Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: If critical care paramedics use thrombylitic agents on scene it requires an additional 90 minutes of CPR, at least in UK guidelines.. ### Response: Those don't really exist here. And if they do, they are in remote academic areas where transport should have been quick..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Where do you work? A lot of EMS protocols around the world are "No ROSC = no transport" except maybe in some extreme cases that can't be treated in the field (ie. PE in some places, or intrapartum cardiac arrest).. ### Response: I am so sorry for your loss, it seems you got into a very tough situation but did all you could to help her and gave her and the EMTs the best chances; you're a good friend and person. I would agree with the colle ague that a PE or another clot of some sort (intracranial bleed/occlusion) comes to mind as a plausible possibility, and that waiting on the autopsy results is the best step. A serious underlying reason would also explain why the resuscitation was unsuccessful..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: UPDATE ABOUT MY MOM: Chronic respiratory failure - hypoxia w/o pulmonary or cardiac explanation.51F, 59, thin, white, USA. never-smoker, non-drinker; no prescriptions; unintended weight loss of now 28lbs since January, oxygen desats started in January w/ exertion, suddenly worsening in the past few days and now on continuous oxygen. Exhausted and weaker every day. X-post.This is just an update for anyone interested. Ive posted about this several times on the various medical subs here out of desperation and have been blown away at the helpful advice and input. I wanted to post an update in case anyone remembers spitballing about this and might be curious about new developments.Today mom had her follow up with her pulmonologist following the normal shunt study. He spent a solid hour with us going over everything shes been experiencing the last six months with a fine tooth comb, reviewing prior records in the hospital system from the past year before the oxygen issue, and doing a thorough physical exam - we knew something crucial might be in those clues.Very long story short - its not a happy update but it unfortunately makes sense given a lot of other problems mom has been having during this same timeframe that just seemed insignificant or unimportant compared to the chronic respiratory failure. Things she thought could sit on the back burner til that was solved, but have been accelerating in just the past 2-ish weeks along with the worsening oxygen desats.Basically, there are several observable, objective signs and symptoms that seem to point to some kind of neurological/neurodegenerative process/disorder.He ordered a lot of tests that will be happening next week, and she will be seeing a neurologist for further evaluation on Tuesday.The more we read, the more huge lightbulbs are going off on this kind of process being a possibility. Not going to assume anything, and not trying to be negative, it is just undeniable that a lot of the puzzle pieces fit and we want to prepare for the worst mentally/emotionally. It's a long way from here to final answers (if we ever get any, we are well aware we might not ever get this figured out, that there are limits to medicine), but I just thought Id update since my moms situation is such a very odd, even bizarre, case. Thanks so much to all of you who have pitched in.. ### Response: Glad to hear you've found yourself a solid pulmonologist. Might I ask what institution he/she is working at? I like to know where there are good folks if I ever need to reach out..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I (27F, 65in, 125lbs) was recently prescribed propranolol (20mg twice a day) for migraine prophylaxis. As I was reading through the information, I saw that multiple occurrences of past bronchitis are a significant contraindication. I have had pneumonia several times, and am not sure about bronchitis because the several pneumonia cases I had, I put off going to the doctor until I had to go to urgent care (less than ideal, I know. poverty can really be a bitch.) The last time I had pneumonia I ended up with cracked ribs from coughing so hard.Is it safe for me to be taking propranolol, and are there early warning signs I can look out for if my respiratory system is being negatively impacted? Would I develop a cough?I would call the prescribing PA but not only was it the first time I had an appointment with them, it was also their last week at that job, and they also were a little bit dismissive when i asked if there could be any interactions with my psychiatric medications (bupropion xl 300mg & concerta xr 27mg.)Thanks for your help!. ### Response: Previous infections shouldn't affect you today, I wouldn't worry about it too much but yes you are correct, they would be signs. The main sign would be an asthmatic sensation, in which case you should not take any more propranolol and seek help.It's very hard to give good medical advice you seem to have shared lots of pertinent information, I can only suppose, but I suppose there's no problem taking this beta blocker at this moment..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you! Would asthmatic sensation feel much different than respiratory symptoms from sickness? I noticed today that drinking very cold things makes me cough and feel like i have an itchy throat/need to clear my throat. This isnt completely unusual for me, but its been more extreme than normal.. ### Response: Not really, shortness of breath, is shortness of breath.Allow me to advise you not to drink very cold things..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is brain fog/cognitive dysfunction in sleep apnea caused by sleep fragmentation or intermittent drops in SpO2?24M, 176cm, 78kg, mild sleep apnea (AHI = 10), not on any meds, non-drinker, non-smoker.I have had mild OSA for the last 2 years and was only recently diagnosed in March; during this time, my main symptom is brain fog/cognitive dysfunction which was bad enough to impede my ability to study. I have since been treated with CPAP and I have noticed mild improvement even though I am still not 100% used to the machine and the mask and am hence sleeping only for 6 hours at a time. I still feel sleepy on days where I sleep this little, but the brain fog is improving gradually nonetheless. This makes me wonder: was the brain fog caused by the oxygen deprivation while my OSA was untreated, or was it due to the sleep deprivation? If it was caused by sleep deprivation which occurs as a consequence of the OSA, then why am I experiencing improvement in the brain fog even though I am feeling sleepier than most of the days before I began using CPAP?. ### Response: They are both tied in together, as the low oxygen level triggers an awakening response that fixes the low oxygen level but results in sleep fragmentation. Disorders that are associated with frequent awakening but not hypoxia, such as restless leg syndrome, are also associated with "brain fog" and other symptoms of poor quality sleep so it isn't really just the oxygen.There are two possibilities here for you.Cognitive dysfunction and daytime sleepiness are not affected equally by quantity/quality of sleep though they are related. It is possible that 6 hours of higher quality sleep is helpful for your cognitive symptoms, but isn't enough to pay off the sleep debt you've accrued especially since total sleep has decreased. Increasing comfort over time with the CPAP is the rule of thumb, and eventually it tends to become a sleep cue.The other possibility is your cognitive improvement is a placebo effect. Your OSA is mild by AHI, depending on the rest of the picture including nadir oxygen and other symptoms (snoring, high blood pressure etc) this may or may not be causing your symptoms. I think this is less likely.There are some other possibilities with persistent daytime sleepiness when you have started treatment for sleep apnea, including a mixed sleep-disorder, and if it persists may warrant testing in the sleep lab if this wasn't done already..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks for the comment. This is more comprehensive than I expected.But what I meant is, without the sleep deprivation/fragmentation, could the SpO2 drop still cause cognitive dysfunction? My nadir oxygen (lowest Spo2 recorded in my sleep study) was 88% (for a total of 9 minutes, not continuously but distributed across the night), and usually the drops are to the levels between 90-94%. If it was the sleep fragmentation caused by the Spo2 drops that is the culprit, then it doesn't really explain why I have been feeling sharper and yet I am feeling sleepy. I have had insomnia in the past and the sleep deprivation have never given me "brain fog" neither, I simply felt so tired that I can't continue with my day anymore subjectively but I wouldn't notice a "fog" over my head. One way to illustrate the difference would be the comparison between the times I had to do an all-nighter before I had OSA and when I had to do an exam after having slept say 6 hours the night before while having OSA: I still found it harder to think on my feet in the latter case even though theoretically I should be more tired in the first case due to the acute sleep loss.I don't think that my cognitive dysfunction is a placebo effect because the difference that I have noticed is a bit too big. I have taken anxiety medication (atarax) and followed the advice of a psychologist to just take it easy and relax before as well when my clinicians thought that the brain fog was caused by stress and anxiety, but even though I convinced myself that the it was psychological and even layed off my studies for a whole year, I did not experience any improvement as significant as that which I am experiencing now.I know why I am still feeling sleepy: it is from the simple fact that I get woken up by the sunlight in the morning easily, since the CPAP mask is making it hard for me to put my eye mask on and I haven't learnt to sleep under my duvet yet due to the heat underneath (the CPAP mask is making that a possibility as an added benefit anyhow).. ### Response: I don't think that there is a distinction between the SpO2 drops and the sleep awakening here. They aren't really separable since you are treating both.To whit, treating sleep apnea with oxygen supplementation isn't really effective at improving symptoms, and other causes of sleep disruption that don't cause intermittent low oxygen also result in cognitive dysfunction.I see that you are trying to separate these things out but no I don't think it is just that you are recovering from a hypoxic injury to the brain..