Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Age: 36 years old Gender: Female Height: 5'4" Weight 160lbs Location: USA Smoking: Never Meds: xyzal 5 mg daily for chronic idiopathic urticaria and angioedema 200mg Zoloft (serteraline)I recently gave birth. I had pre-eclampsia with high blood pressure, protein in my urine, headache and chest pain. I was given an ECG, EKG, and chest x-ray while in the hospital. I was discharged a couple days later and they put a zio heart monitor on me for 2 weeks.This past Friday I had a follow up appointment with a cardiologist after my monitor results, the other tests, and one more ECG. The cardiologist told me (in a relatively relaxed and casual way) that I have a long QT interval and that can increase the risk of sudden cardiac death. She referred me to a geneticist who I'm waiting on for an appointment.At the time my brain stopped working when she said death but now I'm trying to gauge what is.me.being overly health anxious and what is justified worry. I am emailing the doctor but I suspect it willl take awhile for a response since it is the weekend.But given that I have no history of drinking, smoking, drugs, eating disorders, or any vitamin imbalances. How worried should I be?? Like should ainbe saying my goodbyes?! Or do I just ignore it and my life will be relatively normal??? I haven't had any fainting spells and I don't THINK either side of .y family has a history of SCD. But on both sides there is cardio history -- my maternal grandfather died of a heart attack and my maternal uncle has had a couple I think? My paternal uncle has had a heart attack and I think my paternal grandfather died from one as well? But that one I am really unsure about.Is this the sort of thing that everyone has and is NBD?? Or is this the sort of thing where I need to 100% commit to completely devoting myself to Cheerios and heart healthy choices if I want to live???I really appreciate any help or advice you can give. I really know SO LITTLE about cardiology it's like I don't even know what I don't know.. ### Response: I'm sorry you're going through this. I don't think you need to say you're goodbyes at this point. There are varying degrees of prolonged QT intervals. Without actually knowing how prolonged it is it's hard to really guess. Depending on how prolonged it is it may be nothing to worry about but it sounds like you're in good hands with seeing a cardiologist and moving forward with workup..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your reply.I feel so ignorant about how hearts work I feel like my brain can't even comprehend the risk or understand. I'm not a particularly stupid person but this is all just beyond my capacity.. ### Response: Don't feel that way! It's a complex organ and no one would expect you to fully understand. You should reach out to your cardiologist and just see if they can explain it better to you, that may be helpful before seeing the geneticist and answer some of your questions..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: F49, 55, 143 lbsI had a severe allergic reaction and I almost died on Tuesday. I got stung 2-3 times by a yellow jacket while cutting the grass. I came inside to get some Benadryl and saw all these black spots (probably 4 minutes later). Then I was profusely diaphoretic, dry heaves, had copious amount of phlegm from my mouth and nose, couldnt breathe, weakness and was blacking out. It was so so fast.My husband (hero #1) happened to be coming from the airport so he called 911 and My 13 year old gave me one of her epipens in the thigh (she is anaphylactic to shellfish and buckwheat). First responders came (maybe 4.5 minutes) and I couldnt open my eyes, they put me on a blood pressure monitor and then it was alarming, so they turned the alarm off. Then advanced life support I think or Ems literally picked me up and ran me out to the ambulance. I think I blacked out and woke up and I barely remember the ambulance ride with sirens and lights and them laying on the horn. I could hear them saying we got gotta get her pressure up, we got nothing here. I remember trying to talk to them and my tongue wouldn't work. When I was conscious and realized the lights and sirens were on, i saw the seriousness. When I heard them say ETA 3-5 and BP of 40/20 - I 'm like , that's not compatible with life. The paramedics worked on me the entire time. At hospital had me in a trauma room and called all staff over loudspeaker. Thankfully they got my pressure up and gave me another epipen and steroids and Benadryl. The epipen and lack of blood flow gave me some cardiac issues and Im following up with cardiology.That said, I dont feel right. Im weak. I keep waking up with nightmares about not being able to breathe and I keep replaying the incident in my head. I have little appetite. Do you think I would benefit from some counseling? Did I almost die? I feel like I certainly came close. Would I be a candidate for venom therapy? I feel like this if my only chance at a normal life.Is there any way I have some sort of Mast Cell Disorder for this to come on so suddenly?. ### Response: Sounds like a pretty traumatic experience and I'm sorry you had to go through that. It is normal not to feel completely yourself this quickly after such an event, and it may take some time to feel back to normal again.Medically, it is good that you have recovered. I must emphasize you need to have an epi-pen with you at all times in the event you do have another sting at some point. The strength will come back. It's hard to tell how bad off you are, but can say a BP of 40/20 is pretty bad.Counseling is up to you. It sounds like you are having an acute stress reaction to a traumatic experience (think PTSD, but happening essentially immediately after). This may improve on its own, or may need some help to get through..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry to hear about how much has happened to you in such quick progression  I can imagine it was and continues to be very jarringBased on your description and recollection of the events, you went into severe anaphylactic shock which likely would have been fatal had your husband/daughter/EMS not been around. Will reiterate what has been said already to keep an epipen on you at all times moving forwardOnly other thing Id add to whats been said is you likely may be a candidate for venom therapy. However, it sounds like theres still quite a few things going on so take it one day at a time. Once everything else has settled, you may want to consider connecting with an allergist to receive venom testing  in Canada the 5 main sting tests we do are on honeybees, wasps, yellow hornets, yellowjackets, and white faced hornets. If you test positive for a stinging insect, venom immunotherapy can be 98% effective for the rest of your lifetime. That being said, its not cheap, and it can take 3-5 years of injections at the very leastWishing you all the best in your recovery!. ### Response: In reference to your last sentence - your mast cells must work normally for you to get anaphylactic shock in the first place, the issue is that your immune system is sensitised to the venom in the sting. Given that there is no definite way that you can guarantee avoidance of the same allergen in the future you should be referred to an immunologist for consideration of a desensitisation program.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Could a Physician clarify as to why Cardiology have told GP to omit Ramipril until blood tests and ECG have taken place.34 year old male BP 160/110 (Schizophrenia/Meds Olanzapine/Valproic Acid/Citalopram)GP prescribed Ramipril 1.25mg, he started to take though 6 days later a call from the surgery saying omit Ramipril until above has been done. Booked for 2 weeks time, but has left (my son) with no BP moderation. Very worried as seems so high!. ### Response: Your doctor will likely be able to answer this question in much more detail, but often before starting an ACE inhibitor (which ramipril is one) it's important to make sure a patient has normal/stable kidney function and potassium. A blood pressure of 160/110 isn't imminently dangerous, no reason to make hasty decisions..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im a 40(F), 410 and 113 pounds. I was diagnosed with hypertension in 2018, its been u fee control with Lisinopril HCTZ 20-12.5 with no issues. I was diagnosed with ADHD in December 2019 and put on methylphenidate 20 mg(2 in the morning and 1 at 1:00 pm). I always checked my blood pressure around lunch to make sure it was t too high, I never had an issue. I was diagnosed with Hashimotos last October and started seeing a functional medicine doctor last December. I was put on NP Thyroid 30 mg, moved up to 60, then doubled to 120 by June. I have had labs drawn every 3 months since December. I felt really good until around the beginning of August. My TSH was <.02 but T3 and T4 were in range so she reduced my medication to 105 mg a day.Since I was checking my BP for it being to high, I didnt realize it was going down. I happened to miss my afternoon dose of the methylphenidate and my nephrologist commented is was a little low. This was the last week of August. I had some scans done by my cardiologist the next week. I mentioned my fatigue and she suggested I stop the methylphenidate for a few days to see if that helped and to follow up with her in 2 weeks. The next few days my BP just completely went down, I ended up in the ER twice because of it. The did CT scans the first time I went and I had kidney stones. The second time I went, they though it was a kidney infection. I went back in the methylphenidate because it kept my BP up. I followed up with my cardiologist. She said everything was fine cardiology wise and to continue to take the methylphenidate without the lisinopril until I could find out the cause for the drop.At this point a reached out to my thyroid doctor to see if anything thyroid related could cause this and she said no because usually signs of over medication is high blood pressure. She said to let her know what the urologist and nephrologist said.I made an appointment with my urologist and he did a cystoscopy and ureteroscopy based off the CT from the ER visit but he found nothing wrong and no stones. The nephrologist also found nothing wrong.So last Wednesday, I finally get her to run my TSH, Free T3 and Free T4. I got the results back yesterday. My T4 is in range. TSH is <.01. T3 is 5.3. I ask about T3 thyrotoxicosis and again she says that would cause high BP. She wants me to not take my thyroid meds for 2 days then go down to 90 mg.This has been going on for 2 months. The constant up and down with my BP has me struggling. My vision is getting blurry. Im exhausted. Do I wait it out to see if what she says or should I go to the ER?. ### Response: With hyperthyroidism, hypertension is definitely more common, but this is not always the case. In acute crises of hyperthyroidism, blood pressure can also be lowered, particularly diastolic. In general, I'm pretty sure the problem here is the interaction between the various medications you are taking. The thyroid medication is largely overdosed considering that TSH value, and has been increased quite randomly over the various months. Also, I am not a fan of NP thyroid, since adjusting the dosage is difficult with that medication. Until the TSH is in range, we can't be 100% sure thyroid is not responsible. Look for an endocrinologist..