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### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 45 year old male. I had an accident before 10 years. At that time, my knee x-ray was done and I was reported to have osteoarthritis. I have been suffering from pain for few years. I have lower back pain and pain in some of the joints. For the past few weeks, I have pain in my left palm, particularly in my finger joints and more on left middle finger joint. Also, on my foot joints. I also feel very fatigued and tired. My blood pressure (BP) was 110/70 mmHg a week back. I am enclosing a comprehensive blood test report, which was done very recently and I have advised to take tablet Nusam 400 for six months. I have been taking for the past two months. Please suggest me the remedy and preventive measures. ### Response: Hi, Welcome to Chat Doctor forum. Vitamin D deficiency and autoimmune cause. Ultrasound abdomen and pelvis, rheumatoid factor, MRI of spine with sacroiliac joint and MRI of the whole spine, screening and ultrasound of hands to look for active arthritis, HBsAg (hepatitis B surface antigen) and HCV (hepatitis C virus). Seronegative spondyloarthropathy. 1. Rheumatoid arthritis.2. Seronegative spondyloarthropathy. Calcirol sachets (vitamin D) 60000 units once in a week with a glass of water for six weeks and tablet Dolo 650 mg (Acetaminophen) for pain. 1. Avoid alcohol and excessive weight lifting.2. Also, try to avoid painkillers as your liver functions are abnormal.

Hi doctor,I am a 45 year old male. I had an accident before 10 years. At that time, my knee x-ray was done and I was reported to have osteoarthritis. I have been suffering from pain for few years. I have lower back pain and pain in some of the joints. For the past few weeks, I have pain in my left palm, particularly in my finger joints and more on left middle finger joint. Also, on my foot joints. I also feel very fatigued and tired. My blood pressure (BP) was 110/70 mmHg a week back. I am enclosing a comprehensive blood test report, which was done very recently and I have advised to take tablet Nusam 400 for six months. I have been taking for the past two months. Please suggest me the remedy and preventive measures.

Hi, Welcome to Chat Doctor forum. Vitamin D deficiency and autoimmune cause. Ultrasound abdomen and pelvis, rheumatoid factor, MRI of spine with sacroiliac joint and MRI of the whole spine, screening and ultrasound of hands to look for active arthritis, HBsAg (hepatitis B surface antigen) and HCV (hepatitis C virus). Seronegative spondyloarthropathy. 1. Rheumatoid arthritis.2. Seronegative spondyloarthropathy. Calcirol sachets (vitamin D) 60000 units once in a week with a glass of water for six weeks and tablet Dolo 650 mg (Acetaminophen) for pain. 1. Avoid alcohol and excessive weight lifting.2. Also, try to avoid painkillers as your liver functions are abnormal.

### Instruction: Answer this question truthfully ###Input: Hi doctor, I am constantly unable to focus on anything in my life. My brain just seems like damaged. I feel alone, depressed, sudden anxiety attacks, shivering, numbness, extreme mood disbalance, fatigued, extra exhausted, strange short feeling in which I feel very bad for myself like guilty of anything. My mother always curses me and my brothers. Our family is wealthy, educated but my mother and father have some domestic issues which have never ever been closed even I have become 18 years old. I do not want to kill myself but I do not have any light ahead for living. I am not able to describe each and everything right now. I need to contact a psychiatrist or psychologist for better consultation. ### Response: Hello. You seem to have a mixed anxiety-depressive disorder. This is very common and about 10-15 percent of people have this problem. It is also very easily treatable. You will need to visit a psychiatrist and he will prescribe you SSRI type of medicines (such as Escitalopram 10 mg, or Fluoxetine 20 mg, etc) which will help with your problem. It basically happens when some neurotransmitters such as serotonin reduce in your brain leading to a problem with handling the day to day stresses of life. Medicines are usually given for two to four months and then tapered off slowly and stopped. In addition to the medicines, you can also undergo a few sessions of cognitive-behavioral therapy from a clinical psychologist. Also, do consider doing deep breathing exercises or progressive muscle relaxation daily. T. Nexito 10 mg (Escitalopram 10 mg) daily one at night after food.

Hi doctor, I am constantly unable to focus on anything in my life. My brain just seems like damaged. I feel alone, depressed, sudden anxiety attacks, shivering, numbness, extreme mood disbalance, fatigued, extra exhausted, strange short feeling in which I feel very bad for myself like guilty of anything. My mother always curses me and my brothers. Our family is wealthy, educated but my mother and father have some domestic issues which have never ever been closed even I have become 18 years old. I do not want to kill myself but I do not have any light ahead for living. I am not able to describe each and everything right now. I need to contact a psychiatrist or psychologist for better consultation.

Hello. You seem to have a mixed anxiety-depressive disorder. This is very common and about 10-15 percent of people have this problem. It is also very easily treatable. You will need to visit a psychiatrist and he will prescribe you SSRI type of medicines (such as Escitalopram 10 mg, or Fluoxetine 20 mg, etc) which will help with your problem. It basically happens when some neurotransmitters such as serotonin reduce in your brain leading to a problem with handling the day to day stresses of life. Medicines are usually given for two to four months and then tapered off slowly and stopped. In addition to the medicines, you can also undergo a few sessions of cognitive-behavioral therapy from a clinical psychologist. Also, do consider doing deep breathing exercises or progressive muscle relaxation daily. T. Nexito 10 mg (Escitalopram 10 mg) daily one at night after food.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 27 years old. I had sharp chest pain on the bus. I suddenly got off from the bus and rushed to a local doctor. My BP was 150/90 and heartbeat was 140 bpm. Then doctor checked ECG and he said it was due to the acidity that I got pain. I have gone through TMT also and got a negative result. Next day, I rushed to another hospital and the doctor did a series of tests. He also concluded the same thing. I was very anxious because it happened the first time in my life. I was worried that, whether I will have a heart attack in the next coming days and always kept thinking the same. The doctor suggested me to consult a psychiatrist. Psychiatrist termed it a panic attack. Nowadays, I am trying not to get anxious and not to worry about that. Currently, I am taking the acidity tablet twice weekly. But, I still get some sharp pain in the chest. I do not know the reason and it leads to negative thinking. So, I need your suggestion on this matter. ### Response: Hello. Please give me some more information regarding your illness, so that I can help you better. Did you feel suffocated in the bus, with a sort of air hunger (feel of insufficient oxygen)? Did you feel something is going to happen to you? Is there any family history of heart disease? How active are you? Do you exercise regularly? Your tests are essentially normal. Kindly answer these clarifications. After that, I will send you a detailed answer as to how you should tackle this problem. I am sure you would be fine. Take care.

Hi doctor,I am 27 years old. I had sharp chest pain on the bus. I suddenly got off from the bus and rushed to a local doctor. My BP was 150/90 and heartbeat was 140 bpm. Then doctor checked ECG and he said it was due to the acidity that I got pain. I have gone through TMT also and got a negative result. Next day, I rushed to another hospital and the doctor did a series of tests. He also concluded the same thing. I was very anxious because it happened the first time in my life. I was worried that, whether I will have a heart attack in the next coming days and always kept thinking the same. The doctor suggested me to consult a psychiatrist. Psychiatrist termed it a panic attack. Nowadays, I am trying not to get anxious and not to worry about that. Currently, I am taking the acidity tablet twice weekly. But, I still get some sharp pain in the chest. I do not know the reason and it leads to negative thinking. So, I need your suggestion on this matter.

Hello. Please give me some more information regarding your illness, so that I can help you better. Did you feel suffocated in the bus, with a sort of air hunger (feel of insufficient oxygen)? Did you feel something is going to happen to you? Is there any family history of heart disease? How active are you? Do you exercise regularly? Your tests are essentially normal. Kindly answer these clarifications. After that, I will send you a detailed answer as to how you should tackle this problem. I am sure you would be fine. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,For the past three weeks, I have had my normal right eye floaters seem strange. I noticed peripheral flashes when blinking and walking and quick black narrow lines. I saw an ophthalmologist. He found the retina to be fine. I now have some flashes around peripheral in the right eye and a new large annoying floater, no curtain or loss of vision. Talked to an ophthalmologist last night. Said not to move eyes much. Should I go to ER? No vision loss. Just flashes and fast moving stringy floaters and flashes when moving eyes and walking. ### Response: Hi. The hollow of the eye is filled with vitreous jelly. With aging, the jelly starts to liquify and separates from its attachments to the retina. This results in a little tug on the retina, resulting in flashes. This phenomenon is known as posterior vitreous detachment or PVD in short. The large floater appears when the PVD is complete, that is, it detaches from its final strong attachment on the optic nerve head in the retina. What you are experiencing is normal aging of the vitreous jelly. Now in this process, sometimes breaks may form in the retina leading to floaters. Floaters may be due to the cells from the back of the retina gaining access to the vitreous cavity through the breaks in the retina. Sometimes floaters may result when the break involves a retinal blood vessel. It is extremely important to get a dilated fundus examination done on an urgent basis to rule out any of the breaks. If found, they can be lasered to prevent further progression to complete retinal detachment. So kindly do see a retina specialist. Let me know how it went. Take care.

Hello doctor,For the past three weeks, I have had my normal right eye floaters seem strange. I noticed peripheral flashes when blinking and walking and quick black narrow lines. I saw an ophthalmologist. He found the retina to be fine. I now have some flashes around peripheral in the right eye and a new large annoying floater, no curtain or loss of vision. Talked to an ophthalmologist last night. Said not to move eyes much. Should I go to ER? No vision loss. Just flashes and fast moving stringy floaters and flashes when moving eyes and walking.

Hi. The hollow of the eye is filled with vitreous jelly. With aging, the jelly starts to liquify and separates from its attachments to the retina. This results in a little tug on the retina, resulting in flashes. This phenomenon is known as posterior vitreous detachment or PVD in short. The large floater appears when the PVD is complete, that is, it detaches from its final strong attachment on the optic nerve head in the retina. What you are experiencing is normal aging of the vitreous jelly. Now in this process, sometimes breaks may form in the retina leading to floaters. Floaters may be due to the cells from the back of the retina gaining access to the vitreous cavity through the breaks in the retina. Sometimes floaters may result when the break involves a retinal blood vessel. It is extremely important to get a dilated fundus examination done on an urgent basis to rule out any of the breaks. If found, they can be lasered to prevent further progression to complete retinal detachment. So kindly do see a retina specialist. Let me know how it went. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 43-year-old female. About a year and a half ago I noticed Raynaud\\s in one finger. I had three episodes in two years. I have lost most of my eyebrows. Recently, I got three episodes of Raynaud\\s in both hands, and most fingers. I have joint pain that comes and goes in all joints. I have widespread muscle pain that comes and goes. The intensity changes. I am fatigued and just noticed that upon awakening, my fingers are a little swollen. I cannot get my ring off until about one or two hours after waking up. I have had plenty of bloodwork ANA\\s, ENA, Scl 70, centromere, PM Scl, all of the scleroderma and lupus testing along with Sjogren\\s. ANCA, P ANCA, CPK, ESR, RF, and ds DNA tests.The only test that was abnormal was C3 and C4 decreased and elevated anticardiolipin IgM. My WBC was also low. Since 99 percent of lupus is shown on positive ANA, what could this imply in the absence of a positive ANA? ### Response: Hello, Welcome to ChatDoctor. I have gone through your query and what I can convey is that in most of the cases, clinical picture is that of systemic sclerosis, scleroderma, SLE (systemic lupus erythematosus) but as per the reports elevated anticardiolipin IgM and decreased complements can also be found in ITP (idiopathic thrombocytopenic purpura), rheumatic, psoriatic arthritis, primary Sjogren\\s syn ChatDoctor.

Hello doctor,I am a 43-year-old female. About a year and a half ago I noticed Raynaud\\s in one finger. I had three episodes in two years. I have lost most of my eyebrows. Recently, I got three episodes of Raynaud\\s in both hands, and most fingers. I have joint pain that comes and goes in all joints. I have widespread muscle pain that comes and goes. The intensity changes. I am fatigued and just noticed that upon awakening, my fingers are a little swollen. I cannot get my ring off until about one or two hours after waking up. I have had plenty of bloodwork ANA\\s, ENA, Scl 70, centromere, PM Scl, all of the scleroderma and lupus testing along with Sjogren\\s. ANCA, P ANCA, CPK, ESR, RF, and ds DNA tests.The only test that was abnormal was C3 and C4 decreased and elevated anticardiolipin IgM. My WBC was also low. Since 99 percent of lupus is shown on positive ANA, what could this imply in the absence of a positive ANA?

Hello, Welcome to ChatDoctor. I have gone through your query and what I can convey is that in most of the cases, clinical picture is that of systemic sclerosis, scleroderma, SLE (systemic lupus erythematosus) but as per the reports elevated anticardiolipin IgM and decreased complements can also be found in ITP (idiopathic thrombocytopenic purpura), rheumatic, psoriatic arthritis, primary Sjogren\\s syn ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 46 years old male. I have a weight of 60 kilograms and a height of 164 cm. I am diabetic for the past ten years. I have an Hba1c of 8.3 %, with no other health issues. I do exercise regularly, and I am taking a healthy diet every day. I am using Gemer 2 mg twice a day, and I am unable to bring Hba1c below 7.5 %.I have an FBS of 130 mg/dL and PBS of 220 mg/dL. Sometimes, I sweat in the morning. When I check my sugar levels, I have an FBS of 120 mg/dL. I am not interested in increasing the dose of Metformin to 1000 mg twice as a concern of weight loss. Would a change in medicine help me to reach my Hba1c target? Please advice. ### Response: Hi. You are taking Gemer 2 mg (Glimipride with Metformin) twice daily. Please say whether you take Metformin alone and tell about the dose. If you are on Gemer 2 mg only, then you can take Glycomet 500 mg (Metformin). You do not need to begin with Metformin 1000 mg directly. Diet and exercise help you a lot. Loss of weight will help to control sugar levels better. Your FBS (fasting blood sugar) is fine. Your PBS (postprandial blood sugar) level is high. So, I suggest controlling diet. If there is no improvement, you can consider taking Metformin.

Hi doctor,I am 46 years old male. I have a weight of 60 kilograms and a height of 164 cm. I am diabetic for the past ten years. I have an Hba1c of 8.3 %, with no other health issues. I do exercise regularly, and I am taking a healthy diet every day. I am using Gemer 2 mg twice a day, and I am unable to bring Hba1c below 7.5 %.I have an FBS of 130 mg/dL and PBS of 220 mg/dL. Sometimes, I sweat in the morning. When I check my sugar levels, I have an FBS of 120 mg/dL. I am not interested in increasing the dose of Metformin to 1000 mg twice as a concern of weight loss. Would a change in medicine help me to reach my Hba1c target? Please advice.

Hi. You are taking Gemer 2 mg (Glimipride with Metformin) twice daily. Please say whether you take Metformin alone and tell about the dose. If you are on Gemer 2 mg only, then you can take Glycomet 500 mg (Metformin). You do not need to begin with Metformin 1000 mg directly. Diet and exercise help you a lot. Loss of weight will help to control sugar levels better. Your FBS (fasting blood sugar) is fine. Your PBS (postprandial blood sugar) level is high. So, I suggest controlling diet. If there is no improvement, you can consider taking Metformin.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have a question regarding co-infection of HIV with various other diseases like syphilis, herpes 1, herpes 2, gonorrhea, hepatitis C, hepatitis B, chlamydia, CMV, HPV, and molluscum contagiosum. Some time ago, I had a paid unprotected oral sex encounter but vaginal sex was mostly protected. I say mostly protected because the condom was very loose due to my erectile dysfunction. I received oral sex from her without any protection. Please take into account that prior to this episode I have been experiencing chronic penile sores and burning in urethra supposedly due to my established herpes infection (earlier tested positive for both herpes 1 and 2). I also have a weak immune system because I suffered from malnutrition while growing up.I have four questions that I want to ask. Would my herpes infection affect the window period for HIV 1 and 2? Would the window period for any of these aforementioned diseases be affected in case of pre-existing or simultaneous co-infection with another STI? Also, would my herpes infection increase the likelihood of getting infected with HIV or any other STI? Lastly, please advise when should I get tested for all these STIs in order to have conclusive results. ### Response: Hello, Welcome to Chat Doctor forum. No, herpes does not affect the window period for HIV 1 and 2. Yes, it could be if the immune system is compromised. The term window period is used mainly with reference to HIV. Herpes infection per se does not increase the chances of an STI. But the mode of transmission of herpes is similar to the mode of transmission of other STI diseases. So the risk of exposure to all STIs is the same.

Hello doctor,I have a question regarding co-infection of HIV with various other diseases like syphilis, herpes 1, herpes 2, gonorrhea, hepatitis C, hepatitis B, chlamydia, CMV, HPV, and molluscum contagiosum. Some time ago, I had a paid unprotected oral sex encounter but vaginal sex was mostly protected. I say mostly protected because the condom was very loose due to my erectile dysfunction. I received oral sex from her without any protection. Please take into account that prior to this episode I have been experiencing chronic penile sores and burning in urethra supposedly due to my established herpes infection (earlier tested positive for both herpes 1 and 2). I also have a weak immune system because I suffered from malnutrition while growing up.I have four questions that I want to ask. Would my herpes infection affect the window period for HIV 1 and 2? Would the window period for any of these aforementioned diseases be affected in case of pre-existing or simultaneous co-infection with another STI? Also, would my herpes infection increase the likelihood of getting infected with HIV or any other STI? Lastly, please advise when should I get tested for all these STIs in order to have conclusive results.

Hello, Welcome to Chat Doctor forum. No, herpes does not affect the window period for HIV 1 and 2. Yes, it could be if the immune system is compromised. The term window period is used mainly with reference to HIV. Herpes infection per se does not increase the chances of an STI. But the mode of transmission of herpes is similar to the mode of transmission of other STI diseases. So the risk of exposure to all STIs is the same.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had a tooth removed a while back, and the tooth next to it feels lower down, and I get toothache every so often my dentist said there is nothing wrong, but I feel it is going to fall out or crack and I have pain when I bite down. I cannot eat the rest off my teeth without really biting down, and when I do it hurts and feels like it is pushing my tooth back up, I cannot even bite down gentle without it hurting. ### Response: Hello. There might be following conditions involved in your case, 1. The tooth you got extracted would be a bit higher and functioning before extraction, that would be used in your bite and the second tooth would be malaligned and a bit lower in height. Once it got extracted now the second lower tooth is only there for a bite and chewing function all chewing load is shifted to it, so it started hurting, and it is not easy for you to eat from this side. 2. There could be an infection or a hairline fracture or split in this tooth that needs to be diagnosed through X-ray and some clinical examinations. Ad ChatDoctor. You need a bridge that can adjust your bite and level down the chewing forces to all teeth equally and your generalized aching will be resolved. While for your second type of condition, the tooth will be treated according to diagnosis. If the infection is there, then root canal treatment is required along with the cap. If there is a bite fracture, then extraction is recommended. Kindly provide me with X-rays so I can suggest you the appropriate treatment. I hope this helps you. Feel free to ask if you have further queries. Take care.

Hello doctor,I had a tooth removed a while back, and the tooth next to it feels lower down, and I get toothache every so often my dentist said there is nothing wrong, but I feel it is going to fall out or crack and I have pain when I bite down. I cannot eat the rest off my teeth without really biting down, and when I do it hurts and feels like it is pushing my tooth back up, I cannot even bite down gentle without it hurting.

Hello. There might be following conditions involved in your case, 1. The tooth you got extracted would be a bit higher and functioning before extraction, that would be used in your bite and the second tooth would be malaligned and a bit lower in height. Once it got extracted now the second lower tooth is only there for a bite and chewing function all chewing load is shifted to it, so it started hurting, and it is not easy for you to eat from this side. 2. There could be an infection or a hairline fracture or split in this tooth that needs to be diagnosed through X-ray and some clinical examinations. Ad ChatDoctor. You need a bridge that can adjust your bite and level down the chewing forces to all teeth equally and your generalized aching will be resolved. While for your second type of condition, the tooth will be treated according to diagnosis. If the infection is there, then root canal treatment is required along with the cap. If there is a bite fracture, then extraction is recommended. Kindly provide me with X-rays so I can suggest you the appropriate treatment. I hope this helps you. Feel free to ask if you have further queries. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 19 years old, seemingly healthy with a history of anxiety. I recently had CBC, thyroid, kidney, cholesterol, and glucose test and all came back normal so I am not anemic or hyperthyroid. For several years, when I go from sitting to standing my heart rate increases to about 110 and I get dizzy initially but I feel back to normal after about 30 seconds. My other symptom is when exercising my heart rate increases very fast very quickly. It often gets to 170. I feel fine when it does, and it comes down when I rest, but why does it get so high during exercise? If I had SVT or AFIB, would the heart rate not stay above 100 even when I quit exercising? What does it sound like I have? Does this sound SVT or POTS? Currently, I am taking Luvox 200 mg. ### Response: Hi, Welcome to Chat Doctor forum. As you are concerned about this HR (heart rate) being atrial fibrillation or atrial flutter or SVT (supraventricular tachycardia), first, HR is usually more than 130 to 140 in these conditions, especially in SVT. Secondly, these disorders do not have any specific relationship with exercise or rest, meaning this does not start with exercising. It can kick in while resting all off sudden and can convert back any time. Your pattern is more consistent with sinus tachycardia. You may need a tilt test for diagnosis. Talk to your doctor. In addition, I would recommend you remain well hy ChatDoctor. This will help you with symptoms. For more information consult an internal medicine physician online

Hello doctor,I am 19 years old, seemingly healthy with a history of anxiety. I recently had CBC, thyroid, kidney, cholesterol, and glucose test and all came back normal so I am not anemic or hyperthyroid. For several years, when I go from sitting to standing my heart rate increases to about 110 and I get dizzy initially but I feel back to normal after about 30 seconds. My other symptom is when exercising my heart rate increases very fast very quickly. It often gets to 170. I feel fine when it does, and it comes down when I rest, but why does it get so high during exercise? If I had SVT or AFIB, would the heart rate not stay above 100 even when I quit exercising? What does it sound like I have? Does this sound SVT or POTS? Currently, I am taking Luvox 200 mg.

Hi, Welcome to Chat Doctor forum. As you are concerned about this HR (heart rate) being atrial fibrillation or atrial flutter or SVT (supraventricular tachycardia), first, HR is usually more than 130 to 140 in these conditions, especially in SVT. Secondly, these disorders do not have any specific relationship with exercise or rest, meaning this does not start with exercising. It can kick in while resting all off sudden and can convert back any time. Your pattern is more consistent with sinus tachycardia. You may need a tilt test for diagnosis. Talk to your doctor. In addition, I would recommend you remain well hy ChatDoctor. This will help you with symptoms. For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a male, 23 years old, weight is 65 kg, height is 5\\9\". My penis is not getting hard for sex. The penis is getting erect but not getting hard enough. Due to this, I am not able to put my penis inside the vagina. Also, I ejaculate within 10 to 15 seconds (3 to 4 stock). And now I am avoiding sex because of this problem and getting less interest day by day. I do smoke regularly and drink occasionally also. I used to watch porn in excess and masturbate regularly. Please help me out. I am very much tensed about my future sex life. Please consult me what to do I want to get rid of this major issue. I cannot tell this issue to my family or friends also. I do not have enough money to consult a doctor privately. Please look into the matter. ### Response: Hi. I have read your problems carefully. After getting above mentioned history, my assumption is that your problem is psychological rather than organic. But I need some information and investigation reports to confirm it further. If you want to visit any physician, I advise to consult with endocrinologist first and after excluding organic disease, you need a psychiatrist. Masturbation and doing sex are different issues. In the case of masturbation, we try to ejaculate as soon as possible. But in case of doing sex, we try to do sex as long as possible. So there is a psychological issue. Besides this, anxiety also can precipitate this problem. So after doing some investigation and excluding organic cause, I think you need some psychological counseling. Take care.

Hello doctor,I am a male, 23 years old, weight is 65 kg, height is 5\\9\". My penis is not getting hard for sex. The penis is getting erect but not getting hard enough. Due to this, I am not able to put my penis inside the vagina. Also, I ejaculate within 10 to 15 seconds (3 to 4 stock). And now I am avoiding sex because of this problem and getting less interest day by day. I do smoke regularly and drink occasionally also. I used to watch porn in excess and masturbate regularly. Please help me out. I am very much tensed about my future sex life. Please consult me what to do I want to get rid of this major issue. I cannot tell this issue to my family or friends also. I do not have enough money to consult a doctor privately. Please look into the matter.

Hi. I have read your problems carefully. After getting above mentioned history, my assumption is that your problem is psychological rather than organic. But I need some information and investigation reports to confirm it further. If you want to visit any physician, I advise to consult with endocrinologist first and after excluding organic disease, you need a psychiatrist. Masturbation and doing sex are different issues. In the case of masturbation, we try to ejaculate as soon as possible. But in case of doing sex, we try to do sex as long as possible. So there is a psychological issue. Besides this, anxiety also can precipitate this problem. So after doing some investigation and excluding organic cause, I think you need some psychological counseling. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,My daughter is 13 years old. She is having moderate to severe stomach pain for a year. We thought that it was related to constipation. After a few weeks, my daughter started to have a headache, feeling of dizziness, and shortness of breath. She had a habit of eating ice all the time. Her stomach pain got increased day by day. I took her to an urgent care. They did an iron deficiency panel. Can it be an iron deficiency anemia? Can I give her an iron supplement? Does her body is unable to convert iron to ferritin? Please help. ### Response: Hi, Welcome to Chat Doctor forum. I have gone through the attached blood test results (attachment removed to protect patient identity). Your daughter\\s serum ferritin is low which reflects the low iron stores. Her hemoglobin is low. Her low ferritin levels support it. Her TIBC (total iron binding capacity) is high, and it is commonly seen in iron deficiency anemia. But her serum iron levels are not consistent with iron deficiency anemia. Her transferrin saturation of 66 % suggests an iron overload. A transferrin saturation of less than 20 % indicates iron deficiency, while transferrin saturation of more than 50 % suggests iron overload. Higher transferrin saturation values are found in high iron status, such as megaloblastic anemia, sideroblastic anemia, and iron overload status. She needs a detailed hematological workup, and she should avoid taking iron pills. You are correct in your thinking. Her iron is being absorbed, but it is not adequately processed and utilized by the body. The underlying cause is needed to be determined soon and treated accordingly.

Hi doctor,My daughter is 13 years old. She is having moderate to severe stomach pain for a year. We thought that it was related to constipation. After a few weeks, my daughter started to have a headache, feeling of dizziness, and shortness of breath. She had a habit of eating ice all the time. Her stomach pain got increased day by day. I took her to an urgent care. They did an iron deficiency panel. Can it be an iron deficiency anemia? Can I give her an iron supplement? Does her body is unable to convert iron to ferritin? Please help.

Hi, Welcome to Chat Doctor forum. I have gone through the attached blood test results (attachment removed to protect patient identity). Your daughter\\s serum ferritin is low which reflects the low iron stores. Her hemoglobin is low. Her low ferritin levels support it. Her TIBC (total iron binding capacity) is high, and it is commonly seen in iron deficiency anemia. But her serum iron levels are not consistent with iron deficiency anemia. Her transferrin saturation of 66 % suggests an iron overload. A transferrin saturation of less than 20 % indicates iron deficiency, while transferrin saturation of more than 50 % suggests iron overload. Higher transferrin saturation values are found in high iron status, such as megaloblastic anemia, sideroblastic anemia, and iron overload status. She needs a detailed hematological workup, and she should avoid taking iron pills. You are correct in your thinking. Her iron is being absorbed, but it is not adequately processed and utilized by the body. The underlying cause is needed to be determined soon and treated accordingly.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I went to the dentist this morning for an extraction on a bottom molar on my left side. After being completely numbed he started the extraction and I had excruciating pain. He numbed me more but no matter how much he numbed, it hurt so bad. He eventually said he would refer me to a dental surgeon so I could be sedated. He was extremely nice about it the entire time but I could tell he just thought I was anxious and misinterpreting the pressure as pain. I was extremely nervous and anxious so I understand but I have had a tooth pulled before and I know the pressure, but this was an intense pain even though I was numbed. He said the dental surgeon would give me an IV that would relax me and make the procedure easier for me. I am worried that being sedated will not stop the pain. He said because I had a bad infection in the tooth that it could be causing the pain so he prescribed me some antibiotics to get rid of the infection. My questions are is this normal to have such terrible pain even while completely numb and will being sedated even help with this pain? ### Response: Hi. It is the best question I have got in my practice and the most frequent query is how and why. This is due to two reasons. Infected tooth with much inflammation or patient\\s anxious nature. So to tackle such cases it is better to prescribe antibiotics for five days then extract even if patient complaints, again it is better to give him or her tablet of Alprazolam before extraction one or two days to relieve anxiety. Moreover, before blocking the nerve, we can also give an injection of Dexamethasone which reduces inflammation.

Hello doctor,I went to the dentist this morning for an extraction on a bottom molar on my left side. After being completely numbed he started the extraction and I had excruciating pain. He numbed me more but no matter how much he numbed, it hurt so bad. He eventually said he would refer me to a dental surgeon so I could be sedated. He was extremely nice about it the entire time but I could tell he just thought I was anxious and misinterpreting the pressure as pain. I was extremely nervous and anxious so I understand but I have had a tooth pulled before and I know the pressure, but this was an intense pain even though I was numbed. He said the dental surgeon would give me an IV that would relax me and make the procedure easier for me. I am worried that being sedated will not stop the pain. He said because I had a bad infection in the tooth that it could be causing the pain so he prescribed me some antibiotics to get rid of the infection. My questions are is this normal to have such terrible pain even while completely numb and will being sedated even help with this pain?

