Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Any pediatric GIs who are familiar with intussusception? Or something that presents as such symptomatically?Any pediatric GIs who are familiar with intussusception?My 15month old son who was full term at birth was diagnosed with a small bowel intussusception when my husband and I brought him to the emergency room yesterday, 12/21/2022. The ultrasound report read, There is a 1.1 x 0.9 cm small bowel small bowel intussusception in the left hemiabdomen near the umbilicus. No evidence of ileocolic intussusception in the right lower quadrant. No free fluid in the abdomen or pelvis.After this was found on ultrasound, after 2 hours, an ultrasound was repeated, and the intussusception was gone.I have to say I wasnt surprised by this diagnosis, and I am GLAD that it was found on ultrasound.Since my son was six weeks old, he has experienced what I intuitively thought was GI distress. He would scream inconsolably, turn red in the face, and grunt as if he were trying to bear down. This wasnt infrequent; it was all happening all the time. Every week we would visit the pediatrician and an urgent care 1-3 times. At these visits, they would tell my husband and me that it was colic or gas or fussiness. We tried different formulas with cutting everything out of my diet because he was getting breastmilk too. We tried gas drops, bicycles, probiotics, and the colic holds we were shown. You name it; we tried it.After six months of torture for my little guy, I finally said ENOUGH was ENOUGH, and I brought him to the emergency room. The imaging at the emergency room showed that he had a lot of gas in his abdomen, and it was recommended that we try a hypoallergenic formula. (Before this, my son was getting breastmilk supplemented with formula.) We switched to Similac alimentum. Once we discovered that all of the formula we had given our little guy was recalled, we changed to Nutramigen. Since being on the hypoallergenic formula, the CONSTANT crying and screaming had subsided but hadnt completely gone away.He would have bouts of inconsolable screaming that would last 20 minutes, and then he would calm down. Sometimes he would have bouts of screaming that would last 20 minutes, calm, and then crescendo into more extended periods of crying with bearing down, turning red in the face, shaking, and vomiting.With that said, I am looking for some guidance. Has any pediatric GI seen or heard of small bowel intussusception reoccurring for this time? The Emergency Room doctor said he couldnt answer this question because he sees the acute visit of patients. He recommended that we follow up with a pediatric GI surgeon and our pediatrician.I spoke with the pediatric GI Nurse Practitioner, and she said they do not perform surgeries on small bowl intussusceptions. She said that they only perform surgeries on small to large bowl intussusceptions. She also said that this should subside when he is 5 -- she said this as if I could look forward to relief for him in 3 1/2 years!!The pediatric GI Nurse Practitioner and the Emergency Room Physician told me that I should bring him to the ED anytime he presented the way he did when I brought him in when he was diagnosed. This cant is the answer. This is not sustainable for us or our child. Since he was 15 months old, we have brought him into the ED, pediatricians office, and urgent care countless times for the same issues. It just so happens that they FOUND the cause THIS time.I would like to know if anyone has guidance or familiarity with this. Some questions I have are, has anyone ever seen a re-occurring intussusception? If this is re-occurring, is our only option to keep bringing him to the ED? Could something else be missing? Who else should I talk to? What else should I do?I am so frustrated with all the conflicting information and advice I have been given over the last 15 months. I feel so discouraged and not heard.I am so worried and heartbroken seeing my son constantly go through this.Any suggestions would be helpful. I am following up with our pediatrician, and hopefully, they will FINALLY put in a referral to a pediatric GI. I am a registered nurse, so I have a general background in the medical field.. ### Response: Transient small bowel intuss is a common finding in kids with belly pain or GI distress.No, it essentially never needs intervention.Kids get it all the time when they have stomach bugs. You just don't have an ultrasound on their belly the whole time.This may or may not be related to his prior issues of belly pain at all.A possible, but unlikely possibility is some sort of pathologic lead point that causes recurrent intuss. Like a Mekels, a real bad Peyer's patch, vascular anomaly, or even less commonly malignancy. I know of these being implicated more so for recurrent ileocecal intuss, but I suppose there's no reason they can't occur higher up.I think referral to peds GI is appropriate.Another possibility is Deitls crisis. It's recurrent, transient UPJ obstruction that causes episodes of pain, similar to intuss. It's rare, but also underdiagnosed, because nobody fucking knows about it. Small kids that have it are actually experiencing renal colic, but can't communicate it, and are presumed to have actually have abdominal pain. It's something to consider in the child with chronic episodic belly pain that self resolves and has no other symptoms..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric Psych patient dosage9 F Caucasian 93 lbs 4ft 6?My daughter was prescribed Lexapro 5 mg and everything I'm reading online says it's not for children under 12. I reached out to her pediatrician and he says to contact them because it's their expertise. I've been trying but am not getting through. In the mean time, is this something I should hold off on giving her or is the dosage small enough?. ### Response: Its likely safe but there is limited evidence to show efficacy (limited number of trials). Id hold off until you speak to psych, 1-2 days while you wait to speak to a psychiatrist for more clarification wont make a difference. It takes 6 weeks of consistent use before you really start to see much in the way of improvement to begin with, for most patients..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your reply! She was given it starting on Saturday and seemed to do fine. I did end up getting through to someone and they said it was fine to give because she had been monitored while on it. I can't find any info as to why it's not recommended for children under 12 but they seem to find it appropriate, so I'm going to assume it should be?. ### Response: They dont recommend against it. Its just the lack of evidence and a strong benefit/risk analysis that prevents them from recommending it in patients under 12 at this point..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: (Pediatrics) 24 month old white female with discordant bone age. 31" tall, 21 pounds. No meds, no surgeries.(Pediatrics) 24 month old white female with possible short stature. 31" tall, 21 pounds. No meds, no surgeries.My 2 year old hasn't been getting very tall as she's gotten older. She's dropped to the first percentile for height. Her first pediatrician wasn't overly concerned, but we saw a new pediatrician and she was concerned and had her x-rayed. I got the report back, but the doctor is out of the office so I won't be able to talk to her until next week.The radiology report says:FINDINGS: A single radiograph of the hand was provided for evaluation of bone age. The patient's chronological age is 24 months. The hand bone age according to the tables of Greulich and Pyle is approximately 2 years. The wrist bone age most closely approaches that of 1 year and 3 months. The standard deviation for the patient's chronological age is 4.64 months. No structural abnormalities are identified.IMPRESSION:Discordant bone age between the hand and wrist, but both are within 2 standard deviations of chronological age per the age and gender matched standards of Greulich and Pyle.Is the discrepancy worrisome?https://flic.kr/p/2nS9y6S. ### Response: Worrisome probably isnt the right term. It isnt indicative of anything dangerous.It can sometimes indicate a hormonal issue that requires endocrine referral.But will also say that pediatric endocrinologists and radiologist often disagree on bone ages.Bone ages are pretty subjective. Basically they x-ray the hand in a specific way and then compare it to a book with known bone ages and say eh, I think it looks like this one the most..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Disagree in what way? Just generally, or does one group tend to say bone age is more/less advanced than the other?. ### Response: Just generally. I dont do bone ages but have heard a few endocrinologists say I never listen to radiologys reads on bone ages. Then they proceed to do it themselves..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 6 year old with hallucinations currently hospitilized. Is this autoimmune encephalopathy?Age: 6Sex: MaleLocation: New England, USAMy child has been in the hospital over the last week for suspected autoimmune encephalitis. I brought him to the ER on 4/11 per instruction from his pediatrician due to visual hallucinations. He was admitted after neurology came to the ER for a consult. The hallucinations have not been improving with treatment as of yet (4 days of IV steroids & 1 day of IV IG, see below for more specifics). I've been advised 90% of the labs will take a couple of weeks to get back. Is there anything else we should be considering? He's the happiest kid, he absolutely loves school and his friends and teachers and he can't wait to go home. He knows what he's seeing isn't real and I wish I could make it go away. Any insight/advice would be so appreciated. He's been a trooper throughout this process but it's not easy wondering every day what is going on. I can provide additional information if needed/requested.Assessment/Plan: Child is a 6 y.o. 5 m.o. male with PMH of hypnagogic hallucinations and asthma who presents for evaluation of 2 days of daytime hallucinations. Given acute onset of worsening visual hallucinations that started with nighttime awakenings on 4/7 and then progressed to daytime visual hallucinations on 4/10, we are concerned for autoimmune encephalitis. LTM EEG with left parasagittal and temporal spike wave epileptiform discharges, suggestive of underlying brain irritability. However, patient is very well appearing with no other classic features of autoimmune encephalitis- no encephalopathy, no weakness, no abnormal movements. Given that he is very well appearing and is not demonstrating significant decline from day to day, we will plan to first obtain CSF and brain MRI with contrast prior to starting immunosuppression. If CSF is bland, we would likely still recommend treating with immunosuppression given clinical concern and patient meeting diagnostic criteria for autoimmune encephalitis.EEG is abnormal but no definite seizures. Frequent and sleep activated left temporal and parasagittal spike and wave epileptiform discharges. Brain MRI normal. LP overall bland with 1 nucleated cell in tube 1, 2 nucleated cells in tube 2. Other labs pending but does have ANA positive at 1:320.Has been on IV steroids since 4/14 with no improvement in visual hallucinations. Will plan to continue steroids for total 5-day course and discuss case with our neuroimmunology colleagues. (This plan changed after neuroimmunology consult, began tapering steroids after 4th day to begin IV IG)Treatment:s/p 4-days of high dose IV methylprednisolone (30mg/kg daily)prednisone taper: 1mg/kg (max 60mg) prednisone tapering over 6 weeks (can roughly cut in half every 