Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Coughing up blood after surgery29M, 150lbs, 57. No medication, no drug use, a drink 1-2x a week.Hello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight.. ### Response: Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you so much! Also, please let me know if you need more details/clarity on his medical history.. ### Response: I'm not a urologist, but I imagine the recommendation was for a transurethral resection of prostate (TURP). Relatively routine from my perspective..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hello, 23f, 56, 48kg, venlafaxine 37.5mg. For the past few years Ive been having microscopic blood in my urine samples with a few clear ones here and there but nothing has ever been done. Another symptom Ive been having for a few years is on and off stinging when burning and multiple urinations during the night despite not drinking anything. I remember even as a little kid though I would pee throughout the night.I have now finally been referred to urology and have a cystoscopy next week and a CT scan at some point. My other symptoms arewaking up with a full bladder in the morning which is painful almost like a period pain which stays for a little while after I pee.Microscopic blood in urine.Cloudy urine sometimesSometimes burning when I peeBelly feels tight most of the time idk if this is what feeling bloated isHaving to stop and start peeing towards the end to empty bladderPain deep in pelvis during sex sometimes, like that tight period pain (dont know if relevant)On top of all this I have agoraphobia and havent left the house on 3 weeks and now I have to go half an hour away for horrible tests so no idea how Im going to get through this. I suffer from severe health anxiety and Ive convinced myself I have cancer and Im spiralling out of control with worry. I dont know if this is relevant but I also had chlamydia 3 times when I was 17 (6 years ago). Im just hoping for some reassurance that not might not be cancer . ### Response: Could be stone issues, urethritis etc. Def not cancer. Go to your urologist appointments!.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you, could I ask why def not cancer? I will try my very hardest to go. ### Response: Too long history, none of your symptoms are signs of cancer and cancer is virtually nonexistent in your age..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: So signs of bladder cancer are: Pain in lower abdomen Pain when urinating Frequent urination during the night Blood in urineAll of these I have? But I do see what youre saying about it being too long history. ### Response: But they are not specific to bladder cancer. In fact, they are some of the most common symptoms there is. Microhematuria for instance, is almost to the point where im more surprised when a random f23 surgical ER patient doesn't have it than when she does. (Macrohematuria is another matter altogether).Health anxiety is difficult, and all I can offer is my perspective that your presentation does not in any way signify cancer..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: [32M] Lung Nodule Time!Age 32Sex MaleHeight 6'0Weight 190lbsRace WhiteDuration of complaint: Just startedLocation: Lower Right LungAny existing relevant medical issues: DepressionCurrent medications: WellbutrinHello, everyone. I know lung nodules are typically nothing, but I can't seem to find a whole lot. And I know wait on my pulmonologist appointment to go over the findings. So naturally I'm freaking out anyway.So last year I had gallbladder surgery so I had a CT scan done. I had another one today for something related to urology and a swollen lymph node (everything fine there) and that's when it was discovered.From my understanding, they compared it to the CT scan from January 2021 to the CT scan today, and it was 1cm then and now it's 2.7cm. I was diagnosed preliminary with a lung nodule that has grown into a cavitary lesion by the primary doctor and he's referring me to a pulmonologist. I currently don't have any symptoms.I know it could be dreaded cancer but is there anything else it could be at that size? Most of what I've found online is people talking about 10mm or less.Thanks for any input. I am just looking for possible alternatives so I can focus on that and can sleep until my appointment.I am 32M. 190 lbs and 6 feet tall. I currently take Wellbutrin for depression. I don't drink, I don't smoke, I don't do any recreational drugs. I had asthma from around age 5 until 21/22 when it went into remission. I had pneumonia once when I was 5.. ### Response: A growing cavitary lesion is most likely to be inflammatory, infectious, or malignant (probably in that order of likelihood for you). There is a long list of possible causes. Something that big likely warrants further investigation, potentially with a biopsy. The pulmonologist will be able to further narrow what the possibilities may be (heavily dependent on where you live and in-depth past medical history)..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you. I'm in Alabama and the pulmonologist will have access to all my past records because I've stuck with the same facility pretty much my entire life. Tomorrow I will continue my good vibes going into this. Your answer helps alleviate a lot of the anxiety - I know how serious this is. I'll update once I know (pulmonary appointment hasn't been established yet). ### Response: Yea. I wouldnt be too stressed about it. Certainly something to get worked up further, but not something to lose sleep over or run to the ER about as long as youre feeling well..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pregnant with kidney mass38 yo female 24 weeks pregnant (IVF) History of hydronephrosis (2017) 3.5 cm simple kidney cyst found while hospitalized for it as well as ovarian cystsI am currently 24 weeks pregnant, I had some pretty bad pain in the same kidney that I had hydronephrosis in years before. The pain only lasted for about an hour but I then had what felt like a UTI so I went to the doctor. My urine tests came back fine but my doc requested ultrasound of my kidneys given my history. I went and got it done and received a call the following morning to go straight to ER that I had an abscess so I did (4.7cm). My urine and cbc both came back ok and didnt indicate any infection so they sent me home with order for another kidney ultrasound in two days. I got that done and it came back complex mass 5.7cm with recommendation for MRI that I cannot get done while pregnant. I have been told that its ok to wait these 4 months but I cant help but be terrified in the meantime. I have an appointment with urologist in 2 weeks. What am I really looking at here? On a scale of 1-10 how concerned should I be that this is cancer? Google is really scaring me. I plan to have MRI while in the hospital after I deliver. What can I anticipate at the urology appt? Any insight is greatly appreciated. Thank you for reading.. ### Response: Youll have to wait for the imaging study, but the wait shouldnt be a big deal. I prefer CT renal protocol over MRI, but maybe your urologist may feel differently. Based on the report its hard to say exactly whats going on. Theres no mention whether it is solid or not, which is critically important. Maybe just be a benign complex renal cyst. CT or MRI will clarify.Pelviectasis is minimal dilation of the renal pelvis. Based on your symptoms it sounds like you probably have a mild UPJ obstruction causing intermittent pain (Deidls crisis).Edit: spelling.