Hi. It is the best question I have got in my practice and the most frequent query is how and why. This is due to two reasons. Infected tooth with much inflammation or patient\\s anxious nature. So to tackle such cases it is better to prescribe antibiotics for five days then extract even if patient complaints, again it is better to give him or her tablet of Alprazolam before extraction one or two days to relieve anxiety. Moreover, before blocking the nerve, we can also give an injection of Dexamethasone which reduces inflammation.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have been experiencing numbness in my left foot. It comes and goes sometimes throughout the day and sometimes it is completely normal. This has been happening for the past year. At night, when I lay down the back of both my calves feel like they are rhythmically pulsing only when lying down. I am freaking out that it might be the start of MS. I am a 36-year-old female. I have also had a mild case of mono (age 20) and have read that can increase my chances as well as being of Scottish descent. I very occasionally have neuralgia in a spot right above my collar bone and it is always in the same spot and very random. The shock lasts for about a few seconds then disappears. This has been happening for probably for the past seven years. I have also read this can be an MS symptom. I am trying to decipher if my symptoms are anxiety-related or if I truly need to be concerned with MS? ### Response: Hello, Welcome to Chat Doctor forum. Your symptoms are not typical of MS (multiple sclerosis). The numbness in your leg may be related to a pinched nerve. The pulsating feeling in your legs may be psychological or related to venous insufficiency. Regarding the pain in your face, it is not typical of trigeminal neuralgia which lasts for minutes and irradiates in the nerve branch territory. I recommend consulting with a neurologist for a careful physical examination. If suspicions are raised, a brain MRI (magnetic resonance imaging) may be needed. I also advise performing a nerve conduction study and a Doppler ultrasound of your legs to exclude the above-mentioned disorders. I hope this helps.

Hello doctor,I have been experiencing numbness in my left foot. It comes and goes sometimes throughout the day and sometimes it is completely normal. This has been happening for the past year. At night, when I lay down the back of both my calves feel like they are rhythmically pulsing only when lying down. I am freaking out that it might be the start of MS. I am a 36-year-old female. I have also had a mild case of mono (age 20) and have read that can increase my chances as well as being of Scottish descent. I very occasionally have neuralgia in a spot right above my collar bone and it is always in the same spot and very random. The shock lasts for about a few seconds then disappears. This has been happening for probably for the past seven years. I have also read this can be an MS symptom. I am trying to decipher if my symptoms are anxiety-related or if I truly need to be concerned with MS?

Hello, Welcome to Chat Doctor forum. Your symptoms are not typical of MS (multiple sclerosis). The numbness in your leg may be related to a pinched nerve. The pulsating feeling in your legs may be psychological or related to venous insufficiency. Regarding the pain in your face, it is not typical of trigeminal neuralgia which lasts for minutes and irradiates in the nerve branch territory. I recommend consulting with a neurologist for a careful physical examination. If suspicions are raised, a brain MRI (magnetic resonance imaging) may be needed. I also advise performing a nerve conduction study and a Doppler ultrasound of your legs to exclude the above-mentioned disorders. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 35 years male who had low-risk penetrative activity (as used condom properly and no breakage) with a female of unknown status. On the 30th day (four-week mark), I had HIV 1 and two antibodies screening test. Serum equal to HIV 1/2 by flow through immunofiltration (seems rapid test) from the reputed lab for which HIV one and two both came negative.On the 44th day (6th-week mark), I again had HIV 1, and 2 antibodies screening test, serum equal to HIV 1/2 and P24 COMBO TEST (CMIA) from the same lab and resulted non-reactive on the next day. Kindly guide am I safe or is it the end of hope for me as I am searching like crazy every hour and any abnormality like cough, pimple, uneasiness in the throat (no pain while swallowing food), etc. is being looked as a symptom of HIV. I am looking for the ray of hope. ### Response: Hello, Welcome to Chat Doctor forum. Do not worry about it, and you are unlikely to experience infected. Firstly, you had a very low risk of transmission as you used precautions and also the status of the partner is not known. Your combo test at sixth week almost rules out the possibility of HIV. However, it is recommended that you test yourself at three months and six months post exposure to be doubly sure. So, stop thinking about it as you are unlikely to have HIV and get yourself tested again at three and six months to be sure. I hope this helps you and get back if you have any doubts.

Hello doctor,I am 35 years male who had low-risk penetrative activity (as used condom properly and no breakage) with a female of unknown status. On the 30th day (four-week mark), I had HIV 1 and two antibodies screening test. Serum equal to HIV 1/2 by flow through immunofiltration (seems rapid test) from the reputed lab for which HIV one and two both came negative.On the 44th day (6th-week mark), I again had HIV 1, and 2 antibodies screening test, serum equal to HIV 1/2 and P24 COMBO TEST (CMIA) from the same lab and resulted non-reactive on the next day. Kindly guide am I safe or is it the end of hope for me as I am searching like crazy every hour and any abnormality like cough, pimple, uneasiness in the throat (no pain while swallowing food), etc. is being looked as a symptom of HIV. I am looking for the ray of hope.

Hello, Welcome to Chat Doctor forum. Do not worry about it, and you are unlikely to experience infected. Firstly, you had a very low risk of transmission as you used precautions and also the status of the partner is not known. Your combo test at sixth week almost rules out the possibility of HIV. However, it is recommended that you test yourself at three months and six months post exposure to be doubly sure. So, stop thinking about it as you are unlikely to have HIV and get yourself tested again at three and six months to be sure. I hope this helps you and get back if you have any doubts.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have not grown to the expected height. I am 173 cm. My mother is 173 cm and father is 189 cm. I had a blood test to determine my HGH levels. The doctor asked me for a testosterone and GH test. The result came back a week later and it said that I had a low HGH level and a 21/42 level testosterone. Is this normal for an 18 year old male? I was devastated that my growth plates were closed, because I also had an x-ray of left hand. My doctor asked me whether I am sexually active. I answered him no. But, I got a doubt regarding erectile dysfunction. Am I suffering from erectile dysfunction? Should I be worried? Is my testosterone too low? How can I increase testosterone? I had torsion three years back and nothing back happened. But, this could be a factor. Another factor may be that I used to hold my mobile phone in my pocket all the time.I am a sprint athlete and have defined leg muscles, but this could be due to my short stature. I have gone for another blood test for GH, just as a follow up and that time I was advised to fast for 14 hours. But, I did not fast during my first blood test. Please help me. ### Response: Hello, Welcome to Chat Doctor forum. Please relax and do not worry. 1. Free and total testosterone.2. Serum FSH and LH levels.3. Ultrasound examination of your scrotum to look for the status of your testes. Revert back with the reports to an an ChatDoctor. -

Hi doctor,I have not grown to the expected height. I am 173 cm. My mother is 173 cm and father is 189 cm. I had a blood test to determine my HGH levels. The doctor asked me for a testosterone and GH test. The result came back a week later and it said that I had a low HGH level and a 21/42 level testosterone. Is this normal for an 18 year old male? I was devastated that my growth plates were closed, because I also had an x-ray of left hand. My doctor asked me whether I am sexually active. I answered him no. But, I got a doubt regarding erectile dysfunction. Am I suffering from erectile dysfunction? Should I be worried? Is my testosterone too low? How can I increase testosterone? I had torsion three years back and nothing back happened. But, this could be a factor. Another factor may be that I used to hold my mobile phone in my pocket all the time.I am a sprint athlete and have defined leg muscles, but this could be due to my short stature. I have gone for another blood test for GH, just as a follow up and that time I was advised to fast for 14 hours. But, I did not fast during my first blood test. Please help me.

Hello, Welcome to Chat Doctor forum. Please relax and do not worry. 1. Free and total testosterone.2. Serum FSH and LH levels.3. Ultrasound examination of your scrotum to look for the status of your testes. Revert back with the reports to an an ChatDoctor. -

### Instruction: Answer this question truthfully ###Input: Hello doctor,My friend is 21 years old and suffers from anxiety. He feels like it is getting in the way of his daily activities and interactions with people. He used to get attacks more often but that is a lot better now. He decided to start taking L-Theanine pills or supplements. I would like to know more about these pills. How safe are they? How long or often should they be taken? He currently takes them with caffeine (200 mg of supplement for every 100 mg of caffeine) average of 400 mg L-Theanine a day. Could they become addictive? Does it have any side effects? What more should we know? ### Response: Hello, Welcome to Chat Doctor forum. L-Theanine is an amino acid synthesized from tea. It helps with reducing stress and anxiety and induces a sense of calmness by increasing serotonin and dopamine in the brain which are the feel-good chemicals. As such, it is a supplement and not a medicine per se, so there are no fixed guidelines issued by any regulatory authorities. Normally people do get relief with 200 to 600 mg. Since it is synthesized from a stimulant (tea) it is advised not to combine with other stimulants like caffeine. It can increase anxiety once the effect of caffeine wears off. Apart from that, there are no side effects as such and not really addictive. If the anxiety issues are troubling, it would be advisable to visit a local psychiatrist and take a short course of SSRI (selective serotonin reuptake inhibitors) class of medicines which will help with this problem. Also, consider doing deep breathing exercises or yoga or meditation.

Hello doctor,My friend is 21 years old and suffers from anxiety. He feels like it is getting in the way of his daily activities and interactions with people. He used to get attacks more often but that is a lot better now. He decided to start taking L-Theanine pills or supplements. I would like to know more about these pills. How safe are they? How long or often should they be taken? He currently takes them with caffeine (200 mg of supplement for every 100 mg of caffeine) average of 400 mg L-Theanine a day. Could they become addictive? Does it have any side effects? What more should we know?

Hello, Welcome to Chat Doctor forum. L-Theanine is an amino acid synthesized from tea. It helps with reducing stress and anxiety and induces a sense of calmness by increasing serotonin and dopamine in the brain which are the feel-good chemicals. As such, it is a supplement and not a medicine per se, so there are no fixed guidelines issued by any regulatory authorities. Normally people do get relief with 200 to 600 mg. Since it is synthesized from a stimulant (tea) it is advised not to combine with other stimulants like caffeine. It can increase anxiety once the effect of caffeine wears off. Apart from that, there are no side effects as such and not really addictive. If the anxiety issues are troubling, it would be advisable to visit a local psychiatrist and take a short course of SSRI (selective serotonin reuptake inhibitors) class of medicines which will help with this problem. Also, consider doing deep breathing exercises or yoga or meditation.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My two year old son has eye power.RightS C A-1.50 -1.00 169-1.50 -1.00. 171-1.50 -1.00. 171-1.50. -1.00. 171.LeftS C A2.00. 0.75. 1491.75. 0.75. 1401.75. 0.75. 1391.75. 0.75. 140Does he need glasses? Which type of eye power? Will his number reduce when he grows? He squints a little. ### Response: Hello. I have gone through the reports (attachment removed to protect patient identity). The retinoscopy that has been done is the final refractive error. The automatic refractometer readings that you have mentioned are in negative but retinoscopy that has been mentioned is in +3.0. Your child is esotropic, that is inward-deviated eyes. So, we will subtract 1 for atropine. The final refractive error is plus 2 in both eyes. The frame should be plastic, squarish, lightweight and cover both eyes easily. These glasses will serve two purposes. One, it will help your child see clearly and two it will straighten his eyes. You have to get four to six monthly checkup. As he comes of age, surgery can be done for squint. For more information consult an eye care ophthalmologist online

Hello doctor,My two year old son has eye power.RightS C A-1.50 -1.00 169-1.50 -1.00. 171-1.50 -1.00. 171-1.50. -1.00. 171.LeftS C A2.00. 0.75. 1491.75. 0.75. 1401.75. 0.75. 1391.75. 0.75. 140Does he need glasses? Which type of eye power? Will his number reduce when he grows? He squints a little.

Hello. I have gone through the reports (attachment removed to protect patient identity). The retinoscopy that has been done is the final refractive error. The automatic refractometer readings that you have mentioned are in negative but retinoscopy that has been mentioned is in +3.0. Your child is esotropic, that is inward-deviated eyes. So, we will subtract 1 for atropine. The final refractive error is plus 2 in both eyes. The frame should be plastic, squarish, lightweight and cover both eyes easily. These glasses will serve two purposes. One, it will help your child see clearly and two it will straighten his eyes. You have to get four to six monthly checkup. As he comes of age, surgery can be done for squint. For more information consult an eye care ophthalmologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am on birth control pill Femilon for the last three months and I have followed 21/7 regime from the last three months. I got my last two periods on the 6th and 7th pill-free days respectively. And now I have advised to follow 21/5 day regime by my gynecologist for proper efficacy of pill. I am still being confused, that I have to continue 21/7 regime or 21/5? My gynecologist said to me do not think about your menses just follow 21/5 regime whether menses come or not. So I want to ask is it normal to lost menses for two to three months, because I feel that if my menses came on 6th or 7th pill-free day on 21/7regime, then if follow 21/5 then I have to start my pack on the 6th day after five pill-free days. And if my menses will not come in these five days then after starting the new pack my menses will not start still a month, is it normal? What I have to do? ### Response: Hi, Welcome to Chat Doctor forum. How are you doing? I would sincerely advise you to keep having pill in the 21 pills, 7 pill free cycles. This will avoid all the confusion. Hormone control will be the same if you take 7 pill-free or 5 pill-free cycle. We give the gap for proper hormone with ChatDoctor. So I would say you just follow the three weeks pills and one week pill-free cycle.

Hello doctor,I am on birth control pill Femilon for the last three months and I have followed 21/7 regime from the last three months. I got my last two periods on the 6th and 7th pill-free days respectively. And now I have advised to follow 21/5 day regime by my gynecologist for proper efficacy of pill. I am still being confused, that I have to continue 21/7 regime or 21/5? My gynecologist said to me do not think about your menses just follow 21/5 regime whether menses come or not. So I want to ask is it normal to lost menses for two to three months, because I feel that if my menses came on 6th or 7th pill-free day on 21/7regime, then if follow 21/5 then I have to start my pack on the 6th day after five pill-free days. And if my menses will not come in these five days then after starting the new pack my menses will not start still a month, is it normal? What I have to do?

Hi, Welcome to Chat Doctor forum. How are you doing? I would sincerely advise you to keep having pill in the 21 pills, 7 pill free cycles. This will avoid all the confusion. Hormone control will be the same if you take 7 pill-free or 5 pill-free cycle. We give the gap for proper hormone with ChatDoctor. So I would say you just follow the three weeks pills and one week pill-free cycle.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 33 years old. One year back, my HbA1c result was 8.2. Then, I started to take medicine Dailyglim M1 for three months and started some workout and took light food. Then, my sugar level came down. Fasting and PP result were in 105 and 160 range respectively. But, after some time it went bad again and I started to take Dailyglim M2 twice a day since the last two months. One week back, my HbA1c result was 6.7 and my fasting 105 and PP (without tablet) was 180. I consulted a doctor. She told me to take Insulin 10 units two times a day. She said this is better than taking tablets. Please suggest what to do. ### Response: Hi, Welcome to Chat Doctor forum. I can understand you are hesitant to use Insulin. But what she has said is right. Finally, Insulin is what controls your blood sugars. Since people are hesitant to use it, we usually do not prescribe it as a first-line treatment. Oral medications help the pancreas to produce insulin. So in case, your cells are not producing any insulin at all, they would not be useful. Also, in the future, you would require using Insulin once your cells are exhausted of insulin. Your body is still responding to medicines. So, if you want, you can tell her that you would like to use oral medications and see how your sugar levels turn up. Or else, you can give Insulin a try and see. Regards. For more information consult a diabetologist online

Hello doctor,I am 33 years old. One year back, my HbA1c result was 8.2. Then, I started to take medicine Dailyglim M1 for three months and started some workout and took light food. Then, my sugar level came down. Fasting and PP result were in 105 and 160 range respectively. But, after some time it went bad again and I started to take Dailyglim M2 twice a day since the last two months. One week back, my HbA1c result was 6.7 and my fasting 105 and PP (without tablet) was 180. I consulted a doctor. She told me to take Insulin 10 units two times a day. She said this is better than taking tablets. Please suggest what to do.

Hi, Welcome to Chat Doctor forum. I can understand you are hesitant to use Insulin. But what she has said is right. Finally, Insulin is what controls your blood sugars. Since people are hesitant to use it, we usually do not prescribe it as a first-line treatment. Oral medications help the pancreas to produce insulin. So in case, your cells are not producing any insulin at all, they would not be useful. Also, in the future, you would require using Insulin once your cells are exhausted of insulin. Your body is still responding to medicines. So, if you want, you can tell her that you would like to use oral medications and see how your sugar levels turn up. Or else, you can give Insulin a try and see. Regards. For more information consult a diabetologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 21 years old and I have always been a shy person. When I was younger I used to sweat a lot because of it and I could barely speak with anyone. As I got older, I became more and more sociable, now I have got friends, I am getting along with everyone at work and I am feeling quite good about myself. I have never been depressed and I am a really happy person. The problem that I am facing is that whenever I talk to somebody, with anyone at all, my heart starts to rush and my face becomes red in just one second. I blush like I have done some dumb thing and it is intense and very very red, anyone can notice it. I have tried to manage it by going out as much as possible and I have learned that when I get comfortable with someone, the blush and red face thing disappears (but it took two years to get comfortable with my boss for example). I am aware the problem might be associated with anxiety, but I have never taken pills for it. I just want the blushing to go away, as that will make me less awkward and better in general. I have got a mitral valve prolapse and a ventricular hypertrophy. ### Response: Hello, Welcome to Chat Doctor forum. The problems you have mentioned like the history of shyness, palpitations and flushing of the face on talking with any new person, etc., are occurring most likely due to anxiety. This could be due to social anxiety. You are facing these problems in day to day routine too and to get rid of these symptoms you should consult a psychiatrist for help. ChatDoctor. Sertraline can be tried. The

Hello doctor,I am 21 years old and I have always been a shy person. When I was younger I used to sweat a lot because of it and I could barely speak with anyone. As I got older, I became more and more sociable, now I have got friends, I am getting along with everyone at work and I am feeling quite good about myself. I have never been depressed and I am a really happy person. The problem that I am facing is that whenever I talk to somebody, with anyone at all, my heart starts to rush and my face becomes red in just one second. I blush like I have done some dumb thing and it is intense and very very red, anyone can notice it. I have tried to manage it by going out as much as possible and I have learned that when I get comfortable with someone, the blush and red face thing disappears (but it took two years to get comfortable with my boss for example). I am aware the problem might be associated with anxiety, but I have never taken pills for it. I just want the blushing to go away, as that will make me less awkward and better in general. I have got a mitral valve prolapse and a ventricular hypertrophy.

Hello, Welcome to Chat Doctor forum. The problems you have mentioned like the history of shyness, palpitations and flushing of the face on talking with any new person, etc., are occurring most likely due to anxiety. This could be due to social anxiety. You are facing these problems in day to day routine too and to get rid of these symptoms you should consult a psychiatrist for help. ChatDoctor. Sertraline can be tried. The

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 34-year-old male. I have recently done a master health check-up. One of the key observations of the checkup was TMT (stress test) is borderline positive for inducible ischemia. Upon consulting cardiologist and post-screening echo, he has suggested doing a coronary angiogram. Could you please assess the attached reports and provide a second opinion on the condition and the way forward. Kindly let me know if you need any further details on the same.Few pointers of the routine and habits1. I do mild exercise. (Play badminton once in two weeks or one week).2. I do booze (beer) once in two weeks or once in a week.3. I do not smoke. But I used to smoke 10 years back.4. I eat non-vegetarian, once or twice in a week.5. No history of cardiac problems, nor in my family.6. No abnormal pain in the chest during TMT nor any time during physical activity.7. Mild gastric pain once or twice in a week. This started about one to two weeks ago, probably due to outside food. ### Response: Hello. Although you do not have any symptoms, but your ECG and TMT shows changes. Your echo is also normal. But we cannot neglect your ECG changes which are striking. So it is better to undergo angiography and get it clarified. Also, sometimes such changes may be seen in hypertensive individuals, but you do not thave such history. So, overall, in my opinion you should undergo coronary angiography to clear the picture. I hope this helps you and get back if you have any doubts.

Hello doctor,I am a 34-year-old male. I have recently done a master health check-up. One of the key observations of the checkup was TMT (stress test) is borderline positive for inducible ischemia. Upon consulting cardiologist and post-screening echo, he has suggested doing a coronary angiogram. Could you please assess the attached reports and provide a second opinion on the condition and the way forward. Kindly let me know if you need any further details on the same.Few pointers of the routine and habits1. I do mild exercise. (Play badminton once in two weeks or one week).2. I do booze (beer) once in two weeks or once in a week.3. I do not smoke. But I used to smoke 10 years back.4. I eat non-vegetarian, once or twice in a week.5. No history of cardiac problems, nor in my family.6. No abnormal pain in the chest during TMT nor any time during physical activity.7. Mild gastric pain once or twice in a week. This started about one to two weeks ago, probably due to outside food.

Hello. Although you do not have any symptoms, but your ECG and TMT shows changes. Your echo is also normal. But we cannot neglect your ECG changes which are striking. So it is better to undergo angiography and get it clarified. Also, sometimes such changes may be seen in hypertensive individuals, but you do not thave such history. So, overall, in my opinion you should undergo coronary angiography to clear the picture. I hope this helps you and get back if you have any doubts.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 31 year old male. I am unable to penetrate my partner. I have tried twice, and it did not work both the times. She is a virgin and I find it too hard to push and penetrate. This somehow kills my erection as well. I have tried foreplay also but somehow cannot get through this problem. I have tried putting my two fingers inside but she complains of immense pain. Also, though I have engaged in oral sex before this is my first penetration as well. I never had any problem in getting an erection. I am an active guy who plays a lot of sports. Can you please help me understand what is wrong here. This is making me very nervous. ### Response: Hello, Welcome to Chat Doctor forum. You are getting good erections, but are losing them when you try to penetrate. This is happening because of tight vagina of your partner. Because of this, you are taking time during penetration and this results in loss of erection. This loss of erection is occurring because of psychological reasons. You have tried long foreplay but this did not result in improvement. She still feels pain during penetration or when you try to insert fingers. This happens when girls start engaging in sex. You should use lubrication during sex. KY jelly can be used. You can also try using Lignocaine jelly. Ask her to apply this jelly to her vaginal opening. This will reduce the sensitivity and will reduce pain to some extent. You are losing erection because you are not able to penetrate her. There is no physical issue and this is due to anxiety alone. With time, the problem will be solved. For more information consult a sexologist online

Hi doctor,I am a 31 year old male. I am unable to penetrate my partner. I have tried twice, and it did not work both the times. She is a virgin and I find it too hard to push and penetrate. This somehow kills my erection as well. I have tried foreplay also but somehow cannot get through this problem. I have tried putting my two fingers inside but she complains of immense pain. Also, though I have engaged in oral sex before this is my first penetration as well. I never had any problem in getting an erection. I am an active guy who plays a lot of sports. Can you please help me understand what is wrong here. This is making me very nervous.

Hello, Welcome to Chat Doctor forum. You are getting good erections, but are losing them when you try to penetrate. This is happening because of tight vagina of your partner. Because of this, you are taking time during penetration and this results in loss of erection. This loss of erection is occurring because of psychological reasons. You have tried long foreplay but this did not result in improvement. She still feels pain during penetration or when you try to insert fingers. This happens when girls start engaging in sex. You should use lubrication during sex. KY jelly can be used. You can also try using Lignocaine jelly. Ask her to apply this jelly to her vaginal opening. This will reduce the sensitivity and will reduce pain to some extent. You are losing erection because you are not able to penetrate her. There is no physical issue and this is due to anxiety alone. With time, the problem will be solved. For more information consult a sexologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,Kindly help me to understand my elder daughter\\s behaviour. She was born 14 years back. At her childhood, she was very energetic and hyperactive. We had put her in pre-school at 2.5 years and now she is in class 9. She is 13.5 years old now. I am finding her maturity level is far below her classmates and she hardly have any friends. She is also very poor in study. We are in such a condition that we only expect her to pass the examination. Sometimes I am feeling guilty about the fact that she is always under pressure.She nowadays does go out and keep herself busy with mobile and TV (cartoon). I have another daughter, who is 6.5 years old and the elder one cannot get along with her sister most of the time. She always tries to attract the attention by some means or other. She is only growing physically, but I am finding the mental growth is not at par. Kindly help me. ### Response: Hello, Welcome to Chat Doctor forum. I am sorry to hear about your situation, I can understand how difficult it might be for you. What you are describing needs a physical examination as well as a mental status examination and IQ testing. You will have to consult a neurologist or a pediatrician. You can also consult a psychiatrist and they will guide you further. The doctor will require to meet your daughter and talk to her to be able to understand whether the issue is neurological or a behaviour issue. If you are mentioning that her mental growth is not at par you will have to go for IQ testing which are available with psychiatrists as well as pediatricians.

Hello doctor,Kindly help me to understand my elder daughter\\s behaviour. She was born 14 years back. At her childhood, she was very energetic and hyperactive. We had put her in pre-school at 2.5 years and now she is in class 9. She is 13.5 years old now. I am finding her maturity level is far below her classmates and she hardly have any friends. She is also very poor in study. We are in such a condition that we only expect her to pass the examination. Sometimes I am feeling guilty about the fact that she is always under pressure.She nowadays does go out and keep herself busy with mobile and TV (cartoon). I have another daughter, who is 6.5 years old and the elder one cannot get along with her sister most of the time. She always tries to attract the attention by some means or other. She is only growing physically, but I am finding the mental growth is not at par. Kindly help me.

Hello, Welcome to Chat Doctor forum. I am sorry to hear about your situation, I can understand how difficult it might be for you. What you are describing needs a physical examination as well as a mental status examination and IQ testing. You will have to consult a neurologist or a pediatrician. You can also consult a psychiatrist and they will guide you further. The doctor will require to meet your daughter and talk to her to be able to understand whether the issue is neurological or a behaviour issue. If you are mentioning that her mental growth is not at par you will have to go for IQ testing which are available with psychiatrists as well as pediatricians.

### Instruction: Answer this question truthfully ###Input: Hi doctor,According to my LMP now I am 9 weeks pregnant. I went for USG TV 20 days back and it showed that I was 7 weeks and 2 days and now it would be 8 weeks. USG shown gestational sac with no yolk sac and fetal pole. They said it is BO and to go through D&C. I am confused what to do now. Shall I wait with hope or go through D&C? Please tell me how gestational age will be calculated from LMP or conception day? I am not sure when I ovulated? Please help me out. ### Response: Hi. At 6 weeks and beyond we expect a fetal pole or yolk sac to be visualized on USG. By 7 weeks, we must see the cardiac activity. If there is no embryo and no heart beat even beyond 7 weeks, we call it a blighted ovum (BO) with only a sac and no contents inside. It can happen due to a chromosomally abnormal gestation and hence does not survive. It regresses on its own. To date your pregnancy, we calculate period of gestation by LMP (last menstrual period) and then confirm it with an earliest scan within 3 months of pregnancy. In case there is no difference between the two dates or a difference is less than a week, we consider the LMP to calculate the expected date of delivery and period of gestation. Do not worry, you can conceive again. But no hope with this pregnancy. Start Folic Acid 5 mg daily for 3 months before next conception. This will help in a healthy embryo, reduce chance of miscarriage and prevent neural defects in the fetus.

Hi doctor,According to my LMP now I am 9 weeks pregnant. I went for USG TV 20 days back and it showed that I was 7 weeks and 2 days and now it would be 8 weeks. USG shown gestational sac with no yolk sac and fetal pole. They said it is BO and to go through D&C. I am confused what to do now. Shall I wait with hope or go through D&C? Please tell me how gestational age will be calculated from LMP or conception day? I am not sure when I ovulated? Please help me out.

Hi. At 6 weeks and beyond we expect a fetal pole or yolk sac to be visualized on USG. By 7 weeks, we must see the cardiac activity. If there is no embryo and no heart beat even beyond 7 weeks, we call it a blighted ovum (BO) with only a sac and no contents inside. It can happen due to a chromosomally abnormal gestation and hence does not survive. It regresses on its own. To date your pregnancy, we calculate period of gestation by LMP (last menstrual period) and then confirm it with an earliest scan within 3 months of pregnancy. In case there is no difference between the two dates or a difference is less than a week, we consider the LMP to calculate the expected date of delivery and period of gestation. Do not worry, you can conceive again. But no hope with this pregnancy. Start Folic Acid 5 mg daily for 3 months before next conception. This will help in a healthy embryo, reduce chance of miscarriage and prevent neural defects in the fetus.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have numbness in my hands and feet for the past two years. It is worsening gradually. The last month, it has got significantly aggravated. The numbness starts with tingling. When I am trying to grab something, I am unable to grab it. I also suffer from worsening cognitive function as I have difficulty in thinking and forming thoughts. I have trouble in organizing my thoughts, and I have difficulty in retrieving my memory. I am confused most of the time. I also have this problem for about two years.But last month, I started to have difficulty to do my job, and I was unable to function normally. I also stagger sometimes, and I have trouble in balancing my feet. So I looked at my symptoms, and I thought that I have vitamin b12 deficiency. So I started taking supplements 1000 mcg a day. But even now also, I have a feeling that my condition is getting worse day by day. ### Response: Hi. You have vitamin B12 deficiency. Your symptoms are related to peripheral neuropathy. It is caused due to vitamin B12 deficiency. It is necessary to perform some tests to know the possible cause. You have to investigate vitamin D levels and vitamin B12 plasma levels for identifying the possible deficiency, thyroid hormone levels for recognizing thyroid dysfunction, complete blood count and iron levels, and nerve conduction studies to investigate possible neuropathy. If vitamin B12 deficiency is confirmed, start to have a high dose of intramuscular injections. In such case, I would also recommend performing a fibrogastroscopy and biopsy to determine the cause for the malabsorption of this vitamin. You should discuss with your doctor for doing these tests.

Hi doctor,I have numbness in my hands and feet for the past two years. It is worsening gradually. The last month, it has got significantly aggravated. The numbness starts with tingling. When I am trying to grab something, I am unable to grab it. I also suffer from worsening cognitive function as I have difficulty in thinking and forming thoughts. I have trouble in organizing my thoughts, and I have difficulty in retrieving my memory. I am confused most of the time. I also have this problem for about two years.But last month, I started to have difficulty to do my job, and I was unable to function normally. I also stagger sometimes, and I have trouble in balancing my feet. So I looked at my symptoms, and I thought that I have vitamin b12 deficiency. So I started taking supplements 1000 mcg a day. But even now also, I have a feeling that my condition is getting worse day by day.