7 days) Week 1: 30mg daily Week 2: 15mg daily Week 3: 10mg daily Week 4: 5mg daily Offstart IVIG today for 2-days- IVIG 2g/kg divided over 2 days. Started on 4/17 treatment was well-toleratedResulted workup:EEG abnormal with frequent abundant spike wave epileptiform dischargesEEG continued to demonstrate frequent abundant left parasagittal and temporal spike wave epileptiform discharges -EEG from 4/12 -Frequent to abundant left parasagittal spike wave epileptiform discharges that occurred both independently and in brief 1-3 Hz runs lasting <10 seconds (BIRDS) -Occasional to abundant left temporal spike wave epileptiform discharges that occurred both independently and in brief 1-1.5 Hz runs lasting <10 seconds (BIRDS)quick brain MRI normalsedated brain MRI with contrast normal, incidental finding of likely arachnoid cystReassuring CBCd, BMP/Mg/Phos, LFT'sESR and CRP normalTSH elevated to 7.44, free T4 normal at 1.1B12 and folate normalRPR non-reactiveRhinovirus positiveCeruloplasmin normalUrine tox negativeUA normalANA positive 1:320, speckledSerum copper within normal rangeCSF opening pressure 15CSF cell count and total protein normalAnti-TPO antibodies negativeHIV 1/2 negativeCollected and pending: [] CSF culture [] CSF HSV PCR, CSF VZV PCR, CSF VZV IgM [] CSF oligoclonal bands, IgG index, beta-2 microglobulin, flow cytometry, cytology [] CSF autoimmune encephalopathy panel [] CSF anti-Glycine-R antibody [] Serum Glycine Receptor IgG [] Myelin oligodendrocyte glycoprotein [] 24 hour urine copper [] 24 hour urine porphyrins [] Double stranded DNA antibodies [] Antiphospholipid antibody panel [] Thyroglobulin antibody [] Serum MaTa Autoantibody test [] SPEP panel [] MS profile, serum and CXF [] IgG index/synthesis rate, serum and CSF [] EBV serology [] VZV IgG, IgM [] HSV PCR, HSV type 1,2 antibody [] Serum encephalopathy panel [] Mycoplasma IgM, IgG [] Lyme screen with reflex to immunoblot [] HSV PCR, serumMENTAL STATUS EXAM: Appearance: appropriately dressed Behavior: cooperative, eye contact good and pleasant Psychomotor Activity: normal Musculoskeletal: moves all extremities; no abnormal movements Station/Gait: normal Speech: regular rate, regular rhythm and regular volume Language: normal comprehension Mood: happy Affect: full range Thought Process: logical, linear and goal-directed Associations: no loosening of associations Thought Content: no delusions and no obsessions Perceptions/Experiences: visual hallucinations Orientation/Sensorium: alert Memory: immediate recall intact. Attention/Concentration: intact to observationImpression: Child is a cheerful and pleasant 6 yo boy, from X attending Kindergarten at X. He has a hx of mild OSA, hypogogic/hypnopompic hallucinations since early on, asthma, no prior past psychiatric history, presenting for worsening hallucinations since 4/10, admitted for medical work up on etiology. Psychiatry consulted for diagnostic clarification, support and medication management.4/14/23: Patient continues to be calm and cooperative, behaviorally appropriate for a 6-year-old boy. Continues to experience visual hallucinations, yesterday night described as "monsters," which patient is understandably afraid of. Most of patient's hallucinations are visual, vivid, and neutral with minimal emotional involvement. No auditory hallucinations. No clear seizure activity on EEG, other than minor blinking, clinical signs of seizure disorder not noted on physical exam. Pt age, onset, and symptoms are not typical of a primary psychotic disorder or normal development. We agree with pediatric neurology and primary team that the origin of hallucinations are organic. No emotional or behavioral dysregulation. Thus, we do not recommend scheduled psychotropic medications at this time. Pediatric neurology assess patient has underlying brain irritability from EEG findings (left parasagittal and temporal spike wave epileptiform discharges), likely secondary to encephalitis, as opposed to seizure disorder.. ### Response: What were the CSF cell counts, protein, and glucose?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 3y(f) Seeing Pediatric Pulmonologist - What to Expect and Genetic TestingMy (37F) daughter (3F) will be seeing a pediatric pulmonologist next week for suspected asthma. Her pediatrician has diagnosed it as "mild or intermittent" but from my observations, it is not mild and is getting worse. It was thought she had recurrent croup but we now suspect those croup episodes have actually been asthma attacks/flares. They only occur during viral illness, but each time she is sick she ends up in respiratory distress and needs an ER/hospital visit. She is prescribed albuterol, flovent, and decadron. Pediatrician agreed to allow us to only use flovent at onset of illness so it is not daily use.I don't know if there will be genetic testing performed, but I did sign a form agreeing to genetic testing.My question is, should I be thinking this is something beyond asthma and possibly genetic? Should I push for imaging and/or genetic testing?. ### Response: Peds ER doctor here, sounds very much like asthma. No, genetic testing is not done routinely at all, i suspect they make everyone sign that form before coming in so that they can streamline the process if they need to test patients for anything..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric Abilify weaning schedule?Hi Reddit Docs, My 8yo (9 in April) son has been on Abilify for about a year, up to 15mg. Long story short we dont feel that it is making a difference and in fact hes getting worse, more physical/aggressive, even violent at times. Especially since we added clonidine again. (In addition hes being treated by a physician who specializes in ADHD, not a psychiatrist. He was diagnosed by a psychologist with ADHD, depression, and motor coordination development disorder. I had to see this Dr because he was diagnosed during the height of the pandemic and no psychiatrist was available. Basically threw different combinations of Vyvanse, guanfacine, clonidine, and Adderrall at him, hes currently on Adzenys, Abilify and just came off clonidine. Finally got him some Lexapro a few months ago and his baseline mood has improved but the outbursts are worse. Ive been trying again to get a psychiatrist with no luck. I currently have an emergency intake visit scheduled in 4 days with a social worker who is supposedly going to get us a faster referral visit.) What is the recommended taper schedule to come off the Abilify? Wanting to make sure current provider is giving us accurate info. Thank you!. ### Response: I am not sure what the guidelines for treating children are where you reside but to me this seems like a hodgepodge of medication. I would personally be very concerned to write out so many medications (some of which counteract each other).My first question would be what was the main problem with your son before he got medicated? Why did you seek help? Is there family history of psychiatric illness?The tapering really depends on the patient and the symptoms experienced. One could recommend to reduce 5mg every week (so 15mg, 10mg and finally 5mg before stopping). This can be further adjusted depending on any side effects. This can be also adjusted more finely if you have an oral solution instead of tablets..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric4 y/o female, turning 5 next month. No significant PMH. Complaining of pin point pain around umbilical area that hurts more when I breathe in and out. Also complaining of GERD symptoms described it perfectly without knowing obviously when I eat my food and drink too, it goes down to my belly and then comes back up and I have to swallow it again.Started complaining of both these symptoms over the last 24 hours.No bulge can be noticed or palpated, even when coughing or taking deep breaths.What could this be?. ### Response: Gastric or duodenal ulcer, GERD, constipation. Would talk to pediatrician about it. Can do a trial with famotidine if it sounds like reflux to them with a more thorough history. If its a one off episode its unlikely to be anything to worry about if it self resolves. Look for food triggers and anything that helps or makes it worse in the mean time..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric burnsMy daughter is 4 years old and was burned with hot water earlier today. She was taken to our local emergency room within about 20 minutes of the accident. The burns are on her chest/belly area covering approximately 65% of the front. The doctor did not specify but I believe it's 2nd degree burns as the top layer skin has came off. The er gave hycet plus gave her a prescription for hycet and silvadene cream. They gave some thin blue towels of hold over the burn area with instructions to not begin the cream or put anything else on it until it stops leaking fluid from the burn. Now she has blue towel fuzz stuck to the burn area and I was told not to wet the wound nor cover with anything else. I don't want to go against the er doctors instructions but I just have a bad feeling that this is going to end up infected. Do these instructions sound correct? Is there anything else I should be doing? Given the burn is on her chest I'm not sure I'm allowed to include a photo but if the mods allow it.. ### Response: This burn would likely meet criteria for inpatient management based on the described size and severity of the burn. Im surprised they would send you home. You should be able to lightly rinse the fibers off but every time you rinse it and if you have any abrasion, you risk destroying the epithelialization of new skin. There is a balance between dressing changes and allowing time for healing. Additionally moisture can increase the risk of infection. Generally speaking the fuzz is likely harmless, so you would have to use your judgement as to whether it needs to be removed based on the amount attached and any soiling or other factors present.If there is a significant amount, Id recommend a return to the emergency room for further management and discuss admission to the inpatient service or transfer to a burn center for further care. Burns often require more significant care than just the initial skin damage, especially if a significant portion of the trunk has been burned. In pediatric patients it is even more imperative to get proper care to ensure proper healing and limit future difficulties secondary to poor healing.They can be managed at home for minor burns, but if you are not comfortable with the care and it has not been described in enough detail that you feel comfortable, return to the ED. Your child will thank you in the future if you get proper care now. Its unfortunate that this may require an additional trip to the emergency room, but I wish you the best and hope your child has a speedy recovery.You may wish to try a different emergency room for a second opinion if you did not feel like you received adequate care at the first one..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric lupus?My 11 y/o daughter had three weeks of low grade fever, headache, body ache, fatigue, nausea and low appetite. Multiple negative tests - covid (including antibody), mono, strep, flu, RSV. Had a positive urinalysis for bacteria and blood - did a round of Bactrim but the symptoms remained. Current meds for asthma - symbicort, xopenex as needed, singular.Doc ran some more blood tests - looks like some were autoimmune tests. Can I get some interpretation of these ANA titer results? Recommend seeing a pediatric rheumatologist?. ### Response: That's quite a high ANA titer (means very positive). Time to see a peds rheum.This is not the place to push Lyme pseudo-medicine..