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you. I was taking Jaimiess birth control until mid-July. The functional medicine doctor kept suggesting I get off of it to help get my hormone levels up since I was only on it to lighten my periods. From what I read, the estrogen acts as an inhibitor for the thyroid medicine, which would explain why the dosage needed to be increased so much before it started working. Then I went off the birth control and the thyroid meds just went wild. I asked her if that could possibly be a factor but she said no. I am now also wondering if my hypertension was caused by the birth control. Hypertension runs in my family so I just assumed that was the reason. I had no idea birth control could cause that. Im looking for an endocrinologist but the 6 Ive called, with good reviews, are at least 3 months out. Im debating if I should go back on the pill so I can get my BP back up for now, then come off of it under the supervision of an endocrinologist. My cardiologist said, shed rather it be high(obviously not too high) that can brought down with meds, than it be too low. I just know I cannot continue with the methylphenidate like I have. Again, thank you for your response.. ### Response: Estrogen has an effect on thyroid function by altering the hormone-binding protein, but generally the problem is when you stop therapy or go through menopause. It is also true that the pill can increase blood pressure, but not so much that you go from hypertension to hypotension. The effect of the pill is modest. I think if therapies are the culprits, it depends more on the triad thyroid hormone-antihypertensive - ADHD meds . I don't think it's a good idea to start hormone therapy again just to control blood pressure, honestly..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My son 3 years old recently diagnosed with autism. He was sitting near me suddenly he started to cry but with very low energy. I looked at him and his face was blue. I quickly grabbed him and he fainted I put some cold water on his face and ran to the balcony to get some fresh air. Then his face turned to very white and he started to open his eyes then he fainted again, on my way out of the building he woke up and slowly got some energy back. I arrived at the ER Almost 30 minutes after this happened, they did blood gases tests and blood counts then after an hour they said all is good but I need to see a cardiology to make sure nothing is wrong with his heart. I took a look at the test results and I think there is something wrong and the tests were not ok. I uploaded a screenshot of the tests. TAM KAN SAYIMI = FULL BLOOD COUNT (Count or percentage) KAN GAZLERI = BLOOD GASES. What should I do now? TestsEdit: Now (after 7 hours in the ER) they gave him the 3rd "fever shot" in his serum. The heartbeat is now stable in 160s after being stable at 180s but it sky rocketed twice to 241 and 250 bpm and when he cries it goes to 200s until he comes doen. They say it may be a flu infection.. ### Response: I believe one of those is chloride. It's a hair above reference range and is fine.The other two are oxygenated vs. deoxygenated hemoglobin. They appear to be applying arterial reference range values to a venous sample, making them look very aberrant. These are also fine.Lactate being slightly elevated is super common in kids also. Nursing often struggle to get good samples with limited tourniquet use, and the lactate is frequently a tad elevated..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Looking for clarification, are you recommending a tighter tourniquet to ensure a more accurate lactate level? I am a nurse.... ### Response: No. Limiting tourniquet use as much a possible is best for lactate..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Okay thats traditionally been my understanding. I just wanted to make sure there wasnt some other thought process. Thank you.. ### Response: No. Nothing in these labs is spooky.Has he had any gastrointestinal symptoms?"Toddler doing weird shit and passing out" is sometimes from intussusception, and we have a low threshold to do US looking for this..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 37F, 5'7, 128lbs, Caucasian. Primary complaint is increased resting heart rate, palpitations at night that wake me as I'm trying to fall asleep and fatigue.Symptoms started 06/15/2022 with one severe episode of diarrhea. After that I was feeling very fatigued. On 06/22/2022 I was very dizzy and almost fainted, my heart rate was elevated (120-140) and I had tingling/numbness in my hands and feet. Went to the ED. Only thing they found was a Potassium of 2.6, they said my ECG was "inline with my low Potassium". They gave me IV Potassium, Magnesium and saline. Got my Potassium up to 3.8 and sent me home.Three days later I had a similar episode and went back to the ER (I thought maybe my Potassium was low again or that maybe it was my heart). They did another ECG and said my heart was fine. Potassium was fine. No other abnormalities. ER doc said maybe viral or Thyroid.In the weeks after my ER visit I was still feeling very weak and my heart rate was still elevated (80's laying, 90's sitting, 110 standing). I was still dizzy. My stomach was destroyed, I couldn't eat without getting severe reflux and I just wasn't hungry. I thought it could be POTS. My symptoms were worse in the morning and in the evenings I felt almost normal.Symptoms slowly started to improve as I started breathing/meditation exercises and started getting back into training and eating. (I lost almost 10 pounds during this because I just couldn't eat).I then started to experience adrenaline surges where my heart would race, I would feel very jittery, nauseous and I would have to pee many times. At first the surges happened only in the morning, but later started happening at night. Only one a day. The surges would leave me very tired. I had very poor exercise tolerance.I saw my PCP and we ran many tests, CBC, BMP, Full Thyroid Panel, T3 and antibodies, H.Pylori, AM cortisol, Catecholamines, PTH, Heavy metals, MTHFR, DHEA serum, ACTH plasma, celiac panel, Homocysteine, CRP, 25 hour Urine Catecholamines and Metanephrines, Folate RBC and serum and B12. The only "abnormal" tests are below:Alkaline Phosphatase low 32 (this has always been low for me).High epinephrine 67 (I was having a "surge" that morning, I am not afraid of blood draws).Heterozygous C665C MTHFRHigh am Cortisol 21.2 (I was having a "surge" that morning, I am not afraid of blood draws).DHEA 686 (she said it was normal but it seems high for me based on my age).24 hour urine Normetanephrine 122 lowFolate RBC 1248 (for context)Folate serum >20 (for context)B12 852 (for context)Background information: When this all started, my husband and I were trying to conceive and I had been taking 800mcg of Methylfolate to prevent neural tube defects since May. The day I ended up in the ER was the day I got my period. I thought that maybe, based on my MTHFR mutation, I had a bad reaction/poor tolerance to the Methylfolate so I stopped taking it 2 weeks ago. My symptoms seemed to align with too much Methylfolate, based on other peoples reports.My biggest complaint now is the palpitations at night. I keep getting jolted awake several times as I am falling asleep. This lasts an hour until I fall asleep until morning. Palpitations are felt when I am lying on my side and sometimes when I lie flat on my back. I have headaches off and on and still feel like something isn't right, like my body cannot relax. I also get this feeling of pressure in my head. I don't have any shortness of breath except for when I am jolted awake at night.I am not an anxious person thought I am certain these issues have caused worries. I am active (strength training three times a week, assault bike workouts and lots of walking/hiking/paddleboarding). I do Olympic lifting for fun but haven't gotten back to that yet. I eat paleo-ish, low carb, Weston A. Price though I am trying to incorporate more carbs into my diet. I take Magnesium Glycinate at night, probiotics, Vitamin D and Cod Liver Oil. I practice good sleep hygiene. I don't lead a stressful life. I have a cardiology appointment at the end of August.Any input would be greatly appreciated as I have already spent so much money on all this, I need to be efficient with my resources.Im thinking that something really messed me up, maybe the Methylfolate combined with a stomach bug? I had COVID in January, maybe that has something to do with it. Will this likely resolve on its own?Thanks in advance!. ### Response: I dont think methyl folate has anything to do with your symptoms. My hypothesis is that the first occurrence sensitised you and made you more introspective. Fear of something can cause tachycardia and introspection can make you notice your heart beat, where you previously wouldnt have noticed it.Relaxation exercises, especially breathing exercises and a distraction from your own thoughts via audio book or podcast might be helpful. 24h ECG could objectify your symptoms, but Im not sure thats a good idea. Maybe try it for a week or so and get back to me, if it doesnt help? Cant promise Ill immediately respond, but I check up on Reddit regularly :).


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Fair enough. I am and have been meditating and doing breathwork. I will continue. Any hypothesis on why the first occurrence happened in the first place?. ### Response: Hm, maybe its not really anything about your body changing, but your perception of it having changed. Concentrate on your belly button, for example. Normally, we dont really consciously feel the pulse there, but if you concentrate on it long enough, it will feel really strong. Its there all the time, but we only notice it, if we actively look for it..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I understand what you are saying, I just don't know that it's true. But, I will go with that theory and see what happens. Thank you for taking the time to reply to my post.. ### Response: Neither of us know if its true. I only have your explanation of everything happening to you, there is no blood work, no images, no test results available to me here. Im trying to give you a direction to work in and my opinion based on the information given. There is a reason this isnt designed as an actual treatment or doctors visit, here :) That said, I hope you get well soon!.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Well, here's my week update. I am definitely continuing to feel better. I told myself that whatever seems to be happening to me is not something that I need to worry about. I am continuing to do my breathing/meditation exercises 1-3 times a day. I am exercising daily (strength training, pushing the sled and riding the assault bike, usually 10 minute TABATA). I drink water with liquid IV daily, am eating well and sleeping well. I sauna every other day. My resting heart rate is still consistently elevated, about 100 - 110 standing. I used to be around the 70 range standing. I've only had one adrenaline surge in the last week. I do think that changing my state of mind has helped me avoid any extra stress but I do still feel like im not my usual energetic self. Like my body is working harder.. ### Response: First of all,thats great to hear. In addition to that, a physical stress response, where your body constantly readies for fight or flight will sap energy from you. Are your palpitations still there?Your cardiology appointment isnt far now, that will hopefully help with stress, too, or maybe allow for more specific advice..