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hello everyone;This is my first ever Reddit post and I am finally turning to the deep dark web for some feedback.I am a 40yr old woman who has some medical issues and I have been my own advocate since July 2019. I am still waiting for a family physician for my son and I here in Canada - it's been too long without support.A little back story...I had my son in 2009 and in 2013, I had the lovely pleasure of having a partial hysterectomy - As a lot of you know these two things can cause the uncomfortable issue of incontinence. Well in 2018, after two and a half years of very uncomfortable sexual activity and very embarrassing incontinence mishaps I finally decided to see a specialist.After all the testing, my only option really was: TVT - which is the procedure where you have your bladder lifted in a mesh/sling. Surgery was unable to be booked as at the time my family had some changes and we had to move away. Finally after a year. I received a phone call from a specialist in the new area, and yet again due to some unforeseen family issues - I had moved away yet again to another area. So in July 2019, I started hitting the ground on my own. From that day I was going to walk in clinics for UTI symptoms (blood in urine each time usually every other month until September) - got antibiotics monthly and went on my way. Finally in September 2021. I had to change my tactics. My life was completely upside down, the pain and the symptoms were increasing and I wasn't getting anywhere. So I started going to the Emergency room. And started asking for referrals. I was there twice a month until March 17. I was confirmed to finally see a specialist for my case in June. However; I was still in the emergency room three more times after.Finally I have a specialist!!! How exciting is that? Finally I can get fixed! After a cystoscopy, I remember three things he said to me;-- "You took that like a champ" (loved this made me laugh, I thought he was funny) -- "Unusual growths" -- "We'll fix you"Had a biopsy surgery on June 20th. And then... I had to wait 4 weeks for my next appointment. Let me tell you ya'll I didn't think I had cancer, I am ill tho I know that. I have no appetite, I don't sleep because of the pain. I am wearing adult diapers because I have no control, and the blood is only sporadic, I am tired, I am anxious, I am nauseated, and sick sometimes. I hold a low grade fever of 99.5-101 daily it will not break.Heading to my results appointment. I was ready for a few things...Not CancerDo the surgery to lift my bladder and while in there they will check others to make sure I am ok everywhere else.Meds to clear up whatever is causing these fake uti's - cause every culture would come back negative. The ONLY thing I didn't want to hear was; "I don't know what's going on, let's try these pills, and not do the surgery..."This is what I remember about the appointment...I told him since he likes to make jokes and laugh I had one for him before we started... He said ok shoot."After my biopsy surgery you tried to poison me". His reaction was inquisitive. I explained that I was prescribed Codeine pain meds and I am allergic and it's in file. He blamed it on one of his staff and then never replaced the medication either. (One reason I already lost trust)2. His exact words "Yay you don't have cancer".Kind of like the first meeting here is what I remember him saying...-- "I made a mistake, there weren't actually growth in your bladder. You have a beautiful bladder. It was just murky from this infection." (Lost trust for the second time - you mean I didn't even need a biopsy surgery?!?) -- "I did measurements of your bladder while you were in surgery because when you are under, your bladder is relaxed. And you don't need it lifted." -- I don't know what's wrong, but we are going to treat you with Overratve Bladder (OAB) with pills and a low grade antibiotic forever.  If in 3 weeks there is no change we will increase your dosage. NEXT ONE'S THE KICKER!!!! -- "If that doesn't work I will refer you to someone SMARTER than me". (Lost all faith - he had a diagnosis from a specialist he was choosing to ignore to what put me on medication he didn't even know as going to help me?!?)So ya'll I am not going to lie. I was angry, frustrated, confused and couldn't speak. I took the script and left. After I left, I was beside myself and totally confused. How one specialist 5yrs ago said my only option when I had NO infections or other symptoms, said I had to have surgery... Now I am 9yrs after a hestorectomy, and this doctor hasn't done half the testing to see about a prolapse bladder (which again was diagnosed in 2018).I called my original specialist, he told me I would need to be referred back to him but he was concerned with the fact that he is over 2 hrs away from me now. He advised me to request a 3rd opinion with someone locally.I can say that has been requested... Now how long do I wait for this 3rd opinion?I am seriously in so much pain. I suffer from fibromyalgia and that is the only medication I am taking, so I am unable to manage. I haven't slept in 4 days. I feel like my right hip/leg are going to snap off me. I want to BIRTH something. I feel like I am in that last push pain of birthing... Everyday ... All day... I have been on medications for 5 days. The only thing that has changed, is that I no longer have blood in my urine. That's it.I am tired... Am I wrong for wanting to have a doctor to just please do an internal ultrasound to see if it's prolapsed? I mean seriously I feel like it's coming out. But they won't do that testing at the ER, and this specialist won't do it. How long do I need to wait?!?Thank you for listening.... ### Response: Incontinence is s vast vast subject, i can't give you definitive answers online.For a tvt one of the most deciding factors if it will help or not is the Marshall