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Right, so basically you're suggesting that the fact that I am noticing improvement despite feeling sleepy can be accounted for by my sleep deprivation being nonetheless less severe in comparison to before I got started on CPAP, even if I haven't been sleeping well for other reasons recently? That can make sense.Are Spo2 drops to the level that I described harmful to the brain? How about the effects of CO2 buildup itself (independent of the fact that it causes you to wake up periodically)?. ### Response: Your respiratory drive is related to things other than just low oxygen levels. There is a pacemaker in your medulla that integrates a bunch of data, including carbon dioxide levels, strain, airway narrowing, lung expansion etc.For instance with OSA there are often respiratory effort-related arousals (RERAs) caused by partial airway obstruction. These increase the effort needed to take a breath, but do not cause hypoxemia. They do cause awakening because of the increased work of breathing and the muscle strain sends and alarm signal to higher centers involved in the sleep-wake cycle.So oxygen doesn't cure sleep apnea because this isn't the only reason that there are awakenings. In addition if there is complete airway obstruction then no amount of oxygen is going to help..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is a full neuro-cognitive recovery guaranteed with full compliance with CPAP treatment? I am still finding it hard to focus and think and I've been dead tired today... I was in bed for more than 8 hours... The CPAP is working as intended because my AHIs have only been at around 1.2 on average since I got started on it.. ### Response: We don't really deal in guarantees in medicine. Also I don't know if your symptoms are due to your sleep apnea. If they are then good recovery would be anticipated..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Well I guess I'm fucked judging by how it feels. I don't see how bouncing back is possible to be honest. If I would think about how I felt at the start of this I was certainly sharper than now so there has been a deterioration over the last 2 years. As far as I know intelligence is supposed to be quite intact/stable and if that has experienced a gradual decline then I would guess that full recovery is quite unlikely as well. I say this because if I would think about a topic that I know from experience wouldn't have difficulty thinking about before, my train of thoughts stop earlier than it previously does.. ### Response: This kind of went from a question about sleep physiology to diagnosis of neurocognitive decline, for which I don't have any information to say that you are or are not "fucked", but would be very shocked if you had some sort of irreversible neurodegenerative disorder at age 24.I would continue to give the CPAP time - this is usually the most treatable thing and as you get more accustomed to it the benefit will increase. You had a one-day setback. Depression/anxiety are the other common causes of these symptoms in a young person..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can chronic CPAP use reduce the natural respiratory strength or capacity?Age: 32 Sex: M Height: 510. ### Response: No.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 3 months sore throat. Urgent care seemed very concerned about oral cancer.https://imgur.com/a/m7onRtJThroat pictures.21 Male. 61 165 lbs. athlete and healthy most of life. Dont smoke and drink on any regular basis. Vaccinated for HPV.Ive had a sore throat for 3 months that began right after a fever but has stuck around. Symptoms include some difficulty swallowing time to time, lots of mucus every morning, and very occasionally pressure near ears, but I wear earplugs every night to sleep right next to train tracks.I visited 1 month into sore throat and was given antibiotics, didnt change anything after full course.Saw them again recently. Negative for all STDs, strep, mono, no growth on culture. Blood work normal as of 1 month ago.This time at urgent care the nurse seemed very concerned it could be oral cancer and urgently referred me to an ENT. Im waiting on that visit on the 28th of April and Im freaking out in the mean time.Thoughts? Thank you for your time.. ### Response: Theres nothing in the images youve posted that appears cancerous.Follow-up with a primary care physician, or at least a midlevel PA/NP who have examined more than a few throats and knows what a normal pharynx looks like.Id probably try to treat your chronic sinusitis with daily flonase in each nostril and a daily allergy pill like zyrtec. Do that for at least a month. Considering you obviously have post-nasal drip, your chronic sinus congestion likely explains the daily morning mucus, sore throat, and ear pressure. And yes, this can cause symptoms that last for weeksespecially if you havent been treating the actual cause.The only person who throws out a diagnosis of cancer in a 21 year old for a sore throat that lasts for three weeks is someone who doesnt know what theyre doing..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What are your thoughts on possible differential of acid reflux (respiratory reflux, LPR)?. ### Response: Possible, but sounds like OPs describing a lot of upper respiratory symptoms. And if youre in the northern hemisphere right now, its the start of spring allergy seasontheres a lot of people with chronic congestion/cough that lasts for weeks and is not infectious.I advise my patients frequently who start developing similar symptoms at the change of seasons to grab their antihistamine of choice along with a nasal steroid and use for at least 4-8 weeks..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you. It has been 3 months however, not 3 weeks. I definitely agree and appreciate all the info. Im definitely considering acid reflux as a possibility too, though I dont have heart burn. I have been eating pretty late dinners and spicy foods lately.. ### Response: Ok so what did the doctor say? Because it would be extremely weird for you to have throat cancer at your age..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Have yet to meet doc, it was a Nurse Practitioner that examined me. I agree. After I mentioned Id performed oral sex before symptoms, she suddenly became very alert and mentioned oral cancer and HPV multiple times. I told her I was vaccinated. She still seemed very concerned even after that. She definitely spiked my anxiety more than necessary.. ### Response: HPV doesnt cause oral cancer in weeks or even months, but years and decades..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I had a bad experience during a procedure and want to make it right.56 yr old female with chronic pain. I had a knee RFA with a new doctor. My most recent previous ones were under deep sedation ( propofol, ketamine, midazolam) in a surgical center because of problems in the past with pain and panic attacks. When I went for the consultation I was told I would be completely sedated with propofol and would not be aware of anything. I asked for an injection of torodol after the procedure as this has what has worked wonderfully for my 3 previous RFAs to control post procedural pain ( I have had gastritis in the past so taking ibuprofen is a no-go for me). The PA said no problem. We discussed in detail previous bad experiences that has lead to a formal diagnosis of PTSD ( anesthesia that resulted in me being conscious of pain, but not being able to tell them to stop the procedure). She took notes and said " I will be fine". I am also diagnosed as immunocompromised with a primary IgA, IgG immunodeficiency. They were aware of this.When I got to the procedure they wouldn't let my husband wait with me. This has never happened before and I was not prepared. Then I was notified that I had to be awake for some nerve testing ( my previous 3 RFAs did not do this, I was out through the whole rhing). I asked if it would hurt. I was told there would be " tingling". Then I asked about the torodol injection and was told " we dont do that". Then they took me back and refused to put the nose canallula under my mask like the other times at the surgical center. I was caught off guard. They shamed me, they raised their voices at me, they made sarcastic jokes. At this point I almost left.I ended up going through with it as I felt trapped because I needed pain relief. The "tingling" was short term burst of pain at a level of 7 or 8 for two of the three nerves tested. I was completely unprepared. The last nerve was okay, just weird.My question is how do I make this never happens again? Why didn't they tell me ahead of time that I would be awake. Why did they say " tingling" instead of " maybe pain, it differs among patients". Why was I refused the torodol after being promised it? Why didn't they tell me about removing my mask at the consultation knowing I'm extremely high risk for all respiratory illness?I have lost trust in this provider and I'm supposed to have another different procedure in two weeks. Botox injections, where I just found out they won't let my husband be with me and I dont understand why. It's hard to find pain doctors and I dont want to change unless I absolutely have to. I just want to try to reestablish trust.Am I overreacting? Is it usual to not let a spouse be in pre-op and I've just been lucky in the past? I've already have had awful experiences in the past, which they know, and I felt trapped yet again. Im considering what to do with the scheduled botox injections as im not sure I can trust them without my spouse being there. I feel like they are going to spring something on me the last minute again when I'malone and vulnerable. Is there any advice you can give me to help me out so I can repair this relationship? I do see a psychiatrist and a therapist for the PTSD. Thank you.. ### Response: Sorry you had to go through this.In regards to the Toradol, I understand why they didn't give you Toradol as if you have gastritis from ibuprofen Toradol is almost exactly the same thing which can cause gastritis so shouldn't be given.I've been at hospitals that allow family in the preop area, I've also been to hospitals that don't allow it. Especially after COVID the rules and policies have changed drastically.Some doctors will tell patients there might be some tingling or pressure or something without using the word pain because some people will actually cause themselves more pain by thinking and dwelling on it, a negative placebo effect. It's a personal practice type of thing.The best thing to prevent things like this happening again to be up front with all the staff you are interacting with about your previous experiences such as this. You can talk to the doctor directly and let him/her know about your negative experience as well..