Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Flu-like ache but definitely not the flu. Could it be linked to a nutritional deficiency?32 F.Height 5' 11. Weight 145lbs.Vegan diet, health-conscious, mildly-moderately active.I've basically had fatigue and consistent mild pain since I was a teenager (my doctor put it down to depression). But this has continued into adulthood and I'm becoming determined to get to the bottom of it.But for the past couple of weeks I've been having this really weird sensation of a deep ache and tightness throughout my body, like it's in my bones and my joints. The closest thing I can describe it as is that it's similar to when you have body aches with the flu, but not nearly that bad. It's quite mild, but I feel like I can feel it throughout my chest/back/ribs, in my arms and hands, and occasionally in my legs. It's not debilitating, it's just weird and a little uncomfortable. It's not consistent either, it sort of comes in little waves/pulses. I get a deep pain in my leg bones sometimes when the weather is very hot or very cold, and it's a similar ache to that but again not as severe, just a similar 'deep'ness.Have you heard of this before?!I'm looking into getting some tests done to see if I have a chronic deficiency. Last time I was tested I was told I don't have anaemia, but I'm also interested in vitamin B12 and D deficiencies. Also considering getting the genetic sequencing test to look for MTHFR mutation, because from my own research it seems that a lot of my symptoms link up with this.Is there anything else I should get tested for?I typically eat a very healthy, balanced diet. I get plenty of protein, supplement with a good quality B12, take vitamin D drops in winter, occasionally take Floradix for iron if I know I haven't eaten much iron that day. Occasionally I take K2 and hemp seed oil for omega 3-6-9.. ### Response: With vague non-specific body aches like that, a doctor can help elucidate a more thorough and specific history and exam. Not sure how long ago the last set of labs were and what exactly the hemoglobin and MCV values were, Id start with repeating routine labs like CBC and CMP, maybe a CK to check for muscle breakdown. TSH and vitamin D levels would not be unreasonable. The presence or lack of anemia on repeat testing can guide whether or not a B12 or homocysteine should be checked. Not sure why one would bypass these cheaper and possibly indicated tests for an expensive test for a gene variant that wouldnt change management without starting with routine labs and going from there.If one were truly concerned about malabsorption from diet, then consider celiacs testing and ruling out IBD if there are other GI issues..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nutritional Advice needed/AlcoholismThis is kinda a weird one, and I'm not sure if it belongs here or some more niche subreddit.I am 25 years old, an alcoholic, I drink approximately 300mL of vodka every day or every other day. I have generally healthy eating habits, avoid pasta, carbs, eat primarily meat, vegetables, kefir, cottage cheese, low carb wraps, etc.. I do not drink anything containing sugar barring clear liquors. I have a family history of high blood pressure, which mine is manageable and better than most of my family. I think all things considered, barring my weight and alcoholism, I am relatively healthy, although I know I won't be forever with some of my habits.Through my insurance, I get gym memberships to basically everywhere for free, and just learned about this, and have been taking advantage of it. I'm not used to prolonged goal-oriented activity, and haven't been since maybe highschool track and field, though I went to the gym in college as well to a lesser degree. I didn't get a car until last year, and my exercise then consisted of a two mile commute by foot to work. I have hovered around the same weight for a long time, about three years maybe.I understand that alcohol has caloric content, which may impede my physical development as well as eat into my daily intake calorically.My big questions are as follows: Does it [alcohol] impede muscle recovery to your knowledge?If I exercise when I still hurt from a prior day's exercise, is that a bad thing? I want to go to the gym literally every available bit of off time I can spare, but I know overdoing things can cause bad effects depending on what they are. I'm not like, in agony, just tight in my legs and other places.I want to work on my alcoholism, but I've been very focused on dieting and exercise lately, and working in a pushy sales job during the holiday season means I got a lot on my plate in addition to those and I can't just fix everything at once I guess.. ### Response: This question is the quintessential rearranging deck chairs on the Titanic. Instead of dealing with the alcoholism you quibble over other issues.Please find a drug and alcohol therapist, preferably someone who specializes in motivational enhancement therapy. Having seen a friend in his 40s go through fulminant liver failure from alcohol use, I can attest that it ain't pretty. His liver is still shitty but he's functional, but his brain is toast....


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Kidney stones training nutrition adviceThree weeks ago I've got my first kidney stone experience, and it wasn't pleasant. I just expelled it recently and went back to the hospital to do one more check up and also to give the stone to them in order to determine what kind of stone it is... After the check up they told me the stone went out and I was ok. But apparently I have another small one forming in my other kidney. They said it's small and even if it started moving I'll probably just expel it without any problems or pain, but I need to be careful on not making it grow bigger so I should drink plenty of water. So far so good.Now my problem is; I'm underweight and I've got a sedentary job, and I'm starting an intensive six months program at the gym to build muscle mass. This program include a very strict diet plan and the consumption of protein whey powder and creatine. I read in many forums that protein powder and creatine are not ideal for subjects with kidney stones history. And when I asked the doctor after my check up he just said "doesn't matter what you eat, just drink a lot of water". Now, I'm not an expert, but I do believe that what you eat does matter...I'm asking for advice here because I cannot see a specialist at the moment. I was wondering if taking protein powder and creatine wont have any negative effect on the formation of other stones as long as I drink plenty of water, or if I should avoid them...And if I should avoid them, are there any substitutes I can take?To give some context. I'm male, 32 years old, 187 cm and 69 kilos, never had kidney stones before, never took creatine before, I took some protein whey powder for about 40 days one year ago. I'm not under medications. I don't have any history of diseases.Any advice is really much appreciated.. ### Response: If you can drink enough water, you can consume a bit more protein (not too much more; up to 60-65g is ok. More is not helpful and is wasted, unless you're training for the Olympics) without problems. Generally, taking more creatine won't help....it gets digested, and is no different than any other (much cheaper) protein. The issue is that the amount of water you need to drink to markedly reduce kidney stone formation is a lot...at least 2.5 liters a day. Most people don't manage to make it to 2 liters a day unless they force themselves to drink more water. It helps if you add a bit of flavoring (e.g lemon flavor) to it. Especially if you exercise a lot, you will need to drink even more. How much more? If your urine is totally colorless (not yellow), you're drinking enough. You can do your weight training and eat a bit more protein with no problem, but generally, one will not see any additional muscle increase by eating much more protein (more than 60 g or 65g per day). So eating 100 g of protein per day will not increase your muscle mass, and will increase the risk of kidney stones. All the protein whey powder and creatine are more psychological...you can get the same benefits by eating a couple of extra egg whites per day..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My arms fall asleep daily while sleeping and usually when using armrests in planes. Do I need to consult my physician on this?Hi there. I'm 28F 5'8" 160lbs white, and generally very healthy and active. I have no major medical conditions, good nutrition, don't drink alcohol, workout several times per week (yoga, lifting, indoor climbing). I take hormonal BC to avoid painful periods (been on it for more than a year) and I started taking a long-term antibiotic for a skin issue a week ago (yes I'm aware they interfere).I've noticed that almost every day while sleeping lately, I wake up at some point with some of my fingers numb and prickly up to my entire arm being limp (where it flops around, can't move it, and have to "shake it back to life" so to speak). I remember this happening occasionally as a kid, as well, so it's not a new development. I take several work trips per year that involve flights and I tend to get a similar problem sometimes when using the armrests in planes.I'd say it mostly happens in my right arm (dominant) but I think it happens in the left arm sometimes, as well. I'm a bit alarmed that this seems to be happening so often. I'm guessing my brain wakes me up when this starts to happen so it can't be that long that it happens but I can't be sure, obviously. I'm just concerned that it may at some point cause damage if this keeps happening.I have a memory foam type of mattress, so I'm wondering if a different type of mattress would help? A side sleeping pillow? Maybe it could somehow be nutrition related?Any advice is appreciated, thank you!. ### 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.Most commonly, the sensation of a limb "falling asleep" is from an issue with a peripheral nerve, and not (as is commonly believed) from an issue of blood circulation.Some people (and I am one) are more susceptible to this phenomenon, but it can happen to anyone. When a nerve is compressed, it will stop functioning temporarily.There are places in your body that are more susceptible to this - generally where a nerve is running close to a bone, and where there is little flesh surrounding the nerve that might diffuse the pressure.One nerve that is very susceptible to compression or injury is the ulnar nerve, commonly known as the "funny bone". If you let your arm dangle at your side with the palm facing forward, the "funny bone" is at the back of the elbow, just above and towards the middle of the body from the bony lump you feel behind your elbow.A sudden blow to this area often produces a sudden sting / burning sensation that radiates down to the hand (this event is the reason behind the name "funny bone"). However, prolonged pressure on the area will also produce symptoms, and is the most likely cause of numbness and tingling in the hand and fingers while leaning on the elbow.Typically, the sensation of the pinky and ring fingers is the most affected, as well as the same side of the hand and forearm as those fingers.The solution that I have worked out for myself is simply to avoid leaning on that part of the elbow. Place the forearm on the armrest instead, or lean on the outside of the elbow, not the inside.This is not, of course, the only place that is affected by nerve compressing. Many people, when sleeping, have their arms under their head and / or pillow, or even under their body. Using trial and errors, you can probably find a sleeping position that will minimize the chance your limbs will "fall asleep"..