Hi. You have vitamin B12 deficiency. Your symptoms are related to peripheral neuropathy. It is caused due to vitamin B12 deficiency. It is necessary to perform some tests to know the possible cause. You have to investigate vitamin D levels and vitamin B12 plasma levels for identifying the possible deficiency, thyroid hormone levels for recognizing thyroid dysfunction, complete blood count and iron levels, and nerve conduction studies to investigate possible neuropathy. If vitamin B12 deficiency is confirmed, start to have a high dose of intramuscular injections. In such case, I would also recommend performing a fibrogastroscopy and biopsy to determine the cause for the malabsorption of this vitamin. You should discuss with your doctor for doing these tests.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 35 year old female. For four years, my right leg has swollen once in a year in the summer or when I go for agricultural works in mud fields. Initially it starts with fever, vomiting, body pain, chillness and then my leg will change to light red color and the swelling will start. Now, I am undergoing treatment. I am attaching the medical reports and the photo of my leg. My doctor told me that the swelling is due to mosquito bite. Please tell me the possible reasons for the swelling and the medical tests if any required. Please suggest the specialty doctor whom I should consult. ### Response: Hello, Welcome to Chat Doctor forum. It looks like you had cellulitis. You might have scratched your leg and later on it has developed an infection. I think you are accumulating gas in your foot and in your leg. I think you should be seen by an orthopedic surgeon sooner rather than later. You need a complete examination of that foot with x-ray, CT scan and blood cultures. I am also afraid, if you are bone has been involved with the infection known as osteomyelitis. I do not think it is because of a mosquito bite.Please let me know if you need any further assistance. I will need to know the results of the x-ray and the blood cultures to suggest any antibiotics. 1. Gas gangrene.2. Osteomyelitis. CBC (complete blood count), kidney and liver function test, electrolytes, CRP (C-reactive protein), x-ray of the foot and lower leg. Consider CT scan of the leg as well. Revert back with the reports to an internal medicine physician online.-

Hello doctor,I am a 35 year old female. For four years, my right leg has swollen once in a year in the summer or when I go for agricultural works in mud fields. Initially it starts with fever, vomiting, body pain, chillness and then my leg will change to light red color and the swelling will start. Now, I am undergoing treatment. I am attaching the medical reports and the photo of my leg. My doctor told me that the swelling is due to mosquito bite. Please tell me the possible reasons for the swelling and the medical tests if any required. Please suggest the specialty doctor whom I should consult.

Hello, Welcome to Chat Doctor forum. It looks like you had cellulitis. You might have scratched your leg and later on it has developed an infection. I think you are accumulating gas in your foot and in your leg. I think you should be seen by an orthopedic surgeon sooner rather than later. You need a complete examination of that foot with x-ray, CT scan and blood cultures. I am also afraid, if you are bone has been involved with the infection known as osteomyelitis. I do not think it is because of a mosquito bite.Please let me know if you need any further assistance. I will need to know the results of the x-ray and the blood cultures to suggest any antibiotics. 1. Gas gangrene.2. Osteomyelitis. CBC (complete blood count), kidney and liver function test, electrolytes, CRP (C-reactive protein), x-ray of the foot and lower leg. Consider CT scan of the leg as well. Revert back with the reports to an internal medicine physician online.-

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have been recently diagnosed with sciatica. I have some difficulty in walking. I am having Tramadol and Paracetamol for pain relief but they are not helping much. Could you tell me the underlying cause? Will I require a walking aid? ### Response: Hi,Welcome to ChatDoctor. As you must be aware by now, sciatica is a term used when a person experiences radiating leg pain due to some pressure on the nerves. Assessment will include intensity of back pain, intensity of leg pain, the distance you walk without any requirement of analgesic and detailed neurological examination including assessment of motor power, sensory evaluation and evaluation of deep tendon reflexes. This will then be followed by dynamic x-ray and MRI scan of lumbar spine if required. Depending upon the correlation of clinical examination and investigation results, management can then be formulated. If you have localized back pain with some radiculopathy symptoms with no other neurological symptoms like numbness, weakness, paresthesias, etc., then you can start with following recommendations for initial period of two to three weeks. We will observe your response to this conservative management protocol for next two to three weeks. If you are not feeling better, then we might have to get some investigations like dynamic x-rays of lower back and few blood tests for evaluation. Enclose your previous investigation and doctor\\s prescription. I can see them and advise you accordingly. Disc prolapse. X-ray LS (lumbosacral) spine - AP (anteroposterior) and lateral (flexion and extension) views. Avoid lifting heavyweight and acute forward bending in mornings. Revert back with the investigation reports to an orthopaedician and traumatologist online.-

Hi doctor,I have been recently diagnosed with sciatica. I have some difficulty in walking. I am having Tramadol and Paracetamol for pain relief but they are not helping much. Could you tell me the underlying cause? Will I require a walking aid?

Hi,Welcome to ChatDoctor. As you must be aware by now, sciatica is a term used when a person experiences radiating leg pain due to some pressure on the nerves. Assessment will include intensity of back pain, intensity of leg pain, the distance you walk without any requirement of analgesic and detailed neurological examination including assessment of motor power, sensory evaluation and evaluation of deep tendon reflexes. This will then be followed by dynamic x-ray and MRI scan of lumbar spine if required. Depending upon the correlation of clinical examination and investigation results, management can then be formulated. If you have localized back pain with some radiculopathy symptoms with no other neurological symptoms like numbness, weakness, paresthesias, etc., then you can start with following recommendations for initial period of two to three weeks. We will observe your response to this conservative management protocol for next two to three weeks. If you are not feeling better, then we might have to get some investigations like dynamic x-rays of lower back and few blood tests for evaluation. Enclose your previous investigation and doctor\\s prescription. I can see them and advise you accordingly. Disc prolapse. X-ray LS (lumbosacral) spine - AP (anteroposterior) and lateral (flexion and extension) views. Avoid lifting heavyweight and acute forward bending in mornings. Revert back with the investigation reports to an orthopaedician and traumatologist online.-

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am an 18-year-old male and suffering from acne since I was 14. I have tried a retinoid, Doxycycline, countless topical creams and scrubs, a six-month course of Accutane, and nothing seemed to work permanently. Accutane was the most effective drug at preventing my acne but, two months after I stopped it, my acne came back, not as severe, though. I believe that signifies the acne I suffer from is hormonal, so I just have to wait until the testosterone I produce stops affecting my sebaceous glands drastically. But I wanted to know if there is anything else I have not tried because my face looks horrible, and I have severe hyperpigmentation from the past pimples. I was looking into a chemical peel because I was told it would make your face produce less sebum in addition to inducing collagen production. More information about my skin is that I am white, light-skinned, and about 150 lbs. ### Response: Hello, Welcome to Chat Doctor forum. It seems like you have had really bad acne and have been trying hard to improve it. I would suggest you not to stop the treatment abruptly as it usually leads to a flare. Instead, once the acne is controlled, you should reduce the frequency to a maintenance dose, such as weekly once or twice, for a longer-term. Salicylic acid peels do work well for acne and oily skin when applied correctly. You may need four to six sessions, with monthly one session frequency. Chemical peels even help to lighten your post-acne pigmentation. Do not prick your acne as it leads to infection, scarring, and pigmentation.

Hello doctor,I am an 18-year-old male and suffering from acne since I was 14. I have tried a retinoid, Doxycycline, countless topical creams and scrubs, a six-month course of Accutane, and nothing seemed to work permanently. Accutane was the most effective drug at preventing my acne but, two months after I stopped it, my acne came back, not as severe, though. I believe that signifies the acne I suffer from is hormonal, so I just have to wait until the testosterone I produce stops affecting my sebaceous glands drastically. But I wanted to know if there is anything else I have not tried because my face looks horrible, and I have severe hyperpigmentation from the past pimples. I was looking into a chemical peel because I was told it would make your face produce less sebum in addition to inducing collagen production. More information about my skin is that I am white, light-skinned, and about 150 lbs.

Hello, Welcome to Chat Doctor forum. It seems like you have had really bad acne and have been trying hard to improve it. I would suggest you not to stop the treatment abruptly as it usually leads to a flare. Instead, once the acne is controlled, you should reduce the frequency to a maintenance dose, such as weekly once or twice, for a longer-term. Salicylic acid peels do work well for acne and oily skin when applied correctly. You may need four to six sessions, with monthly one session frequency. Chemical peels even help to lighten your post-acne pigmentation. Do not prick your acne as it leads to infection, scarring, and pigmentation.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 26-year-old male. I had protected sex with a sex worker a month back. I used one condom, she gave oral sex and post that had vaginal sex for 5 minutes. Once I finished off, I went to the bathroom and got cleaned off. I could not see any tear as such on the condom. I just washed my penis and got back home. The same night after 2 hours I pulled my foreskin behind to clean my penis with soap. The frenulum got too tight and tore. It started bleeding. I washed my penis and let it heal for 2 weeks.What are the chances of getting HIV from what had happened? I do not have any symptoms. Just had fever for a day and now I have a common cold. On the 15th-day post exposure (yesterday), I went for the HIV PCR RNA yesterday. The results are yet to come. Will the torn frenulum give chance for HIV virus to get in after 2 hours? I am feeling very anxious and stressed out. I really need your guidance. Please suggest what I need to do to rule out HIV and live a normal life. Please help. ### Response: Hi, Welcome to Chat Doctor forum. The chances of transmission of HIV with given description is almost nil. The HIV test is likely to be negative. If the test is negative, it is almost conclusive provided there is no further risk exposure. The chance of test result coming positive later is almost nil. You can go for HIV antibodies tests after 3 months exposure to have final conclusive results to relieve your anxiety. For more information consult a community medicine physician online

Hi doctor,I am a 26-year-old male. I had protected sex with a sex worker a month back. I used one condom, she gave oral sex and post that had vaginal sex for 5 minutes. Once I finished off, I went to the bathroom and got cleaned off. I could not see any tear as such on the condom. I just washed my penis and got back home. The same night after 2 hours I pulled my foreskin behind to clean my penis with soap. The frenulum got too tight and tore. It started bleeding. I washed my penis and let it heal for 2 weeks.What are the chances of getting HIV from what had happened? I do not have any symptoms. Just had fever for a day and now I have a common cold. On the 15th-day post exposure (yesterday), I went for the HIV PCR RNA yesterday. The results are yet to come. Will the torn frenulum give chance for HIV virus to get in after 2 hours? I am feeling very anxious and stressed out. I really need your guidance. Please suggest what I need to do to rule out HIV and live a normal life. Please help.

Hi, Welcome to Chat Doctor forum. The chances of transmission of HIV with given description is almost nil. The HIV test is likely to be negative. If the test is negative, it is almost conclusive provided there is no further risk exposure. The chance of test result coming positive later is almost nil. You can go for HIV antibodies tests after 3 months exposure to have final conclusive results to relieve your anxiety. For more information consult a community medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My 4 years old son fell in the play area and got his left arm fractured (ulna and radius). We went to ER and doctors did alignment and put him on cast and sling. I am attaching the X-rays before and after alignment. In the X-ray after alignment, one of the bones was not aligned properly. The doctor said that it is fine if it is aligned more than 20 % in kids. I am attaching both the X-rays.Can you please check and confirm if it is fine? Also, since he is 4 years old, he is not keeping the sling all time and while playing (with toys inside the home), the sling is getting loosened. My worry is that will it delay the healing process. Does the kid always need to be in a sling while in the cast. Please advise. ### Response: Hello, Welcome to Chat Doctor forum. The reduction is not appropriate in this case, the bone might join in a 4-year-old child but this is certainly taking a risk. The child requires removal of the cast, reattempt at the closed reduction, application of slab for one week followed by checking of X-ray elbow with the forearm with wrist-anteroposterior and lateral view to confirm reduction is maintained or not. If the reduction is maintained, then to undergo cast immobilization. Chil ChatDoctor. Role of the sling is to prevent edema of the limb by keeping it elevated and gives support. The child can play with well-fitted cast provided there is no fall on the limb, the cast is not soft and broken. If there is anything else, feel free to discuss further.

Hello doctor,My 4 years old son fell in the play area and got his left arm fractured (ulna and radius). We went to ER and doctors did alignment and put him on cast and sling. I am attaching the X-rays before and after alignment. In the X-ray after alignment, one of the bones was not aligned properly. The doctor said that it is fine if it is aligned more than 20 % in kids. I am attaching both the X-rays.Can you please check and confirm if it is fine? Also, since he is 4 years old, he is not keeping the sling all time and while playing (with toys inside the home), the sling is getting loosened. My worry is that will it delay the healing process. Does the kid always need to be in a sling while in the cast. Please advise.

Hello, Welcome to Chat Doctor forum. The reduction is not appropriate in this case, the bone might join in a 4-year-old child but this is certainly taking a risk. The child requires removal of the cast, reattempt at the closed reduction, application of slab for one week followed by checking of X-ray elbow with the forearm with wrist-anteroposterior and lateral view to confirm reduction is maintained or not. If the reduction is maintained, then to undergo cast immobilization. Chil ChatDoctor. Role of the sling is to prevent edema of the limb by keeping it elevated and gives support. The child can play with well-fitted cast provided there is no fall on the limb, the cast is not soft and broken. If there is anything else, feel free to discuss further.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 28 years old, a female and I have yellow skin and have melasma on both the cheeks and nose and its been for four years. I have shown it to 3 to 4 doctors within these years and applied many different creams which did not work much. Finally, someone suggested me to apply Tezcort 3S which has lightened my melasma but I have grown pimples because of that I think and my face is not as smooth like before. Even though I had melasma I used to have healthy and smooth skin and now I miss that skin. In order to cure my melasma I applied many different creams because of that I feel like my skin is not good now. Presently doctor prescribed me to apply Kojivit ultra gel but I did not get good result and melasma becomes prominent when I apply it. So I stoped it and now I am applying Tezcort 3S again. Please help. ### Response: Hi, Welcome to Chat Doctor forum. The pimples and uneven skin you have developed is because you have used a strong steroid with Salicylic acid, Tezcort 3S (Clobetasol propionate). This is dangerous and not supposed to be applied over the face. It can cause acne, thinning of skin, telangiectasia and facial hair. I would suggest that you stop Tezcort immediately. You can use Benzoyl peroxide cream over your pimples at night. Once the pimples subside, you can use the Brite Lite cream at night over the melasma in small quantities or you could go for chemical peeling. Make sure you use a sunscreen in the morning which is a must.

Hi doctor,I am 28 years old, a female and I have yellow skin and have melasma on both the cheeks and nose and its been for four years. I have shown it to 3 to 4 doctors within these years and applied many different creams which did not work much. Finally, someone suggested me to apply Tezcort 3S which has lightened my melasma but I have grown pimples because of that I think and my face is not as smooth like before. Even though I had melasma I used to have healthy and smooth skin and now I miss that skin. In order to cure my melasma I applied many different creams because of that I feel like my skin is not good now. Presently doctor prescribed me to apply Kojivit ultra gel but I did not get good result and melasma becomes prominent when I apply it. So I stoped it and now I am applying Tezcort 3S again. Please help.

Hi, Welcome to Chat Doctor forum. The pimples and uneven skin you have developed is because you have used a strong steroid with Salicylic acid, Tezcort 3S (Clobetasol propionate). This is dangerous and not supposed to be applied over the face. It can cause acne, thinning of skin, telangiectasia and facial hair. I would suggest that you stop Tezcort immediately. You can use Benzoyl peroxide cream over your pimples at night. Once the pimples subside, you can use the Brite Lite cream at night over the melasma in small quantities or you could go for chemical peeling. Make sure you use a sunscreen in the morning which is a must.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My 13 year old daughter complained late yesterday afternoon of a really bad headache and blurred vision with numbness in her arm. I gave her Ibuprofen, she then vomited not long after and said she felt better. This morning she woke saying that it was even worse. So, I took her to the local emergency department. Within 5 minutes of arriving, she had a numb arm, and the right side of her face was also numb. She could not talk properly. They administered Panadeine (Paracetamol+Codeine) and sent her to wait for the doctor. The feeling in her face returned, and we were called in. The nurse practitioner asked her questions, and she was not able to answer them properly. She seemed confused and trying really hard to find the words. They diagnosed it as viral sinusitis, and I am concerned that is not right. Please help. ### Response: Hi. I am afraid to say that the clinical history of your daughter appears to be more than just viral sinusitis. Viral sinusitis is probably an incidental finding. Abrupt onset of headache, blurring of vision, difficulty in speaking, and numbness in face and arm is very characteristic of intracranial pathology, likely a vascular etiology. She must be examined by a neurologist and must undergo a brain imaging like MRI of the brain at the earliest. Please take her to a neurologist immediately for a physical examination. This appears to be a neurological emergency. I can confidently say that viral sinusitis is not the cause of the symptoms here. Please be in follow up and keep me updated about the clinical developments. Please write a review, as it would be of help to me.

Hello doctor,My 13 year old daughter complained late yesterday afternoon of a really bad headache and blurred vision with numbness in her arm. I gave her Ibuprofen, she then vomited not long after and said she felt better. This morning she woke saying that it was even worse. So, I took her to the local emergency department. Within 5 minutes of arriving, she had a numb arm, and the right side of her face was also numb. She could not talk properly. They administered Panadeine (Paracetamol+Codeine) and sent her to wait for the doctor. The feeling in her face returned, and we were called in. The nurse practitioner asked her questions, and she was not able to answer them properly. She seemed confused and trying really hard to find the words. They diagnosed it as viral sinusitis, and I am concerned that is not right. Please help.

Hi. I am afraid to say that the clinical history of your daughter appears to be more than just viral sinusitis. Viral sinusitis is probably an incidental finding. Abrupt onset of headache, blurring of vision, difficulty in speaking, and numbness in face and arm is very characteristic of intracranial pathology, likely a vascular etiology. She must be examined by a neurologist and must undergo a brain imaging like MRI of the brain at the earliest. Please take her to a neurologist immediately for a physical examination. This appears to be a neurological emergency. I can confidently say that viral sinusitis is not the cause of the symptoms here. Please be in follow up and keep me updated about the clinical developments. Please write a review, as it would be of help to me.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 51 years old female and suffering from anxiety for decades. Recently it became debilitating, and I ended up in the ER and had an EKG because of heart palpitations. My doctor prescribed me 10 mg of Escitalopram and 1.5 mg of Xanax. The Xanax was supposed to be taken as needed, but I misunderstood and have been taking it three times a day (5 mg every eight hours). After six weeks, the SSRI is not helping much. My doctor has increased the dosage to 15 mg. I took the new dose at night and felt awful nauseous, depressed, and lethargic in the morning. Is this the wrong drug for me, or should I go through the side effects? My goal is to feel well enough to start weaning myself off the Xanax. I have not been able to eat solid food for weeks. ### Response: Hello, Welcome to Chat Doctor forum. Escitalopram is an effective medication for managing anxiety disorder. The usual dose is between 10 to 20 mg daily. You are currently on 15 mg. Side effects can occur commonly in the first two weeks of starting the medication or increasing the dose, and then it tends to settle. Take your medicine after food to minimize nausea. Depression and lethargy can take up to two to four weeks to get better. Taking Xanax (Alprazolam) regularly for more than a month can lead to dependence, and it will cause a with ChatDoctor. Consult your doctor and discuss the earliest to gradually taper off Xanax in a safe manner. Do breathing exercises and muscle relaxation exercises.

Hello doctor,I am 51 years old female and suffering from anxiety for decades. Recently it became debilitating, and I ended up in the ER and had an EKG because of heart palpitations. My doctor prescribed me 10 mg of Escitalopram and 1.5 mg of Xanax. The Xanax was supposed to be taken as needed, but I misunderstood and have been taking it three times a day (5 mg every eight hours). After six weeks, the SSRI is not helping much. My doctor has increased the dosage to 15 mg. I took the new dose at night and felt awful nauseous, depressed, and lethargic in the morning. Is this the wrong drug for me, or should I go through the side effects? My goal is to feel well enough to start weaning myself off the Xanax. I have not been able to eat solid food for weeks.

Hello, Welcome to Chat Doctor forum. Escitalopram is an effective medication for managing anxiety disorder. The usual dose is between 10 to 20 mg daily. You are currently on 15 mg. Side effects can occur commonly in the first two weeks of starting the medication or increasing the dose, and then it tends to settle. Take your medicine after food to minimize nausea. Depression and lethargy can take up to two to four weeks to get better. Taking Xanax (Alprazolam) regularly for more than a month can lead to dependence, and it will cause a with ChatDoctor. Consult your doctor and discuss the earliest to gradually taper off Xanax in a safe manner. Do breathing exercises and muscle relaxation exercises.

### Instruction: Answer this question truthfully ###Input: Hello doctor,When I brush, my gums bleed and are painful. However, I do not brush very hard. My gums have an indentation and feel rough. I brush twice a day, floss at night, and use Listerine mouthwash. I take Ibuprofen in the morning sometimes due to a bit of mouth pain. ### Response: Hi, Welcome to Chat Doctor forum. I have seen the pictures attached along with your complaint (attachment removed to protect patient identity). It looks like trench mouth (in dental terms acute necrotizing ulcerative gingivitis). It is one of the common dental disease caused by bacterial infection. It is aggravated by stress, weak immune system, or habits such as smoking. It is usually painful and ulcerative. Instead of Ibuprofen and Listerine mouthwash, I suggest using warm salt water rinse thrice daily or Colgate Peroxyl rinses twice daily after meals. Just use 10 mL of the mouthwash to gargle for one minute and spit it out. This helps in pain relief and removing dead tissue on the ulcers. Please avoid smoking habit if you do and also avoid hot and spicy food. Brushing and flossing are to be continued, and never stop doing it. But, avoid vigorous brushing. The indentation and the white gums in between the teeth is the appearance of the ulceration and this disease usually presents in this form. It will heal as you do the rinse treatment along with good oral hygiene. Meanwhile, I also advise you visit your dentist to get a professional cleaning done along with a blood check up to confirm any underlying infection. You might also be prescribed an antibiotic medication for the same. For more information consult a dentist online

Hello doctor,When I brush, my gums bleed and are painful. However, I do not brush very hard. My gums have an indentation and feel rough. I brush twice a day, floss at night, and use Listerine mouthwash. I take Ibuprofen in the morning sometimes due to a bit of mouth pain.

Hi, Welcome to Chat Doctor forum. I have seen the pictures attached along with your complaint (attachment removed to protect patient identity). It looks like trench mouth (in dental terms acute necrotizing ulcerative gingivitis). It is one of the common dental disease caused by bacterial infection. It is aggravated by stress, weak immune system, or habits such as smoking. It is usually painful and ulcerative. Instead of Ibuprofen and Listerine mouthwash, I suggest using warm salt water rinse thrice daily or Colgate Peroxyl rinses twice daily after meals. Just use 10 mL of the mouthwash to gargle for one minute and spit it out. This helps in pain relief and removing dead tissue on the ulcers. Please avoid smoking habit if you do and also avoid hot and spicy food. Brushing and flossing are to be continued, and never stop doing it. But, avoid vigorous brushing. The indentation and the white gums in between the teeth is the appearance of the ulceration and this disease usually presents in this form. It will heal as you do the rinse treatment along with good oral hygiene. Meanwhile, I also advise you visit your dentist to get a professional cleaning done along with a blood check up to confirm any underlying infection. You might also be prescribed an antibiotic medication for the same. For more information consult a dentist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 32 year old male. For the past one month, I have been feeling an itchy sensation in my penis occasionally. Today, I checked and found some white substance inside the foreskin and the glans area on that side is red. The foreskin inside there is also red. The white substance cleared when washed but after one hour when I checked again, it was back there. I washed again and it cleared mostly but some still remained. There is no lump or fluid discharge except the white substance. There is no pain or unusual feeling while urinating or any unusual smell. But there is slight itchiness at times as I said. I did not have any sexual contact with anybody in the past seven months. Please advise what this could be and how to deal with it. ### Response: Hello. It would be better if you can take a picture of it and upload it. There are two possibilities. Is this whitish substance present at the base of glans where foreskin meets the glans? If yes, this is a normal thing. This is called as smegma. These are normal secretions and nothing needs to be done about it. Daily morning, you may just pull your prepuce back and wash it. No need to wash it frequently. If location is just on the glans, but not at the base then there is a possibility of fungal infection called as candida infection and you need to apply antifungal like cream Clotrimazole two times a day for two weeks. So overall, it is likely a possibility of smegma and nothing to worry about it. For more information consult an internal medicine physician online Take care.

Hello doctor,I am a 32 year old male. For the past one month, I have been feeling an itchy sensation in my penis occasionally. Today, I checked and found some white substance inside the foreskin and the glans area on that side is red. The foreskin inside there is also red. The white substance cleared when washed but after one hour when I checked again, it was back there. I washed again and it cleared mostly but some still remained. There is no lump or fluid discharge except the white substance. There is no pain or unusual feeling while urinating or any unusual smell. But there is slight itchiness at times as I said. I did not have any sexual contact with anybody in the past seven months. Please advise what this could be and how to deal with it.

Hello. It would be better if you can take a picture of it and upload it. There are two possibilities. Is this whitish substance present at the base of glans where foreskin meets the glans? If yes, this is a normal thing. This is called as smegma. These are normal secretions and nothing needs to be done about it. Daily morning, you may just pull your prepuce back and wash it. No need to wash it frequently. If location is just on the glans, but not at the base then there is a possibility of fungal infection called as candida infection and you need to apply antifungal like cream Clotrimazole two times a day for two weeks. So overall, it is likely a possibility of smegma and nothing to worry about it. For more information consult an internal medicine physician online Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I took Benzodiazepine Alprazolam for insomnia for 2 months for a total dose of 30 mg, while stupidly attending college parties and binge drinking once a week during the period (I have never taken the pill on the day I was drinking). I did not take the drug every day and after roughly two months I quit the drug altogether, the withdrawal, that I did not recognize at the time, kicked in (Extreme tinnitus, sweating, heart racing, heightened anxiety). I went to ENT doctor and she gave me two Dexamethasone injections in 3 days (I think 8 mg). I developed during these 3 days a major loss of short term and then long term memory, trouble finding words, trouble learning in general. The physical symptoms of the steroids and benzo withdrawal went away in 2 weeks. It has now been a month since I feel physically fine, but the cognitive issues persist and they do not get better at all. I have been to a psychiatrist because I felt overwhelmed that Iam not going to be able to finish school in such a state and she gave me Escitalopram thinking it could be psychological, but there is no improvement in cognition after a months use.Does that combination have that drastic side-effects and could it caused a chemical or structural problem in brain? What can I do to return somewhere close to my old self? I am 24 years old. ### Response: Hi, Welcome to Chat Doctor forum. People taking Alprazolam should not combine it with alcohol and avoid combining it with other medications, such as narcotic pain relievers, that cause ChatDoctor. Doing so can cause additive

Hi doctor,I took Benzodiazepine Alprazolam for insomnia for 2 months for a total dose of 30 mg, while stupidly attending college parties and binge drinking once a week during the period (I have never taken the pill on the day I was drinking). I did not take the drug every day and after roughly two months I quit the drug altogether, the withdrawal, that I did not recognize at the time, kicked in (Extreme tinnitus, sweating, heart racing, heightened anxiety). I went to ENT doctor and she gave me two Dexamethasone injections in 3 days (I think 8 mg). I developed during these 3 days a major loss of short term and then long term memory, trouble finding words, trouble learning in general. The physical symptoms of the steroids and benzo withdrawal went away in 2 weeks. It has now been a month since I feel physically fine, but the cognitive issues persist and they do not get better at all. I have been to a psychiatrist because I felt overwhelmed that Iam not going to be able to finish school in such a state and she gave me Escitalopram thinking it could be psychological, but there is no improvement in cognition after a months use.Does that combination have that drastic side-effects and could it caused a chemical or structural problem in brain? What can I do to return somewhere close to my old self? I am 24 years old.

Hi, Welcome to Chat Doctor forum. People taking Alprazolam should not combine it with alcohol and avoid combining it with other medications, such as narcotic pain relievers, that cause ChatDoctor. Doing so can cause additive

### Instruction: Answer this question truthfully ###Input: Hello doctor,My dear daughter just completed 1 year yesterday and still on breastfeed (twice, a full day) along with normal food. She is lactose intolerant and was hypocalcemic (less calcium) by birth. Her doctor gave her OstoCalcium and retested after six months and she turned to be absolutely fine with calcium levels and other reports. The doctor advised going off the medicine.Now the complaint is; from last Friday, she was vomiting frequently three times. She was on breastfeed and her mother was having super acidity. On Saturday, we did not make her consume breastmilk and she was fine. On Sunday, we went for a wedding and while to and fro in the car she was vomiting.After that, there was no vomiting. She is very active but very restless (like throwing anything in hand, continuously trying to chew something specifically her own finger and looking to drink water more than normal, suddenly crying and then stops and starts behaving normally).Today, she did watery potty twice and we have her Peditrol ORS. What can be the issue? Please suggest, we are perplexed as the symptoms keep on changing each time. Is she teething? ### Response: Hello. Do not worry so much. What you are describing seems to be gastroenteritis. Continue the same medications which are going on. Watch for lethargy and dehy ChatDoctor. The matter should settle in two to three days. I suggest giving Enterogermina respule (probiotic vials), one respule twice a day for three to five days for faster action. Consult your child\\s specialist doctor, discuss with him or her and start taking the medicines with their consent.

Hello doctor,My dear daughter just completed 1 year yesterday and still on breastfeed (twice, a full day) along with normal food. She is lactose intolerant and was hypocalcemic (less calcium) by birth. Her doctor gave her OstoCalcium and retested after six months and she turned to be absolutely fine with calcium levels and other reports. The doctor advised going off the medicine.Now the complaint is; from last Friday, she was vomiting frequently three times. She was on breastfeed and her mother was having super acidity. On Saturday, we did not make her consume breastmilk and she was fine. On Sunday, we went for a wedding and while to and fro in the car she was vomiting.After that, there was no vomiting. She is very active but very restless (like throwing anything in hand, continuously trying to chew something specifically her own finger and looking to drink water more than normal, suddenly crying and then stops and starts behaving normally).Today, she did watery potty twice and we have her Peditrol ORS. What can be the issue? Please suggest, we are perplexed as the symptoms keep on changing each time. Is she teething?