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm(M17) 176cm(5'9) and 48kg(105 lb), my BMI is 15.5 and I'm REALLY skinny, everytime somebody sees me they get either scared or concerned, and at the beginning i said i was fine but now I really feel like I need help. We contacted many different doctors in my city(I live in Italy) and nobody knows what my problem is.. we(my family and I) did many exams looking for problems with metabolism and we got nothing, we were thinking to get my self hospitalized (as you know, it's free in Italy xD) but they asked us a kind of "hint" of what medical department(like "cardiology" i don't know if it's correct in English) i should go in, and our doctor told us he'd inform himself but didn't tell us anything.So my questions are, what could be my problem, what department should I get hospitalized in and in general what should I do?Any answer is appreciated and I'll try to answer every question. ### Response: "You're not eating enough food" is the answer about 98% of the time..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Add a couple of glasses of sustagen/ensure and a few spoonfuls of peanut butter to your daily intake (in addition to everything you already eat), if you still havent gained any weight after a few months then I would see a gastroenterologist to check for malabsorption.Well, I'm not the 98% I eat enought I'm quantity and i get all the nutrients i would need, yet i can't gain any weight nor muscle. We've been struggling with his problem for a while and it's getting always worse.. i grew 10cm in about 1 year and a half while not gaining any weight, i actually lost weight. I get it that many people jump to that conclusion, but I'm 100% sure it's not that. ### Response: How many calories per day are you eating?What brand of food scale are you using?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Don't know exactly, but I can estimate about 2.6k calories a day, altough some days it may be Less and some a lot more. ### Response: Also, you can't say it's "100% not that" when you haven't ever measured your calorie intake.It's like saying your checking account is getting lower and lower and you don't know why, but you've also not looked at the math for your income vs. expenditures."You're not earning enough money for how much you spend."Nah, can't be that! I'm certain."Have you actually looked at you budget?"Nope.Unless you have some malabsorption disorder where you can't absorb nutrients (these people have constant diarrhea, gas, belly pain, and even oil in their stool), you just aren't eating enough calories.That's not enough.Young men, especially active young men, typically need 3,000-4,000 kcal to gain weight.Anything in the low or mid 2,000s isn't going to cause weight gain.This isn't a medical mystery. Eat more food and workout. You need r/gainit, not an inpatient stay (assuming no eating disorder)..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes, but I don't think it should cause this much weight loss either, as well as the fast loss of muscle.I'll try eating even more as you told me.. even tho I'm still skeptical about it, as me and my brother eat pretty much the same things yet he's alright(skinny but not on the same level as me). ### Response: That's literally the only answer. If you've been evaluated for metabolic disorders, malignancy, etc, the only thing that will make you gain weight is eating more calories.Even moreTo clarify, mid 2,000s is not a lot of food for a teenage boy. If that's an accurate estimate at all, is not surprising you're not gaining weight. You're not eating a lot to start with.Eating the same amount of food won't make you gain weightEating less food won't make you gain weight.You must eat more food..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: If I feel heart flutters about once a day, and cardiology tests come back normal, at what point do I need a medicine to prevent strokes? In other words, when, if ever, would it be time to go on Plavix or Eliquis?(Female, 55, no drugs, overweight, normal blood pressure, normal cholesterol). ### Response: The sensation of flutters versus having atrial flutter / fibrillation is different. Unless you actually were diagnosed with it, you do not need medicine for stroke prevention..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 35F, 145lbs, 511 dont smoke, drink rarely. Generally consider myself healthy, however mid last year I underwent double jaw surgery and have since not taken part in any form of exercise and feel very unfit, but I still eat a well balance diet for the most part!After surgery however I lost over 20lbs in around 2 months and then gained it all back in the following 4 I had a hard time psychologically during recovery for a plethora of varied reasons and also unexpectedly became a carer for a relative who developed dementia whilst I was still recovering, this took a toll on mental health and I fell into a bit of a depression, I was prescribed Sertraline 50mg in late September 2022 however my mental health has VASTLY improved, it is my physical health that is bothersome.I also have a history of IBS and GERD (diagnosed over 10 years ago so is my normal but has slowly gotten a little worse over time).I reached out with no urgency to doctors for a health check as my generally sense of physical health felt at an all time low. I wanted to reassess IBS and GERD with focus on regular urgent diarrhoea (occasionally up to 6x a day), and regular nausea. Additionally I find myself easily very short of breath, dizzy and nauseous, and ultimately I feel weak. The disconcerting feeling this brings means I avoid any physical activity (historically I have enjoyed being more active). I noted that my heart rate has been falling lower and lower in the last 8 months since surgery and I am not physically fit at the moment. I feel slow. Maybe I am just getting old I was given a battery of tests and most of my bloods are generally fine, I have some deficiencies eg. Folate (which I queried as I dont drink and enjoy my greens) but was advised that some people are built different and need more vits or nutrients than others and I just need to take supplements  I assume this may cause some of my symptoms such as diarrhoea?I also had a 24hr Holter monitor and results came through yesterday. I havent seen them but doc noted 357 counts of bradycardia with lows of 37bpm. Coupled with my nausea and dizziness, I have an urgent referral to cardiology (although that still means in 3 months).However when I read up on Bradycardia, it doesnt seem to be a concerning issue? I dont have the full results but is it only the coupling of my nausea etc that makes it more concerning. Unsure if relevant, but despite low heart rate I often have slightly high blood pressure.Tldr: is bradycardia with nausea and dizziness worthy of urgent cardiology referral? Can heart issues cause additional symptoms such as regular diarrhoea?Also not sure if relevant, but I had a persistent rash and redness and deep itch in left breast for last 2 months, ultrasound shows I have lots of benign cysts and a fibroadenoma, they (radiologist and consultant) seemed unconcerned but did biopsy due to my age and I will get results soon, the lack of concern from consultant means I have little concern also (my mother has fibroadenomas that have never caused any issues), but thought I would add everything that ails me! Ha! In case there is some magical connection to it all.Thanks!. ### Response: What is your normal heart rate? Was it sinus bradycardia? How long were these episodes in duration?. Also would be helpful to know any medications other than the SSRI and whether you have sleep apnea, have had Lyme or chagas disease or are hypothyroid.To he honest I would also be surprised if it is sinus bradycardia that it is causing your symptoms rather than vice versa. Nausea and bowel movements are an excellent way to temporarily lower your heart rate. Most often it is just a normal variant, and if it is sinus bradycardia almost never requires a pacemaker. Wouldnt get too overwrought.The downside is i there is no magical connection here to any issue other than maybe being a symptom of nausea, which isnt that magical..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks for response! I take no other medication, however I did take antibiotics and omeprazole briefly post surgery last year. I cannot see the detailed results,. ### Response: okay then what i said above i guess..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have zero other health issue than those noted in my post, when I was very young I had migraines and I have always had dodgy joints (again Im getting older and runs in the family) and that is about it.I have never had any ailments you noted. When first diagnosed with IBS I was given lansoprazole in case I had an ulcer. But generally I have been in good health most of my life and taken little medication. Its just a bit cloudy all at once now I have reached my mid 30s  Blood tests historically are fine only regular things to note: I consistently have high bilirubin in liver blood tests but as the rest are fine this is usually noted as Gilberts syndrome? And again, not an issue. Cholesterol is teetering on high side but still currently in normal range. High but normal MCV in last few blood tests (~100)Im more concerned that I am not in need of an urgent referral and wasting time? But secondarily would like to know why I feel so rotten, and if it could relate to heart at all? It would be great if I could actually see the results and notes - I should call and ask for them and see if they will share!. ### Response: I suspect that this is not cardiac related and it is incidental. But with your symptom of dizziness and bradycardia and your GP's concern followup is prudent and not a waste of time. "urgent" and "three months" don't seem to belong together.You certainly have symptomatic gastrointestinal disease, diagnosed IBS but some of the symptoms sounds like gastroparesis. I would continue to followup with gastroenterology for workup and treatment..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hey guys,Today I had a pulmonary function test performed and results are mostly normal, which I expected. The only abnormal result is my FEF25-75%. The final value was 2.04, 64% of the expected reference value.I didn't have a bronchio dilator test performed due to palpitations, which I take beta-blockers for. Still being studied in cardiology.I didn't expect much to come out of this, because my GP suspects it might be exercise induced asthma. I wasn't feeling particularly bad when I had the test performed either.I experience chest tightness, wheezing, sob, air-way burning feeling and it hurts when I try to take a deep breathe. If I talk too much or laugh, I also get chest pain and cough.I have been prescribed Atrovent/Ipratropium bromide and it's so far the only thing that has helped me. It has taken me from barely being able to walk 40-50min, to walking 40-90min (usually 40-60) depending on the day without collapsing.. ### Response: The FEF25-75 is the forced expiratory flow throughout the middle of your expiration. When we fully exhale our lungs are left with some air leftover (called residual volume, or RV on your PFT). This RV is there because as we exhale our small airways close down as the intrathoracic pressure rises above the intra-bronchiolar pressure -- it's a normal part of expiration. A lower FEF25-75 is thought to reflect early small airway closure, which could be a component of asthma (as asthma affects small airways).You'll notice I use a bunch of hedgy language (lots of "could" and "thought to"). PFT guidelines recommend against using FEF25-75 to diagnose or treat anything. The data just isn't very strong. The American Thoracic Society recommends not even putting the FEF25-75 on the PFT report. All that said, the FEF25-75 isn't entirely worthless, it just has to be interpreted with caution. If you have the right symptoms, a reduced FEF25-75, and a positive clinical response to bronchodilators it can be very reasonable to suspect asthma.If you have a great response to the inhaler, great, there's your answer. If not, it would be a reasonable time to seek an evaluation by a pulmonologist. Your goal should be feeling normal. All-too-often asthmatics will talk about having daily symptoms, which is a real shame. They either need more aggressive treatment or a different diagnosis altogether..