Bonney test (you know the one with the urologist inserting 2 fingers in vagina and lifting motion to full bladder and telling you to cough)Has it been done and what was the result?A tvt or tob isn't always the answer, it doesn't work for any woman, there is a host of urodynamics tests and pelvic floor, abdominal pressure etc etc....that need to be done beforehand.The cystoscopy is also a must before the tvt for multiple reasons i cant describe them all (limited English and time) one of the reasons for the cystoscopy to be done and under anesthesia is to relax completely the abdominal muscles so the urologist can apply pressure to lower abdomen and with other hand to look at the roof and forward wall of bladder so not to miss anything. Without anesthesia he will not be able to see clearly and make a good assessment of the forward wall and roof.The biopsie isn't necessarily done only by suspected bladder cancer but also to outrule something called interstitial cystitis which is somehow similar symptoms to uti with clean uricults.Also not all urologists are the same, some like working exclusively in a practice, work fixed hours, ultrasound, diagnostics, cystoscopy, small stuff. And they know urodynamics and incontinence stuff (diagnostics) much better than me.Others like me work almost exclusively in the hospital performing multiple surgical procedures daily and also doing oncall shifts for EREven in hospitals, some do like 5-6 renoscopie procedures daily, others do kids daily, others the lucky ones do mostly DaVinci robot assisted surgeries, others kidney cancers, others tur-p tur-b holep etc... etc......That's why you can always get a second opinion. A urologist who is good with kidneys and works that daily and is concentrated on the malignancies in urology will not be a good fit compared to a urologist who knows his pelvic floor good and all types of incontinence and meds and bands. Also OAB represents similisr symptoms and can be treated with meds, if tjey don't work and marshall bonney test is negative, then botox injection in bladder is an option that works wonders for someIf you can provide me result of marshall bonney test i can give you a "guess" if tvt is right for you or not. A trustworthy diagnosis i cant provide online.Tvt done unnecessarly not only it will not help but can lead to complete shut close urethra and acute urin retention, so we don't want to do unnecessary procedures that will make matters worse. Also there is conservative approaches like pelvic floor exercises which in some patients do work well.Also TVT/TOB procedures aren't emergency and don't get priority so right now the waiting list at my workplace is about 3 months minimum and if another covid wave hits, it will be delayed further.Another Tip: gynecologists are more than capable of placing a tvt or tob. Its not a complicated procedure. Fairly straightforward but carries risks but rare when done by an expert. So if you can get a faster appointment with a gynecologist then do it..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: [ Please Help ] CT Scan Abdomen and PelvisHi , i am male . the doctor at the Urology hospital asked me to do a CT scan of the Abdomen and Pelvis. will be done next week. My question is, will this CT scan show a testicle report if there is a problem with the testicles. or it is a different scan. because the Scan is for Abdomen and Pelvis. ### Response: Nope. Testicles can't really be seen on this kind of CT..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Were my father's doctors negligent?My father was in hospital being treated for a suspicious catheter bleed and a UTI. As part of this the urologists had stopped all his anticoagulation/antiplatelet medication and presumably because of this he suffered a large ischaemic stroke. He was admitted on a Tuesday and I first noticed the stroke symptoms on the Thursday evening when I attempted to call my father on his mobile phone and when I finally managed to talk to him he had severe aphasia and cognitive decline. I immediately called the ward he was on and told the nurse that this was a very sudden and severe change in my father's condition (my sister had been to visit him that afternoon and he'd been absolutely fine - I had spoken to him earlier too and he was fine then) and the nurse said she would call for a doctor to review him overnight and he'd also be seen by his regular urology doctors in the morning and they would better understand the changes in him. I called the hospital a further two times that evening expressing my concerns about him and that I was concerned he might have had a stroke.On the Friday morning I call him and obviously he was still struggling to speak and still sounding very confused but he was however able to follow along with a conversation. I call the ward and the doctor has bumped my father up to IV antibiotics and fluids. I'm told later in the day that he was sleeping for most of the afternoon and didn't eat much through the day.Then Saturday morning my older sister spoke to the nurse looking after my father again expressing how concerned we are about this major change in him and we're told she will get the on call registrar to come and review him again. Later I am told he's being given stronger antibiotics. Saturday evening my father seems to be improving and is once again eating normally, also able to speak a little better.Sunday morning when I call the ward I am told by the nurse that my father isn't very good and he has been sent for a CT scan because he was really messed up that morning, exceptionally confused, unable to swallow and his aphasia has gotten worse. I called back a while later and spoke to a registrar who confirmed that the scan shows that my father has likely had a stroke. That afternoon he was moved to a specialist stroke ward.Over the last few weeks I've spoken regularly with the doctors on the stroke ward and they seem pretty mortified that it took 3 days for anyone to think to order a CT to check for a stroke. It seems obvious to my sister and I that when we have kicked up a fuss and he's been seen by a doctor they have just assumed that it was delirium brought on by the UTI but according to his notes no one had considered any alternatives. So I'd like to ask, would you consider this negligence?Relevant info81MUKWhite British79Kg5'11"Non smoker, no drugs or alcoholHistory - Alzheimer's, type 2 diabetes, metallic valve replacement and double bypass in 2011, diagnosed with kidney stone in late 2021, left side PCNL at beginning of February and recatheterised after a failed TWOC a few days after surgeryMeds - enoxaparin sodium 80mg twice a day, aspirin 75mg once a day, metformin 500mg two twice a day, gliclazide 80mg two twice a day, oxybutynin 2.5mg twice a day, linagliptin 5mg once a day, tamsulosin 400 micrograms once a day, donepezil hydrochloride 5mg once a day, colcalciferol 1,000 units once a day, bisoprolol 1.25mg once a day, atorvastatin 40mg once a day. ### Response: Wait they took a guy with a prosthetic valve replacement off anticoagulation? How bad was the bleeding? Which valve was replaced? This is kind of concerning since mechanical valves need anticoagulation or else they clot and cause  you guessed it, stroke.Were they giving the enoxaparin and aspirin in the hospital??Obviously hindsight is 20/20 and perhaps it wouldnt have changed anything, but it seems like an oversight that no one ordered even a CT..