Hello. Do not worry so much. What you are describing seems to be gastroenteritis. Continue the same medications which are going on. Watch for lethargy and dehy ChatDoctor. The matter should settle in two to three days. I suggest giving Enterogermina respule (probiotic vials), one respule twice a day for three to five days for faster action. Consult your child\\s specialist doctor, discuss with him or her and start taking the medicines with their consent.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have recurring UTI. Last time,a few months back, after taking medicines for the recurring UTI, results were normal. I took Cital syrup and antibiotics. After experiencing pain recently I again went for urine test, and it shows RBC, epithelial cells and bacteria. I have attached the reports. I was consulting a gynecologist prior to this, but she told me to consult a urologist. I have attached my last ultrasound and kidney function test along with today\\s urine test. ### Response: Hi, Welcome to Chat Doctor forum. After reviewing your complains and your blood and urine test with ultrasound reports (attachment removed to protect patient identity), kidney functions are normal, your ultrasound is normal, your urine analysis showed pus cells and few red cells and white blood cells. My question is do you have symptoms like difficulty in passing urine? Or pain while passing urine? If not then did you have urine culture result before your antibiotics treatment? If you have documented UTI before and you got treated then you have pus cells and white cells in urine, your test might have been performed soon after antibiotics. The possibilities are incomplete treatment or chronic inflammation of the urinary bladder as sending infections are also common in postmenopausal period. You will need to follow up with urine culture test, if it is negative and you have no symptoms then no need to treat. If it is negative and you are still having symptoms (pain while passing urine), we need to do more tests. I hope to follow up you after urine culture results. As preventive measure, you need proper hy ChatDoctor. Cystitis, incomplete treatment. Urine culture. Cystitis bacterial, TB. Cystitis. Observation and hy

Hello doctor,I have recurring UTI. Last time,a few months back, after taking medicines for the recurring UTI, results were normal. I took Cital syrup and antibiotics. After experiencing pain recently I again went for urine test, and it shows RBC, epithelial cells and bacteria. I have attached the reports. I was consulting a gynecologist prior to this, but she told me to consult a urologist. I have attached my last ultrasound and kidney function test along with today\\s urine test.

Hi, Welcome to Chat Doctor forum. After reviewing your complains and your blood and urine test with ultrasound reports (attachment removed to protect patient identity), kidney functions are normal, your ultrasound is normal, your urine analysis showed pus cells and few red cells and white blood cells. My question is do you have symptoms like difficulty in passing urine? Or pain while passing urine? If not then did you have urine culture result before your antibiotics treatment? If you have documented UTI before and you got treated then you have pus cells and white cells in urine, your test might have been performed soon after antibiotics. The possibilities are incomplete treatment or chronic inflammation of the urinary bladder as sending infections are also common in postmenopausal period. You will need to follow up with urine culture test, if it is negative and you have no symptoms then no need to treat. If it is negative and you are still having symptoms (pain while passing urine), we need to do more tests. I hope to follow up you after urine culture results. As preventive measure, you need proper hy ChatDoctor. Cystitis, incomplete treatment. Urine culture. Cystitis bacterial, TB. Cystitis. Observation and hy

### Instruction: Answer this question truthfully ###Input: Hello doctor,Can you please give the diagnosis of the uploaded MRI brain and CSF studies with a detailed report? Please advise on the action plan as to how to get the CSF findings treated. The MRI report is enclosed. Does the enclosed report co-relate with your findings? The MRI report CSF studies report shows CSF hyperdynamic flow of absolute stroke volume of 110 microliters per second against the normal of 50 microliters per sec per cardiac cycle. Also, my treating neurologist wanted an opinion on the following. Are there signs of NPH? But do the findings of brain atrophy, ventriculomegaly, hyperdynamic CSF flows suggest of idiopathic hydrocephalus and are some intervention required? ### Response: Hi, Welcome back to ChatDoctor. The findings in the report and the images are matching and acceptable (attachment removed to protect patient identity). The term NPH is usually applied in cases where there is abnormal CSF hyperdynamic circulation with gait problems or without gait problems if incontinence is there. Confirming NPH without typical features is difficult in your case. There are controversies regarding NPH and CSF hyperdynamic values and different researchers have come to variable conclusions. Since gait problems are most common in NPH, therefore, most researches have mentioned the importance of gait problems when confirming NPH or incontinence if gait problem is not there. Treatment with shunting might help only when NPH is confirmed. If there is no NPH then the diagnosis is likely due to neurodegenerative disorders and the symptoms can be treated by medicines. There are many different and complicated types of neurodegenerative disorders and a clinical emphasis is more important than only MRI findings when confirming a condition.

Hello doctor,Can you please give the diagnosis of the uploaded MRI brain and CSF studies with a detailed report? Please advise on the action plan as to how to get the CSF findings treated. The MRI report is enclosed. Does the enclosed report co-relate with your findings? The MRI report CSF studies report shows CSF hyperdynamic flow of absolute stroke volume of 110 microliters per second against the normal of 50 microliters per sec per cardiac cycle. Also, my treating neurologist wanted an opinion on the following. Are there signs of NPH? But do the findings of brain atrophy, ventriculomegaly, hyperdynamic CSF flows suggest of idiopathic hydrocephalus and are some intervention required?

Hi, Welcome back to ChatDoctor. The findings in the report and the images are matching and acceptable (attachment removed to protect patient identity). The term NPH is usually applied in cases where there is abnormal CSF hyperdynamic circulation with gait problems or without gait problems if incontinence is there. Confirming NPH without typical features is difficult in your case. There are controversies regarding NPH and CSF hyperdynamic values and different researchers have come to variable conclusions. Since gait problems are most common in NPH, therefore, most researches have mentioned the importance of gait problems when confirming NPH or incontinence if gait problem is not there. Treatment with shunting might help only when NPH is confirmed. If there is no NPH then the diagnosis is likely due to neurodegenerative disorders and the symptoms can be treated by medicines. There are many different and complicated types of neurodegenerative disorders and a clinical emphasis is more important than only MRI findings when confirming a condition.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 20 years old. I had a pretty bad cold three weeks ago. The cold seems to have subsided, but my lingual tonsils seem to be enlarged. I also have little bumps on the back of my throat. I have drainage in the bottom of my throat as well. Also, a few patches of white under my right tonsil. I do not seem to have any painful symptoms, except once in a while my thyroid or Adam\\s apple presents discomfort. But, nothing painful though. I will include pictures if that is an option. I had an appointment with an ENT and he said everything looked normal. Just curious as to why this has not subsided or showed any real signs of recovering. It had been occurring for about three to four weeks. Thank you. ### Response: Hi, Welcome to Chat Doctor forum. Lingual tonsils may get enlarged during an episode of upper respiratory tract infection. Also with details you have provided it appears that you have some remnant inflammation in your upper respiratory tract. That is causing the granular pharyngitis, tonsillitis and mucus ChatDoctor. I suggest you take the following medications. Tablet of Trypsin-Chymotrypsin combination that acts as anti-inflammatory twice a day before meals, with Acetaminophen tablet as and when needed, with steam inhalation and Chlorhexidine mouth gargles. Continue this for five days. I also suggest you a tablet of Omeprazole once daily before breakfast for two weeks. If still your symptoms do not subside, then we need to do a throat swab and an endoscopy. Consult your doctor, discuss with him or her and take the medicine with consent.

Hi doctor,I am 20 years old. I had a pretty bad cold three weeks ago. The cold seems to have subsided, but my lingual tonsils seem to be enlarged. I also have little bumps on the back of my throat. I have drainage in the bottom of my throat as well. Also, a few patches of white under my right tonsil. I do not seem to have any painful symptoms, except once in a while my thyroid or Adam\\s apple presents discomfort. But, nothing painful though. I will include pictures if that is an option. I had an appointment with an ENT and he said everything looked normal. Just curious as to why this has not subsided or showed any real signs of recovering. It had been occurring for about three to four weeks. Thank you.

Hi, Welcome to Chat Doctor forum. Lingual tonsils may get enlarged during an episode of upper respiratory tract infection. Also with details you have provided it appears that you have some remnant inflammation in your upper respiratory tract. That is causing the granular pharyngitis, tonsillitis and mucus ChatDoctor. I suggest you take the following medications. Tablet of Trypsin-Chymotrypsin combination that acts as anti-inflammatory twice a day before meals, with Acetaminophen tablet as and when needed, with steam inhalation and Chlorhexidine mouth gargles. Continue this for five days. I also suggest you a tablet of Omeprazole once daily before breakfast for two weeks. If still your symptoms do not subside, then we need to do a throat swab and an endoscopy. Consult your doctor, discuss with him or her and take the medicine with consent.

### Instruction: Answer this question truthfully ###Input: Hello doctor,This query is about my mother. She is 57 years old. She has these dizzy episodes since last two to two and a half years. They are very short most of the time, lasting for a maximum of few seconds. It happens most of the time when she gets up from the bed or changes position on bed. She shows excellent response to both Vertin and Zevert. She took Vertin 24 mg BD for three months and then left it. She was alright for three months after leaving the medicine. But, last night she had symptoms again, same lasting for two to three seconds. She does not have any other symptoms. Her balance is perfect. She has a migraine for the last 10 years. My query is should we start her on Vertin or Zevert again? For how long? And should we go for any other investigation? Can it be something serious? ### Response: Hello, Welcome to Chat Doctor forum. I read your question and would explain that your mother symptoms seem to be related to an inner ear disorder. There is nothing to worry about, as her situation improved with Zevert and Vertin once. For this reason, I would recommend starting again Zevert (Betahistine) for a month, with the same dose. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. If her complaints persist, I recommend consulting with an ENT specialist and performing labyrinthine tests. A Doppler ultrasound of the cervical arteries would help exclude possible vertebrobasilar insufficiency. Hope you will find this answer helpful. For more information consult a neurologist online

Hello doctor,This query is about my mother. She is 57 years old. She has these dizzy episodes since last two to two and a half years. They are very short most of the time, lasting for a maximum of few seconds. It happens most of the time when she gets up from the bed or changes position on bed. She shows excellent response to both Vertin and Zevert. She took Vertin 24 mg BD for three months and then left it. She was alright for three months after leaving the medicine. But, last night she had symptoms again, same lasting for two to three seconds. She does not have any other symptoms. Her balance is perfect. She has a migraine for the last 10 years. My query is should we start her on Vertin or Zevert again? For how long? And should we go for any other investigation? Can it be something serious?

Hello, Welcome to Chat Doctor forum. I read your question and would explain that your mother symptoms seem to be related to an inner ear disorder. There is nothing to worry about, as her situation improved with Zevert and Vertin once. For this reason, I would recommend starting again Zevert (Betahistine) for a month, with the same dose. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. If her complaints persist, I recommend consulting with an ENT specialist and performing labyrinthine tests. A Doppler ultrasound of the cervical arteries would help exclude possible vertebrobasilar insufficiency. Hope you will find this answer helpful. For more information consult a neurologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor, I have a cracked tooth which I believe needs a root canal and a crown that I think went bad. I am in excruciating pain. I have been to emergency rooms they have given me Clindamycin and Vicodin for pain but it barely touches the pain. I have been on antibiotics for two days. I thought I would see some improvement but the swelling and pain are getting worse. I have had a staphylococcus infection before is it possible that this could be one? The infection was on the right side of my face. I have been waiting for two months to get into my dentist. ### Response: Hi, Welcome to Chat Doctor forum. I read your complaint and relevant details. You have mentioned you got a swelling. I just want to make sure if the swelling is confined close to the tooth or is it spreading? The severe pain along with fever and swelling confirms that the infection has gone bad. Clindamycin is the only antibiotic that you are taking. I recommend you to take Metronidazole 400 mg orally twice daily along with Clindamycin for five days. This will fight against another group of bacteria and reduce the swelling to an extent. Also, continue with your pain killers as well. Tramadol works well for moderate to severe pain. But in your case, it does not sound so. For immediate relief, crush one tablet of Ketorol DT (ketorolac tromethamine) in half a glass of water and ChatDoctor. You will feel better in 15 minutes. Otherwise, complete relief will be got only after the necessary dental treatment. Antibiotics are just add ons. Do not totally rely upon them.

Hi doctor, I have a cracked tooth which I believe needs a root canal and a crown that I think went bad. I am in excruciating pain. I have been to emergency rooms they have given me Clindamycin and Vicodin for pain but it barely touches the pain. I have been on antibiotics for two days. I thought I would see some improvement but the swelling and pain are getting worse. I have had a staphylococcus infection before is it possible that this could be one? The infection was on the right side of my face. I have been waiting for two months to get into my dentist.

Hi, Welcome to Chat Doctor forum. I read your complaint and relevant details. You have mentioned you got a swelling. I just want to make sure if the swelling is confined close to the tooth or is it spreading? The severe pain along with fever and swelling confirms that the infection has gone bad. Clindamycin is the only antibiotic that you are taking. I recommend you to take Metronidazole 400 mg orally twice daily along with Clindamycin for five days. This will fight against another group of bacteria and reduce the swelling to an extent. Also, continue with your pain killers as well. Tramadol works well for moderate to severe pain. But in your case, it does not sound so. For immediate relief, crush one tablet of Ketorol DT (ketorolac tromethamine) in half a glass of water and ChatDoctor. You will feel better in 15 minutes. Otherwise, complete relief will be got only after the necessary dental treatment. Antibiotics are just add ons. Do not totally rely upon them.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am not able to conceive after trying for almost one year. I was diagnosed with pituitary microadenoma and I am on medication. My prolactin levels have now reached normal levels after two months taking medication.I suffer from hypothyroidism and on medication. I have had this for five years now and it is well within the limits as per my endocrinologist now. This is due to an autoimmune disease where my TPO (thyroid peroxidase) antibodies were high during the diagnosis five years ago. My husband and I would like to know how should we best prepare for pregnancy and what to look out for. We would have preferred to visit the clinic. Unfortunately, I am not in a position to visit the doctor due to travel restrictions. It would be great to get in touch with a specialist.I am currently on Euthrox 100 mcg, Cabergoline 0.25 mg once a week, and Folic acid 450 mg daily. ### Response: Hello, Welcome to Chat Doctor forum. I have gone through all your reports (attachment removed to protect patient identity) and your prolactin and thyroid levels are well in control. What is missing in the follicular monitoring profile of the dummy cycle and also your husband\\s semen analysis test? You have been following the correct protocol using LH kits for ovulation and post LH surge if a natural trial or timed intercourse did not work then husband\\s semen analysis becomes mandatory. Then when both male and female infertility causes are ruled out then comes mechanical causes where positions and version of uterus need to be considered and measures implemented. Anyways please send these two remaining reports before we can proceed further.

Hello doctor,I am not able to conceive after trying for almost one year. I was diagnosed with pituitary microadenoma and I am on medication. My prolactin levels have now reached normal levels after two months taking medication.I suffer from hypothyroidism and on medication. I have had this for five years now and it is well within the limits as per my endocrinologist now. This is due to an autoimmune disease where my TPO (thyroid peroxidase) antibodies were high during the diagnosis five years ago. My husband and I would like to know how should we best prepare for pregnancy and what to look out for. We would have preferred to visit the clinic. Unfortunately, I am not in a position to visit the doctor due to travel restrictions. It would be great to get in touch with a specialist.I am currently on Euthrox 100 mcg, Cabergoline 0.25 mg once a week, and Folic acid 450 mg daily.

Hello, Welcome to Chat Doctor forum. I have gone through all your reports (attachment removed to protect patient identity) and your prolactin and thyroid levels are well in control. What is missing in the follicular monitoring profile of the dummy cycle and also your husband\\s semen analysis test? You have been following the correct protocol using LH kits for ovulation and post LH surge if a natural trial or timed intercourse did not work then husband\\s semen analysis becomes mandatory. Then when both male and female infertility causes are ruled out then comes mechanical causes where positions and version of uterus need to be considered and measures implemented. Anyways please send these two remaining reports before we can proceed further.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have high eye pressure of 30 and 24, visual field loss, and at times I go completely blind in both eyes. I have also gone blind in just one eye. I just went back to the eye doctor when I had the pressure of 24 and 30. I have been there three times and each time I had a high eye pressure. He at first told me everything looked good until I asked him what my pressure was again because he specifically said my pressure was good when I knew that it was high. He told me that it was fairly high when I asked for it but he says I do not have any optic nerve damage and that it is highly unlikely that I have glaucoma because I am 23 years old. But my research has told me differently that high eye pressure alone does not mean that that you have glaucoma but if you have visual field loss or optic nerve damage with your high eye pressure then you do. So I do not know what is going on? Can you please help me understand and is it possible that I do have glaucoma and should go to another doctor? ### Response: Hello, Welcome to Chat Doctor forum. I reviewed your history. The presence of elevated intraocular pressure is called as ocular hypertension. If it is associated with visual field changes or optic disc changes it is called as glaucoma. However, ocular hypertension alone also requires treatment particularly in your case as intraocular pressure is high. Hence you need to consult glaucoma specialist for evaluation and advice accordingly. Increased intraocular pressure. Visual fields, OCT (optic coherence tomography). Glaucoma. Antiglaucoma ChatDoctor. Once in six months.

Hello doctor,I have high eye pressure of 30 and 24, visual field loss, and at times I go completely blind in both eyes. I have also gone blind in just one eye. I just went back to the eye doctor when I had the pressure of 24 and 30. I have been there three times and each time I had a high eye pressure. He at first told me everything looked good until I asked him what my pressure was again because he specifically said my pressure was good when I knew that it was high. He told me that it was fairly high when I asked for it but he says I do not have any optic nerve damage and that it is highly unlikely that I have glaucoma because I am 23 years old. But my research has told me differently that high eye pressure alone does not mean that that you have glaucoma but if you have visual field loss or optic nerve damage with your high eye pressure then you do. So I do not know what is going on? Can you please help me understand and is it possible that I do have glaucoma and should go to another doctor?

Hello, Welcome to Chat Doctor forum. I reviewed your history. The presence of elevated intraocular pressure is called as ocular hypertension. If it is associated with visual field changes or optic disc changes it is called as glaucoma. However, ocular hypertension alone also requires treatment particularly in your case as intraocular pressure is high. Hence you need to consult glaucoma specialist for evaluation and advice accordingly. Increased intraocular pressure. Visual fields, OCT (optic coherence tomography). Glaucoma. Antiglaucoma ChatDoctor. Once in six months.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I noticed a small triangular bald spot in my beard three weeks ago. It was likely alopecia areata. Saw my dermatologist last week, she said it was likely folliculitis. I have had folliculitis before in the same area and it was much different. She is the doctor. So I accepted and moved on. One small spot that has some hair growing back, small thin white hair. Yesterday, I noticed what appeared to be a bald spot in my pubic hair above the penis. When I trimmed the hair back, it revealed a quarter sized bald spot and a smaller dime sized spot. I am not sure how long they may have been there as they were somewhat masked by a longer pubic hair. So, now I have what I believe to be three spots, two below abdomen and one on beard. My concern is more of them spreading than the current spots.I am now thinking back about the annual checkup that I had with my GP six months back. I advised him that in the past year the amount of semen I produce has gone down drastically. I thought it may be a testosterone issue. He advised it was likely a result of my vasectomy the year before. Also as a part of my visit, my WBC was lower than normal, outside of the range by a couple. He was not concerned about that either.My question is whether any of these things are related ### Response: Hello, Welcome to Chat Doctor forum. Alopecia areata is an immune disorder and is separated from folliculitis and it has nothing to do with your semen count and low WBC. Nevertheless, please send me a few good quality photographs taken in a natural light.

Hello doctor,I noticed a small triangular bald spot in my beard three weeks ago. It was likely alopecia areata. Saw my dermatologist last week, she said it was likely folliculitis. I have had folliculitis before in the same area and it was much different. She is the doctor. So I accepted and moved on. One small spot that has some hair growing back, small thin white hair. Yesterday, I noticed what appeared to be a bald spot in my pubic hair above the penis. When I trimmed the hair back, it revealed a quarter sized bald spot and a smaller dime sized spot. I am not sure how long they may have been there as they were somewhat masked by a longer pubic hair. So, now I have what I believe to be three spots, two below abdomen and one on beard. My concern is more of them spreading than the current spots.I am now thinking back about the annual checkup that I had with my GP six months back. I advised him that in the past year the amount of semen I produce has gone down drastically. I thought it may be a testosterone issue. He advised it was likely a result of my vasectomy the year before. Also as a part of my visit, my WBC was lower than normal, outside of the range by a couple. He was not concerned about that either.My question is whether any of these things are related

Hello, Welcome to Chat Doctor forum. Alopecia areata is an immune disorder and is separated from folliculitis and it has nothing to do with your semen count and low WBC. Nevertheless, please send me a few good quality photographs taken in a natural light.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 41-year-old, healthy female, average height and weight. I recently had a CBC which was concerning to me. The WBC count was slightly low at 3.78 (reference range starts at 4.16) and the ANC was 1.08 x 103/uL. All the rest of the CBC was entirely normal. No immature granulocytes, etc., and lymphocyte count normal (although obviously percentage was higher at 55 %). I recently completed a short course of Ciprofloxacin for a tooth issue (about 3 to 4 days prior to blood draw). Also had a mild stomach flu about two weeks ago. Only other medication is Wellbutrin. Should I be very concerned about cancer, etc? I have been feeling hotter at night recently, but I have also been under a tremendous amount of stress. I recently was laid off and I am having trouble finding a job. ### Response: Hi, Welcome to the ChatDoctor. I have seen your attached report here (attachment removed to protect patient identity). It is not suggestive of any cancer. Your Hb (hemoglobin), HCT (hematocrit), RBC (red blood cells) and platelet count all within range. You had mentioned the history of flu which can lead a temporary decrease in WBC count may be by bone marrow suppression or relative decrease because of increased lymphocytes. Immature cells are not present so I do not think you have to worry about that. Repeat CBC (complete blood count) after few days. It will be normal if not then will investigate further. Take care. For more information consult a hematologist online

Hello doctor,I am a 41-year-old, healthy female, average height and weight. I recently had a CBC which was concerning to me. The WBC count was slightly low at 3.78 (reference range starts at 4.16) and the ANC was 1.08 x 103/uL. All the rest of the CBC was entirely normal. No immature granulocytes, etc., and lymphocyte count normal (although obviously percentage was higher at 55 %). I recently completed a short course of Ciprofloxacin for a tooth issue (about 3 to 4 days prior to blood draw). Also had a mild stomach flu about two weeks ago. Only other medication is Wellbutrin. Should I be very concerned about cancer, etc? I have been feeling hotter at night recently, but I have also been under a tremendous amount of stress. I recently was laid off and I am having trouble finding a job.

Hi, Welcome to the ChatDoctor. I have seen your attached report here (attachment removed to protect patient identity). It is not suggestive of any cancer. Your Hb (hemoglobin), HCT (hematocrit), RBC (red blood cells) and platelet count all within range. You had mentioned the history of flu which can lead a temporary decrease in WBC count may be by bone marrow suppression or relative decrease because of increased lymphocytes. Immature cells are not present so I do not think you have to worry about that. Repeat CBC (complete blood count) after few days. It will be normal if not then will investigate further. Take care. For more information consult a hematologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I fear I may have contracted HIV. A month back, I had oral sex and regular sex from an unknown girl. Three days later, I started to feel very sick, headache, cold in warm weather, tired, diarrhea, sweating in bed (I thought this could be food poisoning). A week later I felt better but had breakouts on my whole back (thought maybe from sweating in bed and training in severe heat the past week). A week back, I felt fine most of the day but once 4 PM hit, my throat started to hurt, I had a severe headache, cold sweats, very tired, fever at 102 F. Felt better by the next night except for the throat which still hurts when swallowing. My neck feel kind of stiff as well. I wondered how much stress can play a factor in producing symptoms, because the first time I was extremely stressed for a couple hours about something and the second time the same thing. And I mean extremely stressed out and anxious, thinking alot, heart racing, etc. I of course will get a test but fear it is too early to show a positive result if it happens to be. ### Response: Hello. I have noted your concern. Unprotected oral is not much of a risk. The only risk factor involved here is regular sex. The breakout on your back looks like acne (attachment removed to protect patient identity). Your throat symptoms and other systemic symptoms could be just part of throat infection. I suggest you take a fourth generation HIV screening test at four weeks from your risk exposure with the girl of unknown HIV status. That would be conclusive. For more information consult a venereologist online

Hello doctor,I fear I may have contracted HIV. A month back, I had oral sex and regular sex from an unknown girl. Three days later, I started to feel very sick, headache, cold in warm weather, tired, diarrhea, sweating in bed (I thought this could be food poisoning). A week later I felt better but had breakouts on my whole back (thought maybe from sweating in bed and training in severe heat the past week). A week back, I felt fine most of the day but once 4 PM hit, my throat started to hurt, I had a severe headache, cold sweats, very tired, fever at 102 F. Felt better by the next night except for the throat which still hurts when swallowing. My neck feel kind of stiff as well. I wondered how much stress can play a factor in producing symptoms, because the first time I was extremely stressed for a couple hours about something and the second time the same thing. And I mean extremely stressed out and anxious, thinking alot, heart racing, etc. I of course will get a test but fear it is too early to show a positive result if it happens to be.

Hello. I have noted your concern. Unprotected oral is not much of a risk. The only risk factor involved here is regular sex. The breakout on your back looks like acne (attachment removed to protect patient identity). Your throat symptoms and other systemic symptoms could be just part of throat infection. I suggest you take a fourth generation HIV screening test at four weeks from your risk exposure with the girl of unknown HIV status. That would be conclusive. For more information consult a venereologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I wanted to take a second opinion about my mother. In her ultrasound, it was diagnosed that she had gall bladder stones. There was no pain but it was accidentally observed in the ultrasound. We waited for three years, but then, later on, one of my friend's mother developed gall bladder cancer which was fatal. This incident prompted us to take a second opinion. And this time, the doctor also suggested that gall bladder should be removed because the stones might create problems in pancreas. Therefore we had her operated and the gallbladder was surgically removed. After the operation, biopsy of the gallbladder was also done. (All the relevant reports are attached the pre-operative medical tests are also there. In one of the reports in history, it is written that patient gives a history of pain in abdomen, complaints of acid peptic dyspepsia. She had no pain in the abdomen and no problem of gas or indigestion before the operation). After the operation, she had pain in the operation area which was healed later on.She has had typhoid thrice and TB once when she was young. She had chikungunya type fever last year which was negative for chikungunya tests, but the doctor said it might have been chikungunya and the tests might not have been done in the right time period that is why they came negative. She also takes medicines for blood pressure, knee and joint pain (calcium), cataract, homeopathic medicine for nose polyp infection.Here are my questions ### Response: Hi. Having gone through the reports (attachment removed to protect patient identity) I just need to reassure you that the surgery was done by a world class surgeon. Reply to your queries

Hello doctor,I wanted to take a second opinion about my mother. In her ultrasound, it was diagnosed that she had gall bladder stones. There was no pain but it was accidentally observed in the ultrasound. We waited for three years, but then, later on, one of my friend's mother developed gall bladder cancer which was fatal. This incident prompted us to take a second opinion. And this time, the doctor also suggested that gall bladder should be removed because the stones might create problems in pancreas. Therefore we had her operated and the gallbladder was surgically removed. After the operation, biopsy of the gallbladder was also done. (All the relevant reports are attached the pre-operative medical tests are also there. In one of the reports in history, it is written that patient gives a history of pain in abdomen, complaints of acid peptic dyspepsia. She had no pain in the abdomen and no problem of gas or indigestion before the operation). After the operation, she had pain in the operation area which was healed later on.She has had typhoid thrice and TB once when she was young. She had chikungunya type fever last year which was negative for chikungunya tests, but the doctor said it might have been chikungunya and the tests might not have been done in the right time period that is why they came negative. She also takes medicines for blood pressure, knee and joint pain (calcium), cataract, homeopathic medicine for nose polyp infection.Here are my questions

Hi. Having gone through the reports (attachment removed to protect patient identity) I just need to reassure you that the surgery was done by a world class surgeon. Reply to your queries

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was diagnosed with OSA and parasomnia/sleepwalking. I have been on CPAP for several months now with success, but still having some episodes at night, where I act out my dreams and I am afraid and run out of the house onto the street. I was also violent and aggressive towards my partner during this time of the last episode, which was two nights ago. She has children that live with us and we are extremely concerned about their safety if I have one of these episodes. I do not drink alcohol, smoke, and try to reduce my stress level. I have been using the CPAP religiously but would like a backup method to suppress these violent episodes that may/may not happen. It is really affecting my sleep, especially since I broke my foot. Please help. ### Response: Hello, Welcome to Chat Doctor forum. I understand your concerns. Your sleepwalking is mainly because of your OSA (obstructive sleep apnea). But as you said it is under control then sleepwalking should also be in control. You can try some measures to prevent any harm to others and yourself. 1) Always cover your window and doors before going to bed. 2) Place an alarm on door and on windows. 3) Remain away from stress you can try some pranayam and meditation as well. 4) Exercise during day time so that you feel tired physically which leads to a deep sleep. We start you on some medication as well like Clonazepam in the range of .25 mg to .5 mg. You can repeat your sleep study also. If you have any other doubt you can always consult me here on ChatDoctor.

Hello doctor,I was diagnosed with OSA and parasomnia/sleepwalking. I have been on CPAP for several months now with success, but still having some episodes at night, where I act out my dreams and I am afraid and run out of the house onto the street. I was also violent and aggressive towards my partner during this time of the last episode, which was two nights ago. She has children that live with us and we are extremely concerned about their safety if I have one of these episodes. I do not drink alcohol, smoke, and try to reduce my stress level. I have been using the CPAP religiously but would like a backup method to suppress these violent episodes that may/may not happen. It is really affecting my sleep, especially since I broke my foot. Please help.

Hello, Welcome to Chat Doctor forum. I understand your concerns. Your sleepwalking is mainly because of your OSA (obstructive sleep apnea). But as you said it is under control then sleepwalking should also be in control. You can try some measures to prevent any harm to others and yourself. 1) Always cover your window and doors before going to bed. 2) Place an alarm on door and on windows. 3) Remain away from stress you can try some pranayam and meditation as well. 4) Exercise during day time so that you feel tired physically which leads to a deep sleep. We start you on some medication as well like Clonazepam in the range of .25 mg to .5 mg. You can repeat your sleep study also. If you have any other doubt you can always consult me here on ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor, I am a type 1 diabetic and have been injecting insulin every day for years already. With this current quarantine going on, I gained some weight which made me worry. Although my BMI says that I am on the normal side, it still made me upset because the belly, arms, and legs have gotten bigger. So I started doing minimal resistance training and changed my eating habits for three weeks already. I noticed that my legs look leaner but my upper body is still the same. This made me anxious because it might have something to do with my insulin medications and I cannot go to an actual dietician since they were still on quarantine so I thought someone might be able to help me online. I am hoping to hear from you. This would really be a big help to my overall health for the rest of my life. ### Response: Hi. Yes, insulin might result in some weight gain, but if you are keeping a check on your calories and include a good amount of non-starchy food including whole grain, fresh whole fruits, and vegetables will help you to shed some fat. Keep a check on your exercise minutes, you can easily do 150 minutes of aerobic exercise per week which includes walking, bicycling, and other forms of moderate muscle strengthening exercises. Just keep in mind that your sugar level must not go down, do not reduce your insulin dosage. Also never skip a meal, if you skip a meal you will tend to indulge more calories in the next meal. Include more protein rich food, protein, and fiber rich meals will bring early satiety and will easily help build in more muscles than fat. I hope this helps.