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 23F, 51 and 115 pounds, Asian. depression, anxiety, ptsd, adhd, taking 20mg adderall, 57.5mg paroxetine, 50mg welbutrin. i drank weekly in college but since ive left, i barely have. no weed either.I crashed my car a while back into a pole, but I have no idea how it happened - my memory is blank from me just driving on the road to me being in front of a pole, where i tried to break before i crashed. i dont know why theres a gap in the memory, but my pcp is suggesting i may have passed out or have had absence seizures, but she feels its neurological and not cardiological which is why Im seeing a neurologist in a week. i am just wondering if there are any ideas of what it could be / if i have any disorder. i know i didnt fall asleep as i have a pretty routine sleep schedule, but i just want any ideas of what could have happened to soothe my nerves. the car crash left me with a broken ankle and a friction burn, but nothing else. thank you in advance.. ### Response: You need to be evaluated for potential seizures - that's why you're scheduled to see a neurologist. If nothing found there, probably worth getting some kind of cardiac workup..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Age: 28Sex: Non-binary/Female (she/they with a uterus)Height: 59Weight: 145Race: White/EuropeanDuration of complaint: N/A, 3-weeksLocation: New England USAAny existing relevant medical issues: Depression and anxietyCurrent medications: Wellbutrin (daily 150mg), Xanax (as needed, usually ~0.25mg/month)Hi Docs,This is a question about my spouse (she/they) in their late 20s and physically healthy. She has a panic disorder thats especially bad in medical settingse.g., took 0.5mg Xanax before their recent echocardiogram, but was still hyperventilating and crying throughout.Three weeks ago she was having some chest tightness, which we thought was from a workout we did the prior day, but wanted to go to urgent care just in case. Urgent care gave her an EKG (her first one), which had an inverted T wave in one lead (EditI think it was actually in two leads, EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.). Along with the tachycardia (which always happens in medical offices, but goes back down to ~70bpm after) and they sent us (in our car, not ambulance) to the ER.ER did blood panel CBC/diff, some hormones, D-dimer in case clot, etc, all looked normal except for neutrophils at 82% (reference 48-76), then checked for fluid in the heart cavity with an ultrasound. ER wasnt concerned and sent us home with a cardiology f/u.Cardiology NP was worried about potential inflammation (e.g. myocarditis, as Ive heard has been a more common than usual in young women lately from covid, which we dont think weve had yet) so did an echo and a few more blood tests, including a sediment test, all of which looked normal.No chest pain or tightness or swelling other complaints since the ER incident.I dont have the full EKG, but herere the values they released to us from one lead:PR interval: 123ms QRS: 78ms QT: 318ms QTC: 443ms P Axis: 65 degrees R Axis: 69 degrees T Axis: -4 axis (was -36 at previous visit)Cardiology NP is concerned about the inverted T wave and wanted a cardiac MRI after the echocardiogram, but to me the T wave seems like an unconcerning variation in the absence of other symptoms. If I was the patient Id be fine with the MRI but, given how psychologically difficult an MRI would be for my spouse, Im not sure its necessary and want to encourage her to talk to her primary care doctor about her options.Based on the (of course incomplete) picture Im giving here, does my interpretation sound reasonable, or am I missing something?Thank you!. ### Response: Inverted T-waves in V1 and V2 are normal..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you! Yeah I just went back into the ER notes to check. It looks like it was two leads, not sure which ones (Thinking back, I think they circled the top right cornerlead 4?)From the ER Chart: EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.. ### Response: Would need to be able to see the EKG to tell more info.Are they still having symptoms?Could provide more info with: Troponin lab value D dimer lab Echo report.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks for the responseAh, that makes sensebummer that they dont provide the full EKG, I shouldve taken a picture. Ill update this post if I somehow get it.Theyre not having any symptoms anymore, aside from the anxiety.Troponin is <6 ng/L. D-dimer is <270 ng/mL.Echo summary: The left ventricular cavity size and wall thickness are normal. Left ventricular systolic function is normal. There are no segmental left ventricular wall motion abnormalities noted. The estimated ejection fraction is 60% The right ventricular size is normal. The right ventricular systolic function is normal. Normal valve structure and function.Reason for exam: eval in ED with CP x 4 days, EKG showed TWI inferolateral leads, trop <6, Dimer wnl, no history of Covid. Persistent tachycardia. Abnormal EKG Palpitations. ### Response: Thank you. So labs and the echo are normal. TWI is not an indication for cardiac MRI. TWI in inferolateral leads can even be due to things like lead misplacement.I think it would be in your partners best interest to ask the ordering NP how the cardiac MRI would impact their care. If it's positive for myocarditis, what will they do to treat it? (The answer is probably nothing). If it is negative for myocarditis, what will they do to treat it? (Also nothing) Secondly, it could be in their best interest to discuss this test and their care with a physician.Gotta give you a disclaimer: My assessment and recommendations are based on the information provided and I have not seen the EKG, taken a history from the patient, or performed a physical exam. I don't want to sow mistrust and am not attempting to disagree with other medical personnel, since the ordering NP has performed all of these assessments..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 40M, 5'10", 210 lbs, Caucasian, California.5mg Bisoprolol for arrhythmia, 160mg fenofibrate for high trigs, 300mg gapapentin for chronic thoracic spinal painHello. I'll try to keep this as short as possible as I know you're all busy.TL:DR - https://imgur.com/a/m5lprmBWondering if anyone can offer an opinion on this ECG from my implanted loop recorder. The loop recorder was inserted 1.5 years ago to investigate a an episode of sustained arrhythmia + syncope. I have a history of AVRT (ablated in 2006, possibly WPW, but that wasn't made fully clear to me). It seems something didn't go quite right during the ablation and the AVRT was eliminated but I developed frequent PVCs that were not present before the procedure. I have some documented NSVT from holter monitors and 30 day loop recorders over the past 10 years.My loop recorder seems to not be programmed to detect much of anything on its own. I think I would have to literally be in v-fib for it to automatically flag an event for review. After about a year of it literally capturing nothing despite having symptoms, I requested a patient trigger device that I can use to force the device to record and upload an event. Since I have started using the trigger, I have been able to capture several episodes such as this: https://imgur.com/a/m5lprmBWhen I look at this, my untrained sees a salvo of PVCs, which I guess technically defines NSVT. I have asked my doctor for an opinion on these events and every time his response is basically "Doesn't look like anything to me".What he doesn't seem to understand or appreciate is I find these episodes to be physically very uncomfortable and honestly, highly distressing, like hand over heart, feeling like I'm going to die sort of vibes. I admit that's probably a bit dramatic and an overreaction, but my cardiac history and long road to a diagnosis has trained me to think this way. Additionally, I am dealing with Kaiser Permanente in California and unfortunately, they have a rather abysmal reputation for cardiology and electrophysiology is basically non-existent.I realize there's people out there that have PVCs and other palpitations and barely notice them, but for some reason when I experience them, its like I'm getting punched in the chest.My hope is that someone out there can give me a reason why I should NOT be worried about these events. My doctor seems to be very, very, unconcerned by them, and maybe he's right to think that, but an explanation would be nice and if there's a way to be less frightened by these episodes, I think that should be considered therapeutic and part of the plan for care in this situation.Thanks for reading.. ### Response: So first things first I dont see clear P waves and you seem to be slightly irregular. Do you have a history of AFib? Secondly the beats that you point out are wide but also irregular. This makes it less likely that they are PVCs/NSVT and more likely to be AFib with aberrant conduction if you have AFib to begin with. Since you have AVRT and have had ablation, its not unusual to have some aberrancy when the rate changes since you have an abnormal electrical conduction system thats also been burned. While this isnt life threatening in any way, increasing your bisoprolol dose would probably help keep the rates better controlled and decrease your symptoms. You can also get a cardioversion/ablation if you are actually in AFib.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: No history of AFib.I think the lack of visible p waves may have more to do with how the ecg is rendered with this recorder (very small), plus this is a screenshot of the report's summary, so maybe the actual report renders the morphology with better detail (I don't ever have access to that). For comparison, I have a 6 lead Kardia ecg device that is much clearer and shows clear p waves.This isn't the first time I've gotten a recommendation to increase the bisoprolol dosage but im a bit concerned about the long term side effects of that. I've already been on it for over a decade and I'm 40 now. However, after this recent episode, I think it's probably best for my sanity.Follow-up question. Does your opinion change knowing that I have never been diagnosed with afib, despite several doctors reviewing my strips in the past?. ### Response: I think the answer no matter what is to increase bisoprolol..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Now I am off them in the past few weeks I have noticed mild chest pain and fluid retention in my legs. I have always carried weight in my legs but recently I have been needing to pee quickly after lying down at night. I can speed the process up by lying on the ground and putting my legs up against the wall to let it drain down them. I always get a lot of fluid when I pee when I do this, lots more that I should do. I know fluid retention can be dangerous with heart problems and Im getting quite concerned. I have a GP phone appointment next Friday but Im concerned Im not pushing for the right things fast enough.I also suffer from what I have always assumed was IBSI have been tested for Celiac, thyroid problems, absorption levels and all the standard things you would be tested for on the NHSI know that the heart problems could be caused by the low levels in my blood, but what is causing my levels to be low in the first place. Im really worried and really at a loss. Thanks. ### Response: The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication.. ### Response: Often, but not always. Your physiology changes over time so sometimes you may start to see side effects that you previously didnt..