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thanks for taking the time to respond. Your comment about torodol is interesting. My PCP, the previous anesthesiologist, my previous pain management doctors and the new PA all agreed I could have it, all knew my medical history. My PCP said it bypasses my stomach so it's safe. What in the world is going on here? I see your a pharmacist so I am now going to ask some more pointed questions from my providers. They nurse just said, " we don't do that here " when I asked for it, nothing about my specific history.I have a hard time believing not allowing my husband back with me was a COVID policy as they don't require masks on staff or patients at this practice. In fact the doctor gave me a snarky comment about me wearing one in pre-op. He said, " I should take some deep breaths if my mask will allow it".You may be right about them wanting to avoid a nocebo effect and so they underplay the pain component. I've had the same experience with previous doctors. I always thought consent was a big deal though and knowing what pain you may be in seems to be a part of giving, or not giving, consent for a procedure.I informed them of my negative experiences in detail in order to avoid all this, they knew. I guess I just have to decide if I want to use the mental energy to try again with them.Again, thank you for the response, much appreciated.. ### Response: The stomach bypassing actually doesn't affect the mechanism of action that it works. The reason why NSAIDs like Toradol and Motrin cause issues with the stomach is due to the inhibition of COX-1 which happens whether it's taken orally or given IV/IM..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: You literally just have to leave and reschedule if you dont feel heard. Its not worth the medical ptsd in my opinion . My rfa for my back I asked for sedation at the center they blew 4 veins and got blood all over, (which triggered my thoughts of cutting i suppress as much as possible), then told me I didnt need sedation anyways and told me my only other option was to leave if I didnt want to do it with nothing . Feeling trapped and not wanting to seem like a wimp I did it with no Iv line of any kind.Ive never heard of them having someone completely out where they cant test the nerve . You can ask for a medrol dosepak tho to help inflammation /post op pain or go into any urgent care for toradol . Ive done the urgent care option often .Sedation isnt used for like anything injection or nerve burning wise anymore and idk who got the idea to torture patients , cheap insurances not wanting to pay most likely, but it makes me sick . 15 years ago you got sedation even if you didnt want it. We were treated like humans . Oh what a time .Im sorry you experienced this. Therapy has helped me in dealing with some medical ptsd issues . At least the anger and feeling violated .. ### Response: We dont sedate all the time because sedation has very high risks and can result in aspiration, inability to ventilate, and death. Sedation is taken very seriously and is a very high risk thing to do..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Any respiratory therapists or pulmonologists on here? I feel like I'm getting no support in weaning my 4 month daughter off her home oxygen and my anxiety is through the roof.4 month female15.5 lbsWhiteLow oxygen saturations is the main concernFlovent, bactrim, iron, vitamin d, recently discontinued diuril.My 4 month corrected has been off daytime for months, always 97 and above, usually 99 or 100.Nightime weaning has been more difficult because of her periodic breathing. Its usually the most extreme when she first falls asleep. She will go up and down from 97 to 89/88/87/86 sometimes low 80's every 10 seconds or so. Down 5 seconds, up 5 seconds. This happens over and over again for about an hour, then she comes out of it and sits at 97/95. Then she goes back into it, usually not dipping as low as the first cycle.The first time they tried to trial her off nighttime they told me to "watch her" the night before her appointment. I tried to get more info. When do I put the oxygen back on? What is concerning? "Just watch her". So I stayed up as late as I could and tried to peek intermittently. Lowest I saw was 89. This didn't seem like the most accurate sleep study but whatever. She had been tearing out her oxygen every single night at this point for weeks. After me relaying what sats I saw, they decided to wean the diurul first, then check back in in Feb.I reached out this past week because its been impossible to keep her oxygen in. I'm using the works, the strongest adhesives, using mittens, socks, swaddles, and she still manages to get it out. She's also started trying to eat her tegaderm and I am certain she ate some at least one night. And a really problematic rash has been developing on her cheeks from the duoderm. I decided to leave her oxygen out since last week after the tape eating incident and to give her cheeks a chance to heal. I let her NP and NEO follow up know and they are in agreement that we should just leave it out indefinitely and "see what she does". But what does that mean exactly! Shes definitely going lower than usual the past couple of days, as low as 83 so far.TLDR: WHEN DO I PUT THE OXYGEN BACK ON WHAT IS SAFE/NOT SAFE. I have asked her NP time and time over what her parameters are and she never gives me a straight answer. I understand that dips to 80s are fine. But how many? She cycles like this for at least an hour every night, probably a total of 2 or 3 hours. Are these dips cumulatively an issue? We've never gotten an alarm when her oxygen is out (alarms at below 90 for longer than 10 seconds). Should I just based my concern off of that? I have to go back to work in a couple of weeks and will no longer have time to stay up late watching her monitor and watching her naps.. ### Response: How are you positioning the NC? Dont tighten it under her chin like an adult would wear it, instead put the prongs in the nose, and adhere the cannula up by her eyes - not level with her nostrils, keeping it up higher will hopefully reduce them coming out, then tighten the cannula up by the top of her head.Tegaderm is pretty weak, I place douderm down on the skin, place the cannula on top, then secure with 3M multipore tape. Taping the cannula to the douderm not to the skin, that way if it is tore off, the skin isnt being torn. Hope this helps..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Im doing all of the above but will look into the 3M tape, thank you!. ### Response: Hey there. Patience is key. Helping your 27 weeker who needs home oxygen is a marathon, not a sprint. The impact of BPD/CLD is going to take a while for her lungs to get to the point where she can be off oxygen entirely, and will affect her lungs for the rest of her childhood and to some degree her entire adult life.That being said, trust what your team is saying here. The alarm parameters are perfectly fine as a level for concern. In the NICU, we would only care about desats longer than 10-15 seconds; momentary dips are much more likely to mean nothing. If your team thinks shes ready for room air overnight, particularly given her vigorous attempts to pull the cannula off, I think thats a good sign.Let her alarm do the work. You shouldnt have to be staying up next to her like this. The alarm can tell you when shes going longer than 10 seconds in the 80s. These short blips dont matter as much. If it alarms, just keep track of how many alarms overnight youre having, how long, and the low number reached during the desat. The monitor should be tracking this for you.Its okay. You are doing so much hard work for your daughter right now and are asking a lot of really important questions about how to give her the best treatment and recovery; that shows me that you are taking great care of her. Just keep talking with your team and dont be afraid to ask to speak with them in between appointments if you feel like things are changing..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Opinions on posterior tracheopexy for 2.5yr old?My son, 2.5yr old male, 32lbs has severe tracheobronchomalacia and moderate bronchomalacia and a type 1 laryngeal cleft. The bronchomalacia goes deep into the bronchi. Hes had multiple hospitalizations and 2 PICU stays. Most recent in December. His sleep studies always come back as mildly failed. His baseline o2 overnight is 94 with multiple dips into the 70-80s when healthy. Im in Canada and our doctors feel that surgery is too aggressive since he is generally healthy but struggles with respiratory viruses. They also feel that because the bronchomalacia goes deep into the bronchi it cannot be fixed and therefore correcting the tracheomalacia may not do much and they cant correct the bronchomalacia. Doctors at John Hopkins in Florida feel he is possibly a good candidate for the tracheopexy and would like to see him and run tests however that would be all out of pocket (5-10k$ for tests, 100k$ for surgery). When he is sick, his overnight o2 stays in the 80s. I dont even bring him to the ER anymore because often hes fine otherwise. He may sleep more. When he gets lethargic is when I go in now. Doctors here say he will get stronger as he grows. He sleeps around 15hts per day and does get winded easily. Ive pulled him out of daycare as the risk is just too great to his health. Sorry this is all over the place. Opinions?. ### Response: My opinion is 100k is a truck load of money when you have a team of doctors telling you it isnt necessary. But my other opinion is multiple 02 dips to the 70s isnt great. Have you tried anything less drastic like home oxygen? I would want to even ask about cpap before pursuing a surgery OOP your doctors dont think you need..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Freaking out about my echo results. PLEASE advise.27f 5'3" 280lbsPLEASE can someone look over my echo results and tell me if there is anything alarming? I am so scared.. (Yes, I have called my cardiologist who is out until Thursday and I truly cannot wait that long)Left Ventricle:The left ventricular chamber size is normal. There is no leftventricular hypertrophy. Global left ventricular wall motion andcontractility are within normal limits. The estimated ejection fractionis 55-60%. Normal left ventricular diastolic filling is observed.Left Atrium:The left atrial chamber size is normal.Right Ventricle:The right ventricular cavity size is normal. The right ventricularglobal systolic function is normal. TAPSE measures 2.2cm.Right Atrium:The right atrial cavity size is normal. The interatrial septum is notwell seen.Aortic Valve:The aortic valve is trileaflet. There is no evidence of aorticregurgitation. There is no evidence of aortic stenosis.Mitral Valve:The mitral valve leaflets appear normal. There is no evidence of mitralregurgitation.Tricuspid Valve:The tricuspid valve leaflets are normal. There is trivial tricuspidregurgitation. Unable to estimate the right ventricular systolicpressure due to incomplete spectral Doppler waveform.Pulmonic Valve:The pulmonic valve appears normal. There is trace pulmonicregurgitation.Pericardium:There is no pericardial effusion.Aorta:There is no dilatation of the ascending aorta. There is no dilatation ofthe aortic root.Venous:The inferior vena cava was not well visualized; unable to accuratelyevaluate size and respiratory change.