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Definitely in a tick borne illness area - Lyme tests are in these results too - but she was only reactive on one of the bands. I think that means shes negative?. ### Response: That means she's negative. Please don't listen to the internet panic about Lyme disease. It's easy to test for and straightforward to treat..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric Wellness Exam around PubertyI am trying to find a new pediatrician for my daughter (11y/f). We went to a local female pediatrician, who was nice, albeit a little rushed and pushy. We talked for a little while, and the pediatrician did ask if she had her period yet or not. She has not. Upon physical examination, with little notice (hey I'm going to do this, and then did it) the doctor pulled up my daughter's shirt and bra, and then pulled up her pants at the waistband to look at her vaginal area. My daughter was struggling to not let her do this and is now traumatized by the interaction and felt like she could have given a little more warning. I know that physicians are very busy and have many patients to see, but I feel like I've failed to protect my daughter from this. I would think a conversation asking if she is developing breast tissue or pubic hair would have been just as efficient without stressing my child. Or even saying what she is going to do before doing that kind of exam. Is this a normal practice on a wellness exam? My daughter will not be returning to this doctor.. ### Response: It is normal practice to check these areas, yes. Sounds like the doctor could have explained the process a bit better. At this age, I generally talk to the patient about what I'm going to do and why, then ask for their assent before proceeding..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 7yo old with Hashimotos and Lichen SclerosisMy apologies for such a vague request but Im searching for any answers of how these two are connected or if we should be traveling out of state for second opinions. My daughter was diagnosed in the past year with both conditions. We live in the US (Nevada). She currently sees a pediatric endocrinologist and a pediatric urologist (we do not have a pediatric gynecologist where I live and our pediatric dermatologist is a male and my daughter wasnt comfortable seeing him).My issue is that everywhere we take her they comment on how rare her conditions are or how they havent treated it before. To me, that doesnt mean they are incompetent or she is receiving poor treatment, I just wonder if there are people who do treat these conditions more frequently and if it is worth our time to seek second opinions.Definitely not rich, but could most likely cover basic assessments if need be.Thank you in advance!. ### Response: If someone has one autoimmune condition, they are at increased risk of developing other autoimmune conditions. These are both autoimmune conditions but unrelated except for the autoimmune diathesis. No comment on the thyroid disease, but skin biopsy results are definitive and treatment of lichen sclerosus is usually straightforward..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: For my son.Age: 8 months old Weight and height: 20 pounds and 2 foot No medications being taken No smoking No current medical issues Location of complaint: headIll start with saying we took him immediately to the ER and got seen by a neurosurgeon at a pediatric hospital afterwards. They said he was good to go after observing him for a few hours and said his CT scan was clear of any bleeding or fractures by both the ER and neurosurgeon at at the pediatric hospital.I was at work and my wife called me and told my son fell back off of the couch, which is about a foot and half up off the floor (which is hard tile, there is a rug there as well about a quarter of an inch thick if that.)She picked him up and then said he was crying but then he stopped and his eyes rolled to the back of his head, he started bubbling at his mouth and got stiff. Wasnt responding to anything. I work at the hospital where we brought him into the ED at and I saw him, I was moving him but he wasnt responding either so they called in a code and gave him 2.5mg diastate to help him out. After they gave him that, I saw him start moving and making noises. Afterwards they took a CT scan on him which, at that point, I was informed by one of the doctors there it was clear from any fractures or bleeds. However, I was also told that since there wasnt a radiologist there the doctor told me she couldnt say for sure. At this point, they send us to the pediatric hospital where he was seen by the neurosurgeon, who told us she didnt see anything either and it looked clear to her as well. Afterwards we were three from about 10:30-5:00 pm. During the time we waited he fell asleep and ate like normal, didnt throw up or anything. Neurosurgeon came back and did some other tests, he grabbed some keys she had and played with them like he normally does with things. From there, they discharged us and said to watch him over the next 48 hours for any changes in behavior or anything out the norm. Neurosurgeon stated she doesnt think he had a seizure but doesnt know for sure since the scan was done about 20-25 minutes after he arrived and wasnt sure if it was done too early. For a bit of a better timeline of events, he fell about 8:59 a.m. and arrived at the hospital about 9:05 a.mSo after we got home hes been completely normal. Even today hes been fine. He has a regular check up in about two weeks but I want to do a follow up and wanted your alls advice due to the fact of how he was immediately after the fall, since that seemed to be the part that had most of the providers a little stumped. I did on searching on google (I know) to see if I could find anything similar to the situation but found nothing that seemed similar to it. They way a nurse and the neurosurgeon explained what it was, that it couldve been he had response to the trauma of the pain and that his was reaction was what made him go into that state. I apologize for the long read but there was no short version that had enough info. But, if theres a question that anyone needs answered for more context please let me know.. ### Response: t's hard to say if he seized or not. Seizure after head injury isn't super rare. You can have seizure in absence of bleeds or fractures. The timing or findings of the CT has no bearing on whether he seized.He may have been concussed. Concussion is a clinical diagnosis, and is not something that is diagnosed by imaging.I frankly would be shocked if he had seizures or concussion from the fall, as described. I've seen >100 babies with falls like this, none have had serious injury.I've seen many infants and toddlers with falls from 2nd story window/balconies. I don't recall any ever having serious head injury.But yeah, likely either a weird pain response, or concussion. Or there is more to this story than an 18" fall onto carpeted floor..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Trans (FTM) invasive exam at endocrinology visit *repost **is this common practice??4 years ago i had visited a pediatric endocrinologist for my first dose of T after 2 years of therapy. i had done everything i needed to, i was excited, i was desperate the endocrinologist did everything routine blood tests, usual physical examinations during the physical, it was quite apparent that i did have excess hair and signs of hyperandrogenism. the blood work even indicated that my cholesterol was high. the day of my follow-up he had asked me to wear a gown so he can check down there i dont remember ever getting a reason why but he did let my mom stay in the room and brought a chaperone. i was desperate so i let him do it. it haunted me for a while.4 years later. i had learned that that examination apparently isnt routine via my friends and this examination was never reported in any of my records so i decided to give him a call about it to express my concerns. he told me that people who have hyperandrogenism, their clit grows so he wanted to check for signs of that and anything that can indicate for signs of a tumor, that is causing it so that he would order a CT scan if he suspected iti still dont know how a physical examination can make that clear but i felt pressured today so i just agreed just like i did 4 years ago he even admitted to checking several patients clits for a baseline for T but he said he doesnt do it anymore because its uncomfortable or has a (female) nurse do it if he feels its necessary.i still dont have an answer im afraid i gave consent that day under false pretenses i feel strange just leaving this alone even though i dont think he had any ill intentions.should i ask for another opinion? or am i making this a bigger problem than it is?. ### Response: Sounds like they were assessing for clitoromegaly and they werent very sensitive to your needs or reading the room. I dont think this is common for FTM physical exams, especially when youre displaying signs of hyperandrogenism.What I can say is that my guess is a pediatric endocrinologist is definitely more likely to assess genitalia because they are the ones that first pick up on hormonal imbalances caused by tumors or abnormal genitalia so it may actually be within their scope. I think they were being thorough during a time when trans care was evolving given that they brought a chaperone. If they did a full pelvic exam then that would certainly raise some red flags.I think your being uncomfortable was warranted and I dont think what they did is standard practice. However, Im not sure Id pursue it anymore given that a genitalia exam in some cases might be appropriate. Again, if penetration occurred then Id be more worried. Today, this would typically be monitored by a Gyn as part of a multidisciplinary team..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What exactly do percentiles mean for pediatrics?I took my two year old for his appointment today he weighed 32.2 lbs/90th percentile and his height was 34.5/63rd percentile.I know this might sound bad, but does this mean my child is on the short and chunky side? Only asking because I didnt mention his diet and the doctor never brought it up except to cut out juices and switch to 2% or 1% milk for him.. but didnt seem concerned with his weight and said his teeth were great.I shouldve asked, but my son was trying to get into everything, it got hectic and it completely slipped my mind to ask. ### Response: He's on the heavier side for kids his age. He's still taller than average, though, so in general he's just a bigger than average 2yo.Switching to low-fat milk and avoiding sugary beverages are standard things that we suggest at this age, so I wouldn't read into the pediatrician talking about those. That's the recommendation for every kid!.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: The only time percentiles posed a problem for my kiddos was when they were used to detect a head growth problem in one of my kiddos  extra imaging was requested and there was an actual reason for the extreme jump off of the datum points off of the growth curve.Would it be fair to suggest that growth curves and percentiles are used to detect changes in growth?. ### Response: Yes, that's a good way to explain it. When we're watching from visit to visit, we're looking at the trend in percentile over time.50th percentile would be exactly average, 90% percentile means in a room of 100 kids his age hes heavier than 90 of them..