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Cross from /AskCardiologyDetails to previously deleted post, dad had heart attack but refuses medical adviceI previously posted and deleted due to lack of details. My dad (56M) had a cardiac event two weeks ago that he refused to explain. Yesterday he invited me to dinner to explain his situation. He looks TERRIBLE, he is gray with the blackest bags under his eyes. He explained he was working out and suddenly had SVT bad enough to where he lost feeling in his body, his left arm turned blue and he collapsed (didnt lose consciousness) and couldnt get up for a couple hours. As a nurse, he 100% believes he had a heart attack. He stated he has been feeling ill for 6 months, had this event, and has not felt normal since. His cholesterol and triglycerides are insanely high and he knows he has hereditary atherosclerosis. He is very anti-doctor/pharmaceutical and is relying on a diet of nitrous oxide-rich foods and Willow bark to clear is arteries of plaque. He looks like a corpse and Im afraid he will die soon without medical attention. If he did have a heart attack, whats his outlook without treatment?Edit: he is not on any medications, works out twice a day, his father had triple bypass at 70.. ### Response: Ok man, I'll be pretty straightforward - lack of attention to this could kill your father.The thing you worry about after a heart attack is that part of the heart muscle doesn't work well. You can get heart failure pretty easily when one wall of the heart isn't contracting. If he looks bad to you, keep gently encouraging him to get checked out. Use words like "I'm worried about you" and "I don't want to lose you." Don't push. Encourage and focus on your concern for him.It isn't clear it was a heart attack, but something bad happened. An arrhythmia, exacerbation of undiagnosed heart failure, a heart attack, some other vascular event are all on the table and need proper testing to sort out..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: hanks for your response, I did ask that he see a doctor but he is very stubborn and just accepts if its my time then oh well. So Im not expecting much here unfortunately.. ### Response: Ugh. Im sorry. So hard to watch a parent do that. Be persistent. Enlist other family members. Avoidant behavior is very common. Especially for healthcare workers..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im 34, female, 5 ft. And currently depending on the day between 209 and 223 lbs ( its weird, Ill get to that.)Day 1 Normal bp: 90/60. Weight 184 pounds 5/29/21.So back in June, I was working in a facility housing homeless individuals. During my shift, I smelled what I thought it was an electrical fire or fumes coming through or exhaust system. I discovered that folks were either cooking or smoking methamphetamine in the facility, but couldnt do more then create an incident report and narrow down where this happened.I coughed a bit, Had a headache, went outside to clear my head. Didnt think anything of it. By the end of my shift It felt weird to breathe. Like I was stuffed up. Within 48 hours I was wheezing coughing and very fatigued. COVID negative. Started azithromycin and prednisone 7 day taper.By day 4 post incident I could feel It wasnt helping. Went to the hospital. 02 was in the high 70s, I was coughing so hard. Confused. BP elevated for me 120/70s. Admitted for 4 days. 3 COVID tests (2 pcr, 1 rapid) negative. No fever this whole time. Nothing came up in sputum tests or blood work other than what they explained as inflammation.According to docs notes: patient was admitted to the hospital originally for suspicious of pneumonia based on the chest x-ray reading. In speaking to the patient, her symptom is more consistent with a asthma/COPD attack and lack the usual signs symptoms of infectious pneumonia including fever, productive cough, leukocytosis, and known sick contact. Instead, her symptom was brought about by inhaling smoke at her workplace. Patient has a history of childhood asthma for which she managed at home with rescue inhaler, patient did not have any asthma issues as an adult until exposure at her work.Therefore, after admission, she was treated for an asthma/COPD exacerbation. Antibiotics initiated on admission ( levaquin, azithromycin)to a more appropriate diagnosis. She responded well to bronchodilators, nebulizer, and oral steroid. So I finish the azithromycin, prednisone and have duoneb, and albuterol to help.CT scan showed glass opacities, right side of lungs was worse. 5th PCR test negative for COVID.06/13-I go back to the doctor 6/13. I feel worse. They tell me to give it time.06/24- return to work on light duty. No more than 4 hours a day of walking.07/03-7/23- doctors are still saying give it time. My lungs sound clear. I quit my job with the county to work from home.07/29- go into urgent care because I feel like I cant breathe. Exacerbation of symptoms. They talk about referral to pulmonologist but nothing yet. More prednisone dosepak7/30-8/15- using flutter, spirometer, albuterol and duoneb still as directed. Flutter/ spirometer every hour. Albuterol every 8 hours.Hospital admission 8/16-8/21 doctors notes*Called by nursing due to worsening hypoxia. Patient was admitted for presumed asthma exacerbation with high suspicion for COVID-19 infection. She was initially on room air with SPO2 of 90%. Since her admission, her oxygen needs has been gradually increasing. She is currently on 15 LPM oxygen mask with SPO2 95%. She is becoming more tachypneic with respiratory rate up to 36.Due to lactic acidosis of 3.9 on presentation, patient was started on normal saline at 125 mL/h. She was also started on dexamethasone for presumed asthma exacerbation with possible COVID-19 infection. She is on albuterol MDI inhaler every 4 hours and every 2 hours as needed.Vital signs: Temperature 98.7, pulse of 107, respiratory rate 36, blood pressure 114/74, SPO2 95% on oxymask.On physical exam, patient is alert and oriented. She shows signs of mild respiratory distress with increased work of breathing and tachypnea. She has decreased breath sounds with mild crackles expiratory right greater than the left. No active wheezing.Laboratory studies show white count of 18.3, hemoglobin 14.7, platelets 277. Chemistry panel within normal limits with potassium of 3.9. Magnesium low at 1.7. Lactic acid improving to 2.2 from 3.9. Procalcitonin less than 0.05. D-dimer 0.41.CTA with PE protocol per my review shows no filling defects consistent with pulmonary embolism. There are mild diffuse patchy interstitial bilaterally concerning for COVID-19 infection versus asthma related pneumonitis. No pleural effusions or focal consolidations.Acute hypoxemic respiratory failureLactic acidosisHigh suspicion for COVID-19 infection. Progressive worsening with administration of IV fluids. Improving lactic acid.Plan: -Discontinue IV fluids. -Furosemide 40 mg IV once. -Continue dexamethasone 6 mg by mouth daily for 10 days. -Continue albuterol scheduled and as needed. -Magnesium sulfate 4 g IV once to assist with treatment of possible asthma exacerbation. -Check ABG. -Continue levofloxacin. -Follow-up COVID-19 testing results. Continue precautions for now. -Escalate to high flow oxygen to decrease work of breathing.Patient is critically ill. The patient continues to have: Acute hypoxemic respiratory failure the vital organ system that is affected is the: Respiratory system If untreated there is a high chance of deterioration into: Respiratory failure, cardiac arrest, and eventually death. The critical care that I am providing today is: I performed an extensive data review and discussed care with patient. I have stopped IV fluids and started diuresis with furosemide 40 mg IV. I started magnesium sulfate IV for treatment of presumed asthma exacerbation. I have escalated oxygen needs to high flow oxygen.I get discharged from this hospital stay with 2L oxygen constantly. I get to see my doctor for follow up 9/8. They tell me again to get better first. Then well look at respiratory therapy and pulmonologist and physical therapy long term. I talk to them about my weight gain and my puffy face. They say its common with steroids. I can self monitor for oxygen use.9/17 develop vertigo, confusion, nausea and vomiting. Diagnosed with colitis. COVID negative. Urgent care visit. No longer on oxygen but still exhausted.9/25- diagnosis sinusitis, vertigo from left ear infection. Lungs clear. COVID negative10/5- vertigo doesnt go away. Given meclizine. COVID negative10/17- patient noted to have slightly elevated blood pressure likely circumstantial secondary to presenting complaint (152/90). Referred to primary care physician for further evaluation.Medical Decision Making: CT temporal bones show some fluid within the left mastoid. Slight elevation of white count. Patient also has an abnormal dilatation of the right lateral ventricle on CT of her head. This is concerning in light of her ongoing nausea vomiting and vertigo over the last several weeks. Discussed with pharmacy and placed on antibiotics to cover for possible mastoiditis and discussed with hospitalist for admission for further evaluation and treatment of this ongoing vertigo and abnormal CT head. Admitted in guarded condition.10/17- COVID positive. Test results received after discharge. 10/18. 10/21 tests negative for COVIDWeight gain from June to October 21 is from 184 pounds to 222.October 27- pcp follow up after quarantine. Currently 231 pounds. BP is 148/86.Doc notes History of Pneumonia, RecurrentRecurrent pneumonias with recurrent hospitalizations Exposure to methamphetamine at work at shelter - ended up with ground glass opacities on imaging. Tested multiple times for covid, negative at that time. Has had persistent fatigue, lightheadedness, loss of energy Positive for Covid 10 days agoWeight GainGained 30 pounds since September. Has had recurrent doses of steroids with recent infections. Orthopnea Has had decreased appetite and is not eating much at all. When she does eat a lot, feels need to vomit.HypoxiaDesaturations throughout hospitalizations, was discharged on home oxygen which she was able to wean down, but does still have hypoxia when she sleeps and exertion. Concerned for sleep apnea.VertigoRecurrent episodes of vertigo especially after recent illnesses Reports that she is occasionally awoken by vertigo and hot flash symptoms. Repeat evaluations for the same - does have history of CP, recent finding of R ventricle enlargement on MRI. Some benefit with Meclizine, but has had abnormal associated symptoms including confusion, word finding difficulty. Continued to say istory of pneumonia, recurrent Suspicion for initial covid infection with negative test causing initial ground glass opacities As these are consistent with many other etiologies and she has significant other symptoms (fatigue, weight gain, hair loss, vertigo with normal TSH) will consider other etiologies ANA, RF, anti-CCP for evaluationWeight gain TSH normal in the past, so has never reflexed to T4 and T3 - will measure these Autoimmune evaluation as elsewhereHypoxia Pulmonology evaluation,possible covid long-hauler symptoms, possible other causes of groundglass opacities Sleep study and general PFTsCurrently taking : Claritin albuterol Flonase every day. Meclizine as needed. I think they help.I KNOW THIS IS A LOT. I m sorry thank you for even reading this but I wanted to be thorough.How can I advocate for myself further? What can I ask about? Any additional testing you would suggest? I dont feel like a person anymore. If I eat, clean my kitchen and walk the kids to school it takes everything I have.. ### Response: This is a hell of a history. From the right ventricular dilatation, hypoxia, and continued GGOs on CT scan Id say that the cause is probably the lungs. The pulmonologist is going to be your best friend here. PFTs are going to be helpful.