______________________________________________________________________MeasurementsName Value Normal RangeIVSd (2D) 0.93 cm -IVSs (2D) 1.19 cm -IVS % thickening (2D) 28 % -LVPWd (2D) 0.98 cm -LVPWs (2D) 1.46 cm -LVPW % thickening (2D) 49 % -IVS:LVPW ratio (2D) 0.95 ratio -LVIDd (2D) 4.21 cm -LVIDs (2D) 2.86 cm -LV FS (Teichholz) (2D) 32.1 % -LV FS (cube) (2D) 32.1 % -EF Teichholz (2D) 60.6 % -Ao root diameter (2D) 2.84 cm -LA dimension (AP) 2D 2.47 cm -LA:Ao ratio (2D) 0.87 ratio -Name Value Normal RangeLA ESV SP 4CH (MOD) 44.1 ml -LA ESV SP 2CH (MOD) 38.7 ml -LA ESV BP (MOD) 42.7 ml -LA ESV BP (MOD) index 22.1 ml/m2 -LV EDV SP 4CH (MOD) 93.7 ml -LV ESV SP 4CH (MOD) 32.5 ml -EF SP 4CH (MOD) 65.4 % -LV EDV SP 2CH (MOD) 66.8 ml -LV ESV SP 2CH (MOD) 30.2 ml -EF SP 2CH (MOD) 54.8 % -LV EDV BP 81.9 ml -LV ESV BP 31.9 ml -BP EF (MOD) 61.1 % -Name Value Normal RangeMV E-wave Vmax 0.91 m/sec -MV deceleration time 185 msec -MV A-wave Vmax 0.76 m/sec -MV E:A ratio 1.2 ratio -LV E:e' septal ratio 9.1 ratio -LV E:e' lateral ratio 7.6 ratio -Name Value Normal RangeAV Vmax 1.26 m/sec -AV VTI 24.25 cm -AV peak gradient 6 mmHg -AV mean gradient 4 mmHg -LVOT diameter 1.91 cm -LVOT Vmax 0.92 m/sec -LVOT VTI 17.68 cm -LVOT peak gradient 3 mmHg -LVOT mean gradient 2 mmHg -SV LVOT 51 ml -AVA (continuity Vmax) 2.1 cm2 -AVA (continuity VTI) 2.09 cm2 -Ascending Ao 2.86 cm -Name Value Normal RangeMV PHT 54 msec -MVA (PHT) 4.07 cm2 -Name Value Normal RangeTAPSE 2.2 cm -Name Value Normal RangePV Vmax 0.87 m/sec -PV peak gradient 3 mmHg -RVOT Vmax 0.63 m/sec -RVOT VTI 10.41 cm -RVOT peak gradient 2 mmHg -FindingsLeft Ventricle:The estimated ejection fraction is 55-60%.Thank you so much!. ### Response: This looks like an extremely normal echocardiogram. Like boring normal, nothing interesting or remarkable at all.The regurgitation is described as trivial and trace, which is like saying I saw it so I gotta document it, but its clinically meaningless..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 8 year old F, 4'1" - Undiagnosed Condition / Continued dry cough - 2.5 years ongoingMedicines: Zyrtec (Switched from Claritin recently due to no positive response), Albuterol, Symbicort 160, pre+probiotic, antacid, - Has had adnoidectomy 2 months ago.My daughter has been going through an extremely long period of troubleshooting and we're still not at the end. What started out as a chronic cough and getting fevers and flu like symptoms were passed off as Covid towards the end of 2020.Then as the months went by it was passed off that she was getting sick at school. Various antibiotics and not getting better.Then in mid 2021 it was passed off as chronic sinusitus and told to use saline solution and more antibiotics.Then a few months later it was allergies and to take Claritin.Then after seeing the allergist it was Asthma because after 60pt test she's not allergic to anything but clearly decrease in breathing capacity so Albuterol.After seeing the cardiologist it was lower respiratory and take Symbicort with Claritin and Albuterol.After seeing ENT it was adnoids. After adnoidectomy she is to keep taking all of the above as well.Here we are two months later my daughter is home from school coughing just as she did two years ago. I have given her antacids and childrens pepto, along with pre+probiotics (largely because of the antibiotics) including all of the above mentioned medicine, and while she's no longer getting the flu-like symptoms she coughs so much she doesn't even realize she's doing it anymore. I don't know what's next. All ideas are welcome.. ### Response: Have you seen a pulmonologist? Or was that wrapped in with the allergist?One consideration would be tic cough or somatic cough disorder which would require behavioral therapy. I would especially think about this as you say she doesn't even realize she's coughing. Usually chronic cough is very noticeable to the child. Is she up all night coughing?.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 1: It really seems like he should have been diagnosed and started treatment for MDS after the bone marrow biopsy/aspiration in July 2021, not 11 months later given the fact he has tried so many therapies for ITP with no response. It also notes that patients "typically have mild-moderate thrombocytopenia." He has always been below 50K, surely that's not moderate?What is your opinion on his history/diagnosis?2: I believe the nurses screwed up with premedicating him for his tranfusions during his last hospital visit. He had negative reactions on the two days I know they deviated from what is clearly on his chart AND on the request from his hematologist/oncologist which tells them what medication he needs when. Then, units aren't even ordered for the following two days, a man who is recorded as transfusion-dependent in his chart. Prior to his hospital visit, the premeds were followed almost exactly with no negative reaction, and after noticing his head bleed, the nurse followed the premeds exactly with no negative reaction. I am going off of his medical history acquired from the hospital which notes exactly when the medication is administered (not being confused with when they charted it). His cause of death is noted as acute respiratory failure due to PNA, but its only because we took him off the oxygen due to the head bleed which I believe they caused.Am I looking at this wrong? Did they mess up?THANK YOUI know, it's a long one. I really appreciate it if you took the time to read through it and give your thoughts and opinions.I know he had a rough disease, and I believe I could accept his death, but something in these hospital notes stinks.... ### Response: Having treated many patients like this, these cases are often very difficult to manage. They sent off clonal hematopoiesis of indeterminate potential (CHIP) which is helpful in identifying mutations that may be causing cell abnormalities in MDS and sometimes garners targetable mutations eg IGH, del5q, ringed sideroblasts. However many of these we do not have detailed data given rarity so their effects on treatment are still unclear. In February 2023, that loss of chromosome 7 confers a very very poor prognosis along with refractory thrombocytopenia. I believe getting palliative care involved at this point may have been warranted. I do not believe any treatment wouldve changed his course by this time.I dont think a mistake was made by not treating him since signs of transformation to AML were not evident on the marrow from 2021. A score we use to predict transformation would also predict that prognosis was good with low chance of AML transformation in the next 10 yrs. Your father also has an extensive cardiac history and the drugs we use to treat MDS to AML have significant side effects including heart failure which Ive seen happen before from anthracycline. He had too many comorbidities so Vidaza was appropriate when it was given which is used to treat AML. Wed classify him as medically unfit but not frail and these patients are typically very hard to treat. Patients also become refractory to transfusions over time because their body starts making antibodies towards platelets. I do not think the mix up with premeds made a difference.Watching a loved one die from a hematologic malignancy is not easy, especially MDS. Please make sure you take care of yourself as well. I am very sorry for your loss. You did the right thing letting him go like you did. There was no meaningful way out of his situation where he would go on living a quality life. Please know that his medical team did everything they could..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 19 month old has had fever since end of JanuaryAge: 19 monthsSex: MaleHeight: 33 inchesWeight: 27lbsRace: CaucasianDuration of complaint: just over three monthsLocation: Southern United StatesAny existing relevant medical issues: Dominant Dystrophic Epidermolysis Bullosa with recessive traits. This is a genetic skin disorder. When googling this disorder, you'll find very bad cases. My son's case is very mild compared to some other children. My child's father also has the same type.Current medications: Tylenol and Motrin as needed.Include a photo if relevant: noneI'm on a mobile app, please forgive me if this looks awful as far as formatting goes. My son and I got COVID back at the end of January. We both seemed to recover okay. We both ran fevers throughout the duration, never above 102F. After recovering, we then noticed a new fever and took him to the doctor where he presented with a high pulse, left ear infection, and an upper respiratory infection. Dealt with that with antibiotics and the fever came and went. Never above 102F. About a month later, still not better. Back to the doctor with a right ear infection and strep throat. Antibiotics once more, different one this time. Two or so weeks later after antibiotics were finished, back to the doctor where he had a double ear infection and still had strep. My husband and I double down at this point and begin sterilizing everything this child touches. We clean his toys and play areas every evening after he goes to bed, sterilize common areas, threw away toothbrush and bottles and sippy cups, wash every single stuffed animal and pillow and change sheets. We went over the top to try and keep the germs at bay. They had him on the strongest antibiotic they could give him at this point. He finishes the antibiotics and we take him back to the doctor to ensure all the infections and strep are gone. They are. Relief, right?No. He still has the fever. He's had a fever of at least 100F nearly every single day since he got COVID at the end of January. The last appointment he had at the doctor where they confirmed ears looked fine and the strep was gone, the doctor said his fever was from teething. A nearly 102F fever from teething? For that long? I'm not buying it. I had another doctor we took him to (before all this) while his regular pediatrician couldn't see him tell me that it wasn't normal for a baby to have that high of a fever while teething.He goes back to the doctor tomorrow. I don't even know what to ask them to test for. I don't know what to even do. They're blaming it on teething. It doesn't seem normal for a toddler to have a fever for this long even when his sickness is no longer there. He doesn't currently have any infected sores from his skin condition, either. Nothing open and nothing oozing or bleeding, so that's not it. It's something else and I have done so much googling to try and figure out what it is he has or what's wrong and I don't know where to turn anymore.Please help. Thank you.. ### Response: Hi, wondering what happened with your little one.