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: low neutrophils high lymphocytes pediatricMy son is 3 years old. Got a ton of blood work for his weight I guess. He's 27lbs. He has high energy and no concerns other than occasional constipation. The blood work came back with low neutrophils 21% and high lymphocytes 71% (which has me sick to my stomach thanks to Google. WBC, RBC and hemoglobin is normal. Hematocrit is low 32.9% with the range min of 34%. His neutrophils absolute is 1.56 which is in range but on the low end of the range that says the min is 1.50. Lymphocytes absolute is in range. All morphology is normal. His ferritin is low at 23 with the standard low being 36. Everything else is normal. They did a lipid panel which I didn't have him fast as no one informed me. And his triglycerides were pretty high at 238mg/dl. He had half a sugar cookie an hour before and I was feeding the other half during his blood draw to distract him. VLDL was high at 48mg. Everything was normal on lipid. Carbon dioxide was low at 17.0mm.. ### Response: First off keep in mind the percentages always have to add up to 100. So either the neutrophils are low because the lymphocytes are high, or the lymphocytes look high because the neutrophils are low. So he's got one problem, not two. Based on the other values my guess is that it's probably the low neutrophils but I'd have to see the absolute numbers.His iron is a little low but otherwise everything else is normal. Do you have a hard time getting him to eat meat? Because it's likely just dietary.In general, I really recommend against googling labs because it always comes up with scary stuff. Those aren't cancer values if that's what you're worried about. Could be he's fighting off an infection, could be related to a malabsorption issue or dietary deficiency, could just be normal for him.If it were my patient or my child I would think it's not likely a big deal, but would want to recheck at some point in the next few months to see if it changes. Keeping in mind I'm a family doctor and not a pediatrician, so they may have a slightly different plan..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Neutrophils Absolute Your Value 1.56 103/uL Standard Range 1.50 - 8.50 103/uL Lymphocytes Absolute Your Value 5.26 103/uL Standard Range 2.70 - 10.50 103/uL Monocytes Absolute Your Value 0.44 103/uL Standard Range 0.10 - 1.10 103/uL Eosinophils Absolute Your Value 0.15 103/uL Standard Range 0.00 - 0.90 103/uL Basophil Absolute Your Value 0.00 103/uL Standard Range 0.00 - 0.20 103/uL Bands Absolute Your Value 0.00 103/uL Standard Range 0.00 - 2.10 103/uL. ### Response: Honestly that doesn't really look awful. Mild neutropenia. Not particularly scary..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Ascites 4 weeks post-op, acute renal failureUpdate: Over 5L of fluid was drained from my dads abdomen today. The fluid was high in creatinine and consistent with urine. He initially felt much better, but then started experiencing extreme pain, likely from muscle spasms due to the drastic change in his body over the course if only 2 hours. His O2 dropped to 86 due to the pain. He is now medicated for pain and sleeping on and off. We are hoping that his status will improve over the next few days. Thank you to everyone that commented.70M, 6ft even, 205 lbs, Barrett's esophagus, eczemaHistory of heavy smoking decades ago that was reduced to once or twice per day in the 1980s. Uses edibles/microdosing to manage anxiety and depression.Regular medications include acid reducers for well-monitored esophagus and fish oils and supplements for controlled eczema. Very active lifestyle for age including managing half acre yard, frequent 15 to 20 mile bike rides when weather permits, strength training at gym multiple times per week.January 12th, dad underwent robot assisted prostate removal. Lymph nodes were clear and there was one area where cancer had spread one millimeter into outside tissues. No radiation is recommended at this time. He was disharged home with a catheter. The catheter was removed one week later, but about 18 hours after it was removed, he was having trouble urinating and developed severe pain. He went to the ER cathed again. He was determined to have continued swelling in his urethra.A few days later, a cystogram with his surgeon revealed a small tear in his bladder where his bladder and urethra meet. His surgeon said that he expects the tear to heal on its own.My dad was admitted to the ER today for increasing discomfort in his abdominal area with pain and diarrhea. When I showed up, I noticed that his abdomen was visibly distended. CT confirmed ascites. Nothing else to note other than a 2 mm calcification in a kidney and cirrhosis. He is a recovered alcoholic that hasn't touched alcohol in 37 years. Labs shows some RBCs and WBCs in his urine. Also indicated acute kidney failure. BUN 56 mg/dL, creatinine 4.54 mg/dL, eGFR-Cr 13 mL/min/1.73m2.It is a lymphatic leak? Maybe urine leak caused it? If so, what next?. ### Response: In a patient with cirrhosis and new onset renal failure with swelling by the prostatic urethra, your dad appears to be at risk for urinary retention because of how much inflammation and swelling there is by the pelvis at the neck of the urethra. A simple noninvasive bladder scan can be done at the urologist's office after he voids or is allowed to empty his bladder completely , called a "post void residual". If there is more than 300-450 cc (every doc has their own cutoff) after a reasonable attempt to empty every last drop, he is considered to have urinary retention. This can cause urine to flow backwards and cause backpressure into the kidneys, effectively causing hydronephrosis (which can be picked up on a renal ultrasound (ultrasound of kidneys), or CT scan of the abdomen. Obstructive uropathy is this condition and can be source of renal failureAlso, ascites is not uncommon in decompensated cirrhosis. Make sure your dad is on a low salt diet. Also it is important to check a Complete metabolic panel or hepatic function panel to see his albumin level. Low albumin can contribute to ascites. Your dad could be in what we call hepatorenal syndrome if his cirrhosis is not under control and can lead to renal failure and death..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What would cause someone to spiral into acsites when they have not touched alcohol in 37 years? He quit drinking when he was only 33 years old and hasn't had a drop since. He has never had any issues with his liver before.I will put his CT impressions, but I don't recall seeing anything about hydronephrosis.. ### Response: low albumin levels coupled with changes in portal pressure can cause this too, as can increased salt in diet or from IV fluids he had received during surgery. You mentioned the CT had findings of cirrhosis. Cirrhosis physiology is complex and would need complete liver function panel, INR, Tbili, serum albumin, Na levels to fully evaluate severity.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you. I just got off the phone with his surgeon, and we were able to talk for about 30 minutes. He feels that there is a continued bladder leak and that we are likely to find that the fluid collection is high in creatinine. They are putting a drain in tomorrow and they'll test the fluid. If this is the case, his kidney function is likely not as poor as it appears, as his body is reabsorbing creatinine through his peritoneum. I did ask him to run a liver panel out of an abundance of caution and he agreed.. ### Response: If that's the case, then this is a Urinoma I believe. Still though a creatinine of 4.54 and BUN of 56 is quite high but you're dad's urologist is right that creatinine can be inflated in this rare but unique scenario. BUN would be expectedly a bit higher if his creatinine were that high but not always. Cystatin C measurement can be another surrogate used to indirectly measure his true GFR. That hole wont repair itself unless the urologist diverts the urine elsewhere and hence the drain is needed. Bladder wont heal if there's continuous flow of any liquid, in this case urine, through the hole..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your input. I feel significantly more at ease. Hopefully, this is truely just the continued leakage. When my dad's labs came through electronically, I was initally shocked and alarmed. Now I feel cautiously optimistic.His urologist us going to mess with catheter sizing and try to inflate the balloon a bit more to put a bit of a stretch and seal up that leak. He'll give it two more weeks to see if the fistula can repair itself before going in for a corrective surgery.. ### Response: I'd be worried about a bladder leak given the bladder injury. Need to aspirate and sample that fluid before writing it off as simple ascities, imho..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: They are putting a drain in tomorrow morning, so we will find out what thr fluid is then. I feel extremely frustrated right now that there isn't more of a sense of urgency.. ### Response: Either the fluid is persistent leak from the tear which seems somewhat likely. The other possibility is obviously cirrhosis with ascites. As a prior heavy alcohol user, long-term smoker likely some degree of poor lifestyle habits (ie dietary) and his age he has more than enough risk factors to develop cirrhosis.Either way, sampling the fluid will give the necessary info.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My husbands diagnosis. Please help. I posted a few months ago about this and you were all so helpful.Pt: 41 y/o male, former marine, non smoker, very occasional drinker, 170 lbs 60.My husbands official diagnosis is Metastatic renal cell carcinoma, which spread to his lungs. They went in and took the tumor off the kidney (he has horseshoe kidney so he only technically has one) and he was very optimistic about getting it all from that area. Said his body encapsulated the tumor and they didnt see anything else on his kidney. They said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.No chemo, no radiation, no immunotherapy yet or maybe at all. Is this normal?His lymph nodes have been so swollen I can see them under his collar bone, and in his neck. Im worried. Is metastatic a automatic stage 4 diagnosis?Is his prognosis good? His oncologist and doctor seem to think so, but they wont really speak on anything early on. They said we would meet in December and talk more then. What do I do now?My husband isnt able to work, and is taking time off from getting his degree. He can barely walk around without being winded. I have picked up extra shifts at work, so I dont get to see him and how hes doing. I just want to know if I should trust what they are telling us, or ask for them to check him again since hes so weak. Help? Im losing my mind.Thank you. I appreciate you all so very much.. ### Response: Dont wait, call the oncology office now and let them know these concerns, they may need to start other treatments sooner.See a palliative care doctor ASAP. They are experts in cancer pain. Some cancer treatment centers also have anesthesiologists or rehab doctors who are experts in cancer pain.Oncologists are experts in the extreme complexities of treating cancers. There is a lot more to having cancer, and it's best to have an interdisciplinary team..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: He definitely needs to be checked out sooner rather than later, so if the oncologists cant see him urgently then he should still see primary care, or failing that, go to ED where they can check him over and perhaps even do a CT to establish whats going on with his nodes / progression.. ### Response: Yea an ER doc can check to make Sure he hasnt developed a PE (blood clot in the lungs) which is common and cancer and causes shortness of breath. The CT will also see if the cancer is bigger. Just be sure to go to an ED thats affiliated with his oncologist so they can see the images.