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Ruptured calcaneofibular ligament and ?fracture of the anterior process of the calcaneus I am a little unsure of where that exactly is on the ankle after looking at multiple diagrams, doctors werent helpful enough in explaining it.- backstory if youre interested:Ill try and keep this short, history of ankle injuries in the past, never quite this bad on that ankle (other one has had reconstructive surgery).I am a 24yo Female who works in emergency as a critical care RN.Rolled the ankle after stepping on a hockey ball 2.5 weeks ago. First 3 days was horrendous, then the pain settled and all I needed was Panadol once a day.XR on day 1 said no fractures. Went home and played another game of hockey a week later (with some pain after of course).US at week 1 said fully ruptured ligament and small ossicle 2.8mm indicating a possible fracture. Recommended CT.CT at 2 weeks showed possible cortical fracture at anterior process of calcaneus.Now Ive had ligament damage in the past, on the other ankle, and this feels relatively minor in comparison.Im being told by an orthopaedic surgeon that I need to be in a moon boot. I am ambulating fine on flat ground with rigid strapping tape on to replace the broken ligament.Its relatively painless to poke around the ankle area. Im not sure I even understand exactly where this supposed fracture is.Im worried by going in a boot when Im coping so well, will hinder my recovery and extend the time itll take me to get back to sport.I can attach some paperwork in the comments.Whats your opinions? Is it possible theres no fracture?. ### Response: Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.The anterior process of the calcaneus is deep inside the foot, and thus fractures do not always produce tenderness, as you cannot palpate it directly. I assume that when you say "no bone pain", this is what you are talking about.Fractures of the anterior process can be occult, not seen on plain x-ray due to the overlap of bones in the area, and sometimes CT or MRI are needed to confirm.I am a little surprised at you posting here, as you are a registered nurse who has access to emergency physicians and have already seen an orthopedic specialist for consultation. The opinion of your orthopedic specialist is that you have a fracture, and the treatment recommended is immobilization. No one who has neither examined you nor had access to your imaging studies will be able to give you better advice.The rationale behind immobilization of such fractures is simple: the foot has many bones that articulate (touch and move) with each other. Broken bones that do not heal well will cause permanent pain and debility due to interruption of the way the bones can move in relation to each other.If you want a second opinion, then see another foot specialist, bring them all of the imaging tests on DVD (reports are of limited use in these situations)..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Height: 1.8m (5' 11")Weight: 64kg (141lbs)Race: CaucasianLocation: Seattle, WA, USA (German born, Berlin)Vices: occasional vaping with very weak nicotine content, no drinking, no illicit drugs, chronic pain patient (fentanyl patches, 50 microgram)Current physical conditions: pituitary macroadenoma, adrenal cortext carcinoma, and a ton of implants and artificial bones. I cannot afford treatment for either and my insurance, medicaid, will not pay for removal of either or even treatments since my treatment is HCG, which comes from only fertility clinic pharmacies, and medicaid doesn't cover and fertility treatments for menCurrent mental health conditions: PTSD, bipolar, BPD, ADHD, generalized anxiety, and recently depression. All are treated quite effectivelyMedications (total daily doses): 50microgram fentanyl patches, 6mg prazosin, 12mg tizanadine, 7.5mg mirtazipine, 2700mg gabapentin, 2mg clonidine, up to 150mg hydroxyzine, 80mg Latuda, 200mg Lamotrigine, 40mg viibryd, 10mg melatonin, 8mg ondansetronEmergency Usage Only Medications: Hospital only: 100mg dex, 20mg morphine, 4mg lorazepam all IV for cluster headaches; Personal use: 50mg IM dex for cluster headaches, epi-pen for food allergiesWARNING: This will be long. I deeply apologise, but I feel like I need to be very specific and include context to get an accurate answer, if one even exists.----------------------------------------------CONTEXT:I want to start this off by saying I don't particularly believe in homeopathy, certain Eastern medicine, religion (I'm agnostic, borderline atheist), or the paranormal. I do many things for work, taking whatever pays me, but I have spent the majority of my career as a data architect in medical research. I believe in what can be proven, but I also acknowledge we can't prove absolutely everything to be true or false and that the sciences are ever changing and ever growing. I would also note that my life have been a very challenging one and I seem to have the single worst luck of anyone I've ever personally met. I've been very stressed and it has gotten significantly worse of late, though I've been told that I'm handling it quite well. Of course, I also acknowledge that there's plenty of people who've lived much worse lives. I'm not trying to play the victim or be arrogant.----------------------------------------------IMPORTANT LEAD IN:I went to bed last night around 23:00. I woke up an hour or so later to the sounds of small booms outside the front of my house. I initially thought I'd imagined it, but I rolled over and say all 3 of my cats with their faces pressed against the window screen, ears perked up. The sounds actually happened. A few moments later, I heard out smartlock on the front door unlock followed by the door opening and closing. Aside from internal doors, the front door is the only "normal" door to the house. the others are sliding doors that were all locked and barred and sound completely different when opened and closed. My roommate was asleep in his room and had been for hours. Nobody else lives here. Once again, I thought I imagined it, but the cats had all left my room and run downstairs to the door, which is what they do when someone comes over or gets home from work, errands, or whatever. I then head a set of male and female voices coming from downstairs. I grabbed a replica Master Sword (from The Legend of Zelda game series my roommate gave me a few years back) and went to my roommate. I tried to wake him up repeatedly, but he just mumbled something inaudible and rolled away over and over. So I went downstairs quietly. I spent 15-20 minutes walking around the house, following the voices, but never found anything. One of my cats, Needles, kept running off towards the voices then coming back to yell at me to follow him to them, which is what he does whenever someone comes home and I don't instantly go see them, but I never could find them. He's an utter attention whore. After that, I gave up and went back upstairs. Within 5 minutes I heard the door open and close again and the voices stopped. I don't have the greatest hearing in the world and never got close enough to make out what they were saying. I checked my Nest doorbell camera and at no point did anyone walk past the door. It is always recording and saved online for 5 days and, with the way it's positioned, it couldn't possibly fail to see someone come in or leave. I checked my smart lock app to see how it was unlocked and it said it was unlocked using a key by a user named "error". To clarify, the account's username that opened it was not literally "error", but rather that the app produced an error trying to identify the user. There are no physical keys to our house. It's entirely electronic and only myself and my roommate have the access codes.I have no explanation for what happened. I was wide awake for it all. The cats saw it. My smartlock confirms it. It definitely happened.----------------------------------------------THE REAL ISSUE:After that all happened I went back to sleep. It generally takes me hours to fall asleep, however that's not what happened last night. I always fall asleep with the TV on for noise, but turned down. South Park is what I had on last night and throughout the course of the night, I could clearly identify the voices and episodes as they came and went, even during the "dreams" I'm about to talk about, but NOT during the dream at the end of my story. That's a VERY important thing to note. After maybe 30 minute I felt like I was asleep, but I wasn't. I could feel my sheets, feel my head and arms on the pillow, move around, and feel my cat against my leg. That said, I started "dreaming" as if I was asleep. I'd note now that I've only ever had 1 lucid dream before and it was right after my long-term secret fiance had left me. It was stressful cause I simply came home to an empty house one day. I hadn't heard a word from him all day and all that was left was a quit-claim, signed and notarized, leaving the house entirely to me and taking his name off it and a hand-written note saying "I'll always love you. I'm sorry". Never heard from him again. He was my world even though he wouldn't allow anyone to know we were together cause he desperately wanted to be "straight". I cried myself to sleep for quite literally years, though over time it became a silent cry. I've been told the stress caused the lucid dream. I have countless wonderful stories about him, but he did give me me a strong case of PTSD, which I already had to deal with from an extremely abusive father.Back to the story now. During this "dream" I found myself on a cement platform in a park with a table and two chairs in front of me, underneath a pavilion. There were lots of oak trees, azaleas, and camellias, like a park would look like where I grew up in New Orleans. A cup of my favourite tea was waiting for me. An middle-to-late aged woman was sitting at the table in a white pants-suit. She had blue eyes and gray hair. She introduced herself as "death" and asked me to sit and chat with her for a while. She discussed my life with me and asked me many questions. She knew things about me that I didn't even realize myself. My memory of it is hazy, however. The "dream" lasted 30-45 minutes. During the "dream" I was able to freely move my "sleeping" physical body. Movement would cause a strange type of interference with the dream that I cannot really describe, but as soon as I stopped moving it went back to being incredibly vivid. At one point I sat up entirely, walked to my desk, and scooped up one of my other cats, and brought him back to bed and wrapped my arms around him. I felt entirely real. I had fully control over my body and words through the entire "dream". At some point in the dream she asked me to stop moving around cause it made her "presence" more difficult and she insisted I trust her that it was real. Over the next 7 hours I had 7 more nearly identical "dreams". Each dream was roughly the same, but the scenery and other person changed. Each "person" I talked to presented themselves as some kind of aspect of life. The ones I remember were: Death, Joy, Lust, Love, Pain, and Plague. I'm struggling to recalled specifics about the conversations, but they all insisted it was real and that I was safe. Each discussion was different and revolved around the aspect of life they claimed to be.I woke up completely after that and was confused, scared, and for some reason, relieved. It felt