Hello doctor, I am a type 1 diabetic and have been injecting insulin every day for years already. With this current quarantine going on, I gained some weight which made me worry. Although my BMI says that I am on the normal side, it still made me upset because the belly, arms, and legs have gotten bigger. So I started doing minimal resistance training and changed my eating habits for three weeks already. I noticed that my legs look leaner but my upper body is still the same. This made me anxious because it might have something to do with my insulin medications and I cannot go to an actual dietician since they were still on quarantine so I thought someone might be able to help me online. I am hoping to hear from you. This would really be a big help to my overall health for the rest of my life.

Hi. Yes, insulin might result in some weight gain, but if you are keeping a check on your calories and include a good amount of non-starchy food including whole grain, fresh whole fruits, and vegetables will help you to shed some fat. Keep a check on your exercise minutes, you can easily do 150 minutes of aerobic exercise per week which includes walking, bicycling, and other forms of moderate muscle strengthening exercises. Just keep in mind that your sugar level must not go down, do not reduce your insulin dosage. Also never skip a meal, if you skip a meal you will tend to indulge more calories in the next meal. Include more protein rich food, protein, and fiber rich meals will bring early satiety and will easily help build in more muscles than fat. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,When I was young I used to lick my lips a lot causing a red line above my lips and under my nose. One day I went out and came back with a permanent blackness above my upper lip (not my skin color). It lools like I have a mustache. Please help. ### Response: Hello, Welcome to Chat Doctor forum. Well, we would be able to help you the most if you are able to provide us with a clinical photograph of your condition. Based on the brief history you have provided to us, you seem to be suffering from Lip-lick cheilitis induced post-inflammatory hyperpigmentation. In simple words, your habit of licking lips too often in childhood made the skin surrounding the lips (called vermillion border of the lips) too sensitive that it developed red lines and made it vulnerable to sun-induced pigmentation. One episode of having stayed out may have resulted in the tanning of the sensitive lip area resulting in pigmentation. To prevent it from becoming darker, you should immediately start using a broad-spectrum sunscreen with an SPF (sun protection factor) of 40+ at least twice a day, every day, irrespective of your outdoor exposure. I am sure you will be able to procure a sunscreen from the pharmacy. For further details about ideal sun protection, you may read the sun protection information posted on our website. Additionally, use a good moisturizer over the lip and surrounding skin at least twice a day. To reduce the established pigmentation, a mild depigmenting cream may be needed. However, to suggest the ideal depigmenting cream for your condition, I would need to see the photograph of your pigmentation.

Hello doctor,When I was young I used to lick my lips a lot causing a red line above my lips and under my nose. One day I went out and came back with a permanent blackness above my upper lip (not my skin color). It lools like I have a mustache. Please help.

Hello, Welcome to Chat Doctor forum. Well, we would be able to help you the most if you are able to provide us with a clinical photograph of your condition. Based on the brief history you have provided to us, you seem to be suffering from Lip-lick cheilitis induced post-inflammatory hyperpigmentation. In simple words, your habit of licking lips too often in childhood made the skin surrounding the lips (called vermillion border of the lips) too sensitive that it developed red lines and made it vulnerable to sun-induced pigmentation. One episode of having stayed out may have resulted in the tanning of the sensitive lip area resulting in pigmentation. To prevent it from becoming darker, you should immediately start using a broad-spectrum sunscreen with an SPF (sun protection factor) of 40+ at least twice a day, every day, irrespective of your outdoor exposure. I am sure you will be able to procure a sunscreen from the pharmacy. For further details about ideal sun protection, you may read the sun protection information posted on our website. Additionally, use a good moisturizer over the lip and surrounding skin at least twice a day. To reduce the established pigmentation, a mild depigmenting cream may be needed. However, to suggest the ideal depigmenting cream for your condition, I would need to see the photograph of your pigmentation.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My daughter underwent a root canal. She is 4. The dentist tried to do it with gas and numbing it. She sat well through the drilling, then when he was doing the pulpectomy, she screamed and choked and flailed around. The dentist seemed unable to handle it all and he said she had a hyperemic pulp. He said he could not stop the bleeding. He was worried for my daughter from the crying and choking. So, he put a temporary filling over it and stopped. He said he was concerned it may bleed and cause pressure inside the molar. Pain and or abscess or infection. I follow up with him in one week just to check it out. Is this something I should be concerned with or is it common? It sounds very scary that her tooth could be bleeding from inside. I am just wondering if I need a second opinion, she needs to see her pediatrician or what. I am nervous. Is this a common thing or do I need a new pediatric dentist? ### Response: Hello. It is normal for the pulp to bleed profusely when it is a little enlarged inside, like a polyp. The dentist could have easily managed her, had he given a local anesthesia (just a ChatDoctor. He could have then removed the pulp polyp and done the remainder. As soon as the pulp polyp is scraped away, the bleeding would have stopped instantly. Do not worry. In the next appointment, he may do it. Anyway, the bleeding is nothing to worry about, as it will not cause any severe pain now due to pressure. But, next time, when he opens it, ask him to put local anesthesia

Hello doctor,My daughter underwent a root canal. She is 4. The dentist tried to do it with gas and numbing it. She sat well through the drilling, then when he was doing the pulpectomy, she screamed and choked and flailed around. The dentist seemed unable to handle it all and he said she had a hyperemic pulp. He said he could not stop the bleeding. He was worried for my daughter from the crying and choking. So, he put a temporary filling over it and stopped. He said he was concerned it may bleed and cause pressure inside the molar. Pain and or abscess or infection. I follow up with him in one week just to check it out. Is this something I should be concerned with or is it common? It sounds very scary that her tooth could be bleeding from inside. I am just wondering if I need a second opinion, she needs to see her pediatrician or what. I am nervous. Is this a common thing or do I need a new pediatric dentist?

Hello. It is normal for the pulp to bleed profusely when it is a little enlarged inside, like a polyp. The dentist could have easily managed her, had he given a local anesthesia (just a ChatDoctor. He could have then removed the pulp polyp and done the remainder. As soon as the pulp polyp is scraped away, the bleeding would have stopped instantly. Do not worry. In the next appointment, he may do it. Anyway, the bleeding is nothing to worry about, as it will not cause any severe pain now due to pressure. But, next time, when he opens it, ask him to put local anesthesia

### Instruction: Answer this question truthfully ###Input: Hello doctor,I got 6 fillings done a while back that were causing me no pain whatsoever or sensitivity, so I found a new dentist got the filling done and by week 3 the fillings on the left top were causing me more severe pain than week 1 and my bite was off no matter how many times she adjusted it there was only 1 tooth touching and being damaged, dentist is denying she did anything, says there is no infection.I finally went to the ER and dentist visits later and I had an abcsess lanced on the roof of my mouth and need a root canal on a tooth that had a short cavity in the first place by the dentist, the pain goes away with antibiotics and I have been doing alright for the past 2 months except pain when eating on the effected side, now all of sudden the top 2 molars on the left where the infection was there are red around them and pain when pressure is applied. Mind that when I bite down on top left second to the back molar is the only tooth touching anything all the others are not touching each other no mattter how hard I try since my dental work and I am scared I am getting an infection again. ### Response: Hello, Welcome to Chat Doctor forum. The problem with cavities are either you will find out about it when you start getting severe pain or if some dentists points it out. in your case, occlusal corrections could have been done more accurately to find out which tooth is having the high point and reduce it appropriately. If there is an abscess get root canal treatment done. I need to see X-rays and pictures to give you any definitive diagnosis and treatment plan.

Hello doctor,I got 6 fillings done a while back that were causing me no pain whatsoever or sensitivity, so I found a new dentist got the filling done and by week 3 the fillings on the left top were causing me more severe pain than week 1 and my bite was off no matter how many times she adjusted it there was only 1 tooth touching and being damaged, dentist is denying she did anything, says there is no infection.I finally went to the ER and dentist visits later and I had an abcsess lanced on the roof of my mouth and need a root canal on a tooth that had a short cavity in the first place by the dentist, the pain goes away with antibiotics and I have been doing alright for the past 2 months except pain when eating on the effected side, now all of sudden the top 2 molars on the left where the infection was there are red around them and pain when pressure is applied. Mind that when I bite down on top left second to the back molar is the only tooth touching anything all the others are not touching each other no mattter how hard I try since my dental work and I am scared I am getting an infection again.

Hello, Welcome to Chat Doctor forum. The problem with cavities are either you will find out about it when you start getting severe pain or if some dentists points it out. in your case, occlusal corrections could have been done more accurately to find out which tooth is having the high point and reduce it appropriately. If there is an abscess get root canal treatment done. I need to see X-rays and pictures to give you any definitive diagnosis and treatment plan.

### Instruction: Answer this question truthfully ###Input: Hello,About 5 years ago I had wire braces for my teeth.And to have the braces on, I had 4 teeth extracted because my teeth were overcrowded.As far as I know, a lot of orthodontists take out premolars to create space.But for some reason my orthodontist took out 2 premolars, 1 molar on my bottom left and 1 molar on my top left.I got my wisdom teeth removed on the bottom right.So, I have only first molar and partly seen third molar on my bottom left side.I was only 14 years at that time, so I really did not think much of it.This has caused many jaw problems for me.I have not chewed on my left side for the past five years.I heard jaw problems can make my face look weird, as of now I have not noticed anything.But I am worried that it might affect in the future.Is there any way I could put a second molar in the bottom left?I still have space where my bottom premolars were, could I move the molar with braces to fill in that space so that I will have space at the back to put on a an implant?I just really want to fix the problem.Please help. ### Response: Hi. Sometimes orthodontists do extract molars if there is very severe crowding of the teeth. In your case, as you said there was severe crowding. Now you have space present where the molars where previously present and hence you are unable to chew properly. Is your second molar on the left side tilted or upright? I assume that your second molar is upright. There are 3 treatment plans for you

Hello,About 5 years ago I had wire braces for my teeth.And to have the braces on, I had 4 teeth extracted because my teeth were overcrowded.As far as I know, a lot of orthodontists take out premolars to create space.But for some reason my orthodontist took out 2 premolars, 1 molar on my bottom left and 1 molar on my top left.I got my wisdom teeth removed on the bottom right.So, I have only first molar and partly seen third molar on my bottom left side.I was only 14 years at that time, so I really did not think much of it.This has caused many jaw problems for me.I have not chewed on my left side for the past five years.I heard jaw problems can make my face look weird, as of now I have not noticed anything.But I am worried that it might affect in the future.Is there any way I could put a second molar in the bottom left?I still have space where my bottom premolars were, could I move the molar with braces to fill in that space so that I will have space at the back to put on a an implant?I just really want to fix the problem.Please help.

Hi. Sometimes orthodontists do extract molars if there is very severe crowding of the teeth. In your case, as you said there was severe crowding. Now you have space present where the molars where previously present and hence you are unable to chew properly. Is your second molar on the left side tilted or upright? I assume that your second molar is upright. There are 3 treatment plans for you

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 56 years old, diabetic with high blood pressure. In the last four years, when I am sleeping I have multiples erections, dreams and not a calm night of sleep. My wife always complains and we argue because during day time I have no desires and it is very hard to have an erection and this makes more friction between us. Sometimes we take a month to have intercourse. We have been together for almost 22 years. The problem of erection during sleep time started with fewer times and now it is getting worse sometimes six times during a night. I really need some help to have a calm night. What do you suggest?I am currently taking medications for diabetes and high blood pressure along with Insulin and Baby Aspirin. ### Response: Hi, Welcome to Chat Doctor forum. Firstly, you will need good control of your sugar levels. It will help with the erection problem and sleep. Start a good exercise regimen and lose some weight. Also search on the internet for Kegel\\s exercises and do them daily. It will help strengthen the muscles at the base of the penis and help with good erections. Also, start a good multivitamin with a lot of B-complex group of vitamins. Finally, for a few times, you can try taking Sildenafil or Tadalafil to help with getting erections. For sleeping, you should try taking something harmless initially like Melatonin supplements, or you can try to take something which will give you sleep and also help with your stress such as Mirtazapine 7.5 or Vilazodone 20 mg which do not have any sexual side effects.

Hello doctor,I am 56 years old, diabetic with high blood pressure. In the last four years, when I am sleeping I have multiples erections, dreams and not a calm night of sleep. My wife always complains and we argue because during day time I have no desires and it is very hard to have an erection and this makes more friction between us. Sometimes we take a month to have intercourse. We have been together for almost 22 years. The problem of erection during sleep time started with fewer times and now it is getting worse sometimes six times during a night. I really need some help to have a calm night. What do you suggest?I am currently taking medications for diabetes and high blood pressure along with Insulin and Baby Aspirin.

Hi, Welcome to Chat Doctor forum. Firstly, you will need good control of your sugar levels. It will help with the erection problem and sleep. Start a good exercise regimen and lose some weight. Also search on the internet for Kegel\\s exercises and do them daily. It will help strengthen the muscles at the base of the penis and help with good erections. Also, start a good multivitamin with a lot of B-complex group of vitamins. Finally, for a few times, you can try taking Sildenafil or Tadalafil to help with getting erections. For sleeping, you should try taking something harmless initially like Melatonin supplements, or you can try to take something which will give you sleep and also help with your stress such as Mirtazapine 7.5 or Vilazodone 20 mg which do not have any sexual side effects.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am getting a fever every day. But, every day the fever occurs and goes to a maximum of 100 degrees, and it gets back to the body temperature without any medications. It is repetitive. I have done a few blood tests and am attaching the reports. I have found out that my CRP and ESR is very high (I have a history of aortic valve replacement surgery). I am worried. I am taking Betaloc 12.5 mg, Ecospirin 75 mg, Warfarin 5 mg, Fibator 5 mg. Last week, I went out of the station, and I had a significant amount of traveling. ### Response: Hi. It is likely a viral fever only as it settles within four to five days. ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) are usually elevated due to viral fever or any other fever. As it gets recovered within four to five days without any antibiotics, then it is likely a viral fever, and the possibility of other infection goes down like infective endocarditis, typhoid, malaria. So there is no need to get worried. One may get repeated viral fever with travel, change in environment or change in food and the body clears it successfully. So there is nothing to worry about it. Since you have an aortic valve replacement, then we have to be vigilant regarding the possibility of infective endocarditis. So you should get your ESR and CRP done after two weeks, and if they are still elevated, then you should get an echocardiogram done to rule out infective endocarditis. For more information consult a cardiologist online.-

Hi doctor,I am getting a fever every day. But, every day the fever occurs and goes to a maximum of 100 degrees, and it gets back to the body temperature without any medications. It is repetitive. I have done a few blood tests and am attaching the reports. I have found out that my CRP and ESR is very high (I have a history of aortic valve replacement surgery). I am worried. I am taking Betaloc 12.5 mg, Ecospirin 75 mg, Warfarin 5 mg, Fibator 5 mg. Last week, I went out of the station, and I had a significant amount of traveling.

Hi. It is likely a viral fever only as it settles within four to five days. ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) are usually elevated due to viral fever or any other fever. As it gets recovered within four to five days without any antibiotics, then it is likely a viral fever, and the possibility of other infection goes down like infective endocarditis, typhoid, malaria. So there is no need to get worried. One may get repeated viral fever with travel, change in environment or change in food and the body clears it successfully. So there is nothing to worry about it. Since you have an aortic valve replacement, then we have to be vigilant regarding the possibility of infective endocarditis. So you should get your ESR and CRP done after two weeks, and if they are still elevated, then you should get an echocardiogram done to rule out infective endocarditis. For more information consult a cardiologist online.-

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 20 years old. I have one kid and I am seven months pregnant. Since I started puberty, I got a lot of health problems. The left side of my underjaw is not fully grown. It feels like pieces are missing. You can also see the big difference between the left side of my chin and the right side. My cheekbones are also not fully grown. I have poor blood circulation and my face gets very very swollen. Mostly in the morning, my face looks quite normal and my skin color as well. Later, in the day, my face gets swollen and big and also when I eat and when I eat a lot and unhealthy it gets more swollen. When I lay down the swelling lessens. I also have mental stress and an anxiety and I have a scoliosis. I get tired quickly and my skin is very dry. I have dark or purple undereyes and dark patches on my ankles, knees, etc. ### Response: Hello. I just read your query. See the issues like scoliosis, underjaw shape, and underdeveloped cheekbones are anatomical issues which are related to the natural structure of your body. They can not be corrected with the help of medication. You may take help from artificial modern techniques, which you can learn from a nearby physician. The poor blood circulation, swelling on face, stress and anxiety, tiredness can all be related to pregnancy. I advise you not to take any random treatment or any supplement without consulting your gynecologist. This is the crucial time of your pregnancy. So visit a nearby gynecologist and ask for the help for all the issues you are having. Take care.

Hi doctor,I am 20 years old. I have one kid and I am seven months pregnant. Since I started puberty, I got a lot of health problems. The left side of my underjaw is not fully grown. It feels like pieces are missing. You can also see the big difference between the left side of my chin and the right side. My cheekbones are also not fully grown. I have poor blood circulation and my face gets very very swollen. Mostly in the morning, my face looks quite normal and my skin color as well. Later, in the day, my face gets swollen and big and also when I eat and when I eat a lot and unhealthy it gets more swollen. When I lay down the swelling lessens. I also have mental stress and an anxiety and I have a scoliosis. I get tired quickly and my skin is very dry. I have dark or purple undereyes and dark patches on my ankles, knees, etc.

Hello. I just read your query. See the issues like scoliosis, underjaw shape, and underdeveloped cheekbones are anatomical issues which are related to the natural structure of your body. They can not be corrected with the help of medication. You may take help from artificial modern techniques, which you can learn from a nearby physician. The poor blood circulation, swelling on face, stress and anxiety, tiredness can all be related to pregnancy. I advise you not to take any random treatment or any supplement without consulting your gynecologist. This is the crucial time of your pregnancy. So visit a nearby gynecologist and ask for the help for all the issues you are having. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was diagnosed several months ago with bladder stones. Tests on stones indicated uric acid content also. I have been on Flomax, then one week ago started Avodart. Most days, I drink lots of water and sometimes coconut water. I pass stones every two or three weeks - different sizes. Within past 12 hours, I am experiencing lots of pain typical of when I am to pass a stone. However, the stone has not passed. Also, noticing blood in urine for the first time. I have passed urine about four times within the hour. I am aware that this is part of the symptoms but want to know if I should see a doctor immediately. Any other advice appreciated. ### Response: Hi, Welcome to Chat Doctor forum. I hope the bladder stones you mentioned you had earlier had passed. Blood in urine after renal colic suggests stone may have reached the lower end of kidney tube (ureter) and may pass soon. However, it is best to confirm it has passed by getting an ultrasound done. Flomax (Tamsulosin) helps dilate lower end of the ureter and so may help stone to pass. You may take painkiller or antispasmodic for pain. Increased fluid intake helps. If the stone is of pure uric acid, taking citrus juices or taking potassium citrate syrup may dissolve the stone. I suggest, if bleeding continues, or there is pain or fever, or you have difficulty emptying your bladder, go see your doctor. Later, a metabolic workup of your 24-hour urine collection may be needed to see why you form so many stones. For more information consult a urologist online

Hello doctor,I was diagnosed several months ago with bladder stones. Tests on stones indicated uric acid content also. I have been on Flomax, then one week ago started Avodart. Most days, I drink lots of water and sometimes coconut water. I pass stones every two or three weeks - different sizes. Within past 12 hours, I am experiencing lots of pain typical of when I am to pass a stone. However, the stone has not passed. Also, noticing blood in urine for the first time. I have passed urine about four times within the hour. I am aware that this is part of the symptoms but want to know if I should see a doctor immediately. Any other advice appreciated.

Hi, Welcome to Chat Doctor forum. I hope the bladder stones you mentioned you had earlier had passed. Blood in urine after renal colic suggests stone may have reached the lower end of kidney tube (ureter) and may pass soon. However, it is best to confirm it has passed by getting an ultrasound done. Flomax (Tamsulosin) helps dilate lower end of the ureter and so may help stone to pass. You may take painkiller or antispasmodic for pain. Increased fluid intake helps. If the stone is of pure uric acid, taking citrus juices or taking potassium citrate syrup may dissolve the stone. I suggest, if bleeding continues, or there is pain or fever, or you have difficulty emptying your bladder, go see your doctor. Later, a metabolic workup of your 24-hour urine collection may be needed to see why you form so many stones. For more information consult a urologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,About a week ago, I started to notice a fuzzy tingling sensation going down my neck and back when I look down at the floor. If I continue to stretch my head forward and back, I no longer get the sensation down my back and neck, but this sensation will come back after I have not looked down for a while. The closest thing I can find that matches my symptoms is the L'Hermitte sign. I do not have any other symptoms, my vision is fine, I have no problems with balance or anything else associated with MS (as L'Hermitte is typically found in MS sufferers) but this was the only disease I could find that fit my symptoms best.Nothing is painful it is just a weird sensation. I have had no accidents or traumas to my neck or anywhere, and I do not take part in any aggressive physical activity. I am otherwise active and healthy, BMI of 26.2. I am a 25-year-old male. Just to mention, I do have a bad back posture if this is contributing? ### Response: Hello, Welcome to ChatDoctor. Your query will be ad ChatDoctor. Now Coming to your condition, your BMI (26.2) comes in preobese category which could be one of the cause of tingling sensation because weight puts more pressure on your spine and your bad posture may add up to your condition. Do you spent lots of time in front of screen like mobile or laptop? Given your medication history, are you taking it for asthma? Which other medications have you taken for it before? Is it under control? I can prescribe you proper

Hello doctor,About a week ago, I started to notice a fuzzy tingling sensation going down my neck and back when I look down at the floor. If I continue to stretch my head forward and back, I no longer get the sensation down my back and neck, but this sensation will come back after I have not looked down for a while. The closest thing I can find that matches my symptoms is the L'Hermitte sign. I do not have any other symptoms, my vision is fine, I have no problems with balance or anything else associated with MS (as L'Hermitte is typically found in MS sufferers) but this was the only disease I could find that fit my symptoms best.Nothing is painful it is just a weird sensation. I have had no accidents or traumas to my neck or anywhere, and I do not take part in any aggressive physical activity. I am otherwise active and healthy, BMI of 26.2. I am a 25-year-old male. Just to mention, I do have a bad back posture if this is contributing?

Hello, Welcome to ChatDoctor. Your query will be ad ChatDoctor. Now Coming to your condition, your BMI (26.2) comes in preobese category which could be one of the cause of tingling sensation because weight puts more pressure on your spine and your bad posture may add up to your condition. Do you spent lots of time in front of screen like mobile or laptop? Given your medication history, are you taking it for asthma? Which other medications have you taken for it before? Is it under control? I can prescribe you proper

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 61 year old and was lately diagnosed by a doctor as sick in fibromyalgia. In the last three years during the night time, I am suffering from aggressive involuntary movements while asleep. Those movements include kicking in the air and arching and bouncing my back and the whole body. At first those aggressive movements started as a physical response to a dream where I was being attacked which happened once in a while, lately, it happens more and more often without any noticeable reason. As a result of the movements, I suffer from strong pain in my back and knees which lasts for a long period of time and restrict me to my house. I am also very depressed of my physical condition which projects to anything I do in my private life, family life and job. I quit my last job a year ago due to my medical condition. Can you please advice on physical/neurological treatment that will improve my poor physical and emotional conditions?In addition, I am using Lamictal 200 mg which according to the medicine brochure might rarely cause involuntary limb movement. Therefore, I wish to replace it with equivalent medicine. Can you please advise on a possible replacement? I have already tried Seroxat, Depalept, Gabapentin, Lyrica, Teril, and Cymbalta which did not help. ### Response: Hello, Welcome to Chat Doctor forum. Well, these involuntary movements do not sound normal at all. It looks more of chorea/hemiballismus (movement disorder). It can be ChatDoctor. If any problem there, we will have to treat it differently. I understand you have tried a lot of

Hello doctor,I am 61 year old and was lately diagnosed by a doctor as sick in fibromyalgia. In the last three years during the night time, I am suffering from aggressive involuntary movements while asleep. Those movements include kicking in the air and arching and bouncing my back and the whole body. At first those aggressive movements started as a physical response to a dream where I was being attacked which happened once in a while, lately, it happens more and more often without any noticeable reason. As a result of the movements, I suffer from strong pain in my back and knees which lasts for a long period of time and restrict me to my house. I am also very depressed of my physical condition which projects to anything I do in my private life, family life and job. I quit my last job a year ago due to my medical condition. Can you please advice on physical/neurological treatment that will improve my poor physical and emotional conditions?In addition, I am using Lamictal 200 mg which according to the medicine brochure might rarely cause involuntary limb movement. Therefore, I wish to replace it with equivalent medicine. Can you please advise on a possible replacement? I have already tried Seroxat, Depalept, Gabapentin, Lyrica, Teril, and Cymbalta which did not help.

Hello, Welcome to Chat Doctor forum. Well, these involuntary movements do not sound normal at all. It looks more of chorea/hemiballismus (movement disorder). It can be ChatDoctor. If any problem there, we will have to treat it differently. I understand you have tried a lot of

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am having pain in my lower tooth whenever I go to sleep. Due to lockdown, I am unable to consult the dentist. Can you please tell me any tablet that I can use in the meantime. ### Response: Hello, Welcome to Chat Doctor forum. Sorry for the pain you are bearing because of the prevailing situation. As you have already mentioned there is a cavity and when it reaches up to the pulp there develops an irreversible stage which generally is more painful during night time as we sleep. I think your tooth has reached the stage of irreversible pulpitis and a root canal treatment is now must in order to save the remaining tooth. So go for it as soon as the situation in your area gets better. For now, take Amoxicillin clavulanate 500 mg (thrice daily) for five days, Paracetamol 500 mg to thrice daily SOS. Do not take Paracetamol when there is no pain but do complete the Amoxicillin course. Additionally, you can take any one for gastritis if you have a tendency to develop gastritis with antibiotics. You can take PAN-D (Pantoprazole) or Omez (Omeprazole). Take them on empty stomach. Do salt water rinse regularly. You can apply clove oil at the site, it is a good anti-inflammatory. Maintain good oral hygiene regularly, but for sure get it treated. Avoid eating from the affected side until it gets treated or even if you eat make sure nothing gets lodged in that tooth. Do mouth rinses with plain water regularly so that there is no food stuck. ChatDoctor. I hope this helps.

Hi doctor,I am having pain in my lower tooth whenever I go to sleep. Due to lockdown, I am unable to consult the dentist. Can you please tell me any tablet that I can use in the meantime.

Hello, Welcome to Chat Doctor forum. Sorry for the pain you are bearing because of the prevailing situation. As you have already mentioned there is a cavity and when it reaches up to the pulp there develops an irreversible stage which generally is more painful during night time as we sleep. I think your tooth has reached the stage of irreversible pulpitis and a root canal treatment is now must in order to save the remaining tooth. So go for it as soon as the situation in your area gets better. For now, take Amoxicillin clavulanate 500 mg (thrice daily) for five days, Paracetamol 500 mg to thrice daily SOS. Do not take Paracetamol when there is no pain but do complete the Amoxicillin course. Additionally, you can take any one for gastritis if you have a tendency to develop gastritis with antibiotics. You can take PAN-D (Pantoprazole) or Omez (Omeprazole). Take them on empty stomach. Do salt water rinse regularly. You can apply clove oil at the site, it is a good anti-inflammatory. Maintain good oral hygiene regularly, but for sure get it treated. Avoid eating from the affected side until it gets treated or even if you eat make sure nothing gets lodged in that tooth. Do mouth rinses with plain water regularly so that there is no food stuck. ChatDoctor. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am suffering from jaundice for last one month. My current bilirubin is 3.1, SGPT 72.4, SGOT 45.8. Can I join the office after four days of bed rest? ### Response: Hello. To answer your question specifically, it is not advisable to go back to work. I have seen your LFT blood reports which are not elevated too high (attachment removed to protect patient identity). I would like to know if you had done any other blood test, urine test or ultrasound abdomen because in jaundice, it is important to treat the underlying cause for it. It might be due to alcohol consumption, smoking habits, liver disorders such as acute or chronic hepatitis, etc. Some complications of jaundice you have to be aware are anemia, bleeding, chronic hepatitis, etc. If you are not vaccinated for hepatitis B or C, please take those vaccines also. If you are taking any tablets for this jaundice, please continue it. If you have not seen any doctor so far, I would highly recommend you to see a doctor first. Try to avoid alcohol or smoking habits, if you are used to it at once. I would recommend you to undergo a further investigation to know the root cause for your abnormal LFT blood test. Alcohol, smoking, acute hepatitis. CBC, urine analysis routine, urine ketones, serum electrolytes, ultrasound abdomen, X-ray chest, and abdomen. Acute hepatitis, fatty liver. Acute hepatitis. I would suggest treatment after seeing the further blood tests advised. Avoid alcohol and smoking strictly. Try to follow up after doing the above investigation advised and list any complaints if you have.

Hello doctor,I am suffering from jaundice for last one month. My current bilirubin is 3.1, SGPT 72.4, SGOT 45.8. Can I join the office after four days of bed rest?

Hello. To answer your question specifically, it is not advisable to go back to work. I have seen your LFT blood reports which are not elevated too high (attachment removed to protect patient identity). I would like to know if you had done any other blood test, urine test or ultrasound abdomen because in jaundice, it is important to treat the underlying cause for it. It might be due to alcohol consumption, smoking habits, liver disorders such as acute or chronic hepatitis, etc. Some complications of jaundice you have to be aware are anemia, bleeding, chronic hepatitis, etc. If you are not vaccinated for hepatitis B or C, please take those vaccines also. If you are taking any tablets for this jaundice, please continue it. If you have not seen any doctor so far, I would highly recommend you to see a doctor first. Try to avoid alcohol or smoking habits, if you are used to it at once. I would recommend you to undergo a further investigation to know the root cause for your abnormal LFT blood test. Alcohol, smoking, acute hepatitis. CBC, urine analysis routine, urine ketones, serum electrolytes, ultrasound abdomen, X-ray chest, and abdomen. Acute hepatitis, fatty liver. Acute hepatitis. I would suggest treatment after seeing the further blood tests advised. Avoid alcohol and smoking strictly. Try to follow up after doing the above investigation advised and list any complaints if you have.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I picked up a grade 3 hamstring injury from playing football around four months ago. Stupidly, I tried to play football again three to four weeks after the initial injury which caused me to pull my hamstring again. I have then left it for around two and a half months and I have slowly tried to get back into exercise. I started by cycling which I had no problems with I have also been away skiing and I have not felt any pain whatsoever. However, since I came back from skiing I went to play football yesterday and although I was fine for the majority of the game once the game had finished I noticed my hamstring felt sore. It also is still a little bit sore this morning, is this a good thing or a bad thing? I could easily run on it now no problem but it does feel slightly sore. Is there anything I should or should not do? ### Response: Hello, Welcome to Chat Doctor forum. I read your concern. In my opinion, you had enough time to recover from tears. However, a grade 3 hamstring injury needs a bit more concentrated management. I think you should do proper rehabilitation to completely gain strength and stability. Exercises like bridging, single-leg bridges, clamshell, swiss ball jackknife, swiss ball hamstring curls, step-ups, and goblet squats will help you gain stability and strength. Slowly you should start running. If everything goes well then you should start gradual progressive running sessions. These exercises to be done for three weeks and then progress with the next level of rehabilitation. After progressing to full strength and stability and once you are confident then slowly you should return to play. I hope this helps.

Hello doctor,I picked up a grade 3 hamstring injury from playing football around four months ago. Stupidly, I tried to play football again three to four weeks after the initial injury which caused me to pull my hamstring again. I have then left it for around two and a half months and I have slowly tried to get back into exercise. I started by cycling which I had no problems with I have also been away skiing and I have not felt any pain whatsoever. However, since I came back from skiing I went to play football yesterday and although I was fine for the majority of the game once the game had finished I noticed my hamstring felt sore. It also is still a little bit sore this morning, is this a good thing or a bad thing? I could easily run on it now no problem but it does feel slightly sore. Is there anything I should or should not do?

Hello, Welcome to Chat Doctor forum. I read your concern. In my opinion, you had enough time to recover from tears. However, a grade 3 hamstring injury needs a bit more concentrated management. I think you should do proper rehabilitation to completely gain strength and stability. Exercises like bridging, single-leg bridges, clamshell, swiss ball jackknife, swiss ball hamstring curls, step-ups, and goblet squats will help you gain stability and strength. Slowly you should start running. If everything goes well then you should start gradual progressive running sessions. These exercises to be done for three weeks and then progress with the next level of rehabilitation. After progressing to full strength and stability and once you are confident then slowly you should return to play. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hi doctor,My father is 59 years old. He weights 65 kilograms. He has diabetes and also has blood pressure too. Sometimes, my father gets chest pain. He feels better after taking tablet Angised. Last night, he had pain in the heart. We went to the hospital immediately. They gave two tablets to my father. After a couple of hours, he was better. So, we came back home. Please tell me medicine or home remedy to overcome these problems. ### Response: Hi, Welcome to Chat Doctor forum. From your history, it seems that your father has angina pectoris. Angina pectoris is not a heart attack, but it is a chest pain that occurs while exerting such as walking at a high pace, climbing stairs, during emotional stress and relieved by rest or taking tablet Nitroglycerine under the tongue. If this pain occurs more and more frequently or with less exertion or at rest, then there is something to be worried. I do not know about the workups done for your father such as ECG, echocardiography, stress ECG, and angiography. I do not know about the medications taken by your father for BP, and diabetes. Please give a detailed history about it. If you send me the reports, I can guide you further. If your father is having chest pain on rest or despite taking maximum medicines, I advise your father to go for coronary angiography and angioplasty. He has to reduce intake of salt to less than one teaspoon in a 24-hour diet. He should stop taking fatty meals, junk foods, and beef. He has to quit smoking if he has the habit.

Hi doctor,My father is 59 years old. He weights 65 kilograms. He has diabetes and also has blood pressure too. Sometimes, my father gets chest pain. He feels better after taking tablet Angised. Last night, he had pain in the heart. We went to the hospital immediately. They gave two tablets to my father. After a couple of hours, he was better. So, we came back home. Please tell me medicine or home remedy to overcome these problems.

Hi, Welcome to Chat Doctor forum. From your history, it seems that your father has angina pectoris. Angina pectoris is not a heart attack, but it is a chest pain that occurs while exerting such as walking at a high pace, climbing stairs, during emotional stress and relieved by rest or taking tablet Nitroglycerine under the tongue. If this pain occurs more and more frequently or with less exertion or at rest, then there is something to be worried. I do not know about the workups done for your father such as ECG, echocardiography, stress ECG, and angiography. I do not know about the medications taken by your father for BP, and diabetes. Please give a detailed history about it. If you send me the reports, I can guide you further. If your father is having chest pain on rest or despite taking maximum medicines, I advise your father to go for coronary angiography and angioplasty. He has to reduce intake of salt to less than one teaspoon in a 24-hour diet. He should stop taking fatty meals, junk foods, and beef. He has to quit smoking if he has the habit.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 25 year old male, all my life I have required about 13 hours sleep every night, regardless of the bedtime. If I get the 13 hours sleep, I am not tired the next day, but if I only get 10 hours sleep, I will be very tired that day and also get a sleep debt. I went to bed at 8 PM last night and woke up at 1 PM today, as I only slept for 11 hours the night before. I tried forcing myself to sleep for eight hours, but I was a wreck, and I slept for nearly 24 hours straight to compensate. I had blood tests and sleep tests, which were all normal. I only have kyphoscoliosis. I am certain I do not have depression or other psychological problems but have tried several antidepressants for some time. But it had no impact on the amount of sleep I require. It is quite annoying, not being able to live the same lifestyle as nearly everyone I know. I simply just sleep more than everyone. Would I benefit from something like Modafinil? Any other ideas? ### Response: Hi, Welcome to Chat Doctor forum. Thanks for your query. I have gone through your complaint and I think Modafinil is a good option in your case. Modafinil is used to decrease excessive sleepiness and enhances memory and cognitive functions. Modafinil can have some side effects, which are headaches, dizziness, flushing, sweating, gastric irritation, ChatDoctor. Most of the side effects are mild and are self-limiting. For more information consult a sleep medicine physician online

Hi doctor,I am a 25 year old male, all my life I have required about 13 hours sleep every night, regardless of the bedtime. If I get the 13 hours sleep, I am not tired the next day, but if I only get 10 hours sleep, I will be very tired that day and also get a sleep debt. I went to bed at 8 PM last night and woke up at 1 PM today, as I only slept for 11 hours the night before. I tried forcing myself to sleep for eight hours, but I was a wreck, and I slept for nearly 24 hours straight to compensate. I had blood tests and sleep tests, which were all normal. I only have kyphoscoliosis. I am certain I do not have depression or other psychological problems but have tried several antidepressants for some time. But it had no impact on the amount of sleep I require. It is quite annoying, not being able to live the same lifestyle as nearly everyone I know. I simply just sleep more than everyone. Would I benefit from something like Modafinil? Any other ideas?

Hi, Welcome to Chat Doctor forum. Thanks for your query. I have gone through your complaint and I think Modafinil is a good option in your case. Modafinil is used to decrease excessive sleepiness and enhances memory and cognitive functions. Modafinil can have some side effects, which are headaches, dizziness, flushing, sweating, gastric irritation, ChatDoctor. Most of the side effects are mild and are self-limiting. For more information consult a sleep medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,Which OCP is better for long term use in PCOS? Krimson 35 or Crisanta 21, as my endocrinologist prescribed Krimson 35 with Glyciphage 500 twice a day for six months and my gynecologist prescribed Crisanta 21 with Glyciphage 500 twice for two years. I was very confused and started Krimson last month but I have been continuously bleeding from 5th to 6th day after starting Krimson and it is not spotting. It is flowing kind of bleeding. Sometimes, heavy bleeding. Please suggest. I should have started Crisanta. Should I switch to Crisanta from next pack? Which one is better for hirsutism and weight control? I have hair growth on the chest and stomach, weight is 64 and height 5.8. ### Response: Hi, Welcome to Chat Doctor forum. Both Krimson 35 and Crisanta 21 are used in PCOS for long term regime. Please check if you are taking the pills at the same time or missing them? Any vomiting, diarrhea, fever in the last few days? As per various studies, Krimson has shown better control over hirsutism and acne while Crisanta has a better effect on weight control. So, it depends on what symptoms are you concerned about? As per figures, your BMI is around 21, so it is within the normal range. The irregular bleeding shall subside with regular pill usage. For heavy bleeding, you may use tablet Tranexamic acid 500 mg thrice a day for two days. It reduces the flow.

Hello doctor,Which OCP is better for long term use in PCOS? Krimson 35 or Crisanta 21, as my endocrinologist prescribed Krimson 35 with Glyciphage 500 twice a day for six months and my gynecologist prescribed Crisanta 21 with Glyciphage 500 twice for two years. I was very confused and started Krimson last month but I have been continuously bleeding from 5th to 6th day after starting Krimson and it is not spotting. It is flowing kind of bleeding. Sometimes, heavy bleeding. Please suggest. I should have started Crisanta. Should I switch to Crisanta from next pack? Which one is better for hirsutism and weight control? I have hair growth on the chest and stomach, weight is 64 and height 5.8.

Hi, Welcome to Chat Doctor forum. Both Krimson 35 and Crisanta 21 are used in PCOS for long term regime. Please check if you are taking the pills at the same time or missing them? Any vomiting, diarrhea, fever in the last few days? As per various studies, Krimson has shown better control over hirsutism and acne while Crisanta has a better effect on weight control. So, it depends on what symptoms are you concerned about? As per figures, your BMI is around 21, so it is within the normal range. The irregular bleeding shall subside with regular pill usage. For heavy bleeding, you may use tablet Tranexamic acid 500 mg thrice a day for two days. It reduces the flow.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have been trying for a baby for the last eight months. The monthly disappointments are driving me crazy. I feel so low and like a total failure. How do I ensure that I do not spiral into depression? My husband is supportive and encouraging, but I end up crying each time I see or hear news of a baby. ### Response: Hello, Welcome to Chat Doctor forum. You should, first of all, reassure yourself that if you will have sexual intercourse in a relaxed and stress-free mind then this will yield the best results. If you will do sexual intercourse in anticipation of the baby then you will remain stressed and this will make negative results. Stress too is one cause of poor fertility. You should spend more time in foreplay with your husband. Have more sexual encounter during a fertile period of the menstrual cycle that is during 12th to 16th day of the cycle (the first day of the cycle is the first day of bleeding). Keep your both legs up while you will remain lying down after ejaculation. This will prevent the leakage of semen. Remain in this position for around 5 to 10 minutes after sex. This will also help you a lot. Just do not lose your confidence. Just keep one thing in mind that you are healthy and you will have a baby without many issues. Try to spend more time in doing constructive activities. Avoid spending more time on the internet because this increases stress only. Light exercise in the evening too will lift up your mood. Do not get irritated on your family members which could happen in depression. This will help you. If needed, visit a psychiatrist for help.

Hello doctor,I have been trying for a baby for the last eight months. The monthly disappointments are driving me crazy. I feel so low and like a total failure. How do I ensure that I do not spiral into depression? My husband is supportive and encouraging, but I end up crying each time I see or hear news of a baby.

Hello, Welcome to Chat Doctor forum. You should, first of all, reassure yourself that if you will have sexual intercourse in a relaxed and stress-free mind then this will yield the best results. If you will do sexual intercourse in anticipation of the baby then you will remain stressed and this will make negative results. Stress too is one cause of poor fertility. You should spend more time in foreplay with your husband. Have more sexual encounter during a fertile period of the menstrual cycle that is during 12th to 16th day of the cycle (the first day of the cycle is the first day of bleeding). Keep your both legs up while you will remain lying down after ejaculation. This will prevent the leakage of semen. Remain in this position for around 5 to 10 minutes after sex. This will also help you a lot. Just do not lose your confidence. Just keep one thing in mind that you are healthy and you will have a baby without many issues. Try to spend more time in doing constructive activities. Avoid spending more time on the internet because this increases stress only. Light exercise in the evening too will lift up your mood. Do not get irritated on your family members which could happen in depression. This will help you. If needed, visit a psychiatrist for help.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am worried because my gum has been swollen and I was in on and off pain on the left side of my jaw after a filling two weeks ago. Before that two months ago, I had a crown lengthening, and I was supposed to get a crown, but the dentist two weeks ago said it is best to do a filling. Now I have what looks like a pocket or inflammation around the tooth that was placed with a filling.I saw that dentist today to get it checked, and she said it is the gum inflamed, and that I might need to lose the tooth or see the periodontist who might be able to fix it if it does not heal in a week. In that week, she told me to use mouthwash every day, floss extra diligently, and clean the area. Will this help, or am I in significant risk of losing the teeth? If I have to see the periodontist who did the crown lengthening, what would they do? ### Response: Hello, Welcome to Chat Doctor forum. There are two conditions with your teeth, and it might be only due to overhanging filling or due to a pocket surrounding the affected tooth. In that case, you should go to the periodontist first, he will clean the area and give you a better idea of what is happening around the tooth. In the worst cases, it may happen that you will have to get your filling removed and get that tooth root canal treated. But all of this can be clear only after an X-ray. For now, warm water and salt rinse is a good option, no doubt but go to your periodontist as soon as possible.

Hello doctor,I am worried because my gum has been swollen and I was in on and off pain on the left side of my jaw after a filling two weeks ago. Before that two months ago, I had a crown lengthening, and I was supposed to get a crown, but the dentist two weeks ago said it is best to do a filling. Now I have what looks like a pocket or inflammation around the tooth that was placed with a filling.I saw that dentist today to get it checked, and she said it is the gum inflamed, and that I might need to lose the tooth or see the periodontist who might be able to fix it if it does not heal in a week. In that week, she told me to use mouthwash every day, floss extra diligently, and clean the area. Will this help, or am I in significant risk of losing the teeth? If I have to see the periodontist who did the crown lengthening, what would they do?

Hello, Welcome to Chat Doctor forum. There are two conditions with your teeth, and it might be only due to overhanging filling or due to a pocket surrounding the affected tooth. In that case, you should go to the periodontist first, he will clean the area and give you a better idea of what is happening around the tooth. In the worst cases, it may happen that you will have to get your filling removed and get that tooth root canal treated. But all of this can be clear only after an X-ray. For now, warm water and salt rinse is a good option, no doubt but go to your periodontist as soon as possible.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 36 year old male. I suddenly developed sexual dysfunction, I have reduced interest, arousal, plateau, and orgasm. The triggering event seems to be the discontinuation of 150 mg Bupropion because of adverse effects. I switched to 20 mg Citalopram, and over the course of six months, I reduced Citalopram to less than 1.5 mg. However, the sexual dysfunction has remained unchanged. I previously took Citalopram in doses ranging from 10 to 20 mg, depending on the external stress, for six years, and this did not cause significant sexual side effects, except delayed orgasm. While on Bupropion, my semen production stopped, but there were no marked changes in sexual desire, arousal, or behavior. The Citalopram and Bupropion had been prescribed for anxiety and depression, which have been well controlled for many years. Six months after the onset of the sexual dysfunction, a testosterone test revealed total testosterone in the 400s and free testosterone beyond the laboratory\\s ability to measure it (highly elevated >100). I do not use androgen supplements and illegal or recreational drug. There is no history of alcohol addiction or nicotine use. There is no neurological history, history of an endocrine disease, or surgery. I currently take Fexofenadine, antihistamines, and steroid nasal sprays. ### Response: Hello, Welcome to Chat Doctor forum. Do get back to me after you have done these. Hope my advice is of some benefit to you. Revert with more information to an endocrinologist online

Hello doctor,I am a 36 year old male. I suddenly developed sexual dysfunction, I have reduced interest, arousal, plateau, and orgasm. The triggering event seems to be the discontinuation of 150 mg Bupropion because of adverse effects. I switched to 20 mg Citalopram, and over the course of six months, I reduced Citalopram to less than 1.5 mg. However, the sexual dysfunction has remained unchanged. I previously took Citalopram in doses ranging from 10 to 20 mg, depending on the external stress, for six years, and this did not cause significant sexual side effects, except delayed orgasm. While on Bupropion, my semen production stopped, but there were no marked changes in sexual desire, arousal, or behavior. The Citalopram and Bupropion had been prescribed for anxiety and depression, which have been well controlled for many years. Six months after the onset of the sexual dysfunction, a testosterone test revealed total testosterone in the 400s and free testosterone beyond the laboratory\\s ability to measure it (highly elevated >100). I do not use androgen supplements and illegal or recreational drug. There is no history of alcohol addiction or nicotine use. There is no neurological history, history of an endocrine disease, or surgery. I currently take Fexofenadine, antihistamines, and steroid nasal sprays.

Hello, Welcome to Chat Doctor forum. Do get back to me after you have done these. Hope my advice is of some benefit to you. Revert with more information to an endocrinologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,The patient underwent angioplasty two months ago. The medication provided makes the patient unwell and there is a loss of appetite. We need proper medicine advise. ### Response: Hello, Welcome to Chat Doctor forum. I have reviewed the detailed query and the attached picture. I have reviewed the medications patient is taking (attachment removed to protect patient identity). There is no medicine that seems to be unnecessary. All are needed for the patient. That is why the physician has prescribed these medicines. Feeling unwell and loss of appetite have a lot of reasons and can be due to any one of them. The patient\\s heart is also one of them. Certain medications also have a side effect of loss of appetite and feeling sick. The age of the patient and recent angioplasty adds up to the symptoms. To me, there seems no need for medication change (and this is based on the limited information provided about the patient. I do not have knowledge about patient\\s past medical history, recent health issues other than the heart, status of kidneys, liver, and lungs. To start or stop any medication we need to know the health status of all the body organs). I would recommend to regularly check the patient\\s blood pressure, blood sugar levels and other routine blood work. Consult back to his cardiologist in a couple of weeks. This visit is recommended post-angioplasty to see if everything is alright. He would do an echocardiography, EKG (electrocardiogram) and other heart tests to see all is as it should be. Hope it helps. Please feel free to ask more if you need further assistance. For more information consult a cardiologist online

Hello doctor,The patient underwent angioplasty two months ago. The medication provided makes the patient unwell and there is a loss of appetite. We need proper medicine advise.

Hello, Welcome to Chat Doctor forum. I have reviewed the detailed query and the attached picture. I have reviewed the medications patient is taking (attachment removed to protect patient identity). There is no medicine that seems to be unnecessary. All are needed for the patient. That is why the physician has prescribed these medicines. Feeling unwell and loss of appetite have a lot of reasons and can be due to any one of them. The patient\\s heart is also one of them. Certain medications also have a side effect of loss of appetite and feeling sick. The age of the patient and recent angioplasty adds up to the symptoms. To me, there seems no need for medication change (and this is based on the limited information provided about the patient. I do not have knowledge about patient\\s past medical history, recent health issues other than the heart, status of kidneys, liver, and lungs. To start or stop any medication we need to know the health status of all the body organs). I would recommend to regularly check the patient\\s blood pressure, blood sugar levels and other routine blood work. Consult back to his cardiologist in a couple of weeks. This visit is recommended post-angioplasty to see if everything is alright. He would do an echocardiography, EKG (electrocardiogram) and other heart tests to see all is as it should be. Hope it helps. Please feel free to ask more if you need further assistance. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 23-year-old male, 5.6 feet, 140 pounds. So about two months ago I had to feed some puppies. They did not want to eat from the plate so I fed them by hand, their dog food. I always was an anxious person so I eventually thought about it. Read the ingredients of the dog food and read meat flour. My mind went straight for mad cow disease risk. I thought I am sure these dog food have spinal itssue, brain, bone in the meat flour mix. Did my research and I am correct. Many dog food companies do that. So it is impossible to get rid of every trace of dog food from my clothes, keyboards, pockets, etc. I already did that but you know I was not aware of these for the time I was feeding them.My question is, in the worst case how much time do I have before the symptoms start? First expousure might been two months or a month and a half ago. I am thinking of blowing my savings and traveling before the symtoms start and then after I confirm the disease, do not even know what to do. ### Response: Hello, Welcome to Chat Doctor forum. I understand your concern and would explain that usually cows affected by this disease are isolated and their meat is not used in industry, but it is burnt under specialist supervision. Anyway, the period from the first contact with a mad cow product and the disease symptoms may be as long as 10 to 15 years. So just do not think about it. I am sure that nothing bad is going to happen.

Hi doctor,I am a 23-year-old male, 5.6 feet, 140 pounds. So about two months ago I had to feed some puppies. They did not want to eat from the plate so I fed them by hand, their dog food. I always was an anxious person so I eventually thought about it. Read the ingredients of the dog food and read meat flour. My mind went straight for mad cow disease risk. I thought I am sure these dog food have spinal itssue, brain, bone in the meat flour mix. Did my research and I am correct. Many dog food companies do that. So it is impossible to get rid of every trace of dog food from my clothes, keyboards, pockets, etc. I already did that but you know I was not aware of these for the time I was feeding them.My question is, in the worst case how much time do I have before the symptoms start? First expousure might been two months or a month and a half ago. I am thinking of blowing my savings and traveling before the symtoms start and then after I confirm the disease, do not even know what to do.

Hello, Welcome to Chat Doctor forum. I understand your concern and would explain that usually cows affected by this disease are isolated and their meat is not used in industry, but it is burnt under specialist supervision. Anyway, the period from the first contact with a mad cow product and the disease symptoms may be as long as 10 to 15 years. So just do not think about it. I am sure that nothing bad is going to happen.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 60-year-old male. I have swelling and discomfort in the testicle and sperm canal. I have wandering aches and pain around the groin area including buttocks and inner thigh. I am having these symptoms for the past four to five months. I am not taking medications. I have tried Neurontin with a low dose of 100 mg taken twice daily for two weeks. But I stopped it because of its side effects, and it does not relieve my symptoms. I had shaking episodes of anxiety and worried that I might have contracted herpes 2. I have tested for all the common STDs which showed a negative result except herpes simplex showing a positive outcome.I am also experiencing impotence. I had undergone a hernia operation with a net before 11 years. Also, I had undergone a small hernia surgery on my right side which is not very visible. I do a lot of swimming about 10 kilometers per week. I have overstrained myself. I had a sexual encounter with someone whom I do not know a lot. I have wandering pain around my lower abdomen and groin. Often it is hard to distinguish where the pain gets originated. Sometimes, it involves both upper and inner thigh in the vicinity of the testes sack. I have tenderness and minor swelling in my testis and epididymis. I have difficulty in erection. ### Response: Hi. I understand all your concerns. I have checked the provided information thoroughly. I need to know more details. Do you have any redness, swelling or ulcers in the genital or groin area? Have you performed urinalysis? Please send me some photos if possible.

Hi doctor,I am a 60-year-old male. I have swelling and discomfort in the testicle and sperm canal. I have wandering aches and pain around the groin area including buttocks and inner thigh. I am having these symptoms for the past four to five months. I am not taking medications. I have tried Neurontin with a low dose of 100 mg taken twice daily for two weeks. But I stopped it because of its side effects, and it does not relieve my symptoms. I had shaking episodes of anxiety and worried that I might have contracted herpes 2. I have tested for all the common STDs which showed a negative result except herpes simplex showing a positive outcome.I am also experiencing impotence. I had undergone a hernia operation with a net before 11 years. Also, I had undergone a small hernia surgery on my right side which is not very visible. I do a lot of swimming about 10 kilometers per week. I have overstrained myself. I had a sexual encounter with someone whom I do not know a lot. I have wandering pain around my lower abdomen and groin. Often it is hard to distinguish where the pain gets originated. Sometimes, it involves both upper and inner thigh in the vicinity of the testes sack. I have tenderness and minor swelling in my testis and epididymis. I have difficulty in erection.

Hi. I understand all your concerns. I have checked the provided information thoroughly. I need to know more details. Do you have any redness, swelling or ulcers in the genital or groin area? Have you performed urinalysis? Please send me some photos if possible.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had a boil on my lower leg last month. It was paining and in five days it was filled with pus. Doctor advised it poping and after that, I took Amoxiclav 625 twice daily for three days and keep on dressing.After 15 days another one appeared on the upper side of the knee on the same leg. I used black tape (Atropa) and it popped in five days. On the fifth day, another appeared on the same leg and I took Amoxiclav 625 for five days twice daily. It popped yesterday and today is the fifth day of medicine. Now today, I am feeling another coming near it. What should I do? Please suggest.Should I use Mupirocin on it three to four times a day? Should I continue Amoxiclav more?Please guide me if anything else should I do including any home remedy I can not bear more pain and I do not want to take medicine any longer. ### Response: Hi. From your history, I would say you are suffering from folliculitis i.e bacterial infection. Since you have recurrent episodes I would suggest you to get pus culture sensitivity done. So that specific antibiotics can be decided. Secondly, complete your seven days course of Amoxclav 625 (Amoxycillin and Clavulanic acid). Do not burst boils. There is no need for ChatDoctor. Yes, you can use Mupirocin ointment two to three times a day or Fusidic acid cream (Fucidin cream) can be used. If possible please send an image and revert back.

Hello doctor,I had a boil on my lower leg last month. It was paining and in five days it was filled with pus. Doctor advised it poping and after that, I took Amoxiclav 625 twice daily for three days and keep on dressing.After 15 days another one appeared on the upper side of the knee on the same leg. I used black tape (Atropa) and it popped in five days. On the fifth day, another appeared on the same leg and I took Amoxiclav 625 for five days twice daily. It popped yesterday and today is the fifth day of medicine. Now today, I am feeling another coming near it. What should I do? Please suggest.Should I use Mupirocin on it three to four times a day? Should I continue Amoxiclav more?Please guide me if anything else should I do including any home remedy I can not bear more pain and I do not want to take medicine any longer.

Hi. From your history, I would say you are suffering from folliculitis i.e bacterial infection. Since you have recurrent episodes I would suggest you to get pus culture sensitivity done. So that specific antibiotics can be decided. Secondly, complete your seven days course of Amoxclav 625 (Amoxycillin and Clavulanic acid). Do not burst boils. There is no need for ChatDoctor. Yes, you can use Mupirocin ointment two to three times a day or Fusidic acid cream (Fucidin cream) can be used. If possible please send an image and revert back.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have negative HIV, ELISA test on 54th day, 108th day, 210th day and 260th days. May be all tests are second or third generation tests. I also have done an HIV test with the help of home test kit which shows result in 10 minutes. The result is negative.My questions are what are the chances of a false negative? Whether I need anymore testing like PCR, RNA/DNA test? Does three months HIV test is considered conclusive? What are the chances of transmission in case of protected sex (no anal or oral sex)? Whether deep kiss or smooch can transmit the virus? ### Response: Hi. I will answer your query specifically. In your case, the chances of false negative are almost nil. Chances of false negative are high during the window period which extends from three weeks to six months. Usually, a person having HIV has detectable antibody levels by a month. Almost 97 percent of people become seropositive by three months. By six months any person having HIV will develop antibodies. Only a few cases have been reported where seroconversion occurred late after a year. As you have done your tests at monthly intervals till six months and the results have been negative, chances of it being false negative are almost negligible. You do not need any other tests. We consider three months as conclusive but prefer to do a test at six months too. If you have used a condom, you need not worry. If only sex is unprotected chances of spreading through single contact are 0-1%. Kissing does not spread infection. I hope this helps.

Hi doctor,I have negative HIV, ELISA test on 54th day, 108th day, 210th day and 260th days. May be all tests are second or third generation tests. I also have done an HIV test with the help of home test kit which shows result in 10 minutes. The result is negative.My questions are what are the chances of a false negative? Whether I need anymore testing like PCR, RNA/DNA test? Does three months HIV test is considered conclusive? What are the chances of transmission in case of protected sex (no anal or oral sex)? Whether deep kiss or smooch can transmit the virus?

Hi. I will answer your query specifically. In your case, the chances of false negative are almost nil. Chances of false negative are high during the window period which extends from three weeks to six months. Usually, a person having HIV has detectable antibody levels by a month. Almost 97 percent of people become seropositive by three months. By six months any person having HIV will develop antibodies. Only a few cases have been reported where seroconversion occurred late after a year. As you have done your tests at monthly intervals till six months and the results have been negative, chances of it being false negative are almost negligible. You do not need any other tests. We consider three months as conclusive but prefer to do a test at six months too. If you have used a condom, you need not worry. If only sex is unprotected chances of spreading through single contact are 0-1%. Kissing does not spread infection. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I had been diagnosed with inappropriate sinus tachycardia nearly two years back. I have dizziness, chest pain, shortness of breath, not able to exercise, and anxiety. I am currently managing my symptoms with Ivabradine 5 mg, once a day, but the quality of life is very poor due to which I am suffering from depression and anxiety disorders. Sometimes, I feel better and can work off the medicines, but as soon as I try strenuous exercises, all the symptoms return. Please apologize for my words, but I cannot even masturbate. My questions to you are, should I consider for ablation? If yes, then what are the risks and success rate? If I have to undergo pacemaker implantation, then what may be the complications and success rate and will I be able to perform strenuous exercises with a pacemaker? Should I consider going for a pacemaker at 21 years of age? Lastly, should I continue with medicines, if there is a possibility of self-healing in the future? ### Response: Hello, Welcome to Chat Doctor forum. Firstly, do not get depressed, this is not a life-threatening condition, and may resolve with time. The symptoms may be troublesome for some time. How much are your resting and maximum heart rate? You should get yourself evaluated by a psychiatrist for anxiety and depression, which I think is causing your poor quality of life. I assume all other causes are ruled out like thyroid, low hemoglobin, and postural orthostatic tachycardia syn ChatDoctor. The echocardiogram is also normal I guess. Hope this helps you, and get back if you have any doubts. For more information consult a cardiologist online

Hi doctor,I had been diagnosed with inappropriate sinus tachycardia nearly two years back. I have dizziness, chest pain, shortness of breath, not able to exercise, and anxiety. I am currently managing my symptoms with Ivabradine 5 mg, once a day, but the quality of life is very poor due to which I am suffering from depression and anxiety disorders. Sometimes, I feel better and can work off the medicines, but as soon as I try strenuous exercises, all the symptoms return. Please apologize for my words, but I cannot even masturbate. My questions to you are, should I consider for ablation? If yes, then what are the risks and success rate? If I have to undergo pacemaker implantation, then what may be the complications and success rate and will I be able to perform strenuous exercises with a pacemaker? Should I consider going for a pacemaker at 21 years of age? Lastly, should I continue with medicines, if there is a possibility of self-healing in the future?

Hello, Welcome to Chat Doctor forum. Firstly, do not get depressed, this is not a life-threatening condition, and may resolve with time. The symptoms may be troublesome for some time. How much are your resting and maximum heart rate? You should get yourself evaluated by a psychiatrist for anxiety and depression, which I think is causing your poor quality of life. I assume all other causes are ruled out like thyroid, low hemoglobin, and postural orthostatic tachycardia syn ChatDoctor. The echocardiogram is also normal I guess. Hope this helps you, and get back if you have any doubts. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 18 years old, 150 lbs, 5\\8\" male. I am in need of advice for my possible phimosis problem. I am uncircumcised and have never attempted to pull my foreskin back until yesterday. I was able to pull the foreskin back with some struggle but hardly any pain and got a look at the whole head. I have a few questions regarding this. When my foreskin is pulled back, at the end of the glans has excessive skin or somewhat around it and was worried if that was paraphimosis? (No pain except when touching it and feels very sensitive including the glans). Is it okay to leave my foreskin back as it is able to stay retracted and will just have to wait for the sensitivity to desensitize? Now that I am able to pull my foreskin back when flaccid, I cannot pull it back when erect. So, could I retract the foreskin when flaccid and get erect as it is already retracted? ### Response: Hi, Welcome to Chat Doctor forum. I have gone through your query, I would like to know a few more details to answer your query better. It appears that you have a tight foreskin and not phimosis, I would have to examine you to confirm the diagnosis. In either case, the treatment advised would be circumcision to avoid a possibility of paraphimosis at a later date. I would advise you to not keep your foreskin retracted as it may cause a paraphimosis, which will require surgery to correct it if left for long. For more information consult an urologist online

Hello doctor,I am 18 years old, 150 lbs, 5\\8\" male. I am in need of advice for my possible phimosis problem. I am uncircumcised and have never attempted to pull my foreskin back until yesterday. I was able to pull the foreskin back with some struggle but hardly any pain and got a look at the whole head. I have a few questions regarding this. When my foreskin is pulled back, at the end of the glans has excessive skin or somewhat around it and was worried if that was paraphimosis? (No pain except when touching it and feels very sensitive including the glans). Is it okay to leave my foreskin back as it is able to stay retracted and will just have to wait for the sensitivity to desensitize? Now that I am able to pull my foreskin back when flaccid, I cannot pull it back when erect. So, could I retract the foreskin when flaccid and get erect as it is already retracted?

Hi, Welcome to Chat Doctor forum. I have gone through your query, I would like to know a few more details to answer your query better. It appears that you have a tight foreskin and not phimosis, I would have to examine you to confirm the diagnosis. In either case, the treatment advised would be circumcision to avoid a possibility of paraphimosis at a later date. I would advise you to not keep your foreskin retracted as it may cause a paraphimosis, which will require surgery to correct it if left for long. For more information consult an urologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 36 year old female. I am currently breast feeding. I am suffering from severe UTI since 20 days. My gynecologist suggested Ceftum, Citralka, and Urispas for three days. After taking the course I was fine for two days. But, after two days, the UTI symptoms came back, but not as severe as the first time. I continued taking the same medicines again for three days. Still, there was discomfort, though the severity had reduced. I got a urine test done and attached the results. My gynecologist then put me on Nitrofurantoin, three tablets per day for a week and from the second week, I was asked to reduce the tablet to two per day. I have taken a total eight tablets, but there is still a burning sensation while passing urine, especially at night. Is this medicine effective? Will my UTI be cured by this medicine? For how many more days will there be a discomfort? Do I have to try a different medicine? Also, my gynecologist told me that if this medicine does not work, I will need to take a five-day injection course of Amikacin 500. Should I go for it right away? ### Response: Hello, Welcome to Chat Doctor forum. I have seen the reports sent by you (attachment removed to protect patient identity). You are suffering from a urinary tract infection with E.coli. Nitrofurantoin is the correct medicine, as per your urine culture report. As the infection is severe, your symptoms will require some time to resolve completely. For more information consult a urologist online

Hello doctor,I am a 36 year old female. I am currently breast feeding. I am suffering from severe UTI since 20 days. My gynecologist suggested Ceftum, Citralka, and Urispas for three days. After taking the course I was fine for two days. But, after two days, the UTI symptoms came back, but not as severe as the first time. I continued taking the same medicines again for three days. Still, there was discomfort, though the severity had reduced. I got a urine test done and attached the results. My gynecologist then put me on Nitrofurantoin, three tablets per day for a week and from the second week, I was asked to reduce the tablet to two per day. I have taken a total eight tablets, but there is still a burning sensation while passing urine, especially at night. Is this medicine effective? Will my UTI be cured by this medicine? For how many more days will there be a discomfort? Do I have to try a different medicine? Also, my gynecologist told me that if this medicine does not work, I will need to take a five-day injection course of Amikacin 500. Should I go for it right away?

Hello, Welcome to Chat Doctor forum. I have seen the reports sent by you (attachment removed to protect patient identity). You are suffering from a urinary tract infection with E.coli. Nitrofurantoin is the correct medicine, as per your urine culture report. As the infection is severe, your symptoms will require some time to resolve completely. For more information consult a urologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,A couple of weeks ago, I woke up with a bad headache and a very stiff neck. It was so painful that I could not make it through a regular day without crying and intense pain. Since this time, I have been to the doctor four times and each time, they gave me more medicines. I have also been to a chiropractor four times because one of the doctors recommended it after he took an x-ray. The headaches have gone away. I suffer from headaches and this pain is so different. Now, I have constant pain in the back of my lower neck and only on the left side. The stiff neck has improved and I can manage a day but I am still in intense pain. The only medicines I am taking at this time are over the counter medicines. What do I need to do? ### Response: Hello. Your symptoms may be related to occipital neuralgia, which is an irritation of the occipital nerve, which lies in the back of your head. I would like to know what were the results of your neck x-ray. This neuralgia can be exacerbated by cervical spondyloarthritis. I recommend starting Indomethacin twice daily if you have no contraindications to it (stomach problems or high blood pressure). I recommend consulting with a neurologist for a careful physical examination. An antiepileptic ChatDoctor. I hope this helps. Cervical spondyloarthritis or intracranial cause. Neck x-ray, brain CT (computed tomography) scan. Indomethacin. Anti-epileptics (Valproate, Topiramate or Lamotrigine). Take care.

Hello doctor,A couple of weeks ago, I woke up with a bad headache and a very stiff neck. It was so painful that I could not make it through a regular day without crying and intense pain. Since this time, I have been to the doctor four times and each time, they gave me more medicines. I have also been to a chiropractor four times because one of the doctors recommended it after he took an x-ray. The headaches have gone away. I suffer from headaches and this pain is so different. Now, I have constant pain in the back of my lower neck and only on the left side. The stiff neck has improved and I can manage a day but I am still in intense pain. The only medicines I am taking at this time are over the counter medicines. What do I need to do?

Hello. Your symptoms may be related to occipital neuralgia, which is an irritation of the occipital nerve, which lies in the back of your head. I would like to know what were the results of your neck x-ray. This neuralgia can be exacerbated by cervical spondyloarthritis. I recommend starting Indomethacin twice daily if you have no contraindications to it (stomach problems or high blood pressure). I recommend consulting with a neurologist for a careful physical examination. An antiepileptic ChatDoctor. I hope this helps. Cervical spondyloarthritis or intracranial cause. Neck x-ray, brain CT (computed tomography) scan. Indomethacin. Anti-epileptics (Valproate, Topiramate or Lamotrigine). Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 17-year-old. I am 5\\7\" in height and140 lbs weight. My dad is 5\\9, and my mom is 5\\1. I would like to at least reach 5\\9 to 5\\10. My diet is exceptional. I am taking a multivitamin, and I do not have any deficiencies. I am thinking of taking 1500 mg of Glucosamine because I read studies concluding that it may help a bit. Would you recommend glucosamine, or something else?Also, do you think I can still reach my height goal? I am worried that I may have stunted my growth. I have had insomnia, depression, and anxiety for four years now. This has affected my life considerably, and I am worried I would not grow to my potential height because of it. I also have not been getting too much calcium and protein because I have been avoiding dairy products. Should I be drinking more milk and if so, how much? ### Response: Hello. Your average expected height is close to 5\\6. Best way to help increase height is doing stretching exercises three to four times a week for 20 minutes in a 30 minutes session. You can try Glucosamine for a year but if it is not helping then taking it beyond that may not help. You can try Protein shakes, Calcium 800 to 1000 mg/d and Vitamin D 1000 to 2000 IU/d supplements to avoid the deficiencies. I hope it helps.

Hello doctor,I am a 17-year-old. I am 5\\7\" in height and140 lbs weight. My dad is 5\\9, and my mom is 5\\1. I would like to at least reach 5\\9 to 5\\10. My diet is exceptional. I am taking a multivitamin, and I do not have any deficiencies. I am thinking of taking 1500 mg of Glucosamine because I read studies concluding that it may help a bit. Would you recommend glucosamine, or something else?Also, do you think I can still reach my height goal? I am worried that I may have stunted my growth. I have had insomnia, depression, and anxiety for four years now. This has affected my life considerably, and I am worried I would not grow to my potential height because of it. I also have not been getting too much calcium and protein because I have been avoiding dairy products. Should I be drinking more milk and if so, how much?

Hello. Your average expected height is close to 5\\6. Best way to help increase height is doing stretching exercises three to four times a week for 20 minutes in a 30 minutes session. You can try Glucosamine for a year but if it is not helping then taking it beyond that may not help. You can try Protein shakes, Calcium 800 to 1000 mg/d and Vitamin D 1000 to 2000 IU/d supplements to avoid the deficiencies. I hope it helps.

### Instruction: Answer this question truthfully ###Input: Hi doctor,As of now, I am suffering pain in my left rib which results in difficulty in breathing. I suspect this happens when I fall asleep on the sofa in an awkward position and when I woke up, my throat has a little pain but it did not persist but but it started to ache on the left rib part. I feel the pain towards my shoulder. It is almost about two days since I am suffering from this ache.I got breathing difficulty especially when I am lying in bed. But while standing or sitting, I just felt mild difficulty in breathing. Maybe there is an artery that has been damaged or had been under the bone. I am 24 years old. ### Response: Hi. I can understand your concern. According to your statement, you have been suffering from difficulty in breathing due to aching of the left rib part that radiates toward shoulder which may occur when you fall asleep on sofa in an awkward position. You think your ribs may hurt from sleeping wrong and aching of the rib may radiate towards its intercostal muscle. You may feel a sharp pain after intercostal muscle strain or sprain due to sleeping in the wrong position. The pain will become worse when you stretch, breathe in deeply, cough, or sneeze. The area of the strain between your ribs may be painful to touch. Again this pain can radiate to shoulders or sometimes side sleeping can cause damage to the rotator cuff and create a lot of pressure in this group of tendons and eventually produce pain. You can take Tramadol as a painkiller, Domperidone, Lansoprazole, and Diazepam as a muscle relaxant with a sleeping pill.

Hi doctor,As of now, I am suffering pain in my left rib which results in difficulty in breathing. I suspect this happens when I fall asleep on the sofa in an awkward position and when I woke up, my throat has a little pain but it did not persist but but it started to ache on the left rib part. I feel the pain towards my shoulder. It is almost about two days since I am suffering from this ache.I got breathing difficulty especially when I am lying in bed. But while standing or sitting, I just felt mild difficulty in breathing. Maybe there is an artery that has been damaged or had been under the bone. I am 24 years old.

Hi. I can understand your concern. According to your statement, you have been suffering from difficulty in breathing due to aching of the left rib part that radiates toward shoulder which may occur when you fall asleep on sofa in an awkward position. You think your ribs may hurt from sleeping wrong and aching of the rib may radiate towards its intercostal muscle. You may feel a sharp pain after intercostal muscle strain or sprain due to sleeping in the wrong position. The pain will become worse when you stretch, breathe in deeply, cough, or sneeze. The area of the strain between your ribs may be painful to touch. Again this pain can radiate to shoulders or sometimes side sleeping can cause damage to the rotator cuff and create a lot of pressure in this group of tendons and eventually produce pain. You can take Tramadol as a painkiller, Domperidone, Lansoprazole, and Diazepam as a muscle relaxant with a sleeping pill.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My right eye occasionally gets swollen. I do not have any pain, itchiness or watery eyes. But this comes like once in every three months or four months. It would be there only for one day and gets better later. I initially assumed it to be because of body heat since I get this only for one day. It was very difficult to get an appointment with a doctor on that day to show my eyes. However, I continue to have this problem. I researched on the internet (because it is highly impossible to meet a medical practitioner here) and I understood that the cause might be because my right eye tear duct is getting blocked, although it is my assumption as the place between my nose and right eye corner gets swollen. A day or two before the swelling starts my right eye gets a bit teary and I feel like rubbing the right eye often. It would be nice if you could advise what could be the reason for this and whether I should immediately consult a practitioner here. ### Response: Hi. From what you have told about your condition and the photos of yours, I suspect you may be having a benign disease called blepharochalasis. It is quite frequent in your age group and follows the same pattern of on and off swelling of eyelids just like you have told. There are as of now no good tests to confirm this condition nor any proven treatment measures for this. However, I would advise you to avoid stress and being too emotional at times as these are known to cause attacks of blepharochalasis. Apart from blepharochalasis, a few other conditions can cause a similar swelling, these are as follows

Hello doctor,My right eye occasionally gets swollen. I do not have any pain, itchiness or watery eyes. But this comes like once in every three months or four months. It would be there only for one day and gets better later. I initially assumed it to be because of body heat since I get this only for one day. It was very difficult to get an appointment with a doctor on that day to show my eyes. However, I continue to have this problem. I researched on the internet (because it is highly impossible to meet a medical practitioner here) and I understood that the cause might be because my right eye tear duct is getting blocked, although it is my assumption as the place between my nose and right eye corner gets swollen. A day or two before the swelling starts my right eye gets a bit teary and I feel like rubbing the right eye often. It would be nice if you could advise what could be the reason for this and whether I should immediately consult a practitioner here.

Hi. From what you have told about your condition and the photos of yours, I suspect you may be having a benign disease called blepharochalasis. It is quite frequent in your age group and follows the same pattern of on and off swelling of eyelids just like you have told. There are as of now no good tests to confirm this condition nor any proven treatment measures for this. However, I would advise you to avoid stress and being too emotional at times as these are known to cause attacks of blepharochalasis. Apart from blepharochalasis, a few other conditions can cause a similar swelling, these are as follows

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 71-year-old female. I have white coat hypertension. I have had this all my life. I have been to numerous psychologists and therapists. I am in good health and take 1 mg of Synthroid daily. When I go to the doctor\\s office my BP goes sky high. At home, it is around 120/70. I went to the doctor last Monday. Just before leaving for the appointment at home it was 140/80. At the appointment, it was 180/90, and the pulse was 123. I got home an hour later. It was 120/75 again. I have a great fear of high BP since I was a child. At my last appoinment, I took Xanax 37.5. It is the first time ever I have taken any meds like that hoping that would calm me down. I guess it did not work. I am so worried that that high number will kill me. I am so tired of worrying about it. ### Response: Hello, Welcome to Chat Doctor forum. These blood pressure spikes related to white coat syn ChatDoctor. They are caused by the anxiety when consulting with your doctor. These spikes do not need to be treated. There is no need for any treatment, as they do not impose you to any increased cardiovascular risk. I would also recommend checking your thyroid hormone levels, in order to make the proper dose adjustments to Synthroid (Levothyroxine), if necessary. For more information consult a cardiologist online

Hello doctor,I am a 71-year-old female. I have white coat hypertension. I have had this all my life. I have been to numerous psychologists and therapists. I am in good health and take 1 mg of Synthroid daily. When I go to the doctor\\s office my BP goes sky high. At home, it is around 120/70. I went to the doctor last Monday. Just before leaving for the appointment at home it was 140/80. At the appointment, it was 180/90, and the pulse was 123. I got home an hour later. It was 120/75 again. I have a great fear of high BP since I was a child. At my last appoinment, I took Xanax 37.5. It is the first time ever I have taken any meds like that hoping that would calm me down. I guess it did not work. I am so worried that that high number will kill me. I am so tired of worrying about it.

Hello, Welcome to Chat Doctor forum. These blood pressure spikes related to white coat syn ChatDoctor. They are caused by the anxiety when consulting with your doctor. These spikes do not need to be treated. There is no need for any treatment, as they do not impose you to any increased cardiovascular risk. I would also recommend checking your thyroid hormone levels, in order to make the proper dose adjustments to Synthroid (Levothyroxine), if necessary. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I was taking Cipralex 20 mg before 15 months and was fine, and my sex drive is good even with Cipralex. I went to the doctor before five months, and she said to stop the medicine, so I was lowering the dose to 5 mg. While doing intercourse or masturbating, I am so excited, and my sex drive and erection is good. But when I ejaculate, I feel no pleasure, and I do not have a good feel. It seems like my brain not connected to pleasure nerve or something.I went to the urologist and he checked and says everything was fine. He gave me Gentaplex. I tried it for one month and had more power in sex, but there is no pleasure when I ejaculate. I went to the psychiatrist again, and she told me that she does not know what to do in this condition. So I do not know what to do. It is 4-5 months since I stopped taking Cipralex, and I still have this problem, and I am so much worried about it. Please tell me what to do. Is there any other medicine should I take? ### Response: Hello, Welcome to Chat Doctor forum. You are probably experiencing orgasmic anhedonia, which means you are not able to experience pleasure when you reach orgasm. Your sexual ChatDoctor. It can be due to either physical problem or psychological problem. It is good that you have already consulted a urologist and no physical cause has been found. Have you been on any other medication apart from Cipralex? Have you been using any street

Hello doctor,I was taking Cipralex 20 mg before 15 months and was fine, and my sex drive is good even with Cipralex. I went to the doctor before five months, and she said to stop the medicine, so I was lowering the dose to 5 mg. While doing intercourse or masturbating, I am so excited, and my sex drive and erection is good. But when I ejaculate, I feel no pleasure, and I do not have a good feel. It seems like my brain not connected to pleasure nerve or something.I went to the urologist and he checked and says everything was fine. He gave me Gentaplex. I tried it for one month and had more power in sex, but there is no pleasure when I ejaculate. I went to the psychiatrist again, and she told me that she does not know what to do in this condition. So I do not know what to do. It is 4-5 months since I stopped taking Cipralex, and I still have this problem, and I am so much worried about it. Please tell me what to do. Is there any other medicine should I take?

Hello, Welcome to Chat Doctor forum. You are probably experiencing orgasmic anhedonia, which means you are not able to experience pleasure when you reach orgasm. Your sexual ChatDoctor. It can be due to either physical problem or psychological problem. It is good that you have already consulted a urologist and no physical cause has been found. Have you been on any other medication apart from Cipralex? Have you been using any street

### Instruction: Answer this question truthfully ###Input: Hello doctor, Recently I have been having burning with urination and just burning in my urethra in general, sometimes even when I am not urinating. A month ago I went to the doctor\\s office with UTI symptoms and blood in my urine and was told I did in fact have a bladder infection and was given Ciprofloxacin. A couple of weeks after being off the Ciprofloxacin I began having the burning that I am now. The burning got worse after intercourse and even worse once I started my menstrual cycle. I went back to the doctor\\s office for a urine test, assuming it might be the same infection that just did not go away but was told my urine was perfectly healthy and there was no sign of infection. The doctor recommended seeing a urologist. I am concerned as to what sorts of tests the urologist will perform and what possible conditions I might be suffering from? What can I expect from my first visit to a urologist and what are some of the possible conditions that I might have? ### Response: Hello, Welcome to ChatDoctor. From the symptoms, I feel you have a urinary tract infection. Since a course of antibiotics is given already you need a urine culture test and ultrasound abdomen. Culture-specific antibiotic has to be given. If a culture shows no growth it may be due to a condition called interstitial cystitis. More than three urinary infections a year need continuous ChatDoctor. One or two UTIs per year are common and need no worry. UTI. Urine culture and USG (ultra sound) abdomen. Interstitial cystitis. Ureteric stones. UTI. Another course of antibiotic. Take care.

Hello doctor, Recently I have been having burning with urination and just burning in my urethra in general, sometimes even when I am not urinating. A month ago I went to the doctor\\s office with UTI symptoms and blood in my urine and was told I did in fact have a bladder infection and was given Ciprofloxacin. A couple of weeks after being off the Ciprofloxacin I began having the burning that I am now. The burning got worse after intercourse and even worse once I started my menstrual cycle. I went back to the doctor\\s office for a urine test, assuming it might be the same infection that just did not go away but was told my urine was perfectly healthy and there was no sign of infection. The doctor recommended seeing a urologist. I am concerned as to what sorts of tests the urologist will perform and what possible conditions I might be suffering from? What can I expect from my first visit to a urologist and what are some of the possible conditions that I might have?

Hello, Welcome to ChatDoctor. From the symptoms, I feel you have a urinary tract infection. Since a course of antibiotics is given already you need a urine culture test and ultrasound abdomen. Culture-specific antibiotic has to be given. If a culture shows no growth it may be due to a condition called interstitial cystitis. More than three urinary infections a year need continuous ChatDoctor. One or two UTIs per year are common and need no worry. UTI. Urine culture and USG (ultra sound) abdomen. Interstitial cystitis. Ureteric stones. UTI. Another course of antibiotic. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have these spots on my pubic area for a while now. I visited an STD clinic two years ago and the woman who saw these said they are genital warts. I also had one on the shaft of my penis. She used nitrogen to freeze them and they disappeared (except for the big one that you can see in the pictures, that one did not disappear). Now I believe the spots are back. Went to my doctor and he says they are not warts and wants to scrape them away with a sharp spoon (literally what he said). He was not sure what it is but believes they are not warts. What is your opinion? I did a previous free consult and the doctor says it is follicle infection and I should use antibiotics. However, I want to have a second opinion as I looked up the images for this infection and do not think it looks the same. Also, I have used Amoxycillin about half a year ago and this did not influence the big spot, as I have it now for at least two years. ### Response: Hi. I have gone through your complaints and reviewed the attached photographs (attachment removed to protect patient identity). The bigger one is looking like a wart and needs to be removed either by chemical cauterization or electrocautery. The smaller ones seem to be either folliculitis or warts. I would recommend you to apply a topical antibiotic like Fusidic acid cream on the smaller lesions twice daily for 7 to 10 days. This should resolve them. If they do not improve in a week time consult a doctor and get them removed. For more information consult a cosmetologist online

Hello doctor,I have these spots on my pubic area for a while now. I visited an STD clinic two years ago and the woman who saw these said they are genital warts. I also had one on the shaft of my penis. She used nitrogen to freeze them and they disappeared (except for the big one that you can see in the pictures, that one did not disappear). Now I believe the spots are back. Went to my doctor and he says they are not warts and wants to scrape them away with a sharp spoon (literally what he said). He was not sure what it is but believes they are not warts. What is your opinion? I did a previous free consult and the doctor says it is follicle infection and I should use antibiotics. However, I want to have a second opinion as I looked up the images for this infection and do not think it looks the same. Also, I have used Amoxycillin about half a year ago and this did not influence the big spot, as I have it now for at least two years.

Hi. I have gone through your complaints and reviewed the attached photographs (attachment removed to protect patient identity). The bigger one is looking like a wart and needs to be removed either by chemical cauterization or electrocautery. The smaller ones seem to be either folliculitis or warts. I would recommend you to apply a topical antibiotic like Fusidic acid cream on the smaller lesions twice daily for 7 to 10 days. This should resolve them. If they do not improve in a week time consult a doctor and get them removed. For more information consult a cosmetologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am 29 years old with a Paragard IUD, and it has been dropped beyond the normal place. I was told to get my IUD out. I have an abnormal discharge, and I am 10 days late on my period. I got a pregnancy test done, and it was an error. I had an ultrasound, and I saw what looks like an ectopic pregnancy. I am concerned that I saw a heartbeat and a living thing in the scan. My IUD seemed like it was just about to come out and did not appear to swell my fallopian tube. I was told by the technician if the IUD is taken out, then I will be fine. I have unprotected sex every night, but my pregnancy test is an error. If the ultrasound is not negative or positive and looks like a heartbeat and not a flat line, then what does it mean? If it is red and blue scan, what does it mean? They kept asking me about my period for more than five times. The technician had her supervisor suggestion that the IUD needs to come out. I am having weird discharge, bloated, painful stomach and diarrhea. I had a miscarriage last year and the symptoms were the same that time. What shall I do now? ### Response: Hello. You are missing the most important thing that is the pregnancy test is an error, which means it is not positive. Of course, if IUD (intrauterine device) is displaced from the normal position, there is a chance of pregnancy and also of tubal ectopic pregnancy. But, it is not that all cases have a tubal pregnancy.

Hi doctor,I am 29 years old with a Paragard IUD, and it has been dropped beyond the normal place. I was told to get my IUD out. I have an abnormal discharge, and I am 10 days late on my period. I got a pregnancy test done, and it was an error. I had an ultrasound, and I saw what looks like an ectopic pregnancy. I am concerned that I saw a heartbeat and a living thing in the scan. My IUD seemed like it was just about to come out and did not appear to swell my fallopian tube. I was told by the technician if the IUD is taken out, then I will be fine. I have unprotected sex every night, but my pregnancy test is an error. If the ultrasound is not negative or positive and looks like a heartbeat and not a flat line, then what does it mean? If it is red and blue scan, what does it mean? They kept asking me about my period for more than five times. The technician had her supervisor suggestion that the IUD needs to come out. I am having weird discharge, bloated, painful stomach and diarrhea. I had a miscarriage last year and the symptoms were the same that time. What shall I do now?

Hello. You are missing the most important thing that is the pregnancy test is an error, which means it is not positive. Of course, if IUD (intrauterine device) is displaced from the normal position, there is a chance of pregnancy and also of tubal ectopic pregnancy. But, it is not that all cases have a tubal pregnancy.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have a strange sensation in my leg for around two years. It usually only affects the lower half of the left leg and foot but has recently encompassed the upper sections. This is accentuated when walking and more so when the pace gets quicker. The feelings feel as if my lower leg and foot are quite light on the lift and not entirely under my control.The foot can feel as if it wants to turn in when I am running but never does, almost like a buzzy electric wave feeling. There is no weakness of the leg itself. I have suffered from cold feet over the years, and these can be pronounced, making the foot very stiff so that wiggling the foot and toes can be quite difficult.It can occasionally feel as if there is a block in the leg. The same sensation with a feeling there is a block can be felt in the forearm also. There are icy hands as well, which can affect ability with the thumb numbness now and then. When sitting, the feet feel as if they are stretching out with light relief available when I do. I am worried about MND. ### Response: Hello, Welcome to Chat Doctor forum. I read your query. As per your symptoms, there can be chances of MND. In MND, there are also other symptoms, and there are chances of underlying sclerosis. But you can not rule it out on your own. You need a clinical examination by a trained physician. So I advise you to visit a nearby reputed physician and ask for the complete examination. Once a proper diagnosis is made, only then start taking treatment rather than taking random treatment. I hope you understand my point.

Hello doctor,I have a strange sensation in my leg for around two years. It usually only affects the lower half of the left leg and foot but has recently encompassed the upper sections. This is accentuated when walking and more so when the pace gets quicker. The feelings feel as if my lower leg and foot are quite light on the lift and not entirely under my control.The foot can feel as if it wants to turn in when I am running but never does, almost like a buzzy electric wave feeling. There is no weakness of the leg itself. I have suffered from cold feet over the years, and these can be pronounced, making the foot very stiff so that wiggling the foot and toes can be quite difficult.It can occasionally feel as if there is a block in the leg. The same sensation with a feeling there is a block can be felt in the forearm also. There are icy hands as well, which can affect ability with the thumb numbness now and then. When sitting, the feet feel as if they are stretching out with light relief available when I do. I am worried about MND.

Hello, Welcome to Chat Doctor forum. I read your query. As per your symptoms, there can be chances of MND. In MND, there are also other symptoms, and there are chances of underlying sclerosis. But you can not rule it out on your own. You need a clinical examination by a trained physician. So I advise you to visit a nearby reputed physician and ask for the complete examination. Once a proper diagnosis is made, only then start taking treatment rather than taking random treatment. I hope you understand my point.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am suffering an erection problem for the last three years. I am married for the last 1 year but I never did satisfaction and natural sex with my wife. My problem is I used to do a lot of masturbation heavy masturbation with oil so it is erect for a while and again loose.One more thing my penis would not get erect or discharged if my wife do handjob and sex, it gets erect only when I touch. I am trying a lot to discharge in my wife\\s vagina but I could not do so because at the end movement it is going to loose. One more thing I cannot masturbate with my dry hand because I need some oily lubricants to erect my penis. After marriage also I am doing masturbation. Due to heavy masturbation, my penis shrinks and sometimes I forgot things. I am not able to remember anything. ### Response: Hello, Welcome to Chat Doctor forum. Anejaculation is a condition where a man cannot discharge semen. It can be absolute when he cannot discharge in any situation and situational when he cannot discharge in certain situations but can discharge in other conditions. If he can ejaculate with masturbation but not with sex then it is a psychological issue. If he cannot ejaculate even with masturbation or in ChatDoctor. Psychological issue is due to inhibition when a man cannot ejaculate in the presence of another person. It can be overcome by gradual desensitization. He can rub his penis on any body part of the female like buttocks, thighs, breasts, belly, etc, and try to ejaculate. The female can also masturbate him. It is a long

Hi doctor,I am suffering an erection problem for the last three years. I am married for the last 1 year but I never did satisfaction and natural sex with my wife. My problem is I used to do a lot of masturbation heavy masturbation with oil so it is erect for a while and again loose.One more thing my penis would not get erect or discharged if my wife do handjob and sex, it gets erect only when I touch. I am trying a lot to discharge in my wife\\s vagina but I could not do so because at the end movement it is going to loose. One more thing I cannot masturbate with my dry hand because I need some oily lubricants to erect my penis. After marriage also I am doing masturbation. Due to heavy masturbation, my penis shrinks and sometimes I forgot things. I am not able to remember anything.

Hello, Welcome to Chat Doctor forum. Anejaculation is a condition where a man cannot discharge semen. It can be absolute when he cannot discharge in any situation and situational when he cannot discharge in certain situations but can discharge in other conditions. If he can ejaculate with masturbation but not with sex then it is a psychological issue. If he cannot ejaculate even with masturbation or in ChatDoctor. Psychological issue is due to inhibition when a man cannot ejaculate in the presence of another person. It can be overcome by gradual desensitization. He can rub his penis on any body part of the female like buttocks, thighs, breasts, belly, etc, and try to ejaculate. The female can also masturbate him. It is a long

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 30 years old and married for 2.4 years. Now we are planning for a child. On 14th of this month, I experienced periods with very little stomach pain and pain in legs. The next day on 15th there was no bleeding at all, 16th I had spotting of light red colored blood flow, 17th the same thing happened and then the flow stopped. Again on 23rd night I had bleeding light red coloured blood flow, on 24th no bleeding at all, 25th I had fresh pink colored spotting. Then 26th pinkish brownish spotting occurred, 27th morning I did pregnancy test by urine, it came negative, and at 8 AM had brownish spotting, 28th had brownish spotting too. Please help me to know whether it is implantation bleeding or anything else. ### Response: Hello. This is not an implantation bleed at all as even urine pregnancy test is negative. Considering that you have been having regular spotting during this month since 14th of this month with hypomenorrhoea, there are possibilities that your serum Estradiol levels are low which is a possible cause of such irregular shedding of the endometrium. It is important that you get an ultrasound pelvis done to check for endometrial thickness which if less than 8 mm then likely that you would not conceive during this cycle. Please tell me what hormonal profile was done with thyroid levels, serum prolactin, serum progesterone, serum estradiol, FSH, LH and AMH levels to establish the cause of such irregular shedding.

Hello doctor,I am 30 years old and married for 2.4 years. Now we are planning for a child. On 14th of this month, I experienced periods with very little stomach pain and pain in legs. The next day on 15th there was no bleeding at all, 16th I had spotting of light red colored blood flow, 17th the same thing happened and then the flow stopped. Again on 23rd night I had bleeding light red coloured blood flow, on 24th no bleeding at all, 25th I had fresh pink colored spotting. Then 26th pinkish brownish spotting occurred, 27th morning I did pregnancy test by urine, it came negative, and at 8 AM had brownish spotting, 28th had brownish spotting too. Please help me to know whether it is implantation bleeding or anything else.

Hello. This is not an implantation bleed at all as even urine pregnancy test is negative. Considering that you have been having regular spotting during this month since 14th of this month with hypomenorrhoea, there are possibilities that your serum Estradiol levels are low which is a possible cause of such irregular shedding of the endometrium. It is important that you get an ultrasound pelvis done to check for endometrial thickness which if less than 8 mm then likely that you would not conceive during this cycle. Please tell me what hormonal profile was done with thyroid levels, serum prolactin, serum progesterone, serum estradiol, FSH, LH and AMH levels to establish the cause of such irregular shedding.

### Instruction: Answer this question truthfully ###Input: Hello doctor,So for the past couple of weeks, I have been very itchy and will break out in little bumps. I went to the doctor to find out if it was an allergic reaction or something else but they were not very helpful. They prescribed me Desonide for the breakouts. I have been using it but it has not helped with the itching. I also talked to a pharmacist and she asked if I had ever had experience with eczema and I did when I was a baby, but I thought I had grown out of it. She recommended me taking Claritin for the itching and using a moisturizing lotion and to continue using the Desonide. I have been doing this for a couple of days and I am still itching like crazy. I do not know what else to do. ### Response: Hello. I have read your query. Profuse itching over your body leading to a little red bumps could be an urticaria or an allergic reaction. Since it is from two weeks it can be acute urticaria. Urticaria uaually comes down in 24 - 48 hours to appear in other areas. These can also be called as hives. Complete blood count along with differential countIgE (immunoglobulin E). Acute urticaria. Anti-pruritic creams like Sarna or Ritch cream. Can use steroid like Mometosone if the itching is persistent over the area. If there are too much of red bumps and itching is not controlled you can use a low dose oral steroid Prednisone 5 mg for a week along with oral antihistaminics Hy ChatDoctor. Take care.

Hello doctor,So for the past couple of weeks, I have been very itchy and will break out in little bumps. I went to the doctor to find out if it was an allergic reaction or something else but they were not very helpful. They prescribed me Desonide for the breakouts. I have been using it but it has not helped with the itching. I also talked to a pharmacist and she asked if I had ever had experience with eczema and I did when I was a baby, but I thought I had grown out of it. She recommended me taking Claritin for the itching and using a moisturizing lotion and to continue using the Desonide. I have been doing this for a couple of days and I am still itching like crazy. I do not know what else to do.

Hello. I have read your query. Profuse itching over your body leading to a little red bumps could be an urticaria or an allergic reaction. Since it is from two weeks it can be acute urticaria. Urticaria uaually comes down in 24 - 48 hours to appear in other areas. These can also be called as hives. Complete blood count along with differential countIgE (immunoglobulin E). Acute urticaria. Anti-pruritic creams like Sarna or Ritch cream. Can use steroid like Mometosone if the itching is persistent over the area. If there are too much of red bumps and itching is not controlled you can use a low dose oral steroid Prednisone 5 mg for a week along with oral antihistaminics Hy ChatDoctor. Take care.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have had pain in my right elbow and shoulder for a couple of weeks. I lift heavy weights and workout every day. I am doing this for many years, so this is nothing new. But, it is agony now to hold the bar in squats. If I am lying on the floor with the elbow at 90 degrees, I cannot put the rest of my arm on the floor. Also, wearing a sports bra, etc., hurts me and I cannot rotate my arm to try and reach my back. When I am sleeping, I tend to wake up with my arms straight out and above my head, since this is the least painful position. The last day, it is also painful to just stand with my arm straight down, feels like something is ripping across from above my sternum to my deltoid. Is there anything you can do to help this? Either exercises or stretches, which one will be helpful? I cannot recall anything happening during a workout as that has caused this. ### Response: Hi. I am glad to respond to your query. 1. Overstraining in the gym.2. Lifting weights that are too heavy for your shoulders and arms.3. In the absence of the above, it may be because of insufficient healing time (rest) after a minor injury. Ultrasound shoulder would be sufficient and can get an MRI if warranted. Pectoralis major muscle strain. Ice application and rest. 1. Prevent any position of the limb that hurts your shoulder. Keep the arm supported.2. Stop visiting the gym for at least three weeks or till the pain subsides and be regular with your medicines.

Hi doctor,I have had pain in my right elbow and shoulder for a couple of weeks. I lift heavy weights and workout every day. I am doing this for many years, so this is nothing new. But, it is agony now to hold the bar in squats. If I am lying on the floor with the elbow at 90 degrees, I cannot put the rest of my arm on the floor. Also, wearing a sports bra, etc., hurts me and I cannot rotate my arm to try and reach my back. When I am sleeping, I tend to wake up with my arms straight out and above my head, since this is the least painful position. The last day, it is also painful to just stand with my arm straight down, feels like something is ripping across from above my sternum to my deltoid. Is there anything you can do to help this? Either exercises or stretches, which one will be helpful? I cannot recall anything happening during a workout as that has caused this.

Hi. I am glad to respond to your query. 1. Overstraining in the gym.2. Lifting weights that are too heavy for your shoulders and arms.3. In the absence of the above, it may be because of insufficient healing time (rest) after a minor injury. Ultrasound shoulder would be sufficient and can get an MRI if warranted. Pectoralis major muscle strain. Ice application and rest. 1. Prevent any position of the limb that hurts your shoulder. Keep the arm supported.2. Stop visiting the gym for at least three weeks or till the pain subsides and be regular with your medicines.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I and my fiancee had intercourse a month back with a condom and also she had an emergency contraceptive pill. I bought it from a medical. They asked her to take it before one hour of intercourse. She had a regular period. Her last period was on 7th of last month but it is 11th of next month now and till now she did not get her periods. She does not want to get pregnant now as she has her exams in a few months. She is doing heavy exercise like cycling, spot jogging, sit ups. And also she has taken two raw papayas, four pineapples and three times ginger syrup. I am sure that condom did not get broken. My doubts are will she get pregnant? Is there really a pill available to be taken before intercourse. Is that pill true? What she can do further to get her periods? Can she take Probers tablet for getting it? ### Response: Hi, Welcome to Chat Doctor forum. Stress plays important role in periods. She might be freaking out with the fear of getting pregnant, with exams on the head causing a delay in her periods. Please consider doing a pregnancy test, most likely, it will be negative, and that will help her relax. Periods will gradually occur. No need to worry. Yes, there are medicines for getting periods, but they might worsen her condition by causing mood swings, as she already has taken an emergency contraceptive. Secondly, emergency contraceptives should be taken within 72 hours of unprotected intercourse, the earlier, the better effect. She has taken it quite early even before intercourse, so chances of pregnancy are nil.

Hello doctor,I and my fiancee had intercourse a month back with a condom and also she had an emergency contraceptive pill. I bought it from a medical. They asked her to take it before one hour of intercourse. She had a regular period. Her last period was on 7th of last month but it is 11th of next month now and till now she did not get her periods. She does not want to get pregnant now as she has her exams in a few months. She is doing heavy exercise like cycling, spot jogging, sit ups. And also she has taken two raw papayas, four pineapples and three times ginger syrup. I am sure that condom did not get broken. My doubts are will she get pregnant? Is there really a pill available to be taken before intercourse. Is that pill true? What she can do further to get her periods? Can she take Probers tablet for getting it?

Hi, Welcome to Chat Doctor forum. Stress plays important role in periods. She might be freaking out with the fear of getting pregnant, with exams on the head causing a delay in her periods. Please consider doing a pregnancy test, most likely, it will be negative, and that will help her relax. Periods will gradually occur. No need to worry. Yes, there are medicines for getting periods, but they might worsen her condition by causing mood swings, as she already has taken an emergency contraceptive. Secondly, emergency contraceptives should be taken within 72 hours of unprotected intercourse, the earlier, the better effect. She has taken it quite early even before intercourse, so chances of pregnancy are nil.

### Instruction: Answer this question truthfully ###Input: Hai... past underwent 3 miscarriages after taking inj.progestrone. 2 were chemical pregnancy and 1 is sac was formed but miscarriage happened. now I am having the pregnancy symptoms my last LMP was on 40 days back. ### Response: Hello, Welcome to ChatDoctor. Based on your obstetric history , it is necessary to evaluate the cause for your recurrent miscarriages. But please don\\t be disheartened if sometimes no cause is found which happens quite a lot of times. Dear, Progesterone injection will never cause miscarriages as progesterone is the hormone that is required for the continuation of pregnancy and act as a support for pregnancy. So the most common causes for recurrent miscarriages can be either Thyroid hormonal abnormalities or impaired blood glucose levels, or sometimes immune causes like APLA syn ChatDoctor. As per your LMP, you are exactly 6wks pregnant today, so try to get a scan to check if this is a viable pregnancy and also for dating and localisation of pregnancy, so that if viable we can start with progesterone support in the form of oral progesterone supplements to sustain this pregancy. Also I have mentioned the blood test that you need to undertake apart from the routine Antenatal investigations to look for any abnormalities I mentioned above. Please do get them done. Please feel free to contact me in case you have any queries. - Blood group and Rh Typing,- Complete hemogram,- Hb Electrophoresis,- Urine routine and microscopy,- LFT/ RFT- 75 g Oral Glucose tolerance test ( in each Trimester).- HbA1c level,- HIV, V

Hai... past underwent 3 miscarriages after taking inj.progestrone. 2 were chemical pregnancy and 1 is sac was formed but miscarriage happened. now I am having the pregnancy symptoms my last LMP was on 40 days back.

Hello, Welcome to ChatDoctor. Based on your obstetric history , it is necessary to evaluate the cause for your recurrent miscarriages. But please don\\t be disheartened if sometimes no cause is found which happens quite a lot of times. Dear, Progesterone injection will never cause miscarriages as progesterone is the hormone that is required for the continuation of pregnancy and act as a support for pregnancy. So the most common causes for recurrent miscarriages can be either Thyroid hormonal abnormalities or impaired blood glucose levels, or sometimes immune causes like APLA syn ChatDoctor. As per your LMP, you are exactly 6wks pregnant today, so try to get a scan to check if this is a viable pregnancy and also for dating and localisation of pregnancy, so that if viable we can start with progesterone support in the form of oral progesterone supplements to sustain this pregancy. Also I have mentioned the blood test that you need to undertake apart from the routine Antenatal investigations to look for any abnormalities I mentioned above. Please do get them done. Please feel free to contact me in case you have any queries. - Blood group and Rh Typing,- Complete hemogram,- Hb Electrophoresis,- Urine routine and microscopy,- LFT/ RFT- 75 g Oral Glucose tolerance test ( in each Trimester).- HbA1c level,- HIV, V

### Instruction: Answer this question truthfully ###Input: Hello doctor,For the past two months, my 89-year-old husband is suffering from a painful, burning, and itchy skin disease. He has been seen by his family doctor and two trips to the emergency. At first, thought to be shingles and later pruritis. The painful episodes happen at night and early morning. I cool it down with oatmeal compresses and Gold Bond anti-itch lotion. It goes from a 10 down to a two. Sometimes it does not appear for a week and it is back again. The only medication he is on is Coumadin. He is and always has been a non-drinker and non-smoker. He has dementia but, only at night. Our environment is scent free, no chemicals and soap and laundry soap are hypoallergenic. What can this be, is it part of ageing? ### Response: Hi. From your history and description, the most common possibilities are urticaria or peripheral small fiber neuropathy. Shingles is a one-time episode and are usually localized. The complaints do not appear to be related to external factors such as scent or environment. With aging, a lot of degenerative changes set it. These processes could affect even the tiny neurons in the skin resulting in repeated episodes of itching and burning. Antihistamines, oatmeal bath and compresses could help to some extent. However, an addition of ChatDoctor. Do let us know if he is a diabetic, he is known to have vitamin B12 deficiency and any other comorbidities. Please upload appropriate images of any skin lesions if present. For more information consult a dermatologist online Take care.

Hello doctor,For the past two months, my 89-year-old husband is suffering from a painful, burning, and itchy skin disease. He has been seen by his family doctor and two trips to the emergency. At first, thought to be shingles and later pruritis. The painful episodes happen at night and early morning. I cool it down with oatmeal compresses and Gold Bond anti-itch lotion. It goes from a 10 down to a two. Sometimes it does not appear for a week and it is back again. The only medication he is on is Coumadin. He is and always has been a non-drinker and non-smoker. He has dementia but, only at night. Our environment is scent free, no chemicals and soap and laundry soap are hypoallergenic. What can this be, is it part of ageing?

Hi. From your history and description, the most common possibilities are urticaria or peripheral small fiber neuropathy. Shingles is a one-time episode and are usually localized. The complaints do not appear to be related to external factors such as scent or environment. With aging, a lot of degenerative changes set it. These processes could affect even the tiny neurons in the skin resulting in repeated episodes of itching and burning. Antihistamines, oatmeal bath and compresses could help to some extent. However, an addition of ChatDoctor. Do let us know if he is a diabetic, he is known to have vitamin B12 deficiency and any other comorbidities. Please upload appropriate images of any skin lesions if present. For more information consult a dermatologist online Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I recently had my annual exam done and have some odd results. Vitamin B12 was over 2000 ng/ml ref range was 200 to 1100. I do not take any b12 or multivitamins. Globulin was 1.8 g/dl ref range 1.9 to 3.7. Albumin/globulin ratio 2.7 range was 1.0 to 2.5. AST 41 u/l ref range was 10 to 40. ALT 83 u/l ref range 9 to 46. Hemoglobin 17.4 g/dl ref range from 13.2 to 17.1. Is this a serious sign of something wrong? I have noticed. I do not feel that great these days. My doctor has put me into getting an ultrasound on my abdomen. ### Response: Hello, Welcome to Chat Doctor forum. Your B12 level is very high. Liver disease, kidney disease, myeloproliferative blood neoplasm, etc., are some of the causes for elevated B12. Your ALT (alanine transaminase) is high, so for liver disease do further work up in form of USG abdomen and viral marker study. Your hemoglobin is mildly high, the proper workup should be done for that in form of full CBC and peripheral smear examination. Also check serum urea, creatinine for checking kidney profile. Investigate with these reports for primary work up. We can discuss further if needed then. For more information consult a hematologist online

Hello doctor,I recently had my annual exam done and have some odd results. Vitamin B12 was over 2000 ng/ml ref range was 200 to 1100. I do not take any b12 or multivitamins. Globulin was 1.8 g/dl ref range 1.9 to 3.7. Albumin/globulin ratio 2.7 range was 1.0 to 2.5. AST 41 u/l ref range was 10 to 40. ALT 83 u/l ref range 9 to 46. Hemoglobin 17.4 g/dl ref range from 13.2 to 17.1. Is this a serious sign of something wrong? I have noticed. I do not feel that great these days. My doctor has put me into getting an ultrasound on my abdomen.

Hello, Welcome to Chat Doctor forum. Your B12 level is very high. Liver disease, kidney disease, myeloproliferative blood neoplasm, etc., are some of the causes for elevated B12. Your ALT (alanine transaminase) is high, so for liver disease do further work up in form of USG abdomen and viral marker study. Your hemoglobin is mildly high, the proper workup should be done for that in form of full CBC and peripheral smear examination. Also check serum urea, creatinine for checking kidney profile. Investigate with these reports for primary work up. We can discuss further if needed then. For more information consult a hematologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have taken a pregnancy test a few days ago and it turned out to be positive. I took two tests, just to make sure and they both were positive. I was supposed to have my period on March 29, but conception happened on March 14 and the first day of my last period was February 29. I do not feel any changes at all, is it possible that that may not be true at all? Or the tests I took were not accurate? If I got my period this April 29, what does it even mean since I already missed my supposedly period on March 29?I am currently taking Myra e and Poten cee. ### Response: Hello. As you checked twice for urine pregnancy test and it turned out positive, it implies you have been pregnant. It is not necessary that everyone experiences nausea and vomitings or early signs of pregnancy similarly, some may not feel any symptoms, or some have mild symptoms. The urine HCG (human chorionic gonadotropin) tests are definitely an accurate way for testing pregnancy, rather than just relying on symptoms and they cannot be wrong as you had missed your periods too, and it tested positive twice. And if you are pregnant, you would not be even getting your periods again this April too. It would be advisable to get an ultrasound to confirm the pregnancy if in doubt, the site (intra or extra uterine), the gestational age, and the fetal viability. Also, you can start using Folic acid tablets. Routine antenatal investigation. Tablet Folic Acid 5 mg daily. Avoid sexual intercourse in the first three months.

Hello doctor,I have taken a pregnancy test a few days ago and it turned out to be positive. I took two tests, just to make sure and they both were positive. I was supposed to have my period on March 29, but conception happened on March 14 and the first day of my last period was February 29. I do not feel any changes at all, is it possible that that may not be true at all? Or the tests I took were not accurate? If I got my period this April 29, what does it even mean since I already missed my supposedly period on March 29?I am currently taking Myra e and Poten cee.

Hello. As you checked twice for urine pregnancy test and it turned out positive, it implies you have been pregnant. It is not necessary that everyone experiences nausea and vomitings or early signs of pregnancy similarly, some may not feel any symptoms, or some have mild symptoms. The urine HCG (human chorionic gonadotropin) tests are definitely an accurate way for testing pregnancy, rather than just relying on symptoms and they cannot be wrong as you had missed your periods too, and it tested positive twice. And if you are pregnant, you would not be even getting your periods again this April too. It would be advisable to get an ultrasound to confirm the pregnancy if in doubt, the site (intra or extra uterine), the gestational age, and the fetal viability. Also, you can start using Folic acid tablets. Routine antenatal investigation. Tablet Folic Acid 5 mg daily. Avoid sexual intercourse in the first three months.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am an 18 year old female, and I am not on any medications. I am 5 feet 4 inches tall, and I weigh 133 pounds. About 3 to 4 days ago after having a bowel movement, I noticed a little bit of bright red blood on the toilet paper, and my anus was bleeding a little bit for the next minute or so and then it stopped. The next day, I had another bowel movement, and there was a lot less blood on the toilet paper than the day before. The next day it was completely gone. For the next two days, I did not have any bleeding. But yesterday, the bleeding was back except there was a lot more of it had dripped into the toilet. It went away shortly. The same thing happened today. I do not have any pain, constipation, diarrhea, weight loss, fatigue, or nausea. The only other symptom besides the bleeding is that the outer part of my anus feels irritated after I pass stools. ### Response: Hello. You need to get your stool examined for the possibility of parasites which can cause such local irritation. Also, malabsorption of certain compounds in food can lead to local irritation after passing stools. Fresh bleeding is possible if the stools are hard, but there is no such history in your case. I will advise you the following medicines for a week, and if it still does not resolve, please get yourself examined by your physician. Consult your specialist doctor, discuss with him or her and start taking the medicines after their consent. ChatDoctor. If the bleeding is persistent, please get yourself examined.

Hello doctor,I am an 18 year old female, and I am not on any medications. I am 5 feet 4 inches tall, and I weigh 133 pounds. About 3 to 4 days ago after having a bowel movement, I noticed a little bit of bright red blood on the toilet paper, and my anus was bleeding a little bit for the next minute or so and then it stopped. The next day, I had another bowel movement, and there was a lot less blood on the toilet paper than the day before. The next day it was completely gone. For the next two days, I did not have any bleeding. But yesterday, the bleeding was back except there was a lot more of it had dripped into the toilet. It went away shortly. The same thing happened today. I do not have any pain, constipation, diarrhea, weight loss, fatigue, or nausea. The only other symptom besides the bleeding is that the outer part of my anus feels irritated after I pass stools.

Hello. You need to get your stool examined for the possibility of parasites which can cause such local irritation. Also, malabsorption of certain compounds in food can lead to local irritation after passing stools. Fresh bleeding is possible if the stools are hard, but there is no such history in your case. I will advise you the following medicines for a week, and if it still does not resolve, please get yourself examined by your physician. Consult your specialist doctor, discuss with him or her and start taking the medicines after their consent. ChatDoctor. If the bleeding is persistent, please get yourself examined.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 34 year old male, who weighs 82 kg. I am suffering from a bipolar affective disorder (BPAD), and have been advised to take Magnesium valproate 400 mg twice daily and Amisulpride 100 mg at bedtime. I am also taking Etizolam 0.25 mg in the morning and 0.5 mg at night, from two weeks, as advised by my psychiatrist. But, recently I feel short of breath while trying to sleep, I cannot sleep properly because of this. My sexual life is also not pleasurable anymore, and it has become just like a routine work. I do not feel joy after ejaculations. My head feels heavy, and I have vertigo problem, I feel as if I will fall while walking. Kindly help me get rid of these problems. ### Response: Hi, Welcome to Chat Doctor forum. The symptoms like shortness of breath, poor sleep and loss of sexual pleasure are all the side effects of the medicines that you take for bipolar disorder. I will not suggest stopping these medications, but it will be better to take few medications with effective doses. Divalproex sodium 500 mg twice daily, will be better molecule than Sodium valproate as a mood stabiliser. If you are having palpitations, Propranolol or mouth dissolving Clonazepam will be a better substitute. Counselling with a good psychologist will help you along with medications. I suggest you visit your psychiatrist for above changes in medications. I am sure you will be completely fine with the instructions as mentioned above. For more information consult a psychiatrist online

Hi doctor,I am a 34 year old male, who weighs 82 kg. I am suffering from a bipolar affective disorder (BPAD), and have been advised to take Magnesium valproate 400 mg twice daily and Amisulpride 100 mg at bedtime. I am also taking Etizolam 0.25 mg in the morning and 0.5 mg at night, from two weeks, as advised by my psychiatrist. But, recently I feel short of breath while trying to sleep, I cannot sleep properly because of this. My sexual life is also not pleasurable anymore, and it has become just like a routine work. I do not feel joy after ejaculations. My head feels heavy, and I have vertigo problem, I feel as if I will fall while walking. Kindly help me get rid of these problems.

Hi, Welcome to Chat Doctor forum. The symptoms like shortness of breath, poor sleep and loss of sexual pleasure are all the side effects of the medicines that you take for bipolar disorder. I will not suggest stopping these medications, but it will be better to take few medications with effective doses. Divalproex sodium 500 mg twice daily, will be better molecule than Sodium valproate as a mood stabiliser. If you are having palpitations, Propranolol or mouth dissolving Clonazepam will be a better substitute. Counselling with a good psychologist will help you along with medications. I suggest you visit your psychiatrist for above changes in medications. I am sure you will be completely fine with the instructions as mentioned above. For more information consult a psychiatrist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have been diagnosed with mild hereditary spherocytosis. My eyes still yellow. Is it unlikely hematologist who diagnosed me three years ago misdiagnosed? I do not doubt he knows his stuff. More about me getting worried. I lost weight a couple of months ago. I went very yellow in the eyes. I have always felt tired. I have had gallbladder out four years ago, I bruise easily, I do get little red skin dots at times, menstrual cycles can be irregular and spleen slightly enlarged. ### Response: Hello, Welcome to Chat Doctor forum. I have gone through your lab reports (attachment removed to protect patient identity) and they are consistent with the diagnosis made by your doctor.Yellowish tint of the eyes is due to increased bilirubin levels. This is due to the increased red blood cell destruction in the spleen and is commonly a complication of hereditary spherocytosis. It is understandable that you are feeling weak since your body is producing red blood cells at an accelerated rate to compensate for the destruction occurring in the spleen. This is also the reason why your spleen is enlarged. If your condition worsens, your doctor might suggest a splenectomy. This will not cure the condition but will relieve the symptoms since the site of destruction of red blood cells will be removed and your red blood cells will be able to survive for a longer period in the blood. Splenectomy, however, can predispose one to certain bacterial infections and it is important that you receive the appropriate vaccines regularly. You could take folic acid and vitamin B12 supplements since one of your blood tests show macrocytic anemia. For more information consult a hematologist online

Hello doctor,I have been diagnosed with mild hereditary spherocytosis. My eyes still yellow. Is it unlikely hematologist who diagnosed me three years ago misdiagnosed? I do not doubt he knows his stuff. More about me getting worried. I lost weight a couple of months ago. I went very yellow in the eyes. I have always felt tired. I have had gallbladder out four years ago, I bruise easily, I do get little red skin dots at times, menstrual cycles can be irregular and spleen slightly enlarged.

Hello, Welcome to Chat Doctor forum. I have gone through your lab reports (attachment removed to protect patient identity) and they are consistent with the diagnosis made by your doctor.Yellowish tint of the eyes is due to increased bilirubin levels. This is due to the increased red blood cell destruction in the spleen and is commonly a complication of hereditary spherocytosis. It is understandable that you are feeling weak since your body is producing red blood cells at an accelerated rate to compensate for the destruction occurring in the spleen. This is also the reason why your spleen is enlarged. If your condition worsens, your doctor might suggest a splenectomy. This will not cure the condition but will relieve the symptoms since the site of destruction of red blood cells will be removed and your red blood cells will be able to survive for a longer period in the blood. Splenectomy, however, can predispose one to certain bacterial infections and it is important that you receive the appropriate vaccines regularly. You could take folic acid and vitamin B12 supplements since one of your blood tests show macrocytic anemia. For more information consult a hematologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My period was delayed. I had a pregnancy check which was positive. I consulted a gynecologist since I did not want a baby and hence decided to go for medical abortion (as my son is just 12 months). She prescribed me with medicine and after 48 hours she had asked me to place 4 medicines in my genitals before going to bed. My menstrual cycle started the very next morning and continued for 3 days. After 15 days, she had called me for an ultrasound to examine whether all was done perfectly. I had an ultrasound scan (reports attached).The doctor said that it has not come out completely and therefore prescribed medicine (prescription attached). She gave me two medicines to place in my genitals. Next morning, I had very less bleeding which gradually stopped at night. Doctor, I am very much confused as to what is happening. In no case, I want a medical abortion. Please suggest as to what should I do so that all gets fine. ### Response: Hello. I can understand your concerns. I have gone through your history and ultrasound scan and it is showing that the abortion is incomplete and there are a retained products of conception in the uterine cavity. (attachment removed to protect patient identity) Your doctor had given Cytolog (Misoprostol) to clear that product. As you had only minimal bleeding, the chances of retained products are there, so you can repeat your ultrasound scan. If it is still present, then you should consult a gynecologist and get D&C (Dilatation and Curettage) done to clear the retained products of conception. Take care.

Hello doctor,My period was delayed. I had a pregnancy check which was positive. I consulted a gynecologist since I did not want a baby and hence decided to go for medical abortion (as my son is just 12 months). She prescribed me with medicine and after 48 hours she had asked me to place 4 medicines in my genitals before going to bed. My menstrual cycle started the very next morning and continued for 3 days. After 15 days, she had called me for an ultrasound to examine whether all was done perfectly. I had an ultrasound scan (reports attached).The doctor said that it has not come out completely and therefore prescribed medicine (prescription attached). She gave me two medicines to place in my genitals. Next morning, I had very less bleeding which gradually stopped at night. Doctor, I am very much confused as to what is happening. In no case, I want a medical abortion. Please suggest as to what should I do so that all gets fine.

Hello. I can understand your concerns. I have gone through your history and ultrasound scan and it is showing that the abortion is incomplete and there are a retained products of conception in the uterine cavity. (attachment removed to protect patient identity) Your doctor had given Cytolog (Misoprostol) to clear that product. As you had only minimal bleeding, the chances of retained products are there, so you can repeat your ultrasound scan. If it is still present, then you should consult a gynecologist and get D&C (Dilatation and Curettage) done to clear the retained products of conception. Take care.