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Pediatrician ordered blood work at the insistence of my husband after trying to say the fever was due to teething. Again. The CBC with differential came back normal, so they said. But in his medical records, it literally says abnormal in the comments. They also did a blood culture and when I asked about that, they said his preliminary results are fine and they were monitoring for the final results. For some reason, I cannot view this in his patient portal.We found something called PFAPA and are wondering if that's what we are dealing with.. ### Response: You can post the cbc here if youd like. Its not uncommon for a lab result to flag as abnormal but actually be fine. Blood cultures probably dont appear in your portal until 5 days, but if its negative at 1-2 days then it will almost certainly remain negative. PFAPA is certainly possible, or HIDS, but doesnt really fit the fever pattern.Chronic subtle skin infection was my first thought but sounds like not the case. Could just be back to back to back viruses especially if there are intermittent fever-free days, or mono. Can I presume he doesnt have a central line? I wouldnt be surprised if the doctor tomorrow wants to admit him to the hospital to expedite more testing. We typically send blood for lots of less common infections and non infectious conditions, and sometimes ultrasound and/or mri looking for signs of a site of infection. Please update here if youre comfortable doing so..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I've been concerned about mono. But there's no other symptoms. And wouldn't it have already gotten worse after three months if it were? I would be very surprised if the doctor does anything more than try to blame it on teething again. If I could switch doctors, I would do so in a heartbeat. We haven't had the best experience with her as far as caring goes...He does not have a central line, no. What types of things would the blood work be looking for?. ### Response: Viruses can cause fever and no other symptoms in little ones. 3 months is a long time though for one virus. But again if he has had any fever free periods it could just be recurrent normal infections.Testing could look for general inflammation, bone marrow function , mono and other weird infections, autoimmune conditions which would mostly be JIA in a toddler, immunodeficiency, malignancy which seems unlikely here. Many of the diagnoses which cause 3 months of fever do not have a specific test and are tough to diagnose.Im sorry about your experience with your doctor. In my hospital if you showed up in the ER reporting 3 months of fever especially with an underlying condition youd probably be admitted. If it was me and I was unsatisfied with the visit tomorrow Id consider going to the ER at a Childrens hospital if you have one near..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 2 year old respiratory distress?27 month old female, 27 lbs. Meds: duoneb, albuterol sulfate, epi pens. History: born at 31 weeks, required extensive oxygen support including ventilation for a few weeks. Allergies to eggs, peanuts, coconut, sunflower, dogs.2 year old is on day 3 of a relatively minor cold. She is covid negative as is the rest of the family (we tested for Christmas.) Over night started having a little trouble breathing. Resting resp. rate was between 36 and 40 breaths per minute. Grunting occasionally, minor retractions in rib cage and clavicle. No fever, no vomiting, normal energy all day prior. Normal appetite, normal diaper count. Gave duoneb breathing treatment and noticed slight improvement. (Resp rate went from 40 to 36 bpm.)Does this warrant an ER visit? With covid surging Im hesitant to bring a not yet vaccinated former preemie anywhere she could be exposed. My Childrens hospital offers an e visit option but I feel like this is something theyd need to see and or hear for themselves in person.. ### Response: That resp rate is close to normal for her age. The concerning part is the grunting and retractions. That signals she's working hard to breathe. Given her medical history it would be a good idea to have her seen by a doctor. She may need a change to her baseline inhaled medications if she's dealing with a cold..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for your response, and happy holidays. Shes one of three preemies for me so this is not uncharted territory for us. This pandemic makes all of my decisions twice as hard, though. Risk of exposure vs medical treatment  Im calling her on call Ped now.. ### Response: Very stressful, I hear you. It's hard to recommend that you dont have her assessed by her pediatrician given the signs of respiratory distress. That's why there are docs on call on holidays, don't feel bad contacting them..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: COVID-19 FAQNote the information below may well now be out of date. If I get a chance I will update.READ THIS FIRSTIve written this to try to answer some common questions about COVID-19. I will try to answer any other questions you may have.Do not ask what your personal risk is due to whatever medical condition you might have. We simply dont know. Read whats written below - age is the most important factor in determining someones risk of severe disease (ie needing hospital admission) or death.Do not list your symptoms and ask if we can tell you whether you have COVID-19 or what precautionary measures you should take - we cant. You should follow you local public health guidance. If in doubt, isolate and only go to the hospital if absolutely necessary. Read below for more information.Clearly people arent actually reading this and just asking the above anyway, Im no longer going to reply to these questions. I generally reply to all questions, if I havent replied to yours its because youre either asking the above or your answer is contained within this post.What is it?COVID-19 means coronavirus disease 19 (as it was first reported to the WHO on NYE in 2019). It is caused by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2).Why is it so bad?COVID-19 is very contagious. Current data suggests an R0 (that is the number of people an infected person will go onto infect) of 2.5-3. By comparison your average seasonal flu with have an R0 of about 1.3. To put this into perspective, if you start with 10 people infected with seasonal flu, over ten infection cycles youll end up with about 138 infected people. With COVID-19 over the same ten cycles youll end up with tens of thousands to hundreds of thousands of infected people. Bear in mind this is not what is going to happen, only what could happen if the a disease was left to spread without effort to slow it. Public health measures to contain it can massively reduce the actual transmission rate.How come more people dont have it?We only know how many confirmed cases we have. For every one person who is ill enough to be tested theres a large group who have mild symptoms only and arent tested. This number varies wildly but seems to be about 1 in 10 (ie for every confirmed case theres another 9 people out there who have COVID but arent symptomatic enough to get tested.How do I know if I have it?The most common symptoms are a fever and a persistent cough. Other flu like symptoms may be experienced. It will be very variable from one person to another. The only way to know is to be tested - access to that depends on whats being done where you live.Can I find out if Ive had it already?Right now no. There is a test in development.Am I going to die?About 1 in 8 of the KNOWN cases (ie only those who are confirmed to have COVID) will end up being hospitalised. About 1 in 6 of this group will become critically ill and need to be managed on an ICU. Of this ICU group about half will die.For the 7 out of 8 cases who arent hospitalised the symptoms are mild enough to be managed at home. Remember for each of these people theres another 8-9 who arent even aware they have it. Some people have no symptoms, for others its the same and a bout of flu.The good news is if youre young youll probably be fine. Young adults and children have excellent survival rates with deaths very rare. Older people on the other hand are at much greater risk. Amongst the 60-69yr age group mortality is around 3%, whilst in the over 80s its approaching 15% (again of confirmed cases).I have a co-morbidity!The biggest risk factor for higher mortality seems to be cardiovascular disease, followed by diabetes and hypertension, then chronic respiratory disease such as COPD.Age remains the biggest risk factor by far, if youre young and you have one of these that doesnt mean youre going to die. It would be sensible to minimise your exposure.Can I go out?All these restrictions on movement are about slowing spread. The big problem for hospitals now is a sudden tsunami of critically ill people that the usual ICU capacity cant cope with. Think of it like taking a train - go rush hour on a week day and its packed and you cant get a seat, much quieter in the middle of the day. Go on a weekend and theres no early morning peak so the passengers are divided amongst more trains thus everyone sits down, even though a similar number of people travel over the course of the day. If we can slow the rate if infection ultimately therell be the same number of cases but they wont all come at once so the hospitals will be able to manage them. Make sense?Every country is different so you should follow your local guidelines. Doctors on this forum come from all over the world, what is right where they live may not be right for you.What can I do to minimise my risk?Wash your hands. Regularly. Avoid large gatherings. Follow local rules and guidance. If you have symptoms then stay away from other people. Take this seriously, because it is.Do not ask if we can tell you whether you have COVID based on your symptoms alone - we cant.Should I stop taking my medication?There have been media reports that people taking certain types of mediation, specifically ACE inhibitors/A2RBs (eg ramipril/losartan) or NSAIDs (eg ibuprofen) are at higher risk of catching or complications of COVID. To my knowledge there is no good data to support this. You should continue to take your medication as normal unless instructed otherwise by your doctor.. ### Response: Follow local guidelines regarding social contact.Mild can be no symptoms at all to a mild flu like illness.Safe to go out on your own.We cannot comment on individual risk.https://jamanetwork.com/journals/jama/fullarticle/2762130 URL to a paper out of China - the 80% mild figure includes those with viral pneumonia not requiring respiratory support - this will absolutely be the worst viral illness many of us have had.