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm unsure on which valve was replaced, I've honestly never thought to enquire. The bleeding wasn't really all that significant, at least that I saw, my father wasn't complaining of being in any pain either and originally I was told that bleeding without pain shouldn't be a concern - it was only when I noticed he was passing clots into his catheter bag that I was told to get him to hospital.They 100% stopped the enoxaparin but I'm not totally sure about the aspirin.Edit: after checking with family we believe it was an aortic valve replacement. ### Response: From a US standpoint I agree with everything here. Is it worth having a malpractice lawyer look at this? Yes. Is there a clear delay between stroke identification and likely onset? Yes, it sounds like it. Is there clear harm done? Not necessarily. Im so sorry all this happened, OP. Its hard even if there is no mistreatment..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: This is very helpful, thank you. Regarding the improvement and them seeing anything on the CT - the report on the CT only identified a single stroke and described it as sub-acute so I was told it was likely to have happened a couple of days prior. I thought much the same as you originally, minor stroke on the Thursday and larger stroke sometime Saturday night into Sunday but I was told no.I have been intending on getting in touch with PALS for a while now and this should give me the push I need, at this point I'm not even sure what the situation with the bleed was by the time the stroke happened. It's not been an issue since he was moved to the stroke ward and they resumed anticoagulation (high dose aspirin originally and then unfractioned heparin infusion).. ### Response: One thing worth noting is that inflammation after a stroke is worst ~72 hours afterward. The worsening symptoms a few days later may have been related to swelling and inflammation..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Leukocytes but no BacteriaAge: 34Sex : FemaleHeight: 511Weight: 170lbsDuration of complaint: 3 weeksLocation: USAny existing relevant medical issues: NoCurrent medications: None currently, just finished a round of macrobid.Hey guys, I posted something similar to this in a micro group but things have changed since then so Im just looking for further advice.Almost 3 weeks ago, during a routine exam i showed moderate leukocytes in urine with trace blood. Id had no regular uti symptoms at all other than some pressure after peeing like once. No burning, urgency etc. According to my blood work I was also dehydrated. My NP, who is also my boss & friend, gave me a prescription for Macrobid and sent off a culture. I took the antibiotics for 3 days then I got the call that my culture was negative and to stop the antibiotics. So I did. From there it was back and forth because although I was still asymptomatic I still had leukocytes in my urine. So another culture was sent off - same results 25 - 50k cfu mixed urogenital flora okay cool. So what do I do? NP tells me to just finish the antibiotics so I did. I did get a micro UA done as well and it showed 5-10 wbc with few bacteria, mucus and epithelial cells but none of my urine samples were clean catch.On Saturday after finishing my antibiotics completely I took one of those AZO uti strips after a shower and it had a small purple speck in the middle of the leukocyte pad after 2 minutes. I text my NP to let her know and she sent me in yet another prescription for antibiotics.My concern is that Im not one to take a lot of antibiotics. Actually, I havent taken antibiotics in several years so I feel uncomfortable just taking them with no identifiable bacteria present. I do have a referral to urology but its going to take some time and Im worried about getting a kidney infection. I also feel as though my concerns arent being addressed properly because of my NP being my friend, so she doesnt run the tests she would on a regular patient (IE I had to bug her for the culture and micro ua because she just immediately wanted to give me antibiotics and call it a day).Thanks in advance for any advice, I know its a long read.. ### Response: Asymptomatic leukocytes in urine, with no growth on a culture, from a sample that isn't a clean catch, is not a UTI and does not need antibiotics.Stop getting medical "care" from this person. Sounds incompetent. Get an actual PCP, preferably a physician.Urology is gonna be scratching their head on why they have this referral..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Why are small kidney stones worse than my larger one?Female, 38yrs old, bilateral nephrocalcinosis, no other health concerns and only medications are acute pain relief (30mg codeine & 500mg paracetamol combined tablets at 2 per dose, Tramadol 100mg, Diclofenac suppository 100mg, Buscopan 10mg). Currently in absolute agony.8 weeks ago I passed a 4mm stone that was exceptionally painful. Worse than my unmedicated child birth. That pain started around 7am but by 5pm I had passed the stone. It was horrific, more intense pain than I currently have but at least over in less than 12hrs.I had a CT scan and a follow up call from a urology nurse informed me I only had very small stones, described as like gravel left. No treatment or management plan - just a follow CT in a year.Which would be fine but for the past 2 days I have been in agony in my right kidney. Im on maximum doses of all my home pain relief and Im getting breakthrough pain every 2.5-3hrs.I would love to understand why this is more drawn out than my bigger stone? Im drinking large amounts of water to flush it/them out but Im not passing much urine at a time and theres a lot of blood in there too. I think I could cope better if I knew why this was taking longer or if I could work out just how long this was going to go on for. Urology nurse was very terse and basically just said Theyll pass without intervention. Just take your pain relief.Grateful for any insight/ideas x. ### Response: Not a urologist, but we deal with similar issues in the bile duct. When it's a single stone, it is very easy to pop out because there's nothing else obstructing or limiting its dislodgement. However, when the bile duct is full of sludge and copious amounts of smaller stones, it's like trying to pull out a tube full of thick gravel or sand and extraction becomes a lot more tedious and prolonged. My guess is that it's just difficult for the gunk to move through your ureters because it's somewhat clogged up..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Cant stop peeing blood! Help!Hi everyone! Please let me know if theres any other/better places to ask this but I didnt know where else to go. I am going through hell and feel so embarrassed talking about my bloody pee online but I have gotten blown off more times than I can count. I am 22F 59 with no prior history of UTIs and I have been peeing blood for TWO WEEKS with extreme pain! It started out full and just generally lower abdominal pain, but now Im starting to feel occasional sharp stabbing pain in my side/back which is making me think its my kidneys. Heres a timeline of how all of this has gone:1/2/22- notice blood on the tissue when I wipe for the first time, freak out, schedule an appointment with my GP1/3/22- I go to my doctors appointment, she tests my urine and finds high white blood cell count (infection) prescribes me 5 days of macrobid1/6/22- bleeding gets heavier and abdominal pain gets worse1/8/22- finished my antibiotics, still extremely ill, more pain more blood, I start running a low grade fever and throw up1/10/22- I go to an urgent care, blood found in urine but no signs of infection, gave me a shot of ciprofloxacin and sent pill form home with me, told me if it gets worse to go the emergency room1/12/22- after never noticing a difference in pain or blood I go to the emergency room. They test my blood multiple times, take urine sample, and do a CT scan. My blood work shows elevated white blood cells and elevated high lactic acid levels. They send me in for a CT scan (no contrast) and dont see anything. I get sent home because nothing is in my CT scan and get told if the pain gets worse come backI am in a lot of pain and I dont know what to do. I am STILL peeing blood and having awful pain. I have a urology appointment tomorrow but I dont know if I should wait or go back to the emergency room. My back keeps having these painful twitches and I cant stop shaking. The nurse who discharged me said she thinks its interstitial cystitis and it is an infection that is curable that you treat with antibiotics. I looked it up and thats flat out not true. Other nurses had said all night it seemed like I had a kidney infection, and thats honestly what it feels like. What should I do?. ### Response: If they did basic blood work, urine tests, and you haven't had true fever, then you probably don't have a kidney infection.Did you original urine sample ever grow anything in the culture?Do you urine results show blood +? Do they say if they specifically see RBCs or not?Edit: include the actual lab info if you have it availableIt kind of upsets me that the CT A/P was done non con. I guess maybe they were looking for stones... But still. You cannot reliably comment on pyelonephritis on a non con CT.I'm sure they were hunting for stones. Shouldn't really need CT imaging to make pyelonephritis diagnosis.Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. This includes medical students..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How urgent is urinary problem?40F, 5'7, 205 lbs, Caucasian.Primary complaint: blood in urine, lower abdominal painHx: Neurogenic bladder from fall in 2009, Intermittent catheterization. Hx of kidney stones, UTIs. Partial loss of feeling due to nerve damage in abdomen. OA/DDD with SCS implant.Painful cath 4 days ago with strange pinkish red tissue string in toilet.3 days ago Pain in right flank/lower back attributed to too much dancing the night before.Yesterday, orangish tinted urine, blood suspected.Today, bright red blood in urine and a strange feeling in my lower abdomen, which I would describe as pain-like.I moved states and have yet to fully establish care locally. I have not seen my primary or urology. I did see a resident yesterday for medication refills, who ordered blood work and a UA for my primary care appointment next month. The blood work is to be done in a week or two to get me back to full strength on my lithium.My question is: should I do the UA today and wait a few days for results or should I go to urgent care?Medical issues: Osteoarthritis, SI joint dysfunction, neurogenic bladder, Bipolar 1 Disorder, anxiety, PTSD, migraines, recurrent Varicella zoster, IBS-DMeds: Lithium 900mg daily Levothyroxine 50mcg ac am Metformin 500 mg bid (for weight loss) Prazosin 6mg nightly Trazodone 200mg nightly Tizanidine 4mg 1 tab am, 2 tabs qhs Alosetron 1mg bid Voltaren gel CannabisSmoke 1 pack/week, drink 1-2 drinks couple times a month (including the 2 heavy drinks night this began), No street drugs.Any light shed on the urgency of this issue would be awesome! Thank you all!. ### Response: Sooner rather than later. Urgent care may not be that helpful unless you're pouring out blood or you're obstructed from a blood clot. You should do the UA soon. The only specific reason I'd go to urgent care is if you think it's a UTI which of course is possible given you intermittent cath.The bleeding could be trauma or a stone but the worst case scenario would be bladder cancer, especially since you have a smoking history. A work-up is definitely needed if the hematuria is persistent..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How to talk to my daughter's pediatrician about a concernUPDATE: The appointment went as expected. The pediatrician wasn't too concerned because she was still able to eat and "looked fine". So I took matters into my own hands and gave her a total of 6 doses of Miralax starting on Thursday. She had MAJOR success yesterday afternoon and finally ate a whole meal.Hi docs, I need advice on how to talk to my daughter's pediatrician about an ongoing kidney & bladder infection without sounding like a crazy mom. She's 12, 52 inches, and now weighs 87 lbs (from 98 lbs).She first became sick on Aug 25th, with fever and vomiting. The first dr visit was diagnosed with a stomach bug and period cramps. Ended up at the ER a few hours later with a temp of 103.7. ER ran tests for hours. Urine came back good, bloodwork showed an infection. After several tests, the conclusion was a kidney infection. Sent home because there were no available beds. This went on for 4 more days, in and out of the ER. After 8 days of yucky, she returned to school.On Sep 20th, I got a call from the nurse to come and get her. Temp was 102.7, BP 90/49, HR 125 and she was vomiting brown. Took her immediately to the ER. ER put her in PICU to treat the kidney and bladder infection. She was in the PICU for 6 days and step down for 3.Went to her pediatrician for the follow-up. She did bloodwork and ordered ultrasounds. Bloodwork wasn't so great. I picked up the ultrasound report and the report stated there was a fecal impaction. I asked the pediatrician, she told me to give her Metamucil and sent me off to a urologist.We had the 2nd urology appointment on Tuesday. The fecal impaction was brought up again when she was going over her (the urologists') ultrasounds and cystography. I asked more questions about this impaction and was told to give her FiberCon or Metamucil. She still has kidney and bladder infections. Urologists put her back on antibiotics.I have an appointment with the pediatrician this week. I really need to seriously discuss this fecal impaction. I have been giving her both Metamucil & FiberCon for about 22 days now. And have given her Milk of Magnesia a few times. She has not had a bowel movement (a small amount) since Wednesday.I have picked up all lab and radiology reports from 2 hospitals and 3 different doctors. The CTs on Sept 1 and Sept 20th note the impaction. Ultrasounds on Sep 22 and Oct 7 also mention the impaction. And now, the urologist mentioned it on Oct 26.She is still not feeling well and not eating much anymore. This morning her temp was 96.9, BP 103/53, HR was 65, and she said she was extremely tired. I logged in to the portal this morning and received Friday's blood and urine labs, neither are great news, but there is some improvement.How do I approach the pediatrician with all this information without sounding like a crazy paranoid mom? Or maybe I am and this is not a major concern or issue? I have asked about this and feel like I was brushed off. I feel kind of crazy as it is because I went to all these places and got the records and put it all together. Thank you.. ### Response: First of all, don't ever worry about how you come across to a doctor when you're talking about literally the most important thing in your life - the health of your child. I have parents tell me all the time "OK, don't think I'm crazy." I never do. I go out of my way to tell them I don't think it's crazy and that the reason we're talking is to make sure we're all on the same page and we're both comfortable with the plan.Just express your concerns honestly and in a straightforward way. It is literally their job to help you navigate something that evokes a strong emotional response. If they can't do that, they aren't a good pediatrician. (But thankfully, most pediatrician, in my experience, are excellent at this).As far as the fecal impaction, Metamucil won't cut it. Rectal fecal impaction is a common cause of UTIs, especially in girls (who have shorter urethras than boys). I usually use the big guns - like a Miralax cleanout or a Mg citrate cleanout. Basically the same thing we would do before a scope. This usually helps you start over from ground zero and then you can work on keeping her poop soft with Metamucil or whatever else you think works for her on a daily basis (Miralax is still my favorite for this too)..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Granma here, just wondering...no enemas, these days?. ### Response: Enemas work great, but dont go too far up. Cleanouts from above take care of the whole problem at once..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Alcohol Flush Response. If not allergy, what could it be?44M WhiteAbout 3-4 years ago I developed an alcohol reaction. I can have a single drop of alcohol on my tongue and end up with a bright red, itchy and hot face, and I would sweat. I do not get chest pain. Often, if I ignored then the issue would disappear quickly (10 mins). Often, I could continue drinking and be fine.Sometimes the same alcohol would not do this another time (e.g. same drink one week vs next).I have been tested (23&me) GG for alcohol flush syndrome and am fine.I saw a GP after seeing a post on reddit where someone said something similar and everyone told him it was lymphoma. The GP checked me and said I was fine. I have no weight loss, no night sweats, no obvious lymph node issues.I spoke with an allergist and they said:"These reactions are unlikely to be an allergy as it does not occur every time alcohol is taken and also disappears after the first initial reaction.It might be due to the histamine in the alcohol, or even the presence of sulphites, but if this were the case then the reaction would be maintained throughout the period that alcohol is consumed.We do see people who have had reactions to alcohol, to rule an allergy out, but rarely is an allergy the cause."I am currently on betahistines for something else, and have no reaction, so I don't think it can be histamine allergy, and I have tried some drinks which say "includes sulphites" and have no effect.Last year I have had some urology issues (difficulty peeing). They did not get to the end of it and told me I had 'shy bladder' - I disagree, but I was told I had an enlarged spleen after ultra sound, but later told I did not.So, what could this be if not lymphoma or allergy? My GP is not being very helpful, but it is really affecting my mental health and I am worried a sign of something else.I do not drink any longer. I am currently dealing with a new thing, vestibular migraine, and this is all swirling around in my head.. ### Response: A transient effect like this seems more likely to be an autonomic response, which would be very difficult to diagnose and there aren't any tests for it. This sort of thing usually goes away after a few minutes.You might still have an alcohol flush response, despite "normal" genetics from 23&me. There are more genes that have been described recently. The only way to know for sure is to do an acetaldehyde breath test, but this isn't very widely available..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Total loss of bladder controlWhat would cause a complete loss of bladder control in 17 year old with cerebral palsy. Yes he has cp and thats what his primary wants to relate it to, but hes been in control since age 8 and now suddenly, theres about a 2 second warning before he goes. Sometime he doesnt even know he went. Cp is non progressive. Last 2 months there has been 5 separate episodes of blood (not from urine) in his brief in the morning. After standing for sometime and then sits, he feels a slight pain in the groin area. Urine was cultured, no bacteria was found, only microscopic blood. Referred to nephrology and his kidneys are good but his compliment levels were low. Doc thinks from having COVID in November. Testing again in 2 months. Next step is urology. Thanks in advance for any insight....Edit: he is now being followed for increased hemoglobin and hematocrit in RBC. ### Response: How severe is his cerebral palsy? Is he ambulatory? Is he bed bound? in children with significant skeletal deformities or minimal ambulation, kidney stones are very common. These can cause blood in the urine and the urinary incontinence that you are describing. You need to go see a pediatric urologist for evaluation. First step should be checking for a urine infection, but after that imaging with an ultrasound or CT scan is likely the next step.Moderate spastic cp, wheelchair yes, but can walk with a walker short distances. He did have kidney and bladder ultrasound that was unremarkable. He also had a urine culture that was clear of bacteria. Thank you for your repl.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can CT Scan without Contrast IV detect Pelvic/Abdominal Cancer22m, 220lbs, 5'6. No smoking or alcohol use.Got a CT scan from ER to look for kidney stones and they found none.Quote the patients case was ultimately discussed with urology who agreed with further evaluation with CT abdomen and pelvis to rule out renal and urethral calcinotic/renal pathology. The patient demonstrated no signs of acute intra-abdominal renal pathology. Urology advised to follow up with non-urgent cytoscopy"Im currently experiencing a lot of dull abdominal pain and worried about potentially having cancer in the pelvic region.For 3 months Ive had lower abdominal pain, frequency urinating, pain when urinating, urethral pain.I have no signs of kidney stones, leukocytes or blood in urine. Ive tested negative for bacterial STDs as well and even Hep B and C, Syphilis, HIV at 3 months.. ### Response: To answer your question, a non-contrast CT scan does not rule out cancer in the abdomen/pelvis, barring a huge mass or obvious metastases. In fact, even a contrast enhanced CT scan is not very sensitive for several types of cancer.You should discuss with your physician whether or not additional imaging would be warranted. I don't know much about your history but in general, it is exceedingly rare for a 22 year old to suddenly develop some sort of intra-abdominal malignancy..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What would be used to rule out cancer then?. ### Response: Again, I would recommend discussing this with your physician (either primary care or the urologist). We generally do not recommend blanket scanning everyone with CTs and MRIs for non-specific abdominal pain especially in young patients, unless the clinical history warrants further investigation (it's not because we mind the extra work; it would be comically easy to read a bunch of negative studies all day and charge for it).Laypeople and even people in the medical field tend to assume that imaging is a magic answer box, but it oftentimes is not and the potential benefits of imaging may not outweigh the risks/costs..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th.. ### Response: How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder/ureter/renal pelvis, rarely but possible with RCC or a urethral caruncle.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.. ### Response: n a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Complex Cystic Mass 8.5 cm x 5.9 cm x 5.0 cm - Left KidneyYesterday I had an ultrasound of my abdomen as I have had intermittent pain on my right hand side by my gallbladder and liver. I did not expect this result, but now it makes a bit of sense as it is probably pushing things over to the right which is causing my pain.I am a 38 year old female.Symptoms: Tired a lot, Full easily, Nauseous oftenLEFT KIDNEY: Normal size. Normal echogenicity with no hydronephrosis. In the left mid kidney there is a complex cystic mass with several septations and which have internal vascularity and areas of mural nodularity. This cyst measures approximately 8.5 x 5.9 x 5.0 cm.I am having difficulty getting a Urology appointment soon as everywhere is booked up until March or April. I have reached out to my primary doctors as well, but I am curios about what my next steps should be.What should I be eating? What should I be doing while I wait for my appointment? What should I not be doing?What tests should I have?I am assuming due to the size it may need to be surgically removed. Is that generally the outcome?Thank you.. ### Response: Nothing really to do or not do in the meantime. You can expect that they'll want to do an MRI or multiphase CT to see if there are actually any nodular areas that enhance with intravenous contrast, because that would be suspicious for a cystic renal malignancy. If so, these things tend to be really slow-growing and amenable to just being surgically removed with curative intent.Regardless, I don't think the cyst is causing your abdominal pain and was probably just found incidentally..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Low right side front abdomen and right lower back pain (kidney?)Age 43 Hawaii Male UsaSo 3 or 4 months ago after a scan someone out in a Urology referral with no other notes other than hidden away positive for nephrolithiasis.Ive had this pain right where my kidney is. It becomes moderately painful after doing moderate work and takes a couple days to settle down.Is this still potentially a stone or would it have passed because of the time frame?. ### Response: Stones that remain in the cavities of the kidney will grow and recede based on things like pH and ion concentration over time. They are relatively normal to find, particularly as we get up there in age. They almost never symptomatic, unless they break off and get lodged in the ureterat which point its very symptomatic. Its hard to say what the sensation that youre having is; sounds like its causing a pretty significant obstruction for you that would be worth seeing your PCP about to get it worked up..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Coughing up blood after surgeryHello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight.. ### Response: Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 27Female unable to walk, urinary retention, gastroparesis27 year old female, weight:57kg, height164cm. Previously diagnosed with autism, pernicious anaemia, iron deficiency, epilepsy, POTS.Taking Wellbutrin, lamotrigine, clobozam, vitamin d, iron, vitamin b12 injection, pantoprozole, and now because of gastroparesis I am taking domperidone also gravol IVI have leg weakness and my legs feel heavy and like they will give out on me. I have diminished feeling in them but the EMG came back as completely normal.I had an MRI and an MRI with contrast and it showed a disk bulge effacing the anterior disk space and moderate to severe narrowing of both neural foremen on disk L5/S1Disk protrusion which is mildly protruding into the thecsl sac and causing mild stenosis and mild neural foramen narrowing on L4-5I have gastroparesis which was just diagnosed during this hospital stay. I was vomiting almost everything I ate (which wasnt much because I got full so quickly) and they did a gastric emptying study.I have urinary retention meaning that I am unable to start urinating and it caused me to retain over 2L of fluid. I am currently catheterized. A urologist wouldnt see me because they believed it was a neurological problem but neuro suggested I see urology.I have a lot of the symptoms of Ehlers danlos syndrome as well (hyper mobility type) such as hypermobile joints, hyper elastic skin, soft, easily bruised skin, dislocations and TMJ disorder (which have caused jaw to dislocate many times).I have not been diagnosed with this yet but could the leg weakness and other symptoms be caused by ehlers danlos or is there something else we (the doctors and I) should be looking at.I am doing Physio and am getting a bit better at walking but my weight is mostly in my arms and so my legs dont give out I have been using a chair for the majority of the time here and walking with Physio using a walker. Im really unsteady on my feet and have a hard time controlling where my feet go which is making it hard to walk so I can only do pivot transfers.I had an ultrasound done of my abdomen/pelvis and am not sure the results yetDoctor is referring me to an EDS clinic because no one here knows enough to diagnose me. ### Response: Really depends on what the neurological exam shows..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Made an appointment with a urology office to discuss getting a vasectomy, was told that the initial consults are with a nurse practitioner and not the actual doctor performing the procedure. Is this common practice?I'm assuming I won't even be meeting the doctor until the day of the procedure, which I think is kind of strange and makes me even more nervous than I already am. I know doctors are spread thin and minor procedures like vasectomies are probably low on their list, but I would at least like a few minutes of facetime with the guy that's going to be working on my junk.... ### Response: That's typical for many offices. If the doctor is meeting with everyone individually, then that's a lot fewer procedures they can do. Just the way healthcare works in the US..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 21M URGENT UROLOGY HELPI was masturbating excessively yesterday and during / right before ejaculation I lost all hardness and my penis became flaccid, stretchy, and curved to the left. My left testicle is also much more lower now and the right one doesnt doesnt move as smoothly. I basically cant really feel my penis anymore and its hanging very loosely downwards, as are my testicles. I saw a urologist right after it happened and he dismissed any fracture since there was no pain upon inspection and said everything was normal. My penis doesnt look, feel, move the same and i can no longer get a hard erection, the most i can get is a semi erection very loose penis with a 60 degree bend to the left side. What should i do? Had to add that my penis has become much more fatter maybe swollen?, and much more veiny, and has its flaccid size has increased, also scrotum shape is very weird and wrinkly.. ### Response: The only thing that sounds abnormal to me is the bend in the shaft of the penis. I'm not a urologist, but if you were unhappy with the urologist that you saw, I would recommend you seek a second opinion from another urologist..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.. ### Response: In a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Urology vs. Nephrology28M, White, No drugs, Social drinker, no tobacco, 2 days kidney painIve had kidney pain for a couple of days. I went to urgent care this morning, but they unfortunately have no lab or imaging capability. They were able to dip my urine and detect blood. I have had no urinary symptoms. Theyre sending my urine for cultures (3 day turnaround) and also referring me to an outside facility for CT (unknown turnaround time).I am in need of a provider that is able to find the problem (and hopefully solution) sooner than later.My only question is, do I need to try and get an appointment with urology or nephrology?. ### Response: Urology.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Just got a worrying looking letter in the post following an ultrasound for varicocoele. Is there a urologist here that can help me translate this? (UK) Urology Cancer???Age 33Sex MHeight 6"1Weight 74kgHi All,Im based in UK. Just got this letter but I dunno what it means. Its from the Urologist to my GP that I've been CC'd on so it doesn't make a lot of sense to me. I could wait until I actually hear back from the Doctors but obviously I'm a bit worried now having read this so I hoped someone here could explain it to me. Here are the headlines:'His PSA is at 0.65''Ultrasound scrotum showed left scrotal varicocoele, bilateral mild hydrocoele and of note he had an ultrasound of the urinary tract which showed normal kidneys, a residual urine of 400ml and a soft tissue mobile non-shadowing focus within the bladder which is avascular on Doppler. This is unusual and I am going to review this in our MDT.''We will review him in our MDT urgently.'I have done an ETCI for a flexible cystoscopy'.Can someone please translate this for a layman? Many thanksI've just googled that the MDT is the 'Multi-Disciplinary Team (MDT) consists of a team with specialist training and experience of the diagnosis and management of Urology cancer'.. ### Response: You may have a funky mass in your bladder and theyre going to stick a camera up your penis to get a better look at it..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Mobile means its moving around, which is a good sign in general (means its probably not growing from your bladder). The most likely culprit in these scenarios is a bladder stone. The fact that its nonshadowing makes it unusual because most bladder stones have calcifications that shadow. In any case one has to go in with a camera to take a look at it and do something with it.. ### Response: By "mobile" I'm not sure whether they mean like rolling all around the bladder (which in this case sounds like it would be a blood clot, not a stone), or an actual soft tissue mass that is swinging in the breeze but attached to the wall by a stalk.MDTs are used for anything complicated or unusual, not just for cancer..