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pts horseshoe kidney would handle it better than an. NSAID for, say, minor pain. But metastasizing cancer pain is of a much higher order. Hell be initially given Norco, probably transition to higher-order opiates via a learned palliative oncology Al pain specialist.. ### Response: That is an outrageously inappropriate pain regimen for a young person with advanced cancer..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I agree. I was shocked. Its hard as his wife to watch him suffer. The man never complains, and if he says in hurts, it hurts.. ### Response: I'm seeing a lot more tylenol/NSAID management for post operative patients (c-sections, hernias, hysterectomies, etc). However we always give narcs for breakthrough. The cancer patients are the exception, particularly the stage 4 ones. They still get non narcotic pain alternatives but that's in combination with narcs..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Based on all of your comments it truly sounds like its time for a second opinion. Your current oncologist doesnt sound effective nor compassionate and you and your husband deserve a doctor who will listen to your concerns, treat symptoms, and treat his cancer rather than wait another few weeks which could be crucial. ### Response: Im a urologist and I've treated cancer like this.So he should definitely be in some type of therapy if he has metastatic renal cell cancer. Typically this is immunotherapy which is typically not too hard on the body (this is significantly easier than something like chemo). There are many medications out there that all have pretty good effects on cancer. It sounds like your husband had a cytoreductive nephrectomy" where the kidney is taken out even though we know the cancer is spread. The goal is to just get as much cancer out as possible. Typically if there is remaining cancer (in the lungs for example) we then give immunotherapy however you do need to wait about 6 weeks after surgery for recovery. I'm not sure where he is on his recovery from surgery. Bottom line, I would talk to your oncologist about starting treatment, especially immunotherapy.Yes stage 4 = metastatic cancer. This is true of essentially all cancers.i will be blunt his prognosis is not good. With appropriate treatment his chance of living another 5 years is probably ~20%. This doesn't mean he'll die tomorrow but his time is limitedMore worrying is how young he is - 41 is incredibly young. You mentioned he is a veteran - he should see someone asap at the VA. If he had any exposure during combat he may be able to have all his medical bills covered. This is incredibly long and bureaucratic process but would be something I'd strongly suggest looking into.I am sorry but I hope this helps.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: It helps me, as you are being honest and upfront and thats what I need.So theres really not a good chance hes going to walk away from this? If you personally had to put time on it, can you tell me about how long?Thank you for that well thought out and honest reply. His doctors told him that he was going to be fine, but everything I have read online (I know Dr google isnt good, but I have scoured so many articles)Maybe thats why they want to wait until December? He is recovering very slowly. Hes also in a ton of pain and nothing I do helps. His doctors wont prescribe things as they claim its too hard to get around the red tape. I dont understand. Im treating him with edible THC as well as CBD because he wasnt eating. I was honest with them about this, and they didnt seem to see a problem with it.My heart is broken, but thank you for telling me your opinion here. It means a lot.. ### Response: Cancer related pain is one of the major indications for opioid pain meds. Im not sure what red tape these doctors are on about. I think its time for a second opinion..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: NAD, but both of my parents had metastatic lung cancer. There was literally zero red tape in getting them pain meds. My father passed 7 years ago, and was getting fentanyl patches, morphine, and Norco. My mom just passed 3 months ago and she had morphine and OxyContin. Your husbands pain should be treated.. ### Response: Is he getting medical care through the military or civilian hospitals? There's a huge difference in quality as well as the fact that you cannot sue if a practitioner has dropped the ball..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: If he has a positive Virchow node, they need to see him like right now. ### Response: This is all (unfortunately) correct except OPs husband didn't get cytoreductive radical nephrectomy but partial nephrectomy, due to having only one kidney to start with..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: That doesnt sound good.. ### Response: Yes, this partThey said there were nodes in his lungs, but that they werent treating and just want to keep an eye on until mid December, then talk about what to do if they grow. The problem is, he is weak and is having trouble breathing.doesn't sound good at all. Sounds like his metastases are growing pretty fast when he's already noticing bulging from lymph nodes and trouble breathing from lung metastases. But we don't really have enough information to make this determination right now. Missing information:The exact histopathology (is it clear cell renal cell carcinoma or something more exotic?)Imaging reportsThe date of imaging and surgery to get a feeling for the timeline and progression dynamicsWhy his treating physicians said that "his body encapsulated the tumor" when they also said he has lung metastases, and why they didn't indicate systemic therapy and why they seemed to think his prognosis is good.Taking the most likely case based on incomplete information: In metastatic classic clear cell renal cell carcinoma, no chemotherapy is indicated ever, because chemotherapeutic agents don't help, which has been tried and demonstrated over and over. Effective medications are immunotherapy (checkpoint inhibitor antibodies like pembrolizumab), TKIs (tyrosin kinase inhibitors that can be taken orally, like sunitinib, pazopanib, cabozantinib or axitinib) and as probably less effective alternatives medications that inhibit vascular growth (e.g. bevacizumab or lenvatinib) or mTOR-inhibitors (e.g. temsirolimus).What's indicated precipitates on your husband's other medications, comorbidities, performance status (overall health) and other stuff.Also, in oligometastatic renal cell carcinoma, locally ablative therapies can be used to kill all the metastases you can detect at the moment, for example radiosurgery, microwave ablation etc., but your husband's case doesn't sound like that from the very limited information we got.Edit: As /u/Porencephaly already wrote, your next step is to contact his oncologist's office. They need to determine what the problem is right now (maybe it's even an infection and not metastatic progression) probably with new CT imaging and formulate a plan of action.His trouble breathing could be due to anemia, or a number of infections, or heart problems, or lymph node metastases compressing blood vessels or a bronchus, or pleural effusion, or whatever else... this is all more probable than trouble breathing due to lung metastases themselves, which surpisingly rarely are symptomatic in this way..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you!! Ill get him in ASAP!. ### Response: Heme/Onc fellow here, agree with everything youve said.Ill add my two cents and say that in addition to immunotherapy, VEGF inhibitors such as axitinib, cabozantinib, and lenvatinib are options as well. Many of the first-line treatment regimens are a combination of immunotherapy (either pembrolizumab or nivolumab) + one of the VEGF inhibitors. Combination immunotherapy (ipilimumab+nivolumab) is also an option as well for many patients. If someone has non-clear cell histology, the preferred regimens change a bit (and clinical trial is much preferred) but a lot of the same treatments are used.For someone who has a large burden of disease and is symptomatic from it, a combo of VEGF inhibitor + immunotherapy might be better than immunotherapy alone, just because the response rate is faster. But ultimately the choice depends a lot on factors like what other medical conditions someone has and what side effects theyre willing to tolerate, because we dont have any head-to-head trials showing that one regimen is better than the other..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Seeking information regarding dads renal cell carcinoma. Any urologists here?My dad has been having serious issues with vomiting, nausea, and weight loss. They ended up doing abdominal CT because colonoscopy and upper GI scope were normal. There was an incidental finding of a 2 cm heterogenous(I think???) lesion on one kidney. Per radiology report, it says renal cell carcinoma until proven otherwise.Today we saw the urological surgeon who said due to size of tumor and my dads age, hes a candidate for ablation and theyll give him a referral.The appointment was very rushed and I (29 F) went in with my dad because he has a history of TBI and has a hard time remembering/relaying medical info. We basically were just told that its cancer (which I figured from reading rad report) and that it can be ablated very quickly and the doctor then basically told my dad to drop his pants for a prostate exam so I made a swift exit.My questions lie in whether more imaging needs to be done on my dad to make sure theres not other cancer somewhere? The doc said most likely stage one but theyve only done the abd CT and nothing else?? I understand its a small tumor but does that automatically mean theres no metastasis?? I dont understand how they know that its only stage I without additional testing or imaging? Can anyone give me insight here about this process?We will be following up with that physician where I will be asking for clarification. It was such a whirlwind of an appt and I just didnt feel prepared to ask necessary questions.. ### Response: From the information provided, this is not standard of care - but giving us the image files (upload to e.g. dicomlibrary and CT report would be very helpful.Here is NCCN's very helpful patient guideline for kidney cancer.A suspicious 2 cm lesion on a kidney often, but not always is renal cell carcinoma. A 2 cm renal cell carcinoma that's confined to the kidney is usually pretty harmless and very unlikely to relapse or metastasize.The problem is that 1) staging is incomplete and 2) you won't have histology going along with this to confirm that it is indeed renal cell carcinoma and 3) your father has concerning symptoms that are as of yet unexplained.Initial evaluation and staging vitally includes comprehensive labs (CBC, metabolic panel, LDH), abdominal CT with and without contrast, chest CT (or at least, but that's discouraged in the guidelines, chest X-ray) and a thorough physical examination and history.If there are any alarming signs on history or examination, additional imaging must be done. I'd consider vomiting, nausea and weight loss to be alarming. At least brain imaging (preferably MRI) should be done to exclude brain metastases imho.Also, when not performing a partial nephrectomy, which would be preferable to ablation if possible, an initial core needle biopsy to secure histologic diagnosis is recommended. Otherwise you won't ever know what kind of 2 cm mass they burned. The NCCN guidelines stateBiopsy of small lesions confirms a diagnosis of malignancy for surveillance, cryosurgery, and radiofrequency ablation strategies. Ablative techniques may require multiple treatments to achieve the same local oncologic outcomes as conventional surgery..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Distended abdomen, fatty liver, enlarged spleen and left renal fullness?Hi everyone!Just wondering if anyone has any ideas as even my GP seems to be stumped!I'm female, 32, MODY diabetes on insulin and high blood pressure (on nifedipine). Have a history of colon polyps but most recent colonoscopy in June was clear.The last few months I've been struggling with swelling in my stomach (photo) I look heavily pregnant and it is so uncomfortable, and the few weeks I've started having pain around my right rib area and into my back. Also have extreme fatigue.2 different GPs examined me and both were certain it was fluid so referred me for ultrasounds.I had these last week and had the results today - there is no fluid! The ultrasound did confirm moderate fatty liver, an enlarged spleen and left renal fullness.GP has referred me to haematology to look into the spleen, but said the fatty liver is only moderate and wouldn't cause the pain etc. He also doesn't know what the left renal fullness means but I do have a repeat enal ultrasound tomorrow.Full blood count was normal, kidney function came back normal but GFR had dropped from 85 in April to 62 last week, ALT on liver function only slightly raised to 62, cholesteral high at 6.3 with triglycerides at 7.3mmol.Anybody have any ideas at all as to what could be causing the swelling etc?Thanks - sorry it was such a long post!. ### Response: An ultrasound cant tell the difference between fat and fibrosis. Your labs and imaging findings of enlarged spleen are concerning for possible liver disease. You should see a gastroenterologist for further work up..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Dont you think a gynecological exam is warranted?. ### Response: I honestly dont know if abdominal fullness is a reason for a gyn exam. I wouldnt think so though if youre not having other symptoms (bleeding), but not my area of expertise.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: That's doodoo. If fibrosis is significant, US can easily tell the difference between cirrhosis and fatty liver.. ### Response: An ultrasound can show other signs of cirrhosis and can give an idea if a liver is cirrhotic appearing but it doesnt actually measure fibrosis/scar tissue. Sono it doesnt show fibrosis. Youd need a biopsy or fibroscan for that. Or an mri with elastography. 97wrongggggff.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: You said if it can tell the difference. Measure is another thing. Ultrasound can tell the difference between a fatty liver and a highly fibrotic one/cirrhotic. But yeah, it can't measure the amount. Unless you do an ultrasound fibroscan. In that case. Ultrasound can measure the amount . ### Response: You can have an ultrasound that just shows fat and that liver can definitely be a cirrhotic liver even if the ultrasound doesnt call it. Thats my point..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My sebum creatinine level is 5.7 and I want to reduce it by following a renal diet. Is it possible?I am 23F, 55kgs and 5'1. I had high creatinine level of 17, then went through dialysis for 2 sessions and reduced it to 5.7. I do not want to go through dialysis again as it made me feel very weak and made me vomit blood and feel sick. Instead of dialysis, I want to follow the renal low protein diet and take my meds (ketosteril, iron supplements because of my low haemoglobin and antacids). Is it possible to reduce creatinine by this margin without dialysis?. ### Response: I suspect the answer is no, but it's a better question for your kidney doctor. My understanding is that the renal diet won't restore renal function, but reduces the amount of things that don't dialyze well (certain dietary proteins, phosphorus, etc). If you have been started on dialysis I suspect that your kidneys have failed. Your kidney doctor is the one tell give you prognosis if there is a chance of you regaining kidney function or if dialysis would be a long-term thing.I would strongly caution against trying this on your own or skipping dialysis sessions without first discussing with your kidney doctor. It's very possible that dialysis is literally keeping you alive.I'm sorry but this needs more info..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm willing to give any info. What should I add?. ### Response: I'd add the history: what doctor did you see, why was your creatinin so high/what was the reason for your kidney failure, did they tell you doing dialysis twice was enough? This post is very confusing.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Would bladder or ovaries be checked on a CT scan for renal stones?A few months ago I (24f) was in the ER for gross hematuria and the doctors there did a CT scan, suspecting renal stones. Nothing showed up, and its now suspected to be related to my endometriosis as its having a cyclic presentation around my period.The doctors also noted a 4 cm ovarian cyst on my right ovary, which makes me think that the CT scan wasnt just focused on the kidneys.Anyway, all this to say: Im pretty sure the gross hematuria is from bladder endometriosis (which my doctors believe it to be), but Im a bit worried its something more serious like a tumor or large cyst. Would my earlier CT scan rule out these possibilities, or should I maybe make an appointment to do more imaging?. ### Response: Would have been seen on the CT..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Potential Renal neoplastyWent to er for massive dehydration and what I thought was a intestinal blockage. That issue resolved itself but during CT scan for blockages, etc, noticed something on my kidney."Indeterminate lesion in the lower pole of the left kidney measuring 1.7 x 1.5 cm. This is suspicious for a possible renal neoplasm. A follow-up non emergent dedicated pre and post-contrast renal CT would be recommended to further evaluate."Not asking for medical advice, going to get it further checked asap, but anyone with experience here - how concerned should I be? It's the weekend and I can't call pcp and I'm trying to keep my wife from panicking, honestly. The er doc seemed fairly concerned.. ### Response: Based on CT results it's literally indeterminate. You need further imaging which will likely happen rather quickly..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: potential kidney/renal issues? or maybe something else?Hi,I really need so advice, I'm 27 male from UK, bmi within range, slim/average build,Over a year ago now I had a dull ache in my right mid back side which radiated down my flank.I saw my Dr who did a urine sample and a ultrasound, both were fine.. a year ago, however the pain has still persisted.I've gone back and forth to the Dr's who are now being quite stubborn and won't do anything else apart from constant urine tests which come back normal, they won't assist or try other avenues.This pain has continued to plague me, sometimes I have zero pain, live normally, and a hour or so later or the next day I could get the pain back which feels like a deep ache, (like I've been kicked in the testes) this hasn't got any better by itself for a year. And now it's starting to worry me as now when the pain happens, I now get a tender testicle on my right side.At first I thought maybe my underwear are a bit tight, so I've spent a lot of time not wearing underwear to give them space, it's made no difference, as soon as that back pain starts it moves down my flank, and eventually in my testicle where the pain can last 1hr to 5hrs and if like magic completely disappears until the next episode which is usually that same day or the next.I dont know where else to turn, I'm considering going private for gp , who could push me back onto the nhs and refer me. Bypassing my nhs gp. I'm starting to be concerned it could be something more serious which is not being detected and could get worse.I just want the pain to go.The pain severity out of 10 can range from a 2, to a 8, it makes me feel nauseated if it's bad.Thanks in advance.. ### Response: Sounds like a ventil stone in the right ureter, can be seen easily with a native CT scan of abdomen/pelvis.The ultrasounds and urine analysis were done to rule out the most common causes which are hydronephrosis and pyelonephritis.A ventil ureter stone doesn't always cause a hydronephrosis to be seen in the ultrasound. And a microhematurie although is present in most cases of urolithiasis but not always.The next logical step is a native CT scan. Book an appointment with your urologist.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you this sounds similar, I will have to ask my Gp as in the UK we can't book direct with specialists, you need a gp to do so if they feel it's necessary.I cant find anything on ventil stones, but have found a lot of info on ureter stones which sounds very similar. Thanks again. ### Response: Ventil stones are rare, i have only 2-3 cases per year. I don't know if the name in english is same as in german, we call them ventil stones because they act as a ventil or imagine as a Gate, the ventil stone moves a bit=blocks urinary tract causing hydronephrosis and massive pain, then a bit later this stone moves again and opens the way so to say and then urine flows normally and hydronephrosis dissappear so pain goes away. The native CT scan can 100% detect it. If you experience fever with the pain you rush to the Er, otherwise go to your gp as you said..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have a secret IUD and need to undergo a non-invasive pelvic ultrasound, will it be detected?Hi! I'm a 22 year old woman who lives in a conservative Muslim society and I need to undergo a pelvic ultrasound to test for PCOS. I secretly got an IUD while living abroad, never thought I would have to move back to my home country so wasn't prepared for this situation. My mother accompanies me wherever I go because I'm never allowed out of the house alone.I recently had my blood checked and the test report includes: levels of FSH, LH, estradiol, progesterone, testosterone, renal function tests, liver function tests and a lipid profile. Can a doctor come to a conclusion about whether I have PCOS based off my hormone levels, or is an ultrasound mandatory?. ### Response: Yes, they will 100% see it on an ultrasound.Often the hormone results are all theyll need for the diagnosis, but in some cases doctors will recommend the ultrasound to get information on the size and appearance of the ovaries. Its possible to decline to get the ultrasound. If you really dont want one, the doctor may be okay with skipping it.Or is there a way you can go to the ultrasound with another family member who you trust to know about the IUD?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Could they slip a written note to the tech or doctor to not verbally mention the IUD in front of mom?. ### Response: In conservative Muslim countries, it's not uncommon for doctors to share information about adult children with their parents. It would not be safe to send this type of note/email and risk it being shared with the parents.Read more here. (Excerpt from "Factors influencing sexual and reproductive health of Muslim women: a systematic review" below)" Unmarried women seemed to be concerned with healthcare providers informing family members about their visits and expressed worries regarding providers sharing information discussed during consultations. For some single women, family members often accompanied them during health visits, making it impossible for them to discuss any issues privately.A study in Egypt revealed that although patient records were stored securely in filing cabinets in the family planning clinics, a number of healthcare providers stated that they allowed family members to view womens health records. In addition to providers lack of respect for confidentiality, another contributing factor is that in the Egyptian family health model, womens medical records are a part of the combined family health records and could be easily accessed by any family member ".


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much for your answer! I was not aware of this!. ### Response: #1. PCOS can be diagnosed by simply having irregular or absent cycles plus excess hair growth. Ultrasound is definitely not necessary. #2. Unfortunately, if a pelvic ultrasound is done the IUD will be quite obvious..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: NAD, but is it possible for you to call your doctor on your own? Explain the situation, I'm not sure if that is feasible where you are or not, but they really do need accurate medical history. ### Response: You don't need an ultrasound to diagnose PCOS. It's clinical history + exam + hormone levels.If you have a hormonal IUD, though, this can affect diagnosis and treatment plan. Hormonal contraceptives are the first line treatment for PCOS, anyway..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: In Australia you wouldn't need it because you already meet criteria. That being said the treatment doesn't really change wether you label it as PCOS or not - it's to go on hormonal contraceptives.. ### Response: In your case, you still don't need the ultrasound tbh. You need clinical OR laboratory signs of hyperandrogenism (in your case, hirsutism) Coupled with absent periods, you have two features. As long as they don't suspect another etiology (which can be tested for via blood), you can be diagnosed..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry to piggyback this comment but just out of curiosity, can PCOS ever be a possible diagnosis even if hormonal blood test results indicate otherwise? I have always some of the physical symptoms (long periods, cystic acne, mild hirsutism), and my consultant gynaecologist diagnosed me with having PCOS after observing that my ovaries were enlarged and pearly during a laparoscopy to excise endometriosis. But bloods I had taken when I was much younger, and further bloods I had taken 2-3 years after this surgery showed that my androgen & testosterone levels were within normal ranges, so my GPs opinion is that I dont have it (regardless of my consultants observations). Ive never quite known what to make of this difference in opinions. Any thoughts?. ### Response: Yes, if hormonal blood tests are normal and there's no obvious signs of hyperandrogenism (in your case, the hirsutism seems subtle), then that's when ultrasound comes into play. Your GYN did a laparascopy and visualized the ovaries directly, which would replace the ultrasound in this case. Also, women with PCOS tend to have skipped or absent periods, not prolonged periods. So, I can see why your GP would be skeptical..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: MRI Renal ResultsAbdominal Wall: Umbilical defect approximately 9mm TRVCan someone explain this to me? Is this a hernia, if so how is this possible?Also originally I received the mri for a renal mass that was first discovered in 2017 of 3.6 cm and on my recent MRI exam is now 1.1 cm? Does this mean it could still be cancerous or most likely benign?. ### Response: Tiny (presumably fat-containing) umbilical hernia which is so common that half the time we don't mention it.Can't conclude anything about the renal lesion without the full description. If it's one complete thing that has decreased in size, then yes it's benign. If there was a 3.6 cm cystic lesion that has gotten smaller but now has suspicious features, that's a different story..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Respiratory rate while sleeping?Age: 26 Gender: Male Weight: 170 lbs Height: 510I do not smoke or drink.Hello! I have been monitoring my sleep with my apple watch and have seen my respiratory rate be pretty low which from what Ive seen isnt good.Occasionally I see it between 10-11 and apparently last night at 9.5?I dont know if you guys can offer if the apple watch is even a good indicator or accurate. Which is why I rather ask yall.Thank you for helping, wishing you the best.. ### Response: That's normal.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much!At what point would you consider it to be abnormal? I obviously have no knowledge other than the vagueness I see which is 12-20.. ### Response: It's more abnormal to be tracking your resp rate while asleep..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 68M Recurrent right sided nosebleeds resistant to treatment followed by respiratory infectionMy dad is a 68 year old Mexican (mestizo) male. At the time of his first nosebleed, he was diagnosed with diabetes, high cholesterol, and prehypertension. He's 5'6" and weights 180 pounds. He rarely drinks and doesn't smoke or use recreational drugs. He's prescribed metformin, insulin, aspirin, and lovastatin but refuses to use the last two. He also has arthritis in his elbows, for which his doctor tells him to use ibuprofen as needed. I don't know his cholesterol levels or A1C.About two weeks ago now, had a nosebleed (limited to the right nostril) for the first time in over 30 years while he was cleaning the garage. We asked him if he accidentally hit himself, scratched his nose, or sneezed but he insisted that it just started out of nowhere. Initially he was able to stop the bleeding but later that same day the bleeding resumed while he was moving some boxes (15-35lbs). We were unable to stop the bleeding and he went to the emergency room where they tried to stop the bleeding with Tranexamic acid and, after that failed, cocaine hydrochloride before ultimately applying an anterior nasal packing. His blood pressure was checked and it was high 143/83 but the doctor said it could be due to the stress of the situation and didn't warrant immediate treatment (side info, he had a heart rate of 85, low 60s seems to be normal for him). He was told to go back in two days to remove it and cauterize the affected area. He was also prescribed cephalexin (I'm assuming to prevent opportunistic infections). Apart from the nosebleed, he seemed fine. He was a little shook from the experience but was feeling good. No other symptoms.Two days later he went to get the nasal packing removed and the doctor determined nothing needed to be cauterized. My dad was told to be careful for a few days and to schedule an appointment with his PCP, which he did. He has that appointment later today. Two days after getting the nasal packing removed, he woke up with a bloody nose that he was unable to stop. He went to the ER again where they ended up cauterizing his nose. He had some minor discomfort from the procedure but was fine otherwise. He was also referred to an ENT doctor and was able to schedule an appointment, but it's a month from now.Since then, he's experienced 1 more severe nosebleeding episode. He went to the ER and got it treated with lidocaine and since his blood pressure was higher 153/89, he was prescribed blood pressure medication (something starting with an an L -- I don't have the documents on hand). He was also given a nose clip and finally had some lab work done (cbc, complete metabolic panel, and prothrombin time test -- those results will probably be discussed today). He's since experienced two minor nosebleeding episodes that have been effectively treated at home. In addition, starting the day his nasal pack was removed he started experiencing symptoms of what appears to be a respiratory infection. This will be explained in the next paragraph.The day my dad got his nasal pack removed, he complained of discomfort in the nose and sinuses. Some discomfort was to be expected but the day after he started developing a sore throat which eventually progressed to a dry cough, headache, coughing fits and nocturnal fever (no thermometer available to record temperature). He went to urgent care which prescribed him prednisone and azithromycin. It's been two days since and there's been no change on his condition on that front. The illness appears to be communicable since my mom started displaying symptoms about 4 days after my dad. It's possible that he caught the bug during Easter since we had a small gathering (<8 people) though no one else was displaying symptoms at the time or has displayed symptoms since. My dad has been tested for both covid and the flu, for which he has tested negative. It's also possible he caught it while seeking treatment for his nosebleed due to the area of treatment but I'm wondering if the two could be interrelated.It's concerning that after having no nosebleed or symptomatic medical issues for so long (other than the diabetes), one would present so abruptly and severely without any physical trauma or changes in medicine or lifestyle habits. My questions would be what would be some of the most likely causes of nosebleeds in someone with his medical history (hypertension seems to be a big one)? His visit with the PCP is today. What would be some good things to bring up or ask about in his upcoming visit that his doctor might overlook but could be important?. ### Response: Hypertension does not cause nosebleeds, not does it prolong them. Except very rarely and dramatically they are not from an artery.The most common cause is actually nosepicking, so grill him more about this. Dry air, a cold, allergies and exposure to dust in his garage are other likely causes. Once you start getting them they tend to persist for a while. He is not on a blood thinner.While waiting for ENT he can use saline nasal spray to keep it moist, use a humidifier at night, and learn how to apply effective pressure to stop the bleeding..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I guess one of the possible causes they explored during his first visit was nosebleed due to hypertensive crisis but yeah, it doesn't seem like the doctors think hypertension was the cause of his nosebleedsThe dust in the garage does seem like a likely culprit considering it had been two years since it had last been cleaned out. It's just alarming that a man that hasn't experienced a nosebleed in decades would suddenly have recurrent nosebleeds but it sounds like it's not too out of the ordinary to experience them in succession like that, so that's reassuringI'm sure his PCP will grill him about picking or rubbing his nose since he has a habit of doing that, though one would hope he'd be following the doctors' instructions to not touch the area after the first nosebleedWe'll get him a humidifier. Hopefully his visit with the PCP will provide answers or more specific questions. ### Response: It's usually from irritation in an area called Kiesselbach's plexus in the front of the nose. The ENT can cauterize this, usually helps. Noses bleed, it is very rarely a sign of cancer or hematologic disease.Rarely the sinus packing can cause a sinus infection. His symptoms sound more like a viral URI with the dry cough and sore throat plus infecting your mother..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Myasthenia gravis and respiratory infectionHi my first language is not english so please excuse any mistakes. I (24f) have Myasthenia gravis and even though I take several immunosuppressants such as Prednisolon, Azathioprin and weekly Efgartigimod alfa infusions my symptoms are quite severe.I had multiple myasthenic crises the last few months. The last time I was in the hospital was this January because my symptoms worsened due to a covid infection and I was treated with intravenous immunoglobulins and nirmatrelvir/ritonavir. I was released 10 days ago.Two days ago I started to notice that I have symptoms of a respiratory infection (coughing, runny nose, sore throat, breathing is difficult and so on) and the symptoms of my MG worsened too. I am really afraid to call my doctors because they work at the hospital and when my symptoms get worse they admit me to the hospital. I can't stand hospitals anymore. I had several plasmapheresises, was intubated, had a feeding tube, a thymectomy and so on. I am very thankful for all their efforts and they saved my life several times but everything in me has the urge to be as far away from the hospital as possible...Do you think I should be admitted again or is there any possible solution to treat this at home? And if I contact my doctors would it be irresponsible of them to treat me at home?. ### Response: Sorry, but I dont think your question can be answered over the internet. The decision to treat for an MG flair requires a thorough physical exam. It may be worthwhile to note that MG can be very difficult to treat, and its reasonable for your doctor to be conservative and bring you into the hospital. If left untreated it can be rapidly fatal, especially if youre at home..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: (26F) If a breathing pattern disorder is corrected (respiratory alkalosis/chronic hyperventilation), how long does it take for serum bicarbonate to return to normal levels?I developed chronic hyperventilation due to tachycardia. Sustained low CO2 dropped my bicarbonate levels. My heart rate is now under control and breathing pattern disorder in the process of being corrected. How long can I expect it to take for my bicarbonate levels to return to a normal range?. ### Response: Bicarbonate levels will usually normalise within days once CO2 levels are corrected. The kidneys are very good at what they do - I wouldnt worry too much about your bicarb levels if all else is well/improving..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Viral respiratory infection fever not getting better.22M, 5'10, 157 lbs, no drug use, no known health conditions or allergies. I got sick early in the morning on January 7th around 1 AM or so. Instantly got hit with fever, cough, sore throat, headache. Jan 9th I developed severe ear pain and pressure as well as ringing and echoing. NP looked and said it was an ear infection and prescribed amoxicillin. On January 7th my fever peaked at around 101.5-102. I took Tylenol to reduce it and it worked well. On the days after that my fever fluctuates from around 99.5 F to 100.5-101 F. It hasn't gone down from there. Doctor's office didn't detect fever today but they were using a forehead thermometer. At home my thermometer once again showed 99.5 which has now increased to 101 in the evening. My oxygen levels, HR, and BP were all fine. I cough a lot with mucus and sometimes it hurts but nothing crazy. Should I be worried? How long does fever typically last and when should I seek out help? I took a covid test today and should be getting results tomorrow as well.. ### Response: That's fine. Nothing to worry about.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: M19 70 kg . Possible influenza but no respiratory problems.Hi . So my sister got influenza, and got diagnosed. And then I got the fever and the dizziness.So here are my concerns. I a barely coughing (I had like 10 painful coughs the whole day) but other than that I am breathing fine. I am feeling kind of itchyich in my trachea but nothing more.I am also concerned by my dizziness that comes and goes for 5 seconds.Thoughts?. ### Response: Im not sure I follow your question. Influenza has a spectrum of symptoms. Sounds like you have influenza..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How do you clinically distinguish a Viral Upper Respiratory Tract Illness from a Bacterial one?Medical student here, year 2Well I've been reading about respiratory pathogens and found out that while viruses are the most common cause for these, bacterial infections can have terrible sequelae when not treated (RHD), so how does a doctor clinically determine if the person presenting to them has Viral or bacterial infection so that right measures can be taken?I'm assuming throat swabs for every single person wouldn't be very economical and just or would they be?. ### 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.Streptococcal pharyngitis is a fairly distinct clinical syndrome compared to a garden variety viral respiratory infection. Classically, the symptoms are severe sore throat and fever, and the signs are exudative tonsillitis and tender anterior cervical lymphadenopathy. While sore throat is common in viral infection, exudative tonsillitis is less so, and viral syndromes are often accompanied by cough and coryza, which strep infections do not produce.These distinctions are codified in the Modified Centor Criteria, which can give you a pretest probability for the presence of strep throat, and guide your testing and treatment decisions. Here is a link to a calculator that can help you.https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitisBacterial infections of the respiratory tract typically refer to pharyngitis, tracheitis, sinusitis, or pneumonia depending where along the tract you are worried about. Each will have their own physical exam findings, risk factors and severity that over time, you learn to distinguish.Since you're mentioning throat swabs, testing for EBV, flu, RSV, COVID, or Group A Strep can quickly be done with rapid point-of-care testing if they have risk factors (we can use clinical decision making tools like Centor criteria to help us as well)..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Are there these associations like, if pharyngitis is bacterial in etiology the person most likely presents with fever, while viruses produce a runny nose, are any such associations there and are these correct?. ### Response: Not that simple. Viral infections can also cause fever. Runny nose tends to be more viral than bacterial..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: M25 215lb viral respiratory infection and low body tempHello Im M25 and weigh 215 lb. I have been recently (yesterday)diagnosed with a viral respiratory infection and have been experiencing mostly coughing (for a week) and sinus drainage; however, my body temperature has remained consistently lower than normal. Im typically at 98.6 F but Im currently approximately at 96.4. Im using a thermometer under my tongue. Is this drop in body temperature normal?. ### Response: This does not sound concerning. Try a blanket..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your comment. What worries me is that Im wearing a jacket and am using a blanket in bed right now.. ### Response: Throw away your thermometer for an easier life..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can you get an outer ear infection from upper respiratory illness?~2.5 weeks ago I caught a mild illness  sore throat with swollen lymph nodes on left side only. Negative COVID tests.My left ear felt a little clogged afterwards but seemed to be improving.Yesterday, it rebelled. Lots of pain inside, worse today. Jaws a bit sore too and sometimes the pain spikes when I turn my head left.Diagnosed with outer ear infection, prescribed Ciprodex drops.After curiously reading up on it (only had an inner & middle one before), Im feeling confused and wondering if this makes sense.- How does a throat illness/infection end up in your outer ear? Are they unrelated?- Can you get an outer ear infection if your ear hasnt been wet recently?- If it isnt an outer ear infection, will the drops still work?Most of what I read talked about swimmers ear and there being water involved, but embarrassingly between the illness and some other stuff I havent showered in like 2 weeks so it's been dry.I've had past vestibular issues so am extra concerned about addressing this right/quickly so it doesn't start causing other trouble.Thanks!. ### Response: This is a common thing that gets referred to me, and as an ENT this issue slowly kills me inside. Differentiating between an outer and middle ear infection should be quite simple.If you can answer yes to the following questions, then you may have an outer ear infection (aka otitis externa):Is there white/yellow/brown/red stuff draining from my ear?Does the physical ear hurt when I pull on it or press on it?Did it hurt when they stuck the otoscope in my ear canal (more than it may usually if you have sensitive ears)?When they examined the ear, did they see redness, inflammation, drainage in the ear canal itself?If no, then you don't have an external ear infection.If you have a middle ear infection and they gave you drops, the only time this is useful is if you have a hole in your eardrum, and this will often also lead to drainage from the ear.A middle ear infection can be quite painful as well, but you shouldn't be able to really touch the pain in the same way.What is very common post-cold and what you may likely have is Eustachian tube dysfunction. This can result in fluid in the middle ear space, but doesn't necessarily mean an infection. This is treated from the nose side with either short course afrin, sudafed, oral steroid (low dose, short course), Flonase, saline irrigations, or any combination of the above.This all comes with the obvious caveat that I have not examined you and cannot specifically comment on your case or rule out an otitis externa, otitis media, or whatever else..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: can cutting off sugar cure an upper respiratory infection?20F, 5'4, 116 lbs., do not drink, do not smoke/drink/use drugs, USAI got sick around October 29, 2022, after going to the doctor, I was prescribed a 10-day antibiotic dose that was finished around November 11. Although my harsh symptoms were gone afterward, such as tiredness, body ache, and congestion, all of a sudden after the antibiotics I got this harsh cough that was productive with green mucus. The cough was not a dry cough like I had before/during my antibiotics but rather came from my chest and is very loud. I have trouble breathing with this cough. Knowing its been around 40 days and I haven't stopped coughing so much so my back is killing me from the constant coughing, 4 days ago I went to the doctor. He basically told me to cut off sugar from my diet, no junk food, and eat only vegetables and soup for 20 days and I should feel better. (I was a little confused about this suggestion because he never asked about my diet beforehand, previously, I didn't eat junk food every day and I include veggies and fruit in almost every meal. I am quite active and have been consistently healthy.) I was not prescribed anything that can help my mucus but was prescribed cough syrup and an inhaler.I am not sure if a change in diet is a solution and I'm wondering if I should ask for a chest x-ray because I have difficulty breathing.Also this doctor didn't even check my breathing until I had asked him to. He said my lungs sounded fine but did hear mucus in my bronchi.Side note: after finishing my antibiotics I took probiotic pills and drank kombucha, could that have caused this?. ### Response: Generally speaking, eating less sugar and increasing plant-based food is a good thing for your health; but you shouldnt expect this change to make any real difference with an acute infection. I expect in 20 days youre going to feel a lot better regardless of a change in your diet..