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Are things such as a mild sore throat/ fatigue early signs?. ### Response: Possibly yes. Could also belong to another virus. When in doubt, assume you're infected and stay away from others.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What about sore throat caused by swollen lymph node? I can see it on one side inside my mouth and my neck is sore to the touch behind that ear. :( Temp has been slightly above 99 Fahrenheit this evening but its my understanding that body temperature fluctuates throughout the day.. ### Response: If it's just a node it seems unlikely, but I have no way to tell for sure.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is throat clearing the same as coughing? My coworker has been doing it all day and we share an office.. ### Response: not the same, but can be a sign if infection. Im not clairvoyant though..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: How can I tell if I have new onset of asthma vs. COVID-19? I've had low fever, had to clear my throat but not cough, and have tightness in my chest / difficulty breathing and occasional pain in my lungs. There is no wheezing at all, no runny nose or congestion, my airways feel dry. I have no history of asthma, I'm 26 and exercise regularly (been recently training for cardio). The symptoms started in earnest about a week ago and got slightly worse the last few days. I'm trying to figure out if it could be just sudden onset of asthma or if I should be concerned that I have COVID-19. Any thoughts on to what extent these symptoms may resemble asthma?. ### Response: New onset asthma in adults rare Infection common.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is it possible that there was a different strain of coronavirus that was non lethal circulating in the US this winter? I got quite sick in December 2019 and the main symptom was sore throat/persistent cough. Many people in the community were sick as well. It was definitely not flu, I did get screened and was negative and I also get flu vaccination annually. Also the period of fever was short and not particularly high.. ### Response: There are a variety of respiratory viruses that cause essentially the same upper respiratory symptoms. This includes other strains of coronavirus but most commonly it's rhinovirus or others. You can't really tell them apart without viral PCR test..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Glad you asked this. I also have stage 1 or 2 sarcoidosis which is largely asymptomatic. My brother, however, has fibrosed lungs due to severe sarcoidosis. I worry more about him as he is currently on an immunosuppressant which seems to be helping him.. ### Response: Not to my knowledge.That would come under the classification of pulmonary disease so I think would suggest higher risk of severe symptoms, but depends on age and severity of the sarcoidosis..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Anti-inflammatories and steroids and COVID19I have seasonal allergies and I take albuterol, nasonex for symptom relief. I read that anti-inflammatories and steroids aggravate COVID19 symptoms. I'm not sick with any symptoms of COVID19, but should I stop taking these just in case?I also take antihistamines (Zyrtec/loratadine) and a daily inhaler Ventolin (I don't believe that is steroids).. ### Response: Good question.This has been widely reported after comments from the French health minister.As I understand is there is no good evidence suggesting any increased susceptibility to, or severity of COVID amongst those taking non-steroidal anti inflammatory medication such as ibuprofen.People who regularly need steroid such as prednisone should absolutely keep taking them as normal unless directed otherwise by their doctor.Ill add a section to the post..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Shortness of breath muscle pain I wish they would define and describe these things, I am confused as to what they really mean.I have a persistent feeling that I need to yawn but cant- is that shortness of breath? Im not wheezing, I just feel tight. I had this a week to 2 weeks ago as well but attributed it to being on prednisone at the time.I have localized muscle pain, is that muscle pain? or does it need to be full body?I had contact with two people recently returned from Beijing 19 days ago. There are a few hundred confirmed cases in my area. ### Response: Needing to yawn is different from feeling like you can't catch your breath. The latter is shortness of breath. Generalized muscle pain is what you should expect with COVID-19, simmer to a flu or some bad colds..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: came into this thread looking for the same thing. I had a slight tightness in my chest/throat without pain. intermittent chills, feeling feverish (but i dont think i actually have a fever), and no coughing.i have no difficulty breathing persay, but taking a deep breath requires more effort than it used to. I dont know if this qualifies as a "shortness of breath" because the definition is so vague.. is it considered having "difficulty breathing" even if you're not gasping for air?I've had no known contact with anyone with COVID19, been indoors since last Friday. But I live in NYC so I'd say my risk of having already caught it is pretty damn high.. ### Response: The feeling you are looking for is if you cannot catch your breath.We'll use this as the new COVID-19 question thread.We can't answer every question, especially those about whether you might or do have a case yourself. For general questions that we might be able to answer and that aren't explained in government and international websites, ask here. If you're asking a lot about your or loved ones' individual risk, look at the resources from reputable sources, like the sites linked in the original post here. We don't know better than the information provided, and we can't provide individual consultation to everyone.What is my risk?We can't answer that. The data available aren't thorough and granular enough, and we don't have full information, and that can't be calculated accurately even for the best-characterized diseases. All that we can say is repetition of the guidelines from the CDC and WHO websites, or other major organizations. Some comorbidities increase your risk. We can't say anything more individualized than that.What should I do [especially with individual risk factors]?There are no secret super-precautions to take. The recommendations are the same for everyone: wash your hands, don't touch your face, practice social distancing. It's more important for you, personally, if you have higher risk, but it's good advice for everyone. It reduces your risk of getting COVID-19, and it reduces your risk of spreading COVID-19 to someone who is higher risk than you.Previous megathreads:.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Prediabetic and COVID-19So I know that if you have diabetes and you contract COVID-19 it could be bad. I was diagnosed with prediabetes and was wondering if that carries the same risk if I contract COVID-19. ### Response: No evidence of this to my knowledge..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm in the same boat, I really can't tell if I have shortness of breath, or if it's just anxiety. It's been persistent for about two weeks now, with very few other symptoms like extremely mild cough now and then.. ### Response: Top of the FAQ under read this first.Do not seek medical attention unless you are so unwell that you need to go to hospital. Use online resources or call 111..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: In kind of a difficult situation with my children. 50/50 weekly custody split. Their mother got them yesterday and tells me 4 hours later that I need to pick them up because she has covid symptoms. It takes everything for me to not go get them but as I understand, conventional wisdom right now is to assume they are infected and not to spread it (leave them there). Youngest is 9 both children healthy. My girlfriend is also immunocompromised. Am I taking the appropriate precautions or is it better to get them out of there?. ### Response: Majority of guidance is that the children should be isolated for 14 days if they live with someone who is infected. You should follow local guidance..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: have an academic question about asymptomatic carriers of covid-19.people who are infected but not showing symptoms - does that mean their body is not responding to the infection, and not creating antibodies to destroy the invading virus?If that's so, does that mean they will be able to infect other people way past two weeks?. ### Response: Absolutely they are having a normal immune response..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: thank you for the response. Quick follow-up (and sorry about the dumb questions): do you mean an asymptomatic carrier will have a normal immune response, therefore will still create antibodies to fight the virus despite being asymptomatic?Or do you mean in spite of having a normal immune response, their body couldn't detect the virus (therefore asymptomatic and won't fight the virus)?. ### Response: The former.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Hi, hopefully someone can ease my anxiety a little, we have our wedding planned for July of next year, there's still a lot of planning to do, and I'm worried that even though it's over a year away this virus could get big enough that large gatherings will still be banned by then. Is this realistic? Is there enough research going into the virus that we should be able to get on top of it all with vaccines and treatments within a year?I know that there are people out there who's health is on the line, and they have more right than I do to be anxious, but... I'm worried about it too. Basically I just need reassuring that I can keep planning and we won't be living in a post apocalyptic society by then.. ### Response: Sorry I cannot predict the future.I will be surprised if this has not settled down in 16 months.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What exactly is the difference between the names COVID-19, SARS-CoV-2, and 2019-nCoV?. ### Response: Covid19 is the name of the disease,sars cov2 is the name of the virus. The last term isn't used anymore..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is it safe to take anti-histamines if you think you might have COVID? I think I am also experiencing seasonal allergies based on runny nose, sneezing, and dry eyes. I just don't want to suppress my immune response.. ### Response: Yes.