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 2 year old admitted to hospital, unresponsiveLatest update (since coming back to the US after private hospital was unable to treat him in February, and he was having retractions): For future parents that might be in a similar situation and trying to find answers, I thought I would share what we have learned since coming back to the US.While in the hospital, the doctor kept saying he was unconscious because of inflammation. However, as I was trying to gather medical information, his theory at the time was sepsis. He did have a UTI a month or two earlier that we struggled to find antibiotics to treat (although he seemed to respond well and quickly when our pediatrician prescribed Augmentin).Our pediatrician here suspects encephalitis because he was fully up to date on vaccines (including pneumococcal), and the timeline was so fast from a cold to eyes fluttering open but not responding to pain or voices. Hopefully we will never know, because the most likely way to be able to correctly diagnose what happened is that it happens again while in an area with better ability to treat and test.That being said, information that would have been nice to have included a blood culture and a brain scan (according to our pediatrician here). Our pediatrician at the hospital where he was admitted did not have the ability to do either of these, and I still think it was our best option, but I wish I had known that the hospital was so limited because I wish I had at least had the opportunity to consider medical evacuation. I truly believe his pediatrician at the time was doing the best he could, and quite frankly, I still completely believe he saved his life, but I have learned that there are cultural differences. Doctors in some cultures may not be as forthcoming as would be expected in Europe and the US.Although to say, he is fine now. Because of the mystery surrounding the diagnosis in December, we don't really know how likely another similar episode is. However, now he seems like a perfectly healthy, developmental normal, energetic and talkative 2 year old boy! And we have learned to ask A LOT more questions about medical care before moving overseas ;)Update: His primary care just came in. He believes it is a combination of factors. Firstly, he is fighting a virus. Secondly, his glucose level was low and he was dehydrated at admission. He anticipates sending us home maybe tomorrow. For right now, he said he just needs IV nutrition and fluids, and time for his body to kick whatever the virus is that he's fighting.My son, 2 year old male, 12 kg, 85 cm, was admitted to the hospital about 9 hours ago. Our whole family has had a virus. Both he and my daughter received IV nutrition day 36 hours ago. My daughter recovered yesterday almost completely, but my son slept all day. I think it's been several days since he stood on his own. I brought him to the hospital, anticipating needing another round of saline, vitamins, and glucose.As I was transporting him, though, it became apparent that he was even sicker than I realized. He was completely limp, and failed to respond in any way to checking his glucose levels. His eyes would flutter open and sometimes hed briefly make eye contact, but he didn't respond to his name.He has been admitted at least overnight. His glucose and electrolytes were low, as well his leukocytes. One of his liver enzymes was also high (I believe AST...whichever one, it was 42). His urinalysis came back with ammonium urate, mucus, and acetone (according to Google Translate...I am a beginner in the language here, and the doctors and nurses don't speak English, so everything I know is through Google Translate). His O2 was also a little low (94), so he is on oxygen. They have given him glucose and electrolytes and vitamins, as well as an antibiotic.Can anyone explain why he became unresponsive? His BMI was perfectly healthy. I thought fat was able to sustain through sickness like this until able to eat again, and not only that, he had IVs yesterday of vitamins, saline, and glucose. Is he going to be ok? How long is the road to recovery likely going to last? Any theories as to what's going on?I'll also attach a copy of the urinalysis, translated. I don't have a copy of the blood work, though.Edited to add: He has since woken up for brief periods. Maybe 4 hours or so on IVs, he woke up and asked to nurse. He also fought the nurse and doctor while having his nose aspirated... the doctor, nurse, and I all had to hold him. He fell asleep shortly after that, and has not woken up since.. ### Response: There's not nearly enough info to say why he's unresponsive. I know youre stressed and looking for answers but you won't find them here..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can adolescent anorexia have long term effects? Does it have long term effects if it occurs during puberty?26m. No known health conditions. From upstate NY.Ive struggled with my weight my entire life. At birth I was 9lbs. By the time I was 12, I was clocking in around 190 lbs. By the time I was 15, I was well over 200lbs.When I was 15, I had multiple surgeries on my feet. I had arthritis, and flat feet. I had 5 back to back surgeries to correct it. They put me on a ton of pain meds from 15-17. As a result, my appetite was severely suppressed during those 2 years. I remember losing a ton of weight, and people started to notice. I barely ate, due to the low appetite from the pain meds. I remember being 15, and thinking Wow. This was easier than I thought. This led to some pretty terrible choices. Throughout puberty, you probably couldve defined me as a textbook anorexic. I barely ate, and the weight just fell off. I really didnt notice how bad it was until I was 20. I was 20 years old and severely underweight. I was skin and bonesToday, I dont deal with it at all. Im 511 and weigh around 170-175. I dont really check. I eat well, and long distance cycle 3-4 times a week. I do strength training a couple of times a week. Not as much as I should, but I try. I watch what I eat, but definitely consume at least 2000 calories a day. Theres no question about that.But the more and more I read up on this, the more I fear how the prescription pain meds, and anorexia was detrimental to my growth during puberty. Thats such an important time for human beings, and I fear what long term effects my poor decisions caused.Can adolescent anorexia and drug use have detrimental effects during puberty? Maybe Im just paranoid. I fear it stunted my body. I fear I didnt give my body the proper chance to grow and mature. ### Response: Most boys are done growing by 16. You were likely close to your adult height regardless by age 15..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I already take calcium/vitD combination tablets since my anti hormonal treatment started and got worse despite it. I asked my oncologist about vitamin K and she waved it off saying she had never heard of it. So I'd have to look into evidence for that if I want to have mine measured and supplemented I think. Hadn't heard about the combination with vitamine C either. Here they're just like 'oh the calcium and vitamin D don't do enough? Well guess we'll bombard with bisfosfonates then'. ### Response: Possibly. But it can be significantly improved with strength training and good nutrition.It's not clearly wrong. It's a medical fact."Boys tend to show the first physical changes of puberty between the ages of 10 and 16. They tend to grow most quickly between ages 12 and 15. The growth spurt of boys is, on average, about 2 years later than that of girls. By age 16, most boys have stopped growing, but their muscles will continue to develop."https://kidshealth.org/en/parents/growth-13-to-18.html#:~:text=Changes%20in%20Boys&text=They%20tend%20to%20grow%20most,muscles%20will%20continue%20to%20develop.I didn't say ALL boys stop growing at 16.Most resources say 16. Some say 16-18.Most boys are NOT still growing into their 20s.Everybody has anecdotes about somebody they know that grew 4 inches in university. Those are mostly exaggerated, and/or outliers.Your anecdotes about your friends getting taller doesn't change what happens for "most" boys..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: It is just quite frankly wrong, every countries education system and reliable sources all say boys stop growing at about 19-21. ### Response: No, they don't.https://www.google.com/search?q=average+age+boys+stop+growing&oq=average&aqs=chrome.0.69i59j69i57j35i39j0i512l2j0i433i512j0i433i457i512j0i402j0i271l3.1317j0j4&client=ms-android-oneplus-rvo3&sourceid=chrome-mobile&ie=UTF-8#ip=1You can easily see differently by simply googling this.Most resources say 16. Some say 16-18.Most boys do not continue to grow past 19. Some do. Most do not.This is why male growth charts norms plateau at 16-17 years, but weight continues upward.It might be commonly said to be 19-21 in your country's education system, but that's not accurate.If you're able to find a source that says it's typical to keep growing into your 20s, there 100 others that say it's not.This is common pediatric knowledge.You think you're right here, because lay people have told you this while growing up, but it's not medically accurate..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is it unreasonable to try to ask for IV foods, or is this feasible? How else can I stop withering away? Please help.Im not sure what the technical term for IV food is, but here we go:Basic info: Male, white, 33 y.o., 6 foot, down from 190 lbs to 129 lbs. Im in the U.S. and do have insurance.Background info: for the past four years, I have had increasingly bad health issues that doctors cannot diagnose. It started with joints that felt like they were tearing spontaneously and not healing (which makes them to where I have no strength or movement) and it is literally almost every joint in my body. Then it became muscles and other soft tissue that seems to be contracting out of nowhere, and I am losing all range of motion. Then, I have other health issues that pop up and never seem to heal. Examples are erosive gastritis for the past 2 years that wont heal with medicine and prohibits much of what I eat, eyes that were hurt after being outside for 30 minutes and have now made it to where I cannot tolerate light or screens without searing pain, and weird things like that. I have seen so many specialists, and they are all baffled, think something is seriously wrong, but say they cant help. Extensive bloodwork has shown nothing but a TPO antibody, but normal thyroid levels.My main question: with my joint problems, I have not been able to close my jaw for almost a year, which means I havent been able to eat solid food in almost a year. Then, my erosive gastritis limits most high calorie foods from my diet. I stuff my mouth with the foods that I can eat, and if I try really hard, I still struggle to get 1500 cal a day. I have tried everything I personally have control over, but it is just not possible to get enough, and my nutrients are low and making it to where I can hardly stay awake. I have asked doctors if there would be any way that I could get IV food so I can get enough nutrition to, at the bare minimum, not keep getting worse and worse. Ideally, I would be able to get enough to gain weight so I can maybe improve my muscle mass. However, I mentioned this to a doctor and was laughed at like it was the dumbest question on earth. When I say laughed at, he literally said oh my god and rolled his eyes.Is this a crazy request? Is this a feasible option? If you have ANY suggestions, please help. I hate to sound dramatic, but my entire family thinks Im dying, and I feel Im on my way there as well. My stomach and colon have been torn up from all the medicines that have been tried, and I am all out of ideas.. ### Response: If you cant tolerate enough oral intake for nutrition then an appropriate next step would be consideration for a feeding tube of some sort. Either into your stomach or small intestine.IV nutrition is inferior and prone to a lot of problems (also super expensive and hard to get insurance approval). Its not typically used unless you absolutely cant use the intestines for one reason or another..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Before they would consider IV nutrition, they would exhaust all the other ways of feeding you.IV nutrition comes with significant risks. If there is zero other way to tolerate food, it's better than starvation, but putting things in your intestines for nutrition is the safest and best in most situations. ### Response: I also agree. You are not a candidate for IV nutrition. So presumably a gastroenterologist diagnosed you with erosive gastritis after an endoscopy? What was the treatment plan for that diagnosis?Putting this all together: unhealing joint injuries, muscles contracting, light intolerance, stomach and colon torn up, and extensive normal testing raises the possibility of a somatic symptom disorder..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes, I was diagnosed with an endoscopy, and I believe there were erosions in 3 places. At first I was on sucralfate 3x daily, Pantaprazole 1x daily, and dicyclomine 3x daily. That hasnt worked, so Im now on Pantaprazole 2x daily, sucralfate as needed, and dicyclomine 1x daily. That might change, however, as I have sought out a new gastro after the last one dismissed me passing a lot of blood in my stool and colon pain (likely from a large amount of antibiotics I had been prescribed).My symptoms have been strange, and I dont at all understand them. On MRIs they have seen torn ligaments, but there were no reasons for it to be torn; they have seen inflammation in my eyes, but there was no reason for it to be inflamed; and they can feel the popping/tightened muscles and described them as being constantly kicked on. But, the bloodwork comes back fine; the silver lining is that maybe Ill get something named after me?. ### Response: There's a lot that remains unanswered so it's hard to say anything with certainty. I agree with my colleague - IV nutrition is reserved for people with no gut, or a biologically nonfunctional gut.However, if erosive gastritis is the issue preventing you from eating, and you have lost that much weight in 6-12 months, you may be a candidate for a feeding tube placed in your small intestine, past the level of your stomach.I don't understand why the gastritis has been this refractory to treatment (it is usually fairly simple to treat). In general the answer would be fixing the stomach problem. But a feeding tube could be used here while trying to solve the medical issues..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: can i still grow taller? (16f)it's my biggest insecurity to the point i feel like taking my life over it, i know it sounds like i'm exaggerating but it's just been so bad for the last few years. i don't even want to leave the house over it most times.i'm 16, 5"2, 40kg. i had a really bad eating disorder for the last few years and i'm barely eating 600/700 calories a day. i know this is making me malnourished and probably is a reason why i didn't grow that much. but i will put in the effort to recover if it means i'll grow taller. my parents are 5"0 and 5"9. i want to be at least 5"4 which is only two inches but it seems impossible. i just really want to know if i can grow still because it's eating me up alive.. ### Response: 5'2" is an extremely normal height. I'm sorry to hear about your eating disorder but you're a completely normal height.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Any fitness/wellness tips for a 29F, 4'11'', 177 pound jogger?I recently started jogging. I'm up to jogging 2 miles on a treadmill slowly and consistently at 3.5 mph speed. Did it the other day, did it again today. I'm strength training a bit, too.. I can plank for 70 seconds. I'm doing about 65 pounds on 5 rep X 5 set chest press machine routine. I can lat pull down over 100 pounds, and I can shoulder press 55 pounds on the 5 X 5's. I lost 25 pounds in the last year, but it is going so slowly. I bought a scale, and now when I look often, I just feel like I have plateaued. Any tips? Am I doing the right thing here with my routine? Will I ever lose more weight? I JUST now am getting down from stage 2 to stage 1 obesity, almost. Is there something that's supposed to be happening at this point? My blood sugar is now normal, although cholesterol was a bit high at my yearly checkup for the second year in a row.. ### Response: Plateaus are common in weight loss. It'll pass with time. Keep track of nutrition, continue exercise. Look at the positives. You're down 25lbs and are increasing your activity in a meaningful way..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Blood work off after MTX. Should I hold the next dose until Rheum consult?30F non-smoker 147 lb 5ft 2in tall, years long history of rheumatoid symptoms and indicative blood work. My degree is in clinical nutrition which means unfortunately I understand the basics of my blood work but am not sure what to do with it. My rheumatologist is out for a week.After 7 weeks of 10 mg oral methotrexate weekly with absolutely no contraindicated medications (sulfa, alcohol, etc) my blood work has come back. I'm just hoping for clarification on if these results are expected with methotrexate, or if I may want to hold a dose until Rheumatology is back in office next week.Creatinine has dropped to 0.51 and was 0.70 prior to treatment. BUN has risen to 24 and was 17 prior to treatment. CRP at 1.4, was 1.3 prior to treatment.If I can ask for any input just to ease my mind, I'd really appreciate it!. ### Response: I would not worry about these labs. They are inconsequentially different from prior.For your information - Creatinine is a measure of how well the kidneys are working. We worry more about kidney injury when it is high. BUN is not as specific and should be interpreted in the context of your creatinine. Your CRP is basically unchanged.Your rheumatologist would likely go more based off your symptoms in adjusting your meds, they are probably monitoring side effects of methotrexate so looking at blood counts for signs of low counts and liver function tests. Methotrexate is cleared through the kidneys so if there was a major change in your creatinine it may prompt a dose change. CRP and ESR are inflammatory markers that will be trended.Hope this helps!.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nutritional RecommendationsHi, are there any nutritional recommendations for cancer patients? As a caregiver, I am specifically looking into any protein powders to help my dad fight weight loss. Thank you.. ### Response: There are multiple factors that go into creating a nutritional plan, ranging from lab values such as kidney function, to muscle mass, desire to eat, ability to eat, etc. Id recommend speaking with a nutritionist as they are typically even more knowledgeable than physicians for nutritional advice. It should be covered under palliative/supportive care for the cancer. Youll want to consult them anyway depending on the state your dad is in physically as this point to ensure he doesnt have any nutritional deficiencies specific to the cancer he is fighting (e.g. GI cancers scan affect absorption of vitamins, minerals, fats, etc).Realistically if youre just looking for a caloric supplement, any of a number of protein drinks, such as ensure, will work. It will really come down to whether hes willing to drink them, find a flavor or brand he can tolerate and dont be afraid to switch it up for variety.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Failure to thrive, possible causes to consider?Kiddo born last week of October 2022 at 39+1 (vaginal birth via induction) weighed 5lb 9 oz, looked quite small for the weight and had short, withered looking legs and a disproportionately small butt. At 5 months, weighted 12lb 5.5 oz. Has consistently been 0.5 percentile although recently scraped up tp 0.6. Legs have filled out and lengthened, butt is more or a normal size. kid has been hitting motor and social developmentsl markers very well, but is deemed failure to thrive. Baby is breastfed, milk supply not the problem. Bottle is offered after every nursing, but not forced by parents, as this leads to vomiting.Mother 42 at delivery, pregnancy the result of IVF with a PG tested embryo. IUGR was first diagnosed in the second trimester, amnio and weekly placenta monitoring followed. Amnio revealed a microdeletion of unknown significance on 6p which was at length deemed unlikely to be the cause of anything by maternal fetal medicine genetic specialists - even before testing revealed the microdeletion to be inherited from the father, who has no disadvantages or disability.Mother contracted Covid in the early/mid second trimester, was fully vaccinated and fully recovered in 1-2 weeks. Mother struggled to eat during the pregnancy and after birth weighed 10lb less than she had when the embryo was transferred. Mother took diclegis, tums and omeprazole daily throughout the pregnancy to manage nausea. Mother had a UTI from week 10-20 that took 3 treatments to clear. Both the covid and the nausea were dismissed as a cause of the IUGR by both the OB and the Maternal Fetal Medicine Doctors.Currently waiting on a referral to genetics at a local hospital to investigate the possibility of skeletal dysplasia. The only visible symptom for dwarfism is a very, very slightly protruding forehead. Head circumference has always been in the 50th perventile despite the little body.So.What could be causing this, or have caused it? The final opinion from the Doctors at the MFM clinic was "Hes just a little guy." For the sake of assuaging parental guilt, it would be good to know how likely it is that the inability to eat could have contributed to the problem.. ### Response: If the child is growing along a percentile curve and staying on that curve, technically this is "failure to thrive" (also known as growth faltering) but my concern is generally low. If they're gaining weight at a lower amount than they should be or crossing percentile lines, that's where we really get concerned. How does his weight for length curve look?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for responding!Weight for length curve doesn't look great, even to a layperson like me.I do think the numbers here are can in part be explained by the fact that the legs that were withered and disproportionately short at birth seem a lot more proportionate to overall body length at current time. Based on photos, I would guess that this was a visible change by 6 weeks. IUGR diagnosis was asymmetric, with normal enough head and torso with shorter arms and significantly shorter legs (legs measured for 32 weeks at last growth scan prior to birth).So ... leg length caught up a little, but weight did not rise at the same rate.WHO Boys 0-2 Percentile goes:43 at birth1.9 at 1 months3.3 at 2 months1.8 at 3 months0.96 at 4 monthsCDC Boys 0-36 months Percentile goes:60 at birth2.5 at 1 months3.4 at 2 months2.2 at 3 months1.2 at 4 months. ### Response: These percentiles that you record here are for weight-for-length? Then yes, I'd agree that this needs to be worked up further.Given that all this has been post birth, this isn't from any kind of nutritional deficiency during pregnancy.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I [22F] am prediabetic and prehypertensive and my doctor hasn't been helpfulHi all! I am looking for some guidance here. The stats I provide are also from a DEXA scan I did just this week as a participant in a longitudinal study on my campus:22F;166.4 lb;5'8";27.7% body fat;54.95 kg muscle mass (the form says "muscle mass" and idk if that's just lean body mass or muscle mass);1.055 g/cm3 bone density.Doing the DEXA scan and talking through it with the researchers was helpful because it put my weight into better perspective than just comparing it to my BMI.Summer 2021, I went for my first physical assessment living in the US and here were blood results:my A1c came back at 5.7;lipid panel all borderline high at 206mg/dL for cholesterol, 124 for LDL, 76 for HDL, but 62 for triglyceride;my blood pressure is consistently around 120s/80, including this week;my pulse is consistently in the 50s bpm, including this week at 55;I have mild anemia and take 65mg of iron daily. Over the past year my iron levels are back in normal range.I know of a family history of anemia, hypertension (my maternal uncle was also diagnosed in his 20s despite being seemingly physically healthy) and high cholesterol, but have no idea about diabetes.I freaked out at the blood work, and bombarded my doctor with questions including if I needed medication or if I should start monitoring my blood glucose. He gave the vaguest answers, saying there's no need for medication or monitoring at this time, just that I should change my diet and listed generic things I should eat that included a lot of tubers (huh?). I started monitoring my blood glucose anyway and scavenged reddit to learn what others do, but fell into a depression last year and only started picking up my discipline regarding my eating last December. I'd still been exercising throughout, though.I have a history of challenges with disordered eating behaviors and I have been working to address that and making good strides to recognize my triggers. I was overweight all my life and never learned what balanced nutrition or good regular activity looked like. I've been figuring that out for myself at college. For the past 4 years, I have been exercising pretty consistently 3-4 times/week for 45-60mins. I walk a lot, and have in the past six months increased cooking for myself to increase the protein (really just chicken, lentils, and beans lol) and green vegetables on my plate. I have been substituting rice with green banana (I don't really eat Western food) and have been successful at learning how to intuitively eat as a part of addressing my disordered eating habits.I am confident I can continue to improve my wellness habits, but need guidance on addressing my pre diabetes and prehypertension. I am awaiting bloodwork from the study at my school in a few days to see where my A1c and lipid panel's are nearly two years later. But I don't want to develop full blown diabetes and hypertension if there are things I can do now in the "pre" ranges to nip them in the bud.I have scheduled another physical assessment w my primary doctor in two weeks, where we will repeat those tests. I want to advocate better for myself given his last feedback. Should I ask to be put on metformin? What should I continue to do about being pre-hypertensive?I don't want to ignore my issues and don't want to be hard on myself about them either. I just want to know what I should do to live better and keep myself as well as possible. Thanks!. ### Response: Relax.You BP 120/80 is normal.. and even the HbA1c is also not at a pre-diabetes level which is usually considered at > 6.0Keep exercising regularly and eat a balanced diet (which you already seem to be doing).. your cholesterol is also something that I would not worry about at this stage..no medical intervention is necessary at this time... lifestyle modification is sufficient..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What do these results mean?24F, 176cm 46kg. I have hypermobile ehlers danlos & likely gastroparesis, my stomach shut down just over a year ago & I rely solely on a nasojejunal tube for nutrition, hydration and medication. I've gained 8kg from my most unwell point, but my weight has been going on a bit slowly & my blood sugars are constantly low despite feeds. I've also had issues on & off with my liver and recurrent kidney and bladder infections.I had an ultrasound followed by an MRI last year, but I didn't see the results until I called the hospital & requested the results a few months ago. It seemed to suggest nutcracker syndrome, which I know can be related to SMAS. But I've also heard MALS? I don't understand the results, and no doctor has ever even told me them, let alone explained them to me.'Ultrasound: The left renal vein was not clearly visualised crossing anterior to the aorta, and the left gonadal vein appeared dilated with reversal of flow heading downwards into the pelvis. The appearances raise the possibility of nutcracker syndrome.MRI: The aortic-SMA angle is somewhat reduced, assessed at between 17 and 30 degrees on the low quality reformatted images (normal range 38 to 65 degrees).'What does this all mean?. ### Response: Basically there isnt enough fat between your superior mesenteric and aorta to prevent the SMA from crushing your left renal vein and duodenum (beginning portion of GI tract). I have attached a nice diagram below.Your BMI is 15 which is waaay underweight. I understand how hard it is for you to gain weight without a functioning GI tract but weight gain can help decompress structures through fat pad support. There are also surgical options but many will have you try to gain weight before offering surgery. Its often a multidisciplinary team approach in treatment. GI or vascular surgery would be most appropriate to consult about options..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you! Is it 'normal' given my weight & general health, or can this be a separate condition/issue entirely? Is it something I need to raise with my gastro even though they've ignored it?. ### Response: Its not normal. Just low weight worsens it. Whoever ordered the imaging should be the one to make the next referral..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pregnant with a pre-existing umbilical hernia. I don't know much yet, and I have questions.Age/sex: 29F | Height: 5ft 0in | Weight: 117 lbs (~105lbs before pregnancy) | Race: whiteI am 16 weeks pregnant with my first child. I live in the US.Yesterday, I had my 16wk OB appointment. We measured baby's HR at 140bpm, woo! But I have also been referred to a surgeon regarding my umbilical hernia, which, to my knowledge and limited understanding, I got in infancy (my mom watched my bellybutton "pop out" during a screaming fit). Yesterday, before the OB measured baby's HR, I told her about my "outtie" belly button and how it's already doubled in size since pregnancy; also about a day last week when I scraped a bathroom stall door against my bellybutton while opening it, which immediately caused sharp, downward shooting pains and overall abdominal discomfort that lasted for the rest of the day. She kind of wrote it off ("bellybuttons sometimes get sensitive during pregnancy"), until I laid down for her to get the heartbeat. She then looked closely at my bellybutton and asked me to do a sit up, then mentioned that she would be referring me to general surgery for an umbilical hernia. I asked her what the medical implications of an umbilical hernia with pregnancy would be, and she just said, "a lot of pain that we can't do anything about."So that was scary, and made me question why even see a surgeon now? Just to confirm it's a hernia? But then I did some googling, and have further confused and worried myself.My consultation with the surgeon isn't for another month, coincidentally the same day as my 20 week ultrasound._________________________________Here's some more info about my experience that might be relevant:-My bellybutton has always been sensitive, even as an adult. It was much bigger as a kid and got smaller as a I grew up, but definitely still an "outtie." When I was a kid, I remember it filling up and getting "hard" when I had gas. I would "pop" it and it would "deflate." That stopped happening by the time I was like 7 y/o.-I have struggled with constipation on and off throughout the years, but I wouldn't say it's generally "severe." I have had occasions when I'd go 4-6 days without a BM where it seemed like nothing helped, but overall, if I pay attention to lifestyle/proper nutrition, I don't go more than 1-2 days without a full BM.-Only today have I noticed a bulging under my bellybutton. And it's only when I lean back far enough so the rest of my belly/organs/fat go down so I can see it. I've never noticed this before, and I assume it's due to the pregnancy.-I've always had a pretty strong core with visible muscle tone and minimal stomach fat._________________________________I would really appreciate any comments/information about what to expect, what possible outcomes are, other experiences, etc. But some of my specific questions are:-Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)-Is it possible to not need surgery at all-- neither during pregnancy nor after?-Will a CT scan be necessary?-Will I inevitably be in a lot of pain?-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)-What, if anything, should I look out for before my consultation that would constitute an emergency?________________________________________I think that's all, I'll edit if I think of something else I should add.Thank you so much in advance!. ### Response: -Does this pretty much guarantee I'll need a C-section delivery? (to avoid the strain of pushing)No, I don't believe so. I'm not ob/gyn but a general surgeon, so I could be wrong on the indications for a c section.-Is it possible to not need surgery at all-- neither during pregnancy nor after?Depends on if you want it fixed, if its causing you pain, etc. Not mandatory in all cases.-Will a CT scan be necessary?No, usually not unless the surgeon is unsure of something, and a CT is contra-indicated in pregnancy.-Will I inevitably be in a lot of pain?No. Some hernias cause pain, others do not.-What would make a surgery necessary while pregnant? (I understand there is also an option of having the hernia surgery at the same time as C-section)Incarceration or strangulation.-What, if anything, should I look out for before my consultation that would constitute an emergency?hard, very painful lump at your belly button that you cannot push back it and it continues to become more and more painful..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Scared about abnormal CBC results, history of anorexia25F, 5'0, ~105lbsHistory of anorexia and childhood asthma (used a nebulizer as a little kid, no need for inhaler/treatment now)Abnormal lab results: https://imgur.com/a/Mcg5s0kI see my PCP every couple of months at her request since I have struggled with a restrictive eating disorder since I was 13. As part of my semi-regular appointments she runs what I think are fairly comprehensive labs (I only included pics of abnormal results but she also runs thyroid, estrogen, etc.). My vitamin B12 is also slightly high (1,316 pg/mL).Im mostly concerned that my absolute lymphocyte count has been steadily declining since last year  when I first started seeing my doctor in March 2022 it was 1.26 L and in March 2023 it was 0.79 L. There are a few other results like hematocrit and mean corpuscular volume that are elevated, but those at least seem to be closer to the reference ranges. I know a small elevation/drop can be normal since were not robots, but the decrease in lymphocyte count seems pretty dramatic.My doctor didnt call/comment on my most recent labs, so I sent her a message online asking about the lymphocyte count. Her response was that a slightly lowered lymphocyte count isnt uncommon/could be due to nutrition and we could recheck at my next appointment. However, Ive actually been doing much better with nutrition since around December 2022 and am at a stable weight with normal thyroid/estrogen levels, so Im not sure that malnutrition would be a likely cause.Ive been waking up slightly sweaty/clammy in the middle of the night, usually a few nights per week. Ive experienced this before to a much greater extent in residential treatment for my eating disorder when I was going through refeeding and experiencing hypermetabolism, but that is definitely not the case now as my weight and food intake are adequate (confirmed by RD).I have a small lump on one side of my neck that my PCP ordered an ultrasound for in November 2022  result was normal enlarged lymph node, no biopsy recommended. It hasnt changed/grown, but I recently noticed another small lump on the other side of my neck. The lymph nodes just under my jawbone feel slightly swollen as of this weekend, but Im not sure whether to chalk that up to stress about this whole thing.Does my doctors suggestion to wait a few months until my next appointment to recheck the lymphocyte/other levels sound reasonable? Im worried that it will keep declining, or that it could signal a larger issue in connection with the other signs/symptoms. Thought about seeking a second opinion with a specialist, but Im having trouble figuring out how that will work with my insurance.Thank you for your time and advice.. ### Response: This isn't at all concerning. I agree with your doctor..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much, that helps me feel less worried about it. I know I'm a not a doctor and my current PCP has been great, but it's hard not to stress out sometimes.Really appreciate the time you and all the other doctors put into helping others out on here!. ### Response: I agree with your doctor's suggestion. This wouldn't concern me..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How long can formula milk be run through an IV without spoiling?6 months old male Continuous feedI asked in r/nursing when milk goes bad and they immediately closed it and said ask a doctor for medical advice so here I am.Our son was in hospital for 5 months on continuous feed 20 hours a day in 4 hour chunks. We've continued that cadence now he's home and he's currently getting 180ml every 4 hours for 20 hours with a 4 hour break, but we now have a student nurse who watches him during the night while she studies. She's feeding him 360ml in 8 hour chunks which we were under the impression would be a bad idea as formula at room temperature for this long would spoil - is that correct?When I Google it it says formula can't be at room temp for longer than 2 hours which would mean he's been fed incorrectly since birth so just looking for a bit of clarity on how long you would run a continuous feed for in hospital before swapping the bags out so that we're not feeding him bad milk.. ### Response: What is the actual material you are feeding? Is it formula, tube feeds or other types of nutrition?Is it going to his stomach via a tube? Or in an IV?Lots of inconsistencies in the post. Regardless best person to ask is the manufacturer of the feeds..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Please forgive my ignorance, this is genuine confusion and not sarcasm or anything like that but I'm really not understanding how anything is relevant behind the time at which formula milk goes bad at room temperature. Whether he's fed 10ml an hour or 1 liter an hour into his stomach or his bowel, the fact would remain that the rate at which milk would spoil at room temperature would be a constant - I'm having difficulty understanding why the answer is not straightforward that 'formula cannot sit unused at room temperature for xyz hours' as an example. Nothing unique to him or his situation would make milk sat at room temperature last longer - at least that I can think of - but if I am being ignorant to something that changes everything then please tell me so I can learn.Right now in my head I'm having trouble getting away from the concept of whether I eat chicken in 2 bites or 17 or whether I put it in a blender or I eat it fried, it would still be unfit for consumption if it were first left out for a period of time. And given that we believe the nurse is doing something we've been told is bad, it wouldn't make sense to ask her because she wouldn't contradict herself. It makes more sense to me to look for a consensus from different professionals.For his feed, that's my bad referring to it as an IV, it's in a bag that hangs up on a pole and is administered slowly over 4 hours at 45ml per hour. We give him 180ml and change the bag every 4 hours. The line runs through a kangaroo thing that pumps it into his bowel through a J port in a button on his chest. Instead of 180ml at 45 per hour for 4 hours the night nurse is feeding him 360ml in the bag over 8 hours at the same rate so just doubling the contents of the bag and leaving the bag at room temperature for 8 hours while it is administered into him. ### Response: It's not milk though is it? It's some type of tube feeding. Look at the bottle, and then look on the company website.For example, Vital AF, a common tube feed formulation used in my hospital can hang unrefrigerated for 48 hours per the company website.https://www.abbottnutrition.com/our-products/vital-af-1_2-cal.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How do you know if you're nutritionally deficient in some way?Male. Late 20s. Non smoker. Non drug user. Non drinker.So I have a fairly basic diet. I eat a reasonably healthy mix of meat veg and fruit every day. But it is basically the same things every day. So unless there is a major health issue as a symptom is there a way to know if there's something else I need to be eating?For example I can't eat fish/ seafood. Is there a symptom that I should mindful of that means I'm missing something from my diet that fish/ seafood would normally provide?. ### 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.True nutritional deficiencies are almost unheard of in modern first-world countries. They are either the result of very restrictive diets, or of medical conditions that cause problems with the absorption of nutrients, such as inflammatory bowel disease or celiac disease, or surgery of the gastrointestinal system, such as bariatric surgery (weight-loss surgery) or removal of parts of the small intestine (usually due to injuries like getting stabbed or shot in the abdomen).As an aside, there is an "epidemic" of vitamin D deficiency currently. I use the quotation marks, as this is a controversial issue. By some measures, up to 60% of people in the United States are "deficient" in vitamin D. However, it is possible that the values that are considered to be sufficient are just wrong. For an interesting discussion of how this came to be you can read this interesting article about the physician who more-or-less singlehandedly creates the modern idea of vitamin D deficiency.https://www.nytimes.com/2018/08/18/business/vitamin-d-michael-holick.htmlIt should be noted that there are studies that associate vitamin D deficiency with worse outcomes of various illnesses, including COVID-19, but that large studies of vitamin D supplementation have never shown any benefits whatsoever.Finally, and to me mysteriously, despite the "epidemic" of vitamin D deficiency, children are oddly spared the effects: vitamin D deficiency in children produces a specific syndrome called rickets, which is very nasty, but somehow, there is essentially no rickets in the United States. The only case I ever saw was a well-meaning but utterly misguided family feeding their newborn infant home-made vegan formula..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can I survive only on smoothies and fruit bowls if I make them nutritionally complete?Alright so heres the deal. Im 20, female, 119 lbs and 54. I was diagnosed with gastroparesis and IBS when I was 16 and Ive been trying to keep my symptoms at bay. However lately Ive struggled a lot with very intense pain after eating and a lot of bloating, especially when I eat at night. Whenever I eat after like 4 I have trouble sleeping because of the pain, that is if I dont throw up immediately afterwards. I started to realize that the problem goes away if I consume smoothies or smoothie bowls instead of my normal meals. I always have oatmeal for breakfast and I usually dont have an issue with it, I do become full super quickly though. I decided to replace my lunch and dinner with one big smoothie. The smoothie contains: -Spinach or kale -About 1.5 cups of fruit -Coconut oil or sugar free peanut butter -Vegan protein powder -Fortified Almond milk -Cauliflower, Celery or other miscellaneous vegetables.The smoothie is either liquid or thick and topped with more fruit, some light granola and extra nut butter. It would be my one meal aside from my daily bowl of oatmeal which is also topped with berries, nut butter and a little bit of honey. Although sometimes I have eggs for breakfast instead.In addition I take a B complex vitamin, omega 3, vitamin D and Iron supplements. I want to know if this is sustainable and something I can do long term, I honestly cannot stand the pain food causes me anymore and I figure liquid food is better than no food. Im treatment resistant and Ive been on medication for both of my conditions, somehow after I started treatment my symptoms got worse so I had to stop. I appreciate any advice you can provide.. ### Response: sure. You can survive on a blended up vegan diet if you want.Just be sure you're hitting reasonable amounts of fat and protein, and supplement B12. Pay attention to your iron intake, may need supplementation too..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Wouldnt talking to a dietitian help or even be a good idea for anyone considering something like this? Or is that not in line with what a dietician would normally advise on?. ### Response: She can if she wants. If she's not familiar with vegan diets, it could be a good idea.The intake of protein, fats and other micros could become a problem. Remember a healthy diet is first, balanced and second, a diet you can stick to..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What does a toddler really need nutritionally?My husband and I have 3 children. We have always had good eaters but my youngest (2 years) is becoming rather picky. I personally believe she is still eating enough and realize this is just a pretty common childhood thing. My poor poor husband is worried sick. I think this man legit thinks she will starve if he doesn't just get her to eat something and often results in caving to more snack foods, making this whole thing worse.To give you an idea of what she is currently eatingBreakfast - a full bowl of Oatmeal, banana, cup of milk. Lunch - about a quarter (plus a few bites more) of a peanut butter and jelly sandwich, bowl of applesauce, cup of water She will snack on some plain animal crackers or cheerios throughout the day Dinner - usually a small bowl of noodles and a cup of milk. Definitely her smallest meal of the day. I usually will still give her a small bowl of ice cream or a slice of pie if we have it. And I'm talking age appropriate portions. All within reason.I realize she's heavy on carbs and in an ideal world we could get more fresh foods in. I think it will all happen in time but this man really is scared for his daughter. Please help me calm him down and let me know if she will survive to adulthood on this pretty standard kids diet?. ### Response: She'll be just fine. Toddlers are often snackers, and they get in a lot more calories than you'd think through this. As long as she's growing, I wouldn't be too concerned. You can always bring her in and discuss further with her pediatrician if you think your husband needs to hear it directly from them..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I (f21) have been losing my hair and I think its a nutritional issueMy hair used to be super thick when I was younger. As I got older, I would shed like crazy. Id be in the shower and pull out chunks of hair. My part is getting wider and it has mini parts so my big part is shaped like a stitch or spine. What kind of foods could help me grow my hair back, if possible?. ### Response: This post is missing much of the helpful required information for this subreddit and contains no medically-precise information about the distribution of hair loss and medically-precise description of the findings of the scalp examination. Providing an opinion is not possible. Seek dermatology care..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Where to start for a good nutrition deficiency and gastro health testing29 6'1" 200 lbs white male Fatigue last couple of yearsHey everyone. Thanks in advance for any help! I have maxed out my deductible this year for unrelated arm surgery and am looking to make sure I get the most of medical assistance that I have kinda been putting off. For the last couple of years I have felt fairly fatigued and cloudy from day to day and generally held a bit of a fog. I am in great shape physically but my diet is not the best due to very little fruits and vegetables. I was wondering about a good place to start to get a nutrition deficiency test? I would like to do a comprehensive one if possible. This has been something that I have been meaning to check off regardless of if it is the best place to start for concerns around fatigue. I have also noticed frequent black specs that look like coffee grinds in my stool. I got a take home test done with a general physician with negative results. Does this mean I simply do not need to worry about this concern anymore? I was picturing a situation where I might be able to combine the concerns and see a gastro health doctor and have a general look at my overall nutritional picture?On a side note hangovers have been getting really bad for me recently and usually lasting two days.In addition to this, I am open to suggestions on any general medical checkups that would be advised to get an idea of my health prior to the end of the year and having to pay out of pocket next year. Thanks for any help. It is appreciated!. ### Response: Why get a nutrition test when you know the problem already: you need to eat more fruits and vegetables.Why are you still getting hangovers? You're 29 dude. Drink a glass of water between every drink and stop drinking so much that you get hungover. Alcohol is a literal poison. It's fun in moderation, but if you're getting hangovers for days, you aren't drinking in moderation..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nutrition Response Testing21M 165lbs 5'10 I think this is not scientific or accurate but am looking for other opinions. The idea that the body responds differently depending what bottled supplement or substance someone is holding doesn't make sense to me at all. I haven't been able to find any detailed explanation online about the rationale behind this. Still, nutrition response testing is quite widespread and used by many doctors, which is difficult to understand. Do they legitimately believe it works or are they just trying to appeal to more clients/make more money? The fact that Freddie Ulan(founder of nutrition response testing) is a known scientologist is also a red flag to me. My mom is convinced that this works and wants to take me. What are your thoughts?. ### Response: Removed under rule 7. Please do not post pseudoscience/pseudomedicine or other non-medical interventions in this subreddit..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric: Cannabis vs Opiods for pain management?My step-son (13M, 238lbs, 6'3) fractured the growth plate on the back of his ankle today. We were given hydrocodone but he has gotten very agitated/rage-y on painkillers before.Also, there is a history of opioid abuse/addiction on one parent's side and general substance abuse/addiction on the other so we're all very skeptical to give him anything. Two of us parents have used medical marijuana as a replacement for pain medication effectively.Which would be considered the lesser of two evils here? Either way we would mostly be giving it to him once a day to help him sleep.. ### Response: Besides hydrocodone. Is he on any nsaids? (Ibuprofen,naproxen,etc) I assume the hydrocodone is in combo with acetaminophen. Cannabis has and is used for some pain control but it really depends on the legality in your state/country..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes, we are alternating ibuprofen and Tylenol every few hours throughout the day which is why the main concern is him getting some rest at night. Delta 8 and 9 are legal in our state. I'm mainly worried about the whole brain still developing at his age thing.. ### Response: if his pain is bad enough he could get a nerve block with a catheter. would make the pain basically gone and he could keep it pretty numb for 3-5 days till a lot of the inflammation is down.You could try paracetamol and ibuprofen first. If his pain is uncontrolled with that then chat to his doctor about your concerns. Opiates can be entirely appropriate for acute pain. Im not sure of the evidence for cannabis for acute pain, especially in children..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My pediatric urologist wants to put my child under general anasthetics at 6 monthsI am worried about negative impacts this might have on brain development is it possible to have a successful surgery done at 3 years old instead?. ### Response: 3 year old kids get extremely stressed about surgery and will remember both the period before and the pain afterwards. It can be very traumatizing for them.A 6 month old will have no clue what's happening and won't remember.The available evidence suggests that a one off exposure to a general anaesthetic will not have long term implications for neurodevelopment. However your concerns are very valid and you should discuss it further with your paediatrician..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This! When my kid was 6 months old all he needed to feel better was to nurse. At 3 nothing worked!. ### Response: It depends on what surgery your child is having on whether it can be delayed that much. What is it?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Chordee. ### Response: He'll be more uncomfortable after surgery at age 3 than at age 6 mo, but there's really not a solid indication to fix that early. For things like undescended testicles, those should be done sooner..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Was this inappropriate?26M. I recently had a flashback to when I was 15.5 y/o and had regular visits with my pediatric endo. I only have TID, no other autoimmune disorders but my pediatric endo always checked my testicle size during every 3-6 month checkup. Is this appropriate? I'm trying to figure out if this is the norm. ### Response: Most pediatric endocrinologists check the testicles to see the volume and stage sexuality maturity.Endocrinologists also are heavily focused on hormones, so its well within their training to make sure youre testicles were growing appropriately.What's TID? What were you seeing an endocrinologist for?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry, type 1 diabetes. ### Response: Well apparently high sugar levels can damage your testes, so perhaps? Hard to say.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Possible seborrheic dermatitis?Pediatric patient 10M, height 4ft, 80lbs, white/black, healthy and has no medical issues, no meds, etc. I was thinking it was just a serious case of dry scalp as it was starting to peel. He's been itching it quite a bit while at school. I mentioned this to the pediatrician and was told to use selenium sulfide (Head & Shoulders), so that is why the scab appears that greenish/blue color. It is raised pretty high. My concern is if he keeps scratching it could lead to an infection. Does this appear to be seborrheic dermatitis? if not what else could it be? Thank you.. ### Response: 1 marginal quality image. Seborrheic dermatitis could appear this way as could psoriasis, tinea capitis and many other conditions..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks, Doc. It definitely could be tinea capitis. I'll keep treating it with selenium sulfide until my appt with the pediatrician next week.. ### Response: You might consider dampening the scalp, using a salicylic acid shampoo and let it stay in place 5-10 minutes, then rinse it off. This may loosen the scale..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you, Doc. So salicylic acid should work better than selenium sulfide? Selsun Blue and Head and Shoulders have both.Correct, I have been rubbing it in gently and washing it out after 10 minutes.. ### Response: There is no evidence that one active ingredient in these shampoos works better than another for seborrheic dermatitis. I was making a suggestion to help remove the adherent scale..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric neurology help. Sudden onset Anisocoria (1.3mm) in 3 siblingsMy 4.5, 2.5, and 6 week old all have Anisocoria. The first 2 measure 1.3mm difference, the third has not been seen.My 4.5 year old was referred after he didnt pass the vision screen at pediatrician (they turn off lights and the kids look in the box with birds chirping.) My 2.5 year old failed same test and was referred. It is noticeable by naked eye with the 6 week old. The older two have previously passed the eye test in years prior. This is the first appointment for both that they failed.My 4.5 year old went to a pediatric eye doctor and he said he couldnt find any other issues. He said he has seen it come and go in kids and even switch eyes. I cant find anything like that on Google. Nothing about it being genetic. He said 1 in 10,000 chance that its a neurological issue because no other symptoms present. My 2.5 year old will go on 10/20. My 4.5 year old will go for follow up on 10/31.I dont know what other actions to take. It is unsettling this popped up in all of them with no answers.. ### Response: I'm not an opthalmologist, but if three children in the same household developed this as a sudden onset issue in the same time period it seems reasonable to consider an environmental trigger or exposure. New medicines in the house?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My 10 year old had an allergic reaction Sunday night and still has welts. Is it normal for his body to heal like this?My 10 year old son had an allergic reaction while asleep Sunday night and woke up with his trunk covered in welts. He was taken to his pediatrician and prescribed 4mg Dexamethasone, 2 tabs first day and 2 two days after.His only known allergy are peanuts (severe).He is still getting new welt outbreaks and does not seem to be getting better, but physically feels fine minus the itching.Thanks for your help.. ### Response: The most common causes of hives in a pediatric population is actually a viral illness. If you don't think he's having other allergic symptoms, this could be the culprit..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 5.5 Year Old Severe ConstipationTLDR: 5.5 year old is severely constipated, complaining of major stomach pain, trouble swallowing, and nausea. Shes waking up through the night coughing and crying in pain. Doctors are suggesting 5 cap fulls of miralax and 2 ex-lax a day - Im concerned this is not good for her. Thoughts?Hello! I feel like Im new to the constipation world, but weve honestly dealt with it for awhile now without me knowing how bad this is. My daughter is now 5.5 and we are about 5 months into a severe constipation epsiode. Its taken doctors awhile to help figure out how bad this is, but here we are. Shes struggled with constipation on and off ever since she was born (at 4 months old she would pass stool the size of hard boiled eggs), but I didnt know how bad it truly is. She has always pooped once or twice a day for most of her life, its just the consistency and size of the stool that I was ill-informed about. Here is where we are at now: Since November, she has been complaining that as soon as she eats or drinks, her throat feels tight, feels that shes going to throw up, and her stomach hurts so bad. Ive taken her to the ER twice, doctors at least once a week, and have had multiple X-rays. The X-rays consistently show tons of stool. We officially started doing a clean out method about 2.5 weeks ago doing mirilax, milk of magnesia, and ex-lax. Shes been pooping 5 or more times a day, passing lots of ribbon size or huge logs. But her complaints are continuing and shes eating less and less. She is not afraid of pooping and has no problem making it to the bathroom which is good. Weve missed a lot of school (kindergarten) for this and shes only 35 poundsI cant imagine what this is doing to her long term. The X-ray 2 days ago showed that shes still completely backed up right at the exit of her stomach, her stomach isnt digesting her food well, and her stomach is extended. The pediatric GI suggested to do 5 mirilax cap fulls a day and 2 ex-lax still, for up to 3 months. I just dont feel like this is safe for her, how little she is, how little shes eating, and how much pain this is causing her. Im no doctor, which is why Im turning here. Of course the stomach aches are now worse and shes in tears on and off all day. I, personally, have IBS with diarrhea so I have no experience on how to deal with this and asking for all the tips. We have been dairy free for a month, and Im not yet going to try gluten free because I do want her tested. We have only been talking to a pediatric GI on the phone through our regular doctor because her appointment is still a month and a half away (we had to wait almost 2.5 months to get in), so further testing hasnt started yet as to why we are in this mess.. ### Response: I would agree 100% with the pediatric GI given what you say here. Long-term constipation like this causes her bowels to dilate (become larger) at baseline. That distension causes her to have less sensation of when she needs to go. Those nerves in her gut can retrain themselves, but it takes months, so it's important that she get fully cleaned out and stay that way while the retraining happens.If the dairy-free diet is helping, you can continue, but if you don't see a huge difference, it's fine to re-introduce dairy. Most pediatric constipation isn't due to a food intolerance.https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Constipation.aspx.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatrics, please!Hello! Worried Mom here.Patient is 5 years old (almost 6). He weighs 35ish pounds and is in the 90th percentile for height. He is a picky eater, but there has been no loss of appetite.His symptoms are diarrhea. I believe this is from lactose intolerance (his dad has the same issue) because the worst episodes are after he consumes anything that could contain lactose.What I am concerned about are the dark circles beneath his eyes that have developed lately. These two symptoms (diarrhea and the dark circles) pull up neuroblastoma when I Google (I know, no Googling). I had a friend whose child had this so it hits a little closer to home, but I know its rare.He has an appointment Monday. Should I push for tests? Or is it probably just lactose intolerance and allergies/lack of sleep and I am just freaking out as a Mom?I do have health anxiety that is being dealt with by a professional- counselor and medication - but every time my children are sick I always jump to cancer.Thanks for any advice!. ### Response: More concerning that he's not hydrated well, or very tired. Neuroblastoma, just...no. Not up high on the differential at all..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What to expect from a pediatric UTI examFemale Age 5 Weight 42 lbs Symptoms started this morning Occasional burning sensation when urinating Frequent urge to urinate No current medications Exam scheduled for tomorrow morningJust wondering what to expect by the exam. Mostly which areas will be examined and the manner in which it is done. I want to be able to protect my daughter and be able to spot any predatory behaviors.. ### Response: I'm assuming you're asking whether a genital exam will happen. May depend on the physician. Some girls that age will complain of "burning" with urination and not have a UTI, but instead have a yeast infection or vaginal irritation that is causing the symptoms, so I do often do a genital exam unless they have symptoms like fever that make me more certain about a UTI.Genital exam in a prepubescent female would consist of often getting into a frog-leg or "butterfly" position while lying down or sitting back. The doctor may spread the labia majora slightly to get a view of the urethra and assess for redness or discharge. There should be no touching of other structures.If you don't feel safe with your pediatrician, time to find a new doctor. A good doctor should always welcome you asking questions and asking for an explanation before they do an exam..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for the very helpful reply! Im glad you specified what the exam would consist of that was exactly the response I was looking for.Its not so much that I dont feel hes safe or a good doctor, more that I want to be aware. I feel that asking someone involved in the situation with more knowledge than I puts them in a position of power where they could just claim what theyre doing is normal.But again its less the doctor and more about me being suspicious, paranoid, and protective.. ### Response: No problem!.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatric impetigo or something else?Age: 5Weight: 43 lbsRelevant health background: Hes very picky with eating due to some sensory aversions, so he ends up eating a bit of a lopsided diet and barely eats any proteins. He takes multivitamins with iron and no other regular medications. We are in the US, and he is up to date on his vaccines.Maybe relevant maybe not: We live in an area that has brown recluse and black widow spiders. I havent personally seen any. This also began his very first week of Kindergarten. A cough accompanied it, but to be honest my son has a cough 80% of his life.TIMELINESept 2 - My son comes home from Kindergarten and tells me he has a bug bite and his leg hurts. I dont think anything of it, were driving when he tells me this so I dont immediately look.That evening, I see it when giving him a bath. It looks like a bug bite. I put a bandaid on it.Sept 3 - The bug bite is irritating him. Hes scratching at it, I replace the bandaid and give him neosporin.Sept 4 - When I remove the bandaid, the wound has grown considerably. This is the first time I take a photo. Now Im wondering if this was a spider bite. I put some neosporin on and leave it without a bandage Photo: https://imgur.com/a/rB1KJ7BSept 5 - The next day, it looks a bit larger, and with some dots surrounding it. https://imgur.com/a/QdcVImZSept 6 - No change, didnt photographSept 7 - We go to the zoo and he immediately begins complaining about his legs being soooo tired. He was excited to go to the zoo so this was unusual. He whined the whole time and insisted on being carried (hes 5, this is not typical). When we get in the car, he immediately falls asleep. This is important because he had not napped in THREE YEARS. He dropped his naps when he was 2 and never napped since. When we get home, his legs look a lot worse. Not only that, the little bumps around the area have begun popping up all down his back, shoulders, everywhere. https://imgur.com/a/bbCGtFVSept 8 - We visit his pediatrician. He takes one look and diagnosis impetigo. Hes very confident in this. Prescribes topical antibiotic and oral antibiotic for a week. Said he was fine to return to school as long as the wounds werent weeping.Sept 9-16 - The rapid progression stops almost immediately and it begins to heal after about 48 hours on antibiotics. Things are looking good! All my fears of flesh eating bacteria and so on start to go awaySept 21 - Another small sore pops up on the same leg, near his hip. Im immediately suspicious of it, and dont want it to progress, so we go back to the pediatrician the same day.She says it doesnt look anything like the others, and to just keep using the antibiotic ointment, but to add a daily bleach bath (1/4 cup bleach in a tub of water) to help ward off the bacteria living on the skin. She says impetigo is just staph or strep that found its way into a wound and is irritating it, so we just need to keep his skin clean. So we start that.MAYBE RELEVANT - She notes his tonsils are large and does a rapid swab for strep, which is negativeSept 28ish - He has a scrape. Its on the OTHER leg. Hes adamant that he fell and scratched it. We believe him and leave it alone.Oct 1 - Its considerably larger but he also keeps scratching it so were not sure what to think.Oct 2 - We took a walk today and he began complaining that his legs are sooo tired (I cannot stress enough what a hyper boy he is his legs are NOT tired). We go home and that other leg looks IDENTICAL to how the original looked. I go to the urgent care and insist on a skin swab, which they do but since theres no pus, they cannot guarantee accurate results. They prescribe 10 days of Cephalexin but say theyre just not convinced its bacterial. They said it just doesnt look like anything they can readily name.https://imgur.com/a/cObh69dI am worried because it seems to be jumping around his body, made worse by walking/warmth, and hurting his legs more than topical wounds should. I also cant shake that the cough is still there.I also feel dismissed when I repeatedly ask if the cough and exhaustion could be related to his wounds.What do YOU think?. ### Response: Cephalexin is unlikely to be successful at treating a Staphylococcal impetigo. Treating that requires either Bactrim or clindamycin..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: So do you feel it looks/sounds like impetigo? If it is, would the swab they took today tell me what bacteria its originating from?. ### Response: The photos remind me of a bullous impetigo in which the bullae have opened. A culture of the affected skin without fluid from an intact bulla would not show this; the diagnosis is a visual one. Non-bulbous impetigo is Streptococcal, but bullous impetigo is Staphylococcal and one must always treat for MRSA..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: (Almost) 4yo Boy, Many Symptoms, No AnswersBorn 3/2019.Waking up at night from a dead sleep with leg pain for nearly a year now. Happens once or twice a month usually. Right leg more frequently. Chalked up to growing pains. When he wakes up, give him Tylenol, get the heating pad out and wrap his legs. Rub his back and he falls asleep. Seems fine in the morning. Sometimes has complained of pain during the day, but could be a ploy for medicine. Points to his shins, knees, and thighs as sources of pain.Complains of headaches occasionally (I've never even heard the word, "headache" come out of his older brother's mouth). Goes away with Tylenol.Was vomiting a lot last year. I started tracking and the average was 1.5x a month. No fever or other symptoms; would complain of nausea, boot, then be back to normal within an hour. Went to pediatrician on 8/19/22, she recommended we go to the ER because we could get all testing done rapidly and at once. Went to ER, had bloodwork done (normal at the time, no cancer markers), was diagnosed with cyclical vomiting syndrome. Debated on whether to do a CAT scan or MRI, opted to not. Has only vomited 1x since then, was this past October. Not much nausea or vomiting since.Swollen lymph node in armpit and back of neck, both on left side. Just discovered armpit one today. Neck node has been enlarged for over six months. No biopsy, superficial exams by multiple doctors, all advise this is normal and not a concern. Soft, movable, and less than 2cm in size. Hasn't grown.He often just looks pale compared to the rest of the family (we are white, British decent), but could be chalked up to recent rainy weather and being stuck indoors for winter. He also seems thinner than the rest of us, just bonier than his older brother was. Always craves sweets. Weight and height are good, around 70th percentile.I found swelling in the back of his knee four weeks ago. Right posterior, left of the popliteal fossa, about the size of an avocado pit. Puffy, not hard. Took him to the pedi two weeks ago, and she said likely a cyst, but referred me to an orthopedic surgeon for further evaluation. Have appointment this Friday to get it checked (she said probably an ultrasound). She also checked him for a wet cough that he's had for over two months. Said she heard crackling in his lungs, prescribed inhaler, doesn't seem to be helping, will have a follow up next week to check his lungs again. Cough is annoying, but not really impacting day-to-day activities. Still very active and happy kid.Went on a long walk today and he woke up again with knee pain, said only right one hurts. Did the usual late-night treatment and now he's asleep.I am debating on whether to take him to the ER again. Our firstborn was healthy as a horse, never in the ER and sick with typical symptoms. I don't want to be too overzealous with an appointment coming up, but all of these symptoms just have my mom radar screaming there's something really wrong with him. I assume the ortho won't do another blood panel at the time, so it'll be a referral if they find something wrong. I just don't know if I want to keep dragging out discovery appointments for the next few weeks vs. going to the ER and asking for the gamut of tests.Any feedback at all is appreciated. We have a PPO and are financially stable, so cost isn't an issue.. ### Response: I've usually noticed that when your mom radar is screaming, it's better to take your kid to the ER. The symptoms you have mentioned could be due to a viral infection, but I'm still perplexed as to why the doctors decided against the CT or MRI and did they perform abdominal Ultrasound?. Also , cyclic vomiting syndrome can cause dehydration, lethargy , pallor, and muscle weakness. I hope he's taking his fluids well..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: The ER doc and a random physician's assistant both advised against the CT (radiation unnecessary) and MRI (would require sedation) because it would be invasive and likely unnecessary given the results of the blood panel we got this past August. He already had the swollen neck lymph node by that point, but it was dismissed as normal. No one spoke of an abdominal ultrasound at all.He hasn't had a vomiting episode in a while, which I'm grateful for, but he is a very finicky eater. Often says he's not hungry or full, but I try not to stress because his weight and height have been increasing on the right trajectory and he's at the 70th percentile.The tone I perceive from doctors is that I'm overreacting because this is my "baby" and there's nothing wrong with him, but it's just such a stark contrast to his older brother. I think I'm pretty laid back overall as a mom, but this has me questioning myself. Thanks for the two cents.. ### Response: You are welcome. Usually, CVS is triggered by a stressor or a food . Has your pedi advised you to keep a diary to identify it ?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nope, same deal, no mention of keeping a diary. I was essentially told that he'd probably grow out of it, not to worry if he wasnt losing weight. Based on your matrix, I would define it as mild now. He recovers fast and the issues were really confined to early/mid 2022.. ### Response: Maybe he was under some kind of stress at that time , you never know with young kids. But it's good that it's resolved now. The enlarged lymph nodes , in my opinion , need to be investigated, most probably it's due to a viral or bacterial infection, and there's no harm in repeating tests so if antibiotics are needed , they can be given at the right time..


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


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


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


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


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


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