometimes it gets so bad to where i get dizzy spells in the middle of class, and other times when im about to sleep it feels like im "slipping" and jump up (not the kind where you feel like your falling in a dream and wake up). also the past few days its kindof always been on very slightly.when it gets bad it feels like passing out without actually passing out, you know how you technically CAN see, but dont really understand anything? it feels like that, or like those pictures where you cant identify anything, or waking up suddenly from a deep dream, and my mind goes blank and i feel like im "spiraling", and it feels like im about to fall through the world? i dunno how to explain it, but i usually get jumpscared by it and it brings me back to normal, but if i focus i can point things out and describe things. another way i can describe it is it feels like im looking through my peripheral vision at all times, theres a certain lack of clarity to what everything looks like, and sometimes when im reading it feels like im being sucked into the monitor, if i really focus i can read, but it feels trying to read on a rocky boat, yeah i CAN do it, but im not really understanding it because im too focused on reading the words. sorry if im explaining this poorly, i dont really know what it is or whats causing it, im thinking its a mix of brain fog and anxiety? i wouldnt say im an anxous person but idk, and it feels kindof similar to the brain fog i get when i drink coffee, and ideas would be apreciated!

Output: Needs detailed in person. Pediatric psychiatric evaluation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: why does everything feel fake?history: im 16M, have no existing medical issues, nor am i using any medications, and i dont smoke, drink, or do drugs.occurrences: this has been getting progressively worse the past month, at first it was only something i could notice but it never really bothered me, but now it makes taking tests, reading (even this), and programming really difficult without full concentration. it kindof comes in waves where i can read whole chapters with no problem to having to re read a sentence multiple times to understand it (this happened in my ism test where i got stuck on a really easy problem because it felt like whenever i read one part of it, part before it disappeared). sometimes it gets so bad to where i get dizzy spells in the middle of class, and other times when im about to sleep it feels like im "slipping" and jump up (not the kind where you feel like your falling in a dream and wake up). also the past few days its kindof always been on very slightly.when it gets bad it feels like passing out without actually passing out, you know how you technically CAN see, but dont really understand anything? it feels like that, or like those pictures where you cant identify anything, or waking up suddenly from a deep dream, and my mind goes blank and i feel like im "spiraling", and it feels like im about to fall through the world? i dunno how to explain it, but i usually get jumpscared by it and it brings me back to normal, but if i focus i can point things out and describe things. another way i can describe it is it feels like im looking through my peripheral vision at all times, theres a certain lack of clarity to what everything looks like, and sometimes when im reading it feels like im being sucked into the monitor, if i really focus i can read, but it feels trying to read on a rocky boat, yeah i CAN do it, but im not really understanding it because im too focused on reading the words. sorry if im explaining this poorly, i dont really know what it is or whats causing it, im thinking its a mix of brain fog and anxiety? i wouldnt say im an anxous person but idk, and it feels kindof similar to the brain fog i get when i drink coffee, and ideas would be apreciated!. ### Response: Needs detailed in person. Pediatric psychiatric evaluation..


Instruction: 3 months later, doctors hypothesize TTPIm 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 TTPIm 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: Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment.

Output: The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment.. ### Response: The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation..


Instruction: Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains?

Output: High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains?. ### Response: High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes.


Instruction: Could her delayed growth be a byproduct of the IUGR? Or is it more likely shes just not taking in enough calories per feed? Additionally, are there any questions that youd recommend I ask the pediatric GI doc? Thanks so much!

Output: Both. IUGR babies are prone to have poor growth. Most continue to have slow growth in the months after birth, often leading to GI interventions such as increasing nutrient density of formula. This is to make up for the nutrient deficit present that an average infant's daily intake typically cannot surpass on its own.While the vast majority (80%) of IUGR and/or SGA (small for gestational age) do catch-up to reach sizes comparable to other children, this typically takes about two years. Many factors affect growth and stature, including any medical problems that led to her being small. For instance, this nutrient deficit and propensity to growth failure tend to be worse in infants who were also preterm (at 37+1 weeks, your daughter was born just two days further along than what we would consider "late preterm").The main things you can control and monitor at this point are her nutritional intake and feeding habits. For now, the baby's goal is to be improving in her percentiles, not worsening. I recommend working with the GI team on this goal. They will likely have you see a pediatric dietitian as well to help figure out how many calories she should be getting.Don't despair - this is more common than you would think. It doesn't mean you're doing anything wrong. You are working very hard and doing everything you can right now. Getting more hands on deck by bringing in a specialist's perspective only means more people in your daughter's corner trying to get her growing better.Most babies born with IUGR do catch up their growth by this age, so I agree with your pediatrician's concern. Increasing the concentration ("fortifying") her formula is a great first step, but it's worth seeing the pediatric GI to make sure there isn't something else going on. I'd suggest keeping track of about how much she eats in a 24-hour period as well, so the doctor can assess whether she's getting enough calories.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Could her delayed growth be a byproduct of the IUGR? Or is it more likely shes just not taking in enough calories per feed? Additionally, are there any questions that youd recommend I ask the pediatric GI doc? Thanks so much!. ### Response: Both. IUGR babies are prone to have poor growth. Most continue to have slow growth in the months after birth, often leading to GI interventions such as increasing nutrient density of formula. This is to make up for the nutrient deficit present that an average infant's daily intake typically cannot surpass on its own.While the vast majority (80%) of IUGR and/or SGA (small for gestational age) do catch-up to reach sizes comparable to other children, this typically takes about two years. Many factors affect growth and stature, including any medical problems that led to her being small. For instance, this nutrient deficit and propensity to growth failure tend to be worse in infants who were also preterm (at 37+1 weeks, your daughter was born just two days further along than what we would consider "late preterm").The main things you can control and monitor at this point are her nutritional intake and feeding habits. For now, the baby's goal is to be improving in her percentiles, not worsening. I recommend working with the GI team on this goal. They will likely have you see a pediatric dietitian as well to help figure out how many calories she should be getting.Don't despair - this is more common than you would think. It doesn't mean you're doing anything wrong. You are working very hard and doing everything you can right now. Getting more hands on deck by bringing in a specialist's perspective only means more people in your daughter's corner trying to get her growing better.Most babies born with IUGR do catch up their growth by this age, so I agree with your pediatrician's concern. Increasing the concentration ("fortifying") her formula is a great first step, but it's worth seeing the pediatric GI to make sure there isn't something else going on. I'd suggest keeping track of about how much she eats in a 24-hour period as well, so the doctor can assess whether she's getting enough calories..


Instruction: Pediatric question: For an 8mo baby with hypotonia and delayed gross motor milestones, how much could diagnosing the cause impact the PT/OT she is already receiving?We are talking about an IUGR baby who was born 0.03rd percentile at 38 weeks and is now 13th percentile weight, still has low BMI and diagnosed at 6mo with overall hypotonia. Currently working with PT in person weekly and OT via video-chat weekly.Skills being worked on in PT/OT include:rolling front to back (emerging, working on efficiency)rolling back to front (she never does this unassisted)weight-bearing on elbows in tummy time (often lifts arms and arches back)weight-bearing on hands in tripod sitting positionshifting weight and reaching while in prone/various seated posesbuilding lower abdominal strength with targeted exercisessensory brushing and joint compressionsimproving one and two hand grabsreconditioning oral aversion (from extensive craniosacral mouth work and tongue tie revision w/ post-surgical exercises around 4-5 months old)eating solid foods (baby will touch foods, but never bring to mouth, accepts spoon feeding enthusiastically)neck and shoulder stretches for mild torticollisIm probably leaving something out, but this is an idea of our therapy focus. We live in an area with only one pediatric neurology practice, so we cannot begin to diagnose or rule out anything until our scheduled visit in 2 months.My questions are: Is the therapy we are doing appropriate regardless of diagnosis? How could delaying diagnosis until 10 months (or later) affect her long term outcomes? Would there be any reason for us to travel out of state to a larger facility if we could be seen sooner (on our own dime, eight hours away)?TLDR: Is diagnosis of the cause of mild to moderate infant hypotonia urgent when PT/OT is already underway?

Output: A proper pediatric neurological evaluation will better guide PT/OT, as well as if any other necessary treatments if the underlying cause is treatable.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric question: For an 8mo baby with hypotonia and delayed gross motor milestones, how much could diagnosing the cause impact the PT/OT she is already receiving?We are talking about an IUGR baby who was born 0.03rd percentile at 38 weeks and is now 13th percentile weight, still has low BMI and diagnosed at 6mo with overall hypotonia. Currently working with PT in person weekly and OT via video-chat weekly.Skills being worked on in PT/OT include:rolling front to back (emerging, working on efficiency)rolling back to front (she never does this unassisted)weight-bearing on elbows in tummy time (often lifts arms and arches back)weight-bearing on hands in tripod sitting positionshifting weight and reaching while in prone/various seated posesbuilding lower abdominal strength with targeted exercisessensory brushing and joint compressionsimproving one and two hand grabsreconditioning oral aversion (from extensive craniosacral mouth work and tongue tie revision w/ post-surgical exercises around 4-5 months old)eating solid foods (baby will touch foods, but never bring to mouth, accepts spoon feeding enthusiastically)neck and shoulder stretches for mild torticollisIm probably leaving something out, but this is an idea of our therapy focus. We live in an area with only one pediatric neurology practice, so we cannot begin to diagnose or rule out anything until our scheduled visit in 2 months.My questions are: Is the therapy we are doing appropriate regardless of diagnosis? How could delaying diagnosis until 10 months (or later) affect her long term outcomes? Would there be any reason for us to travel out of state to a larger facility if we could be seen sooner (on our own dime, eight hours away)?TLDR: Is diagnosis of the cause of mild to moderate infant hypotonia urgent when PT/OT is already underway?. ### Response: A proper pediatric neurological evaluation will better guide PT/OT, as well as if any other necessary treatments if the underlying cause is treatable..


Instruction: UTI or Kidney Infection?My daughter 14F, 57, 150lbs, was diagnosed with a UTI at the ER on Thursday afternoon. It caused her to have hot/cold flushes and high HR, which is what brought us to the ER. She has been taking antibiotics twice per day, starting Thursday afternoon. NITROFURANTOIN MONO-MCR 100 MG CAPSULE. She has horseshoe kidney, which is why Im worried. Pediatric nephrology sent her urine from the ED for more tests and they came back this morning to MyChart.Urine Culture Your Value 20,000-29,000 cfu/ml Enterococcus faecalis Flag AUrine Culture Your Value 10,000-19,000 cfu/ml Mixed Contaminants X2Friday night she felt awful and had shakes for an hour. We called the Capital Blue nurse hotline and she said that its just my daughters body fighting the infection and she needs more time for the antibiotics to kick in.Its now Sunday afternoon and she is feeling bad again with a low fever (she didnt have a fever before). She doesnt feel well enough to get up and shower.Is there anyone who can offer help until we can call the nephrologist Monday morning?The ER doc dismissed her high HR and hot/cold body flushed as a panic attack, so now when she starts to feel bad she starts to panic. She has finals tomorrow and has an after school commitment starting this week. I need to figure out what is wrong and help her feel better.

Output: Is her temperature over 100.4?Macrobid (nitrofurantoin) will treat enterococcus very well. However macrobid will not treat kidney infections, only bladder infections. If her temperature was truly >100.4 she may need another antibiotic. You can wait till tomorrow to call your nephrologist to check in.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: UTI or Kidney Infection?My daughter 14F, 57, 150lbs, was diagnosed with a UTI at the ER on Thursday afternoon. It caused her to have hot/cold flushes and high HR, which is what brought us to the ER. She has been taking antibiotics twice per day, starting Thursday afternoon. NITROFURANTOIN MONO-MCR 100 MG CAPSULE. She has horseshoe kidney, which is why Im worried. Pediatric nephrology sent her urine from the ED for more tests and they came back this morning to MyChart.Urine Culture Your Value 20,000-29,000 cfu/ml Enterococcus faecalis Flag AUrine Culture Your Value 10,000-19,000 cfu/ml Mixed Contaminants X2Friday night she felt awful and had shakes for an hour. We called the Capital Blue nurse hotline and she said that its just my daughters body fighting the infection and she needs more time for the antibiotics to kick in.Its now Sunday afternoon and she is feeling bad again with a low fever (she didnt have a fever before). She doesnt feel well enough to get up and shower.Is there anyone who can offer help until we can call the nephrologist Monday morning?The ER doc dismissed her high HR and hot/cold body flushed as a panic attack, so now when she starts to feel bad she starts to panic. She has finals tomorrow and has an after school commitment starting this week. I need to figure out what is wrong and help her feel better.. ### Response: Is her temperature over 100.4?Macrobid (nitrofurantoin) will treat enterococcus very well. However macrobid will not treat kidney infections, only bladder infections. If her temperature was truly >100.4 she may need another antibiotic. You can wait till tomorrow to call your nephrologist to check in..


Instruction: Is a prolonged QT wave on one EKG significant? (Pill overdose)Could my incident of one abnormal EKG I received as a teenager following pill overdose need to be reported to docs 10+ years later/in the future?Or if since then I have had 2 other EKGs and a 48-hour holter monitor and only found tachycardia, am I clear? The specific abnormality was a "borderline prolonged QT wave, poss / positive for RVH." Context and other lesser abnormalities to follow.I am currently 29F with sinus tachycardia, fibromyalgia, bipolar disorder. I requested hospital records of my pediatric suicide attempt because my parents and current psychiatrist are not sharing consistent information with me about my diagnosis(es) and prior care, and I would like to get more help. I was never told that I had particular diagnostic tests run or that any came back abnormal, and I want to know whether these should be chalked up to error/a fluke/exclusive to that overdose, or whether it's something I should've reported to my doctor when my tachycardia was being investigated or should report in my future medical histories or if I were to have more concerning cardiovascular complications.As a 14-year-old, I attempted suicide by ingesting 50 ibuprofen and an unknown # of Sonata, best estimate ~10 pills. The ibuprofen # could be higher technically, since I was still taking it when I lost memory/began to hallucinate. The tox screen was also positive for caffeine.14 F 110 lbs, 5'3", on 0.5 mg Risperdal, 25 mg Zoloft, unknown if any particular mental disorder diagnosis was made at that time, "asthma," white, no drug/alcohol use.I was taken to a hospital and an EKG, head CT, and labwork were done ~4 hrs after ingestion. I presented with normal exam/vitals/labwork in the first 6 hours except for visual and auditory hallucinations and ataxic gait. After about 4 hours I was transferred to the children's hospital ER. While the initial ER noted no new symptoms and stated my EKG was normal, I did see that shortly before I was transferred my BP went from 115/80 -> 114/55.Cardiac Consult:The children's hospital notes by 2 different care team providers state that my EKG by the outside hospital had a borderline prolonged QT and poss / positive for RVH. They repeated my EKG 7 days later, and the consulting cardiologist said they were happy to report this present EKG came back completely normal. He did state that I was "admitted to [the] eating disorder program," so I hope misunderstanding why the EKG was being performed wouldn't affect his conclusion? He also offered to do an exercise treadmill test if they desired. Another note by a care team provider said they recommended I do an outpatient stress test after discharge, but I don't believe my parents ever had it done.Other noted abnormalities post-ER EKG after I was transferred to children's:1/6 systolic murmur, diastolic BP was hypotensive for 12 hrs (98/38, 101/35, 94/45, for example), bpm was 70 - 130, 2+ pulses on extremities, somnolence - at one point only arousable with painful stimuli and then immediately falling back to sleep - and a lot of vomiting later on. Seems like I went back to baseline by about 18 hrs post-ingestion.I think my parents and doctors were so worried about my mental state that they didn't even touch on the physical symptoms. Do I need to consider them at all? Or is it fair to assume that the EKG was a result of the overdose or emergency situation, but that it wouldn't have any long-term ramifications?Throwaway due to sensitive details.

Output: An abnormality on an EKG one time in the context of a medication overdose is not worrisome, especially as it normalized later. This is an expected consequence of the medication overdose, as were your symptoms.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is a prolonged QT wave on one EKG significant? (Pill overdose)Could my incident of one abnormal EKG I received as a teenager following pill overdose need to be reported to docs 10+ years later/in the future?Or if since then I have had 2 other EKGs and a 48-hour holter monitor and only found tachycardia, am I clear? The specific abnormality was a "borderline prolonged QT wave, poss / positive for RVH." Context and other lesser abnormalities to follow.I am currently 29F with sinus tachycardia, fibromyalgia, bipolar disorder. I requested hospital records of my pediatric suicide attempt because my parents and current psychiatrist are not sharing consistent information with me about my diagnosis(es) and prior care, and I would like to get more help. I was never told that I had particular diagnostic tests run or that any came back abnormal, and I want to know whether these should be chalked up to error/a fluke/exclusive to that overdose, or whether it's something I should've reported to my doctor when my tachycardia was being investigated or should report in my future medical histories or if I were to have more concerning cardiovascular complications.As a 14-year-old, I attempted suicide by ingesting 50 ibuprofen and an unknown # of Sonata, best estimate ~10 pills. The ibuprofen # could be higher technically, since I was still taking it when I lost memory/began to hallucinate. The tox screen was also positive for caffeine.14 F 110 lbs, 5'3", on 0.5 mg Risperdal, 25 mg Zoloft, unknown if any particular mental disorder diagnosis was made at that time, "asthma," white, no drug/alcohol use.I was taken to a hospital and an EKG, head CT, and labwork were done ~4 hrs after ingestion. I presented with normal exam/vitals/labwork in the first 6 hours except for visual and auditory hallucinations and ataxic gait. After about 4 hours I was transferred to the children's hospital ER. While the initial ER noted no new symptoms and stated my EKG was normal, I did see that shortly before I was transferred my BP went from 115/80 -> 114/55.Cardiac Consult:The children's hospital notes by 2 different care team providers state that my EKG by the outside hospital had a borderline prolonged QT and poss / positive for RVH. They repeated my EKG 7 days later, and the consulting cardiologist said they were happy to report this present EKG came back completely normal. He did state that I was "admitted to [the] eating disorder program," so I hope misunderstanding why the EKG was being performed wouldn't affect his conclusion? He also offered to do an exercise treadmill test if they desired. Another note by a care team provider said they recommended I do an outpatient stress test after discharge, but I don't believe my parents ever had it done.Other noted abnormalities post-ER EKG after I was transferred to children's:1/6 systolic murmur, diastolic BP was hypotensive for 12 hrs (98/38, 101/35, 94/45, for example), bpm was 70 - 130, 2+ pulses on extremities, somnolence - at one point only arousable with painful stimuli and then immediately falling back to sleep - and a lot of vomiting later on. Seems like I went back to baseline by about 18 hrs post-ingestion.I think my parents and doctors were so worried about my mental state that they didn't even touch on the physical symptoms. Do I need to consider them at all? Or is it fair to assume that the EKG was a result of the overdose or emergency situation, but that it wouldn't have any long-term ramifications?Throwaway due to sensitive details.. ### Response: An abnormality on an EKG one time in the context of a medication overdose is not worrisome, especially as it normalized later. This is an expected consequence of the medication overdose, as were your symptoms..


Instruction: Im not going to lie -- between these heart rate numbers, her complaining about "heart pain" when she was younger, and otherwise being healthy and on-target (if slightly smaller than average) for height/weight/BMI...Im concerned. But I'm not a medical doctor. So here are my questions to those of you that are:Should I be concerned? If so, how concerned should I be?If this is concerning, what steps need to be taken? Do we need to take her back to her primary doctor and get a referral to a pediatric cardiologist? Should we insist that she be allowed to (as needed) walk during runs in cheerleading practice / school?Aditional Info and DetailsMy little sister does pee-wee cheerleading, and they start every practice by running 2 laps around a football field, which is ~1/2 mile (i.e., ~0.8 km). She is not quite "sprinting", but is running the whole time at (Id guess) 80-90% of her maximum running speed (with no walking breaks). When she ran it earlier tonight, at the end of the 2nd lap her Fitbit watch said her heart rate was 213 beats per minute. Her heart felt like it was literally beating of her chest, and she said that she felt like she was about ready to pass out.From what I could find online, 213 BPM for a 10-11 year old girl could be dangerously close to her maximum heart rate, though (especially at that age) maximum heart rate is somewhat variable.Ive also measured her resting heart rate a few times (e.g., after sitting down watching tv for 30+ minutes) and it has been in the 100-110 BPM range, which from what I could find online is not unheard of, but is pushing the upper limit of "normal". These measurements were in the evening (close to bedtime, before taking the 50 mg trazodone). I ran the numbers and, at this point, all the vyvanse from her morning dose has been converted into dextroamphetamine, which (on average) has gone through ~1 half-life (~50% has been metabolized, assuming a 1:1 metabolic conversion for Vyvanse --> dextroamphetamine).Note: to check the Fitbit's accuracy, one of these times I also measured her heart rate manually using my (surprisingly effective) homemade double-walled stethoscope. Over a 30-second interval, the fitbit pegged her at between 99-102 BPM, and I counted 50 heartbeats (meaning 100 BPM), so the measurements it takes seem accurate.She isnt the most "active" person -- left to her own she would sit and watch TV and play on a tablet all day -- but between cheer (3x 2-hours practices + 1 game every week), dance (2x 1-hour classes every week) and school (PE, recess) she gets at least an hour or 2 most days whether she likes it or not. And she certainly isn't overweight -- this growth chart suggests she is in the ~30th percentile for weight and ~25th percentile for height. This BMI calculator for girls puts her BMI at the 53.6 percentile (z=+0.09).

Output: Agree with /u/muchtwojaded. Normal resting heart rate for her age/size, and the >200 HR with exercise isn't concerning to me. Sounds like she gets a good amount of healthy exercise, more than many kids her age.Nothing here sounds dangerous. If she's not complaining of symptoms with exercise, I wouldn't do any kind of workup.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im not going to lie -- between these heart rate numbers, her complaining about "heart pain" when she was younger, and otherwise being healthy and on-target (if slightly smaller than average) for height/weight/BMI...Im concerned. But I'm not a medical doctor. So here are my questions to those of you that are:Should I be concerned? If so, how concerned should I be?If this is concerning, what steps need to be taken? Do we need to take her back to her primary doctor and get a referral to a pediatric cardiologist? Should we insist that she be allowed to (as needed) walk during runs in cheerleading practice / school?Aditional Info and DetailsMy little sister does pee-wee cheerleading, and they start every practice by running 2 laps around a football field, which is ~1/2 mile (i.e., ~0.8 km). She is not quite "sprinting", but is running the whole time at (Id guess) 80-90% of her maximum running speed (with no walking breaks). When she ran it earlier tonight, at the end of the 2nd lap her Fitbit watch said her heart rate was 213 beats per minute. Her heart felt like it was literally beating of her chest, and she said that she felt like she was about ready to pass out.From what I could find online, 213 BPM for a 10-11 year old girl could be dangerously close to her maximum heart rate, though (especially at that age) maximum heart rate is somewhat variable.Ive also measured her resting heart rate a few times (e.g., after sitting down watching tv for 30+ minutes) and it has been in the 100-110 BPM range, which from what I could find online is not unheard of, but is pushing the upper limit of "normal". These measurements were in the evening (close to bedtime, before taking the 50 mg trazodone). I ran the numbers and, at this point, all the vyvanse from her morning dose has been converted into dextroamphetamine, which (on average) has gone through ~1 half-life (~50% has been metabolized, assuming a 1:1 metabolic conversion for Vyvanse --> dextroamphetamine).Note: to check the Fitbit's accuracy, one of these times I also measured her heart rate manually using my (surprisingly effective) homemade double-walled stethoscope. Over a 30-second interval, the fitbit pegged her at between 99-102 BPM, and I counted 50 heartbeats (meaning 100 BPM), so the measurements it takes seem accurate.She isnt the most "active" person -- left to her own she would sit and watch TV and play on a tablet all day -- but between cheer (3x 2-hours practices + 1 game every week), dance (2x 1-hour classes every week) and school (PE, recess) she gets at least an hour or 2 most days whether she likes it or not. And she certainly isn't overweight -- this growth chart suggests she is in the ~30th percentile for weight and ~25th percentile for height. This BMI calculator for girls puts her BMI at the 53.6 percentile (z=+0.09).. ### Response: Agree with /u/muchtwojaded. Normal resting heart rate for her age/size, and the >200 HR with exercise isn't concerning to me. Sounds like she gets a good amount of healthy exercise, more than many kids her age.Nothing here sounds dangerous. If she's not complaining of symptoms with exercise, I wouldn't do any kind of workup..


Instruction: Is it PPA or is there something wrong with my 9 week old son?I want to mention that Im not a FTM. This is my second baby. My first didnt sleep consistently through the night until 2.5. But I really feel like this isnt normal and no one is taking me seriously.Around 2 weeks he started refusing to sleep on his back. Weve had to resort to bedsharing(not what I want to be doing) and he still will only sleep in 30-60 min max increments. He breathes through his mouth a lot. And sounds like a pug when he breathes sometimes. He will stop breathing for a few seconds and then wake himself up with coughing/gagging noises. He frequently gags/chokes when breastfeeding as well. My pediatrician thinks the breathing is normal and that hes working us by crying when we put him to sleep on his own (told us to keep putting him on his back in his crib and hell figure it out. But he screams immediately).Hes had his tongue and lip tie removed a month ago. Chiropractor appointments. Hes on reflux meds. And Ive been dairy and soy free (was having green mucousy diapers) for 2 months. All of this has greatly improved his colic/fussiness- hes usually happy now. But not his sleep.My last resort is maybe an pediatric ENT. But idk what they would even do. Everyone keeps telling me his breathing is normal but I just have a feeling its not. I dont want to waste anyones time.Ill link a video of him breathing and screenshot of his owlet sock showing oxygen lvl and how frequently hes waking (orange is awake). I really really appreciate any advice.

Output: See the pediatric ENT.The breathing sounds to me like he may have a "floppy" airway and could have a condition called laryngomalacia or tracheomalacia. It's fairly common, often does not require medical intervention, and typically improves with age, but you should have him evaluated particularly given the nighttime coughing and awakenings, which are likely because of the condition causing temporary drops in oxygen (as you saw on the owlet) resulting in the body's response of cough/awakening to bring oxygen back up. The pediatric ENT can use different techniques to determine whether this (or another) condition is present and responsible for the symptoms.Interestingly, children with this condition are sometimes recommended to sleep on their stomachs as it helps relieve the upper airway obstruction caused by the floppy larynx and/or trachea, so by refusing to sleep on his back, your son might just be telling you what his airway needs right now. The ENT will provide guidance on how your child should best sleep as well as any other recommended modifications to help with the condition.If bedsharing, practice safer co-sleeping techniques as much as possible as described here. Most important is firm mattress, no pillow/blankets present that could possibly obstruct the face during sleep, no smoking, drinking, or siblings.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is it PPA or is there something wrong with my 9 week old son?I want to mention that Im not a FTM. This is my second baby. My first didnt sleep consistently through the night until 2.5. But I really feel like this isnt normal and no one is taking me seriously.Around 2 weeks he started refusing to sleep on his back. Weve had to resort to bedsharing(not what I want to be doing) and he still will only sleep in 30-60 min max increments. He breathes through his mouth a lot. And sounds like a pug when he breathes sometimes. He will stop breathing for a few seconds and then wake himself up with coughing/gagging noises. He frequently gags/chokes when breastfeeding as well. My pediatrician thinks the breathing is normal and that hes working us by crying when we put him to sleep on his own (told us to keep putting him on his back in his crib and hell figure it out. But he screams immediately).Hes had his tongue and lip tie removed a month ago. Chiropractor appointments. Hes on reflux meds. And Ive been dairy and soy free (was having green mucousy diapers) for 2 months. All of this has greatly improved his colic/fussiness- hes usually happy now. But not his sleep.My last resort is maybe an pediatric ENT. But idk what they would even do. Everyone keeps telling me his breathing is normal but I just have a feeling its not. I dont want to waste anyones time.Ill link a video of him breathing and screenshot of his owlet sock showing oxygen lvl and how frequently hes waking (orange is awake). I really really appreciate any advice.. ### Response: See the pediatric ENT.The breathing sounds to me like he may have a "floppy" airway and could have a condition called laryngomalacia or tracheomalacia. It's fairly common, often does not require medical intervention, and typically improves with age, but you should have him evaluated particularly given the nighttime coughing and awakenings, which are likely because of the condition causing temporary drops in oxygen (as you saw on the owlet) resulting in the body's response of cough/awakening to bring oxygen back up. The pediatric ENT can use different techniques to determine whether this (or another) condition is present and responsible for the symptoms.Interestingly, children with this condition are sometimes recommended to sleep on their stomachs as it helps relieve the upper airway obstruction caused by the floppy larynx and/or trachea, so by refusing to sleep on his back, your son might just be telling you what his airway needs right now. The ENT will provide guidance on how your child should best sleep as well as any other recommended modifications to help with the condition.If bedsharing, practice safer co-sleeping techniques as much as possible as described here. Most important is firm mattress, no pillow/blankets present that could possibly obstruct the face during sleep, no smoking, drinking, or siblings..


Instruction: NAD, but came here to say my child had Laryngomalacia as an infant. He was a squeaky breather but ceased showing signs at 18 months. I hope you get answers soon, OP.

Output: Do not take your baby to a chiropractor. Chiropractors are not medical professionals, and they are especially not pediatric professionals. They are at best harmless and at worst lethal.I am not a pediatrician, I have no idea how reliable or useful Owlet monitoring is (I suspect not very), and that minimal video doesn't sound concerning to mebut I can barely hear and I am again not a pediatrician.This is something to discuss with your baby's pediatrician. If the doctor involved is not concerned, it's probably okay. If you're still very concerned, you could try getting a second opinion from another pediatrician, including bringing all of this information.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: NAD, but came here to say my child had Laryngomalacia as an infant. He was a squeaky breather but ceased showing signs at 18 months. I hope you get answers soon, OP.. ### Response: Do not take your baby to a chiropractor. Chiropractors are not medical professionals, and they are especially not pediatric professionals. They are at best harmless and at worst lethal.I am not a pediatrician, I have no idea how reliable or useful Owlet monitoring is (I suspect not very), and that minimal video doesn't sound concerning to mebut I can barely hear and I am again not a pediatrician.This is something to discuss with your baby's pediatrician. If the doctor involved is not concerned, it's probably okay. If you're still very concerned, you could try getting a second opinion from another pediatrician, including bringing all of this information..


Instruction: Can I ask my doctor to request pharmacare to cover Zofran?26F, 195 lbs, white, current meds are Mirena IUD, cipralex, wellbutrin, and pantoprazole. Current diagnosis of IBS.For the last four years or so have been dealing with awful and disruptive GI problems. Rectal bleeding, diarrhea, distention, nausea, vomiting, pain etc. Blood work has only ever shown anemia, which I've dealt with before, and calprotectin, fecal occult, and scopes have all been given, only finding is enlarged internal hemorrhoids but not so large to warrant a banding procedure.I saw my doctor today as nausea and vomiting were controlled by pantoprazole for almost a year, but nausea and vomiting has worsened, and I've been having increased pain localized to LRQ that will stop me in my tracks, and feels like a rolling intense cramp, or intense pressure. She wrote me a prescription for Zofran, and it was $272 for 90 tablets. I have provincial coverage, but since I'm not a pediatric patient or undergoing chemo or radiation I'm not eligible for coverage.Could I ask my doctor to petition pharmacare to get me coverage and explain that I've already been on meds that have failed to control problems? How likely is it that can be covered

Output: Zofran has been off patent for a little while now, ask for the generic, it should be at least half that price

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can I ask my doctor to request pharmacare to cover Zofran?26F, 195 lbs, white, current meds are Mirena IUD, cipralex, wellbutrin, and pantoprazole. Current diagnosis of IBS.For the last four years or so have been dealing with awful and disruptive GI problems. Rectal bleeding, diarrhea, distention, nausea, vomiting, pain etc. Blood work has only ever shown anemia, which I've dealt with before, and calprotectin, fecal occult, and scopes have all been given, only finding is enlarged internal hemorrhoids but not so large to warrant a banding procedure.I saw my doctor today as nausea and vomiting were controlled by pantoprazole for almost a year, but nausea and vomiting has worsened, and I've been having increased pain localized to LRQ that will stop me in my tracks, and feels like a rolling intense cramp, or intense pressure. She wrote me a prescription for Zofran, and it was $272 for 90 tablets. I have provincial coverage, but since I'm not a pediatric patient or undergoing chemo or radiation I'm not eligible for coverage.Could I ask my doctor to petition pharmacare to get me coverage and explain that I've already been on meds that have failed to control problems? How likely is it that can be covered. ### Response: Zofran has been off patent for a little while now, ask for the generic, it should be at least half that price.


Instruction: I did get the generic , don't know what I would have done if got the name brand

Output: Yea right, interesting. 10 wafers generic in australia is around $14 so youre still getting a solid premium over there

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I did get the generic , don't know what I would have done if got the name brand. ### Response: Yea right, interesting. 10 wafers generic in australia is around $14 so youre still getting a solid premium over there.


Instruction: 1 year old sudden loss of visionOn Thursday, my 15 month olds babysitter noticed that she wasnt making eye contact like normal. At home, I noticed the same thing. Normally, if I look at her and smile she smiles back. But it looked like she was looking right past me. Along with that, she was not tracking objects with her eyes.I took her to the pediatrician on Friday who was concerned and wanted her to see an ophthalmologist right away. So we did that, she had a full eye exam with her eyes dilated and there was nothing wrong (like far sightedness or strabismus etc) with her eyes. The ophthalmologist was concerned too and called a neurologist who wanted us to go to the ER so we could be admitted into neurology over the weekend.The ER did a lot of blood work, a spinal tap for fluid (I cant remember the name- Im sorry.) and the doctors there just generally said they were stumped.We are on day 2 of being in the pediatric neurology unit. Shes having an EEG done for 24 hours and hopefully an MRI today. The neurologist says hes fairly confident she isnt having seizures but wants to cover everything.I hope one or both of those things gives us an answer but in the mean time all I have to do is think. What could possibly have caused this loss of vision seemingly overnight? She responds to sounds but not objects. Shes had hundreds of lights (from nurses doctors etc) flashed right in her eyes and she does nothing like youd expect. They shined a light in my eyes to show me how abnormal it was that she did nothing because I instinctively moved my eyes.Also... no falls, no high fevers, no recent illness, her birth was normal, shes developmentally normal.Does anyone have any idea of what this could be?

Output: Sorry to hear about your daughter. It is hard to know the cause without all the test results at the current time, especially the MRI, as this seems to be something less common. If she looks well in other aspects (except for the vision loss), and has already been evaluated by a pediatrician, ophthalmologist, and a pediatric neurologist, you are doing everything you can, and it seems that everything necessary is being done. Vision requires normal eyes, normal optic nerves connecting the eyes to the brain, and normal function of the visual cortex of the brain, and of course normal response to vision requires good function of the rest of the brain. Generally most problems affecting the eyes affect only one eye at a time, and can be seen by the ophthalmologist (either anterior chamber problems such as cataracts or posterior chamber issues such as retinoblastoma). Problems affecting the optic nerves (e.g optic neuritis) are more often seen in older kids (e.g with multiple sclerosis) and are very rare at 15 months. Rarely, there can be problems near where the optic nerves come together just behind the eyes (optic chiasma) when masses (eg. craniopharyngioma)/cysts push on them and can cause visual loss. It is also rare for things to affect the visual cortex of the brain. I suspect that the MRI will be of help. If it does find something, it might need other specialists (e.g. neurosurgeon) to provide further information on management.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 1 year old sudden loss of visionOn Thursday, my 15 month olds babysitter noticed that she wasnt making eye contact like normal. At home, I noticed the same thing. Normally, if I look at her and smile she smiles back. But it looked like she was looking right past me. Along with that, she was not tracking objects with her eyes.I took her to the pediatrician on Friday who was concerned and wanted her to see an ophthalmologist right away. So we did that, she had a full eye exam with her eyes dilated and there was nothing wrong (like far sightedness or strabismus etc) with her eyes. The ophthalmologist was concerned too and called a neurologist who wanted us to go to the ER so we could be admitted into neurology over the weekend.The ER did a lot of blood work, a spinal tap for fluid (I cant remember the name- Im sorry.) and the doctors there just generally said they were stumped.We are on day 2 of being in the pediatric neurology unit. Shes having an EEG done for 24 hours and hopefully an MRI today. The neurologist says hes fairly confident she isnt having seizures but wants to cover everything.I hope one or both of those things gives us an answer but in the mean time all I have to do is think. What could possibly have caused this loss of vision seemingly overnight? She responds to sounds but not objects. Shes had hundreds of lights (from nurses doctors etc) flashed right in her eyes and she does nothing like youd expect. They shined a light in my eyes to show me how abnormal it was that she did nothing because I instinctively moved my eyes.Also... no falls, no high fevers, no recent illness, her birth was normal, shes developmentally normal.Does anyone have any idea of what this could be?. ### Response: Sorry to hear about your daughter. It is hard to know the cause without all the test results at the current time, especially the MRI, as this seems to be something less common. If she looks well in other aspects (except for the vision loss), and has already been evaluated by a pediatrician, ophthalmologist, and a pediatric neurologist, you are doing everything you can, and it seems that everything necessary is being done. Vision requires normal eyes, normal optic nerves connecting the eyes to the brain, and normal function of the visual cortex of the brain, and of course normal response to vision requires good function of the rest of the brain. Generally most problems affecting the eyes affect only one eye at a time, and can be seen by the ophthalmologist (either anterior chamber problems such as cataracts or posterior chamber issues such as retinoblastoma). Problems affecting the optic nerves (e.g optic neuritis) are more often seen in older kids (e.g with multiple sclerosis) and are very rare at 15 months. Rarely, there can be problems near where the optic nerves come together just behind the eyes (optic chiasma) when masses (eg. craniopharyngioma)/cysts push on them and can cause visual loss. It is also rare for things to affect the visual cortex of the brain. I suspect that the MRI will be of help. If it does find something, it might need other specialists (e.g. neurosurgeon) to provide further information on management..


Instruction: Are there different sized tools for transvaginal ultrasound?Female, Canada, 27.I think I'm expecting to get a transvaginal ultrasound sound done today, my first ever. Problem is that although I'm an adult, my body has stunted growth and I also barely have any experience putting something in there. I've only put something in there long ago that's really small and the last was like 2 days ago when I had my pap exam. She used the pediatric sized tool and even that was on the painful side. So I'm really nervous about the upcoming one because I'm worried it will damage me if they don't see where to stop at. Will they be able to see where to stop the end of it and do they've different sized ones?

Output: The probes used for transvaginal ultrasound aren't that big, and are smaller diameter than a pediatric speculum like you would have had used for the Pap smear. Another thing you can do if you're comfortable with it is ask to insert the probe yourself, since it's more comfortable for many people.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Are there different sized tools for transvaginal ultrasound?Female, Canada, 27.I think I'm expecting to get a transvaginal ultrasound sound done today, my first ever. Problem is that although I'm an adult, my body has stunted growth and I also barely have any experience putting something in there. I've only put something in there long ago that's really small and the last was like 2 days ago when I had my pap exam. She used the pediatric sized tool and even that was on the painful side. So I'm really nervous about the upcoming one because I'm worried it will damage me if they don't see where to stop at. Will they be able to see where to stop the end of it and do they've different sized ones?. ### Response: The probes used for transvaginal ultrasound aren't that big, and are smaller diameter than a pediatric speculum like you would have had used for the Pap smear. Another thing you can do if you're comfortable with it is ask to insert the probe yourself, since it's more comfortable for many people..


Instruction: 13 year old athlete EKG results - Sinus bradycardia and Intraventricular conduction delayMy 13 year old is 5'11, 188lbs, was complaining of chest pain on the 29th that every time he took a deep breath it hurt. No pain when breathing normally, pain located almost directly in the middle of his sternum and a little to the left. He does play sports year-round - Football and wrestling. I cannot get an appointment until Monday with a cardiologist and I am having a hard time understanding what this means!

Output: Would need to see the actual ECG. This may be the auto-interptetation by the machine. They are notoriously wrong.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 13 year old athlete EKG results - Sinus bradycardia and Intraventricular conduction delayMy 13 year old is 5'11, 188lbs, was complaining of chest pain on the 29th that every time he took a deep breath it hurt. No pain when breathing normally, pain located almost directly in the middle of his sternum and a little to the left. He does play sports year-round - Football and wrestling. I cannot get an appointment until Monday with a cardiologist and I am having a hard time understanding what this means!. ### Response: Would need to see the actual ECG. This may be the auto-interptetation by the machine. They are notoriously wrong..


Instruction: 1 year old Male, question about delayed passage of meconium as a newbornMy son (1yoM) has had chronic constipation since early infancy, beginning when he was exclusively breastfed. After no success with dietary remedies, ped prescribed Miralax, which has significantly improved his constipation. But it has not gone away, so ped had a barium enema performed. This test was normal, but he was referred to pediatric GI since the constipation has remained, and GI said that Hirschprung's is not ruled out and is wanting to conduct further testing.My question - part of why they're suspicious of Hirschprung's is that my son did not pass any meconium/poop at all from the time he was born until he was 4 days old. I understand this is very delayed passage of meconium. However, he was an out of hospital birth, and my mom, who was present at the birth, is sure that meconium was passed during delivery, because she said the amniotic fluid coming out as he was born was brown. The midwives never mentioned this. Obviously my mom is no medical professional, but I don't want to be raising false alarms with the doctors by reporting that he did not pass meconium if in fact he did during labor.So - if he passed meconium during labor, and then did not poop at all for four days, then passed a large volume of meconium, would this be considered normal, or still qualify as a risk factor for Hirschprung's? I've struggled to get a clear answer from his doctors, and I want to be sure that he isn't getting more testing than he needs due to me misreporting information.

Output: Even if he did pass it during delivery, not having further meconium passage within the first 4 days after birth is abnormal. Sounds like further workup would be warranted.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 1 year old Male, question about delayed passage of meconium as a newbornMy son (1yoM) has had chronic constipation since early infancy, beginning when he was exclusively breastfed. After no success with dietary remedies, ped prescribed Miralax, which has significantly improved his constipation. But it has not gone away, so ped had a barium enema performed. This test was normal, but he was referred to pediatric GI since the constipation has remained, and GI said that Hirschprung's is not ruled out and is wanting to conduct further testing.My question - part of why they're suspicious of Hirschprung's is that my son did not pass any meconium/poop at all from the time he was born until he was 4 days old. I understand this is very delayed passage of meconium. However, he was an out of hospital birth, and my mom, who was present at the birth, is sure that meconium was passed during delivery, because she said the amniotic fluid coming out as he was born was brown. The midwives never mentioned this. Obviously my mom is no medical professional, but I don't want to be raising false alarms with the doctors by reporting that he did not pass meconium if in fact he did during labor.So - if he passed meconium during labor, and then did not poop at all for four days, then passed a large volume of meconium, would this be considered normal, or still qualify as a risk factor for Hirschprung's? I've struggled to get a clear answer from his doctors, and I want to be sure that he isn't getting more testing than he needs due to me misreporting information.. ### Response: Even if he did pass it during delivery, not having further meconium passage within the first 4 days after birth is abnormal. Sounds like further workup would be warranted..


Instruction: displaced acute supracondylar humeral fracture with dorsal and radial displacement - 1/16/23My daughter fell off the monkey bars today. She landed on her back and elbow. I could immediately tell it dislocated. I called rescuer and they put a splint. I took her to the ER and they did X-rays. Based on the X-rays they said she had a displaced acute supracondylar humeral fracture with dorsal and radial displacement - the pediatric orthopedic was not available to come in but the PA said she spoke to him on the phone and they determined she needed surgery. I really dont want her to have surgery unless its absolutely necessary. Shes only 5 years old. Please help. Id like another opinion. Is there another non-surgical option? We were admitted and will stay the night in the hospital.

Output: She absolutely needs surgery. Its a very small surgery in the realm of orthopaedics. It will be 2 or 3 pins placed through the skin and then a cast or splint applied. Theyll be able to take the pins out in the office after it heals. The only type of supracondylar fracture thats amenable to non-operative treatment are those that are non-displaced. If you elect for non-operative treatment for this fracture pattern, your daughter will have permanent, long-term elbow dysfunction.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: displaced acute supracondylar humeral fracture with dorsal and radial displacement - 1/16/23My daughter fell off the monkey bars today. She landed on her back and elbow. I could immediately tell it dislocated. I called rescuer and they put a splint. I took her to the ER and they did X-rays. Based on the X-rays they said she had a displaced acute supracondylar humeral fracture with dorsal and radial displacement - the pediatric orthopedic was not available to come in but the PA said she spoke to him on the phone and they determined she needed surgery. I really dont want her to have surgery unless its absolutely necessary. Shes only 5 years old. Please help. Id like another opinion. Is there another non-surgical option? We were admitted and will stay the night in the hospital.. ### Response: She absolutely needs surgery. Its a very small surgery in the realm of orthopaedics. It will be 2 or 3 pins placed through the skin and then a cast or splint applied. Theyll be able to take the pins out in the office after it heals. The only type of supracondylar fracture thats amenable to non-operative treatment are those that are non-displaced. If you elect for non-operative treatment for this fracture pattern, your daughter will have permanent, long-term elbow dysfunction..


Instruction: I (23F) keep sleeping through my doctors appointments due to a sleep disorder.Caucasian, 95lbs, 54. Diagnosed PTSD, Anxiety, Depression, Essential Tremor, Hypoglycemia. Taking 150mg Oxcarbazepine 2x/Day, .5mg Clonazepam 1x/Day. Vape nicotine and cannabis.Im currently dealing with several medical issues but am unable to get them treated/diagnosed because I sleep all day, every day. The sleep issues have been ongoing and worsening over the past decade.I sleep 16+ hours every day, cannot sleep at night, nothing and no one has been able to wake me up (incl. medical professionals in a hospital setting, my partner, assorted alarms, resetting my sleep schedule, etc)I had an appointment with my PCP on the 26th at 8 AM that I had to pull an all nighter for to be able to go to. I got an abnormal EKG reading and needed labs. They proceeded to try to draw blood..but my veins are tiny (they used pediatric needles) and kept collapsing, so they requested I come back today (the 28th) at 10 AM, extra hydrated and rested (they said my not sleeping couldve been partially to blame for labs difficulty).Well, thats about 2 hours past my bodys chosen bedtime, so I accidentally fell asleep (and woke up at 8 PM today).Everyones getting frustrated with how many appointments Ive missed (myself included). If I continue to miss appointments (especially therapy) I could be labeled as non-compliant, which could royally fuck everything up.How can I make my appointments? How can I treat my condition myself enough so that Im able to get professional care (for this and other issues)? At the very least, how can I show/prove that Im invested in my care despite my repeated missed appointments?

Output: Taking a sedative (clonazepam) whilst also smoking a sedative (cannabis) certainly wont help you to not fall asleep.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I (23F) keep sleeping through my doctors appointments due to a sleep disorder.Caucasian, 95lbs, 54. Diagnosed PTSD, Anxiety, Depression, Essential Tremor, Hypoglycemia. Taking 150mg Oxcarbazepine 2x/Day, .5mg Clonazepam 1x/Day. Vape nicotine and cannabis.Im currently dealing with several medical issues but am unable to get them treated/diagnosed because I sleep all day, every day. The sleep issues have been ongoing and worsening over the past decade.I sleep 16+ hours every day, cannot sleep at night, nothing and no one has been able to wake me up (incl. medical professionals in a hospital setting, my partner, assorted alarms, resetting my sleep schedule, etc)I had an appointment with my PCP on the 26th at 8 AM that I had to pull an all nighter for to be able to go to. I got an abnormal EKG reading and needed labs. They proceeded to try to draw blood..but my veins are tiny (they used pediatric needles) and kept collapsing, so they requested I come back today (the 28th) at 10 AM, extra hydrated and rested (they said my not sleeping couldve been partially to blame for labs difficulty).Well, thats about 2 hours past my bodys chosen bedtime, so I accidentally fell asleep (and woke up at 8 PM today).Everyones getting frustrated with how many appointments Ive missed (myself included). If I continue to miss appointments (especially therapy) I could be labeled as non-compliant, which could royally fuck everything up.How can I make my appointments? How can I treat my condition myself enough so that Im able to get professional care (for this and other issues)? At the very least, how can I show/prove that Im invested in my care despite my repeated missed appointments?. ### Response: Taking a sedative (clonazepam) whilst also smoking a sedative (cannabis) certainly wont help you to not fall asleep..


Instruction: [26][F] I have moved to a new state and have WA State Health Insurance. Questions about choosing my PCP.I previously had a PCP who helped with various issues but mainly helped me with my medication management for my mental health issues. We have found what works for me (see 'Current Medications' below) but I want to have a PCP that is versed with medication for mental health issues in case changes are needed to be made (It took many years, several doctors, and many different medications to come to my current Rx and I am very thankful to my previous doctor for helping me get to such a point). But I also am 26 and am more aware of my women health needs and want to be sure I'm addressing those and staying healthy. I also have an IUD that needs removal soon, at which I will likely get another inserted.I was assigned a doctor that works at a "Pediatrics Associates" place with the credentials (MSN, ARNP, NP-C). I am confused as to why I was assigned to go somewhere for pediatrics, as it was my understanding that it was for children, though I am not discounting my assigned PCP's credentials. I looked into other PCPs that were on the directory and found an MD in Family Medicine and Obstetrics. Seeing this doctor would be a further drive for me but it intrigues me since I have never been to an OBGYN. Since I am getting older and leaning more into health women's health, should I request to begin seeing this PCP instead? -- Note that requests for doctor changes are allowed. -- or does the assigned doctor seem to have plenty credential/ knowledge for me to establish care?Hope this doesn't seem undermining at all, I just want to make sure I'm making a good decision since I will likely establish long term care with my next doctor!TIA :)Height: 5'4"Weight: 110-120 lbRace: Asian AmericanPrimary Concerns: Vaginal Health & Mental HealthExisting Medical Issues: Diagnosed ADHD, MDD, GAD. Prone to overproduction of yeast leading to BV or Yeast InfectionsCurrent Medications: Venlafaxine 150 mg, Vyvanse 60 mgOccasional drinks weekly. No smoking. No drugs.

Output: Yeah, no idea why you would have been assigned someone who works in a pediatric office. I'd switch to the family medicine MD.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: [26][F] I have moved to a new state and have WA State Health Insurance. Questions about choosing my PCP.I previously had a PCP who helped with various issues but mainly helped me with my medication management for my mental health issues. We have found what works for me (see 'Current Medications' below) but I want to have a PCP that is versed with medication for mental health issues in case changes are needed to be made (It took many years, several doctors, and many different medications to come to my current Rx and I am very thankful to my previous doctor for helping me get to such a point). But I also am 26 and am more aware of my women health needs and want to be sure I'm addressing those and staying healthy. I also have an IUD that needs removal soon, at which I will likely get another inserted.I was assigned a doctor that works at a "Pediatrics Associates" place with the credentials (MSN, ARNP, NP-C). I am confused as to why I was assigned to go somewhere for pediatrics, as it was my understanding that it was for children, though I am not discounting my assigned PCP's credentials. I looked into other PCPs that were on the directory and found an MD in Family Medicine and Obstetrics. Seeing this doctor would be a further drive for me but it intrigues me since I have never been to an OBGYN. Since I am getting older and leaning more into health women's health, should I request to begin seeing this PCP instead? -- Note that requests for doctor changes are allowed. -- or does the assigned doctor seem to have plenty credential/ knowledge for me to establish care?Hope this doesn't seem undermining at all, I just want to make sure I'm making a good decision since I will likely establish long term care with my next doctor!TIA :)Height: 5'4"Weight: 110-120 lbRace: Asian AmericanPrimary Concerns: Vaginal Health & Mental HealthExisting Medical Issues: Diagnosed ADHD, MDD, GAD. Prone to overproduction of yeast leading to BV or Yeast InfectionsCurrent Medications: Venlafaxine 150 mg, Vyvanse 60 mgOccasional drinks weekly. No smoking. No drugs.. ### Response: Yeah, no idea why you would have been assigned someone who works in a pediatric office. I'd switch to the family medicine MD..


Instruction: Childs swollen elbow normal?4.5 years old 37lbs 43in.My daughter fell and hurt her left arm on Sunday evening. We took her to urgent care early Monday morning. Got X-rays and there are no fractures. They determined it was a Nursemaids Elbow and tried a few times to reset it, but they werent sure they were successful because she was resisting, even though we were (safely) restraining her (the absolute worst worst WORST for my heart omg).They told us that we should bring her to an pediatric orthopedic doctor today if she wasnt using it by the end of the day (yesterday, Monday).I did notice her using it a little bit more, though not much. She complained it hurt for the rest of the day (when she went to wash her hands and used it to push down on the soap dispenser, she screamed out in pain).Today she woke up and I noticed its a bit more swollen than her other elbow. Shes still complaining that it hurts and is using her other hand to hold her arm close to her body, but she turned a page in a book with it as I typed this, which is way more than shes done in the past day and a half.Im not sure if its just from being a bit manhandled by two different doctors trying to reset her elbow yesterday, and so we should let it be, or if its worse and I should take her to the orthopedic doctor this morning.

Output: I would definitely take her to get checked by the pediatric Ortho. The injury is not consistent with nursemaids and these are typically very easily reduced. Worth a second look for sure.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Childs swollen elbow normal?4.5 years old 37lbs 43in.My daughter fell and hurt her left arm on Sunday evening. We took her to urgent care early Monday morning. Got X-rays and there are no fractures. They determined it was a Nursemaids Elbow and tried a few times to reset it, but they werent sure they were successful because she was resisting, even though we were (safely) restraining her (the absolute worst worst WORST for my heart omg).They told us that we should bring her to an pediatric orthopedic doctor today if she wasnt using it by the end of the day (yesterday, Monday).I did notice her using it a little bit more, though not much. She complained it hurt for the rest of the day (when she went to wash her hands and used it to push down on the soap dispenser, she screamed out in pain).Today she woke up and I noticed its a bit more swollen than her other elbow. Shes still complaining that it hurts and is using her other hand to hold her arm close to her body, but she turned a page in a book with it as I typed this, which is way more than shes done in the past day and a half.Im not sure if its just from being a bit manhandled by two different doctors trying to reset her elbow yesterday, and so we should let it be, or if its worse and I should take her to the orthopedic doctor this morning.. ### Response: I would definitely take her to get checked by the pediatric Ortho. The injury is not consistent with nursemaids and these are typically very easily reduced. Worth a second look for sure..


Instruction: Could they have seen it in an X-ray? They didnt show us the X-ray, but said there were no fractures.

Output: The elbow can be tricky in kids. Sometimes they hide fractures very well there and we may not see them initially on x-ray.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Could they have seen it in an X-ray? They didnt show us the X-ray, but said there were no fractures.. ### Response: The elbow can be tricky in kids. Sometimes they hide fractures very well there and we may not see them initially on x-ray..


Instruction: Pediatric Dentist ? 5yo needs dental work.My son 5M 55lbs no medications or health concerns besides this one.Hoping theres a pediatric dentist on here? My son has a tooth thats got an abscess on the gum above it. That tooth has to be pulled and he also needs a crown on another tooth that has a bad cavity. He doesnt do well at the dentist and they suggested IV sedation for him.They do this in their office (pediatric dentist plus dentist anesthesiologist) which I found unsettling and wanted to know if thats normal? Is this general anesthesia like where hed be intubated? I always thought that needed to be done in a hospital setting.I already feel like the worlds worst mother so I know its my fault for letting his teeth get so bad. So adding this anxiety to my guilt. Just worried about his safety and if an emergency should arise we wouldnt already be in a hospital.My next question is that they didnt schedule it until mid October and thats over a month and a half wait with an abscessed tooth. Im afraid its going to get much worse in that time. They prescribed an antibiotic but Is there anything I can do at home to keep it from getting worse?If anyone has any advice for this terrified mom I would truly appreciate it.

Output: You probably won't find a pediatric dentist on here (this is AskDocs, not AskDentists).IV sedation isn't the same as full general anesthesia where he'd be intubated. They'll use IV medication to calm him down and make him sleepy, but he'll still be breathing on his own. WIth proper monitoring (cardiorespiratory monitor, O2 saturations, etc) this is very safe. Similar to the sedation that's given for many people to get their wisdom teeth removed.Besides ensuring good brushing and taking the antibiotic, not much you can do to keep this from getting worse. Stuff happens, don't beat yourself up.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric Dentist ? 5yo needs dental work.My son 5M 55lbs no medications or health concerns besides this one.Hoping theres a pediatric dentist on here? My son has a tooth thats got an abscess on the gum above it. That tooth has to be pulled and he also needs a crown on another tooth that has a bad cavity. He doesnt do well at the dentist and they suggested IV sedation for him.They do this in their office (pediatric dentist plus dentist anesthesiologist) which I found unsettling and wanted to know if thats normal? Is this general anesthesia like where hed be intubated? I always thought that needed to be done in a hospital setting.I already feel like the worlds worst mother so I know its my fault for letting his teeth get so bad. So adding this anxiety to my guilt. Just worried about his safety and if an emergency should arise we wouldnt already be in a hospital.My next question is that they didnt schedule it until mid October and thats over a month and a half wait with an abscessed tooth. Im afraid its going to get much worse in that time. They prescribed an antibiotic but Is there anything I can do at home to keep it from getting worse?If anyone has any advice for this terrified mom I would truly appreciate it.. ### Response: You probably won't find a pediatric dentist on here (this is AskDocs, not AskDentists).IV sedation isn't the same as full general anesthesia where he'd be intubated. They'll use IV medication to calm him down and make him sleepy, but he'll still be breathing on his own. WIth proper monitoring (cardiorespiratory monitor, O2 saturations, etc) this is very safe. Similar to the sedation that's given for many people to get their wisdom teeth removed.Besides ensuring good brushing and taking the antibiotic, not much you can do to keep this from getting worse. Stuff happens, don't beat yourself up..


Instruction: My 6 year old is sick every other week. I need advice.I need advice! My 6 year old is in kindergarten and has had strep, pink eye, and bronchitis every other week! He's well for a week then gets hit with a new fever, and sick again. I am not sure what to do. Care is the worst around us and we are on a waiting list for a pediatric ENT for possibly getting his adenoids out. Anything I may be missing or what I can do? It breaks me how sick he is all the time and the amount of school he keeps missing.

Output: How are his growth and development? Every child has been getting sick constantly for about 9 months, so probably he is just like every other child. But without any information no one can say.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My 6 year old is sick every other week. I need advice.I need advice! My 6 year old is in kindergarten and has had strep, pink eye, and bronchitis every other week! He's well for a week then gets hit with a new fever, and sick again. I am not sure what to do. Care is the worst around us and we are on a waiting list for a pediatric ENT for possibly getting his adenoids out. Anything I may be missing or what I can do? It breaks me how sick he is all the time and the amount of school he keeps missing.. ### Response: How are his growth and development? Every child has been getting sick constantly for about 9 months, so probably he is just like every other child. But without any information no one can say..


Instruction: Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment.Thank you!

Output: The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment.Thank you!. ### Response: The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation..


Instruction: Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains?

Output: High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains?. ### Response: High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes.


Instruction: 21 year old female with GI issues for years but they keep getting progressively worseI cant remember if I always had these issues, but I remember being 12 years old and starting to have very consistent diarrhea. All throughout middle school and high school I had mostly diarrhea BMs, with a few episodes of constipation. I always assumed it was how my family ate. Around 18 it got worse. I started to become constantly nauseous and lost over 50 pounds from throwing up and diarrhea. I went to the doctor but they told me change my diet. Since moving out last year and making changes to my diet to be healthier and adding more probiotics and fibers, nothing has changed and it feels like its getting worse. Now I have constant painful gas that bubbles in my stomach and honestly smells so bad. Im embarrassed to leave the house most days in fear my coworkers will notice. My joints have started to have unbearable pain, mostly in my hands and hips. I get sick once a month and it leaves me bedridden at least one day. I feel like my body is falling apart on me.I drink lots of water and try to keep my diet to standard to help my stomach, but Im not sure what else to do. I recently aged out of pediatrics and am unable to find any doctor near me that both accepts new patients and takes my insurance. I just feel so lostIve never had a diagnosis before other than for mental illnesses. Ive considered it being stress, and while it does get worse when Im stressed, its always like this no matter what my mental state is.For family history, we have no diagnosis of IBS or Crohns, but my mother had really bad undiagnosed stomach issues and died from breast cancer. All the women in my family have had breast cancer. My sister has diagnosed rheumatoid arthritis (she is 30, was diagnosed at 26)

Output: Have you been tested for celiac disease? You should see a GI doctor if your PCP isn't doing any meaningful work-up. There are many possible causes

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 21 year old female with GI issues for years but they keep getting progressively worseI cant remember if I always had these issues, but I remember being 12 years old and starting to have very consistent diarrhea. All throughout middle school and high school I had mostly diarrhea BMs, with a few episodes of constipation. I always assumed it was how my family ate. Around 18 it got worse. I started to become constantly nauseous and lost over 50 pounds from throwing up and diarrhea. I went to the doctor but they told me change my diet. Since moving out last year and making changes to my diet to be healthier and adding more probiotics and fibers, nothing has changed and it feels like its getting worse. Now I have constant painful gas that bubbles in my stomach and honestly smells so bad. Im embarrassed to leave the house most days in fear my coworkers will notice. My joints have started to have unbearable pain, mostly in my hands and hips. I get sick once a month and it leaves me bedridden at least one day. I feel like my body is falling apart on me.I drink lots of water and try to keep my diet to standard to help my stomach, but Im not sure what else to do. I recently aged out of pediatrics and am unable to find any doctor near me that both accepts new patients and takes my insurance. I just feel so lostIve never had a diagnosis before other than for mental illnesses. Ive considered it being stress, and while it does get worse when Im stressed, its always like this no matter what my mental state is.For family history, we have no diagnosis of IBS or Crohns, but my mother had really bad undiagnosed stomach issues and died from breast cancer. All the women in my family have had breast cancer. My sister has diagnosed rheumatoid arthritis (she is 30, was diagnosed at 26). ### Response: Have you been tested for celiac disease? You should see a GI doctor if your PCP isn't doing any meaningful work-up. There are many possible causes.


Instruction: Is antibiotic resistance some thing I have to worry about?I have a daughter who is four years old. She has no pertinent or obvious health problems, except for a lingering cough she had for about eight months after we had Covid last year. She is almost 4 feet tall and about 55 pounds. She has been having recurring vaginal discharge for over a year now. She has been on amoxicillin, Cefdinir, and keflex. Finally, after so long of not having any answers, they finally sent her to a pediatric gynecologist. She did an internal swab and found the strep bacteria. But, after a phone call with her, she told me that all of the antibiotics she has taken so far should have killed the bacteria. Each time she took antibiotics it was for 10 days.She prescribed her another, fourth kind of antibiotic, and said that if this doesnt kill it, that she will have to have a check up inside her vagina under sedation. I am not against this procedure, but now I have become a little worried about antibiotic resistance. If these previous antibiotics were supposed to kill the bacteria and she took them for 10 days, is this a bad sign? Or is it really possible that these three different kinds of antibiotics that she took for 10 days each didnt really kill the bacteria? Id love another doctors opinion on the matter.

Output: It's probably fine.It's not clear to me she has an infection that needs antibiotics.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is antibiotic resistance some thing I have to worry about?I have a daughter who is four years old. She has no pertinent or obvious health problems, except for a lingering cough she had for about eight months after we had Covid last year. She is almost 4 feet tall and about 55 pounds. She has been having recurring vaginal discharge for over a year now. She has been on amoxicillin, Cefdinir, and keflex. Finally, after so long of not having any answers, they finally sent her to a pediatric gynecologist. She did an internal swab and found the strep bacteria. But, after a phone call with her, she told me that all of the antibiotics she has taken so far should have killed the bacteria. Each time she took antibiotics it was for 10 days.She prescribed her another, fourth kind of antibiotic, and said that if this doesnt kill it, that she will have to have a check up inside her vagina under sedation. I am not against this procedure, but now I have become a little worried about antibiotic resistance. If these previous antibiotics were supposed to kill the bacteria and she took them for 10 days, is this a bad sign? Or is it really possible that these three different kinds of antibiotics that she took for 10 days each didnt really kill the bacteria? Id love another doctors opinion on the matter.. ### Response: It's probably fine.It's not clear to me she has an infection that needs antibiotics..


Instruction: Would a swab that shows strep not indicate antibiotics?

Output: If you swab a human's orifice, it will grow bacteria.Whether that bacteria is the cause of an infectious pathology is a different question.Are you talking about group A or group B strep?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Would a swab that shows strep not indicate antibiotics?. ### Response: If you swab a human's orifice, it will grow bacteria.Whether that bacteria is the cause of an infectious pathology is a different question.Are you talking about group A or group B strep?.