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What are the chances of it spreading through a hvac(forced air) heating system? I live in a basement suite. When my upstairs neighbours get a cough or virus. I seem to get it a few days later.. ### Response: We don't know. It's possible..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Any potential issues taking albuterol through an inhaler for asthma symptoms if the symptoms are actually being caused by COVID-19 respiratory infections?. ### Response: No continue you usual meds.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: There is a post online circulating by someone who says that she has been in pediatrics for 8 years. Her post indicates that she believes that Covid-19 has been moving through the United States for several months. She describes symptoms, cases she has had come into the practice she works at, and says that she would send samples off for testing if it was possible.Her post has been shared almost 300,000 times. In most of the local posts, there are about 30-50 likes. That means that this is reaching upwards of 15 million people.I am also in the medical field, but as someone who helps make decisions for at-risk patients. In my small town in Florida, this nurse's post has been shared by half of my town. The comments are all in agreement - they've all had this before. It's utter nonsense, shared by people who simply don't understand the first thing about medicine or pandemics.I contacted this nurse this morning and informed her that her post is spreading through my community as well as others, and that it is being used to suggest that people don't need to take this seriously, do not need to socially isolate, etc. I asked her to recant and print a retraction. She threatened to sue me for stalking her. She then went and put a disclaimer on her post telling people to take Covid-19 seriously. The issue is - her words are being copy and pasted, and not shared, so people are still reading her post without the disclaimer. And they're taking it as gospel.I decided this afternoon to call her office, only to find out that there was no way to bring this to her doctor's attention without going through her. She already told me that she manages the Facebook page. Apparently she also screens the emails to her doctor, according to the receptionist. There is no way to contact this doctor directly, and I have tried every way possible. I am hesitant to report her to the board of nursing, and even if I did, I don't have her information.Should I let this be? All I want is for her to print a retraction and remove her original post - I don't want to personally be involved, I just don't want the locals in my town to buy her conspiracy theories. I don't know what to do from here.. ### Response: Well youre correct its clearly rubbish but as a physician I have no idea what to suggest.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My dad is a domestic US pilot, and he's going to be in my city this week. Would it be a bad idea to still meet up (in a non-public place)? I'm 24, he's 55, we're both currently healthy - as far as we know - without any comorbidities. Feeling like I should cancel but I really want to see him.. ### Response: If youre both free of symptoms you can certainly see one another. Large gatherings or unnecessary social contact for those at high risk (elderly, co-morbidities) should be avoided. As always follow your local guidance..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 12 days ago my father wasn't feeling well (after a week of feeling unwell, with symptoms of common cold), he went to hospital because he was suspected to be infected with coronvirus, he had a chest CT scan and blood test (I think for CBC and CRP), the doctor said his CT scan showed lung infection but it was not coronavirus, they prescribed her some medication and he's got very well and back to normal life.7 days ago or so my mom got sick too with symptoms like fatigue and cough. he went to our local clinic, got some medication and the doctor prescribed her a blood test. she got well too but 2 days ago she went to doctor to check and show her blood test, the doctor told her "you were close to get coronavirus but the danger has passed" (excuse my language but I don't know what the fuck he meant!) my mom then has asked her if a lung image is needed and he's replied that it's not needed and her lungs are fine (he's checked her breathing pattern with Stethoscope apparently). he then has prescribed Vitamin D and acid folic in addition to her previous medications such as Amoxicillin. My mom is alright and her illness is mostly gone but I looked at her blood test, these are the numbers:W.B.C: 3700 /ulRBC: 4.09 (10*6/ul)Neutrophilis%: 64Lymphocyte%: 36CRP: (Positive) 48 mg/lShould I be worried? what's the right thing to do? as I checked with test references, her CRP is so high, normal level should be less than 6 apparently. Is it possible that she suddenly and silently get very sick without symptoms, now that she's quite fine?. ### Response: Bloods consistent with non-specific infection.Cannot tell you if they have/had coronavirus without a test..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I live my aunt and her boyfriend. They refuse to let me leave or open windows thinking it will make me 100% safe. Does that ensure safety or are there any other things they should o. ### Response: You are minimising risk but nothing is impossible..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: The UK released last night that anyone whos routinely offered a flu vaccine on the NHS due to a chronic condition is now classed in the high risk group Ive got digestive tract paralysis, an ileostomy, dysautonomia, chronic joint pain, chronic fatigue and urinary retention as my main conditions None of these affect my heart or lungs so I accept that I may be higher risk to catch it but in my eyes I shouldnt be higher risk of getting complications except maybe my potassium dropping lower than usual if I struggle with oral intake/get the rare diarrhoea Do you think Im right in my assessment of my risk or would you consider someone like me high risk for complications too ? Im a 24 year old female by the way who does have a history of being hospitalised with chest infections. ### Response: Cannot comment on individual risk.As in the above post age is the biggest risk factor for severe disease..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Highly probable that I have Covid 19 and I was wondering if I should continue nursing my 12 month old daughter. She is also feverish but much milder than myself and I was curious if there is any literature or recommendations in regards to breastfeeding. I know other illnesses can pass on antibodies and wasnt sure if this was the same or if I could make her more sick.. ### Response: To my knowledge no evidence passed on breast milk.Illness generally very mild in children.QuestiomThank you for the information! This is indeed a pandemic of a lifetime, but i just wanted to clarify the overall death rate: 1 in 10 people are sick enough to get tested, of those 1 in 8 get hospitalized, of those 1 in 6 are critical and of those half die. So the death rate is 1/10/8/6/2 which is about 0.1% (probably understated a bit because some COVID deaths are misattributed). Is that correct or have I missed something? These numbers seem much lower than what usually gets reported (2% i believe).Data very rough, dont extrapolate from it.Mortality rate quoted for confirmed cases. Far more out there undiagnosed so probably lower than initially thought in the whole population. Mortality rate amongst elderly is horrific..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Why dont doctors give people antivirals early on in a cough to prevent lung damage. Why are public health authorities waiting until people need or are close to needing ventilators to test them.. ### Response: Multiple studies underway to see if antivirals effective Public health decisions are local and political.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I understand social distancing well enough to understand the message. Stay home. For my own mental health, I was wondering if fishing, alone, on a river close to home is something thats still feasible. Is this a situation in which even while alone, in a quiet place in the woods, Im still putting myself or others at risk?. ### Response: Close contact needed for transmission..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Why isn't thorough nose and face washing being advised with hand washing if the end goal is to keep virus from face (entry points). Thanks.. ### Response: People tend not to touch things with their faces, apart from their hands.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My doctor found a shadow on my liver in an ultrasound. Im scheduled for a ct scan on Monday and a follow up doctor appointment Friday. However, should this wait? What if Im exposed to covid by going to the dr. On the other hand what if I have cancer and should be seen....what would you recommend?. ### Response: Continue normal medical care unless advised otherwise by your doctor.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have about a 28ish BMI so I'm overweight but not obese. Am I at higher risk because of that?. ### Response: Government guidance. High risk BMI >40.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have probable covid-19 but dont meet travel/contact requirements for testing. I am a 28 year old female with no comorbidities, however my lymphocytes are consistently low and neutrophils high in various bloodwork throughout the years. Not sure why.Severe cough for about a week, fever for past five days, influenza A and B negative, virus panel also negative. Chest X-ray shows no pneumonia, but Ive read that covid-19 pneumonia can only be seen on a CT scan. Coughing up frothy sputum almost constantly, pain when breathing, and getting lightheaded with light activity around the house.Naturally I am quarantined with my family however:-should I be concerned about developing pneumonia?-when they talk about the possibility of convos-19 patients developing long-term or permanent fibrosis, what exactly does this mean? What symptoms would one have, and how would one get tested in the first place?Thanks!. ### Response: If your symptoms worsen and you are concerned seek reassessment.Given this virus was only identified less than three months ago anyone whos talking about secondary fibrosis or any other long term effects is full of shit..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What sort of things should people use disinfectant on?Should they use it on surfaces other people people touch because Covid-19 can live on surfaces?. ### Response: Data still emerging about how long it persists on different materials.You cant be too clean.