like everything was going to be ok. I've only experienced that feeling one other time. In December 2016, I was run over, intentionally, by a woman in an SUV while I was crossing the road on my motorcycle. She ran her light with the goal of killing me cause she was enraged by the pride flag sticker on the back of my motorcycle. It's a long story that I've shared many times, but this is already long so I'll skip most of it. The force of the impact sent me flying 30 feet and I slammed into an oak tree and the majority of my body was either broken of entirely shattered and I damn well knew it. In relatively short order, I grew cold from my chest and it spread throughout my body and I knew what was happening. I was about to die. I suddenly felt this massive calming wave overtake me and felt like nothing could ever be wrong and everything is ok. I blacked out shortly later and when I woke up again, I was looking at EMTs and a nurse who'd been attempting to revive me. I had been dead for around 5 minutes and had been kept alive by the person who was driving behind me and just so happened to be an ER nurse heading to work at the hospital less than a mile away.Back to the story again, I was awake for around an hour after all those experiences and ended up falling back asleep. This time, however, I had a regular dream, technically a nightmare, which is normal for me. I suffer from night terrors that are truly horrible and take 6mg of prazosin at night to prevent them. I still get them from time to time, but the overwhelming majority of my dreams are standard issue nightmares. I rarely have any positive dreams.As a reminder, I'd mentioned earlier that I had South Park on throughout the night. During the bizarre "dreams", I could hear the voices and episode as they came and went and even laughed at a particularly funny scene and told the "aspect" I was currently talking to about it when it happened. In my last dream of the night, the standard-issue nightmare, I could NOT hear the TV, could NOT control my body, and was completely asleep. I'm not sure what that means overall, but I feel like it's a VERY important detail.----------------------------------------------THE QUESTION:Quite simply, what in the absolute hell happened to me last night?! I don't know what to make of any of it. As I said, I'm not spiritual or religious in any way, but this is causing extreme level of conflict and concern within me. Furthermore, I've been around a lot of dying people, I live with a doctor and dated him for the last 6 years (we broke up a few months back, but still live together), I've dated other doctors, I spend a ton of time at doc appointments and in hospitals, and I myself work as a data architect in medical research most of the time. I'm very aware that when people are nearing the end of their lives, most (60%, if I remember right) will hallucinate loved ones, angels, or even demons, and have long conversations with them over and over. In my experience, and to best of my knowledge, this usually happens within a few days preceding their death, but can happen as far as a few months in advance. Is that what I just experienced? I certainly have serious conditions, but I'm otherwise perfectly healthy. Other than my migraines, cluster headaches, and chronic pain I feel perfectly fine. I've had the migraines and clusters since I was a kid and the chronic pain since I was run over and nearly murdered. Nothing new has come up. I have been much more depressed and anxious about life lately as I've had awful dating experiences, am struggling horribly to land a new job, and the end of my lease is coming up soon and I will have nowhere to live, but I feel like I'm handling it well.I'm exceptionally worried about what happened last night. I want to see a doctor about it, but I have absolutely no clue who I'd go to. I know there's "doctors" who study dream analysis, but I talked to my ex about it, the doctor I live with, and we both feel like that's psuedo-science and doesn't carry any real validity. Because I'm currently laid off, aren't receiving unemployment, and am only earning money by doing freelance and contract work, I have to use medicaid for insurance. There's no available therapists or psychiatrists I can go to cause I can't afford their cash rates and the ones who accept medicaid are seriously booked up and have multi-year long wait lists. I'm on all of the wait lists, but I'm definitely not gonna hear back anytime soon. I can't afford cancer treatments either and medicaid won't pay for them.My mother insists all of it was a dream and I didn't wake up at any point through all of this. That's 100% false. I damn well know when I was awake and what I experienced. I have proof from the cats seeing and hearing what I did and the history on my door lock. I talked to a friend studying psych and he suggested I could be schizophrenic, but he's not a doctor or even a therapist and I was diagnosed as schizo year ago and treated for it, which worked, but when I moved to WA and found a much better psychiatrist, she vehemently disagreed, changed me to my current diagnosis and changed my medications which work far better, so I'm inclined to believe she was right. My psychiatrist in Louisiana was not on good terms with the board and was wildly aggressive with diagnosis and treatment for all her patients. Her results were remarkable, but her methods were HIGHLY questionable and she was quick to prescribe controlled meds. She had me on lorazepam and adderall while I was also on 50mg of Percoset daily from my neurologist. I absolutely never had any problems, complications, or side effects because of this and it was actually extremely helpful in helping me hold down a job and be a functional adult, but it's generally not appropriate to do. I desperately need my ADHD treated to hold down a job, but the state of WA will not allow you to be on more than 1 controlled medication at a time. I understand, but it makes life extremely difficult for me and I think it's completely unfair to make me choose between living in intense pain or being able to focus for more than 5 minutes at a time. Writing this post has taken me over 3 hours cause I keep walking away and doing other things.Anyway, any advice would be amazing. thank you for reading and I'm sorry for the length.TL;DRHad a series of "dreams" last night that didn't work like any dream I've ever had where I could freely move my physical body, which upset the "people" I was talking to in the "dreams". During the series of "dreams" I met personified aspects of life itself, like love, death, regret, plague, etc that held conversations with me about my life. A while after the series of "dreams" ended, I ended up going back to sleep and having a normal nightmare where I couldn't control my sleeping, physical body and things were normal. Now I'm wondering if that's my version of dying people hallucinating loved ones and I don't know what to do or what kind of doctor to see about it.That said, please, PLEASE read the full post. There's way more to this and the TLDR makes me sound like a lunatic. I spend a lot of time carefully writing it up and explaining everything, like the insanely critical context the TLDR is missing, please read it.. ### Response: Sounds like lucid dreams. I dont want to Monday morning quarterback your doctors but thats a dizzying (literally) array of psychoactive medications you have all mixing together that probably played some role too..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hi docs! Im currently in the neurology critical care unit with an aunt (78F) who was flown from our local hospital to this one. We knew that it was a smaller bleed, but not much else. Im the one that will be asking questions on behalf of her children (who are with me) so that we can fully understand whats going on. What are the questions that I should ask in order to get the most explanation all around?. ### Response: I'm so sorry your family is going through this. I'm board-certified in both emergency medicine as well as critical care. Going to need a little more information in order to help tailor the appropriate questions to ask. What information have you received so far about your aunt's current situation, and what is her current condition (e.g. is she on a ventilator, acting appropriately, etc.)? Have the docs given any updates on her prognosis and/or next steps, medically?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much. No information other than that she was resting and that the bleed was small. They said that they would try their best, but wouldnt guarantee anything. Thats all the doctor told her son. :/. ### Response: Well, that's certainly not very helpful or enlightening at all :/ Idk your aunt's medical history, how the bleed occurred, or what intervention's her medical team has already performed so far. However, it's reassuring that the bleed is reportedly small. Important things that would be good to ask would be:-What interventions have been performed so far, and why? Also, which interventions/procedures can be expected in the future? -How severe is the bleed, and what deficits can be expected following recovery vs. what are the chances of a full recovery (note, they likely won't commit to a specific answer to this question, because there's no good way to predict patient outcome, but notifies the care team that you're actively involved in the patient's care and want to be kept in the loop)? -What does the recovery time/process look like if/when her bleed improves? -Are there any additional co-complications going on? -is there any specialized care that is going to be required following recovery? -How often can we expect patient updates from the doc in the future? -Does the providing physician have any specific concerns of their own that we should be aware of?Additionally, it's probably worth asking what support is provided by the hospital that's available for friends/family of the patient. If you have any additional information to share, please post here so that specific questions can be appropriately addressed..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I chose his CRNP because I was having chest pains and I already knew that I was hypertensive. I'm an advanced EMT and although my scope is nowhere near a CRNP, I can still diagnose myself for what is critical and what is not.This woman is under half of my age. I'm not comfortable with someone fresh out of medical school. She told me that I had to go to the ER. I paid $140 for an office visit for her to tell me that I had to go to the ER, after taking my blood pressure. I already knew that I was hypertensive and they told me over the phone to come in to get some kind of high blood pressure medicine.I told her that and she told me that I needed an EKG and a CBC workup. She told me they could do that at on-site, but without insurance, it would run me around $1,400... and it had to be paid, NOW. Words fail me here. All of this could have been told to me on the phone.I told her that I couldn't afford that out of pocket. She told me that I was going to be sent home... without any medicine. I said, "Let's review here... It's such an emergency that I have to go to the ER or pay for tests now, but you can send me home without medicince???" Unbelievable. I left, had to pay my $140, and went home with no medicine. I got home, at square one again, and was $140 poorer.The social worker called me later that day and she was also an EMT. I told her what I just typed. She emailed the doctor and a few hours later, I was prescribed some amlodipine that could be picked up immediately at my pharmacy.I received better care from a social worker that I paid nothing, than from a CRNP that I had to pay for... amazing. The CRNP obviously didn't even go to the doctor for consult.. ### Response: I'm not comfortable with someone fresh out of medical school.NPs do not go to medical school. They are knowledgeable and can treat common illnesses, but they are not medical doctors.Are you located in the US? Do you not have insurance?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What kind of school do they go to, then? I assumed that they went to some kind of medical school, since their scope is higher than a registered nurse.I am in the US and I just got insurance.. ### Response: What exactly is your question? Any given decision to see an MD vs an APP is a balance of complexity and access..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 31F, went to the ER due to stomach pain and uncontrollable shivering. She was admitted to the ICU and had extremely low blood sugar, hypothermia, hyperkalemia, blood in the stool, gram positive cocci in pairs and chains, anemia, and she had been previously diagnosed with endometriosis. They found cysts in the liver, hypodensity in the left side of the brain and have been taking several tests. ER gave her 3 blood transfusions for the anemia and she now has a swollen back, legs, hands, and feet. She is still anemic even after the 3 blood transfusions. She has undergone multiple MRI, ultrasounds, CAT scans, and blood works but they aren't sure what is causing everything.Her vitals at admission were:K 5.9Hgb 5.5Glucose 17Temp 94.5WBC 5700She started antibiotics yesterday morning and her second ecg was normal. She was taking oxycodone for pain but is now on morphine and lidocaine. Doctors said that she had a reaction to her 3rd blood transfusion and her heart rate went up and blood pressure went down. She is now on medication for that. She has not been allowed any food or water today after the reaction. An MRI found that she has lesions in her brain but the nuero surgery consultant said they were not going to do any procedure.Has anyone had experience with something similar and what was the diagnosis?. ### Response: While I have lots of experience with patients like her, I dont think theres much that can be said over the internet to help. She has a severe critical illness with what sounds like septic shock. The best people to answer your questions is the team of doctor taking care of your sister..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im 30 years old and after a very long and defeating search for a doctor willing to listen, I was finally diagnosed with Nutcracker Syndrome. I have surgery in 1 month, but I am in debilitating pain. Im a critical care nurse of 8 years and no stranger to the difficulties with pain management faced and felt by both physicians and patients. What I was baffled by was the extreme amount of gaslighting I faced as I tried to get this syndrome ruled in/out. Ive fought for months to NOT end up in this position (stuck in pain) by advocating for myself yet listening to each physicians advice, and trying to be a good patient and human being.I was in pain management but left the clinic because the doctor wasnt willing to work with me in any way. I was given Meloxicam, Gabapentin, and one 5mg Norco per day. Only the Norco would do much of anything. I had an appointment set up with a new clinic before I left, but its not till Dec. 12th and my pain has gotten MUCH worse even in the last week. I will also still have to wait the 2 weeks to actually get any medication (as far as i understand).My surgeon cannot prescribe me anything, and I see a PCP who uses holistic and traditional medicene (basically started me on tons of supplements) and really seemed to help me, its pricey but worth it as they are also more available. BUT, they cannot prescribe pain medication as they are a cash pay direct care practice. Ive called other pain clinics and they cant get me in until even later dates, Ive texted every doctor Ive worked with and their leads have fallen through. Meanwhile, the pain is so horrible I can hardly eat or move, and getting worse by the day. I went to the ED out of desperation a couple days ago and the doctor was kind and gave me 14 Norco 5s which help the pain a bit for about 2-3 hours. But I desperately need something stronger and more permanent (obviously).As far as options, My surgeon suggested going back to the ER for more pain meds (which was weird) or my PCP though he knows they cant prescribe those meds. The ER doctor suggested a new PCP which Im considering but Ive had good support with my current one and feel they are far more accessible, especially considering something new happens each week it seems like (strep B UTIs, hypothyroidism, gallbladder and liver issues, you name it). Plus idk if anyone would feel comfortable writing me opiates on a new patient visit.Is it even worth trying a new PCP? Would it be pointless to keep both my current PCP and see a new traditional PCP that could help with pain ? Or should I switch altogether? When my current pain meds run out I WILL have to go back to the ED because it gets that bad and Im no wimp. Its a solid 7-8/10 WITH the Norco on board. Would a second ED physician even consider writing Another script?Should I try and speak to the actual doctor I will be seeing Dec 12 about my hopeless situation or insist that the nurse tell him about it?Im really at a loss, Im in Indiana so medical marijuana isnt an option. I would appreciate any advice, leads, anything. I feel like Ive been failed for a year straight, and I was hoping I would be taken more seriously as someone whose also in healthcare, but its sadly not been the case. TIA. ### Response: I'm sorry OP, this is awful. Not familiar with the health care system where you live and why your PCP can't prescribe opioids, but can you see them for help navigating how to have this addressed? I agree it looks bad if you start seeing a new PCP or go back to ED but perhaps letters from your current PCP explaining the situation would be helpful?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thats a good thought, I have asked them to call the pain management place I have an appointment at the attempt to get me in sooner. I will see if they will do that as well :) Nothing can hurt at this point. And thanks for the validation because honestly, Ive started questioning if its really all that bad (though I know it is).Its crazy what a year of being chronically ill can do to the mind, even someone familiar with the healthcare system (Im in the U.S.). A lot of doctors here would love to be able to help me out but legally cant, or if they can would have to fear for their license (presumably).The ED giving me the small script they did was even kinda going out on a limb. It all comes down to the fact that not many doctors arent familiar with nutcracker syndrome because its rare, and the extreme pain isnt a well known fact about it. So it makes me seem as if Im drug seeking, but one look at my background and its clear theres not history of anything whatsoever.I mean i worked in ICU for 8 years around every narcotic imaginable, and still could be if I wasnt this sick. And I was charge nurse of a high acuity unit. The doctors Ive worked with have helped me alot in this process but their hands are tied on the opiate thing.. ### Response: I'm not familiar with the syndrome but it's not hard to look it up. It's very sad that because of the opioid abuse pandemic we've gone so far the other way that people can't get adequate pain relief for appropriate indications.Good luck, and I hope the surgery is effective!.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I had an awful IUD experience, involving vomiting and fainting as a result of the pain level. I would rate my IUD insertion worse than passing a kidney stone or breaking bones. Im not alone with this experience. If you search IUD on TikTok or other female-dominated subreddits, youll see an abundance of women/ teenage girls who have also described the IUD pain as the worst pain in their life. Ive noticed a trend of increased pain particularly among nulliparous women.The Intensity of pain doesnt seem to be acknowledged by many medical providers though, as many patients are told it will be a slight pinch and arent properly informed about the pain involved. As a result, many of us did not properly prepare for the persisting pain by arranging a ride home from the appointment, a day off from work/school, or mental preparation for pain. Many providers both seem to acknowledge that extreme reactions to the insertion are normal, but the pain isnt enough to warrant preparation or pain medicationsI played rugby, basketball, football, and softball. Ive had many broken bones and torn ACLs. Ive also passed kidney stone. The IUD insertion pain was by far worse and longer than any of the aforementioned pain events. If I was offered pain medicine for all those events, why is nothing given for IUD insertions to reduce the associated pain and discomfort? Is there a specific reason?Edit- I should mention Im directing this question to medical professionals in the US.Edit 2- Ill admit I havent looked into any of the studies about this. We had one doctor chime in that studies show that extreme pain is not the norm, but the trend Im seeing in person and across social media appears contradictory to those findings. Would any medical professionals be willing to share the specific studies that are being referenced for care? Im a PhD student in a different area of public health research, but I wouldnt mind doing some critical review of the publications while I have the time. Update: so far I've only found a few relevant articles in my Uni's database. Most are about a decade or older and have really small sample sizes, like n=40 or less. The more recent articles are recognizing the pain of insertion as an issue, but I'm not finding a lot of resources so far. If anyone has a specific research study they reference when learning, I'd be thrilled to look at it.Edit 3 -I started to search for articles. This is the first abstract I found:"Concerns about pain during IUD insertion are a major barrier to use of IUDs among adolescent and young adult patients who may otherwise be interested in this method. Although few studies of pain control options have been conducted in this population, available data suggest that several pharmacologic interventions discussed in this chapter may be beneficial. Pre-procedure naproxen, ketorolac, or tramadol can help to reduce post-procedure discomfort. Paracervical nerve blockage with lidocaine-based anesthetics, topical lidocaine spray, or EMLA cream also appears to reduce pain with IUD insertion. Intravaginal 2% lidocaine gel may reduce pain with tenaculum and speculum placement. This chapter will discuss the complex nature of pain in gynecological procedures, including IUD placement, and the impact of anxiety and fear on pain perception. It will also review clinical guidelines to assist with pain control during procedures and describe evidence-based pharmacological pain control modalities that can be used during IUD procedures." Optimizing IUD Delivery for Adolescents and Young AdultsTho I don't have full access to the text, this abstract is making it apparent that pain management is a valid concern and there are options. Can doctors weigh in more on those options? If it is indeed a recognized problem in the medical community, why aren't these options considered?Update 4: I have 26 peer-reviewed articles to review. Slamming a coffee and Ill get you my quick-and-dirty lit review asap.. ### Response: I don't do IUD insertions, but pain management should be discussed and offered.I don't care what the studies say. Sometimes you just need to be a human and empathize with other humans. Medicine is as much an art as it is science..