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Does Covid-19 just live on people's skin and then gets transmitted by touch?Is it transmitted through bodily fluids?. ### Response: Most aerosol spread from coughing onto external surfaces or other people. Coughing onto hands then touching other people also spreads. Hence hand hygiene and social distancing essential.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: w.r.t the last FAQ point, I have tried to dissect the Lancet letter in question, and am wondering if my interpretation is correct;https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltextBasically what I understand is that if you are taking ACE Inhibitors, and you encounter a drug interaction with a different drug, there may be additional risk/complications.However, this is only off investigating dead bodies with comorbidities, so it's not necessarily an accurate representation of the facts.Thanks. ### Response: As I understand (DOI I have not read the paper relying on others interpretation) the lancet paper is hypothetical not hard evidence. European society of cardiology has an excellent position paper on the use of ACE- inhibitors/A2RBs that is available on their website..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can you contact COVID19 by eating food that has the virus? Let me give you an example. You order a take out pizza and the cook sneezes on the pizza so virus droplets are on the food. Are you able to get the virus by eating it or would you have to get the virus on your hands and then touch your nose/eyes in order to get the virus?. ### Response: If someone with covid sneezes on something and you then eat it then yes you could contract it that way.Of course if your local pizza chef has a habit of sneezing on food then serving it Id advise finding a new pizza restaurant..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I keep hearing that a large a symptomatic portion of the population spreads the disease because they dont know they have it. If this virus is try spread via droplets, then how do asymptomatic infected people spread it? Wouldnt they need to be coughing, sneezing, etc for it to spread easily? Otherwise wouldnt chances of spreading be super minimal from an asymptomatic person?. ### Response: You could also get it from them touching their face then touching a doorknob..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I read it can survive 3 hours in the air. Is this true? For example, if you go into an elevator that was previously ridden by someone infected, how likely are you to get infected?. ### Response: No, the virus is not likely to be randomly aerosolized as far as we currently know. It's droplets, which can survive on surfaces. The air problem is mostly in the hospital during high risk respiratory procedures..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I don't know if this is the right place to ask this, I can post it elsewhere if it's not.I'm 23F, 5'3 117lbs, in canada. drink occasionally and very rarely smokeI've never had the flu, and I hardly ever get colds. The most I'll get is the sniffles, sore throat and a headache in winter. The only times I've been sick with something that I can remember was a stomach bug 2 or 3 times and I think I had strep throat at some point.I've had the flu shot maybe once when I was a kid but I can't remember another time since then. There's no real reason to it, I know I should be getting it but my parents never enforced it so we all just forget out it (my family is like this too, I could count on one hand the times one of got really sick with something.) I know I should because it hurts other people but that's not the point to this. My question is this, from what I understand having a flu shot and getting the flu builds immunity to the virus, right? If I've never had the flu or the flu shot, and I get the COVID19, is my body not gonna take it well? I know you probably don't have an exact answer to this since we are all still learning about it but maybe theoretically could you tell me what you think? or how would I react if I get the seasonal flu?. ### Response: Having had seasonal flu or the flu vaccine has nothing to do with how you may react to this covid virus.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Low respiratory rate and possible Bradypnea?M35, 57, 190lbsHi all. Ive been tracking my breathing rate using a Fitbit Sense, and it has been fluctuating between 10-11 every night. In addition I snore, occasionally wake up throughout the night, and get lightheaded occasionally (maybe one brief spell once per week), but that often goes when I eat. Otherwise feel fine. I was diagnosed with vertigo a couple of years ago when my dizziness was particularly bad and the medication cleared that up.Is this something to be concerned with? I keep reading that below 12 is abnormal but I cant find much more than that. Is that below 12 when awake? Is 10 ok when sleeping?. ### Response: Yes, it's totally fine. It's a pretty useless thing to track..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you! My hypochondria gets the better of me sometimes. ### Response: So why have a device that gives you too much information with no real need/ability to analyze it usefully? Get rid of that smart watch thing and move on with life..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can the cause of a respiratory infection be determined by listening to a patient's lungs?Patient is 33F, 5'3", 105 lbs, has a history of psoriatic arthritis and gerd and takes humira, methotrexate and pantoprazole.Patient has had wheezing and chest congestion for three weeks. PA listened to patient's lungs and said the diffuse rather than focal crackling/wheezing sound ruled out bacterial and fungal infections. Can these infections truly be ruled out based on sound? No tests were performed.. ### Response: No. Classical "typical" pneumonia tends to be localized to one part of the lung. "Atypical" bacterial pneumonias can be diffuse. I would be very concerned about a patient with an autoimmune condition on multiple immune suppressing medications (especially the humira). Three weeks is a long time to infectious symptoms -- typically if something hasn't gone away in 10-14 days we look into it further. I strongly suggest you seek out another opinion, probably from an MD or DO who will likely have more training and experience than a PA..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Results of blood tests show abnormal for a lot of things and I was randomly scheduled to see a respiratory therapist. Please help me understand25 year old male 62 181 lbsNo alcohol ever, no smoking ever, no drugs everActive duty MarineOver the last 2 months, I started having severe stomach pains and have been unable to eat or drink very much which resulted in me loosing 25 lbs. I started vomiting what appeared to be reddish brownish stuff last Tuesday with coffee ground looking things in it that smelled like rotten metallic feces. I went to the ER and had blood work and a CT scan. The scan showed my small intestines were inflamed in some areas, and the blood work that was available immediately showed my bilirubin and coagulation levels are high, which they already knew because I appeared to have jaundice.I checked my online tricare portal for the results of the blood test and UA that took a few days to come back and I learned that my Lipase level is low (66), BUN is high (21), sodium is low (105), Glucose is high (105), bilirubin total (2.7) and direct (.40) are both high, UA RBC is high (67), UA spec gravity is high (1.041), and that Ketones, blood and protein were all moderately present in my urine.I did my best to google what all that meant and all I learned is that there is possibly something wrong with my liver, kidneys, and pancreas. The reason I am extremely confused is that someone at the naval hospital scheduled me to see a RT? This was not communicated to me. I just happened to see it on my patient portal. I knew about the GI doctor referral but why would I need to see a RT? Also, based on what info Ive given, what seems the most likely to be wrong with me?. ### Response: Gastritis or esophagitis. PPI should help. Follow up with GI doctor. Can't comment on rest.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for responding! The surgeon also said he is thinking Gastritis. The ER doctor prescribed protonix for home until follow up with GI on the 8th of March. ### Response: Omeprazole . Good luck.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have respiratory sinus arrhythmia in my late 20s, is this still normal? RHR is 54bpm and BP is 110/7026 male, when I breathe in my HR goes up, when I breath out it drops drastically. Most devices clock my RHR at mid 50s bpm. Now it goes up no problem, when I workout it goes up quickly but it also drops fast too. I can go from 160 running a mile and sit down and 40 seconds later its 59 bpm (verified by the good old fashioned finger) I do get lightheaded occasionally but its very much tied to anxiety when I do so not really something that I relate to a heart related issue. Im just curious if this is worrisome? I read respiratory sinus arrhythmia usually goes away in early adulthood but I certainly still have it. Ive had a echocardiogram a few years back (unrelated screening) and it was totally normal. A holter monitor as part of the same screening was fine beyond a few hundred PACs a day and a few dozen PVCs which doc said are normal findings.Anyway is anything worrisome about my heart rate and the breathing affect the HR?. ### Response: Nope, not worrying..


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What kind of viruses cause respiratory and gastric symptomsSo my poor baby, (M, one year old, 28 pounds, no underlying conditions) has been sick for 2 days. 101 fever, diarrhea, vomited once, runny and stuffy nose and a slight cough. I also believe his throat may be sore but it's hard to tell. He just tested negative for flu and covid so I'm wonderimg what types of virus cause these diverse symptoms. I'm not super worried because Hes holding down his drinks, and still being playful through out the day. Hes just napping a lot more and not really eating. Any idea what kind of bug he got? No one else in the house is sick and we don't leave the house other than for work.. ### Response: Usually in this age either RSV, adenovirus or rhinovirus.


Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: They didn't test him for RSV but now I wish I asked! My 3 year old had it at his age but he was REALLY sick. My little guy is just really run down but still acting fairly normal. Whatever the diagnoses is, won't really change the treatment though so I'm not gonna stress too much :) thanks for the response!. ### Response: Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification..