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###Input :I'm(M17) 176cm(5'9) and 48kg(105 lb), my BMI is 15.5 and I'm REALLY skinny, everytime somebody sees me they get either scared or concerned, and at the beginning i said i was fine but now I really feel like I need help. We contacted many different doctors in my city(I live in Italy) and nobody knows what my problem is.. we(my family and I) did many exams looking for problems with metabolism and we got nothing, we were thinking to get my self hospitalized (as you know, it's free in Italy xD) but they asked us a kind of "hint" of what medical department(like "cardiology" i don't know if it's correct in English) i should go in, and our doctor told us he'd inform himself but didn't tell us anything.So my questions are, what could be my problem, what department should I get hospitalized in and in general what should I do?Any answer is appreciated and I'll try to answer every question ###Output :"You're not eating enough food" is the answer about 98% of the time.

###Input :Add a couple of glasses of sustagen/ensure and a few spoonfuls of peanut butter to your daily intake (in addition to everything you already eat), if you still havent gained any weight after a few months then I would see a gastroenterologist to check for malabsorption.Well, I'm not the 98% I eat enought I'm quantity and i get all the nutrients i would need, yet i can't gain any weight nor muscle. We've been struggling with his problem for a while and it's getting always worse.. i grew 10cm in about 1 year and a half while not gaining any weight, i actually lost weight. I get it that many people jump to that conclusion, but I'm 100% sure it's not that ###Output :How many calories per day are you eating?What brand of food scale are you using?

###Input :Don't know exactly, but I can estimate about 2.6k calories a day, altough some days it may be Less and some a lot more ###Output :Also, you can't say it's "100% not that" when you haven't ever measured your calorie intake.It's like saying your checking account is getting lower and lower and you don't know why, but you've also not looked at the math for your income vs. expenditures."You're not earning enough money for how much you spend."Nah, can't be that! I'm certain."Have you actually looked at you budget?"Nope.Unless you have some malabsorption disorder where you can't absorb nutrients (these people have constant diarrhea, gas, belly pain, and even oil in their stool), you just aren't eating enough calories.That's not enough.Young men, especially active young men, typically need 3,000-4,000 kcal to gain weight.Anything in the low or mid 2,000s isn't going to cause weight gain.This isn't a medical mystery. Eat more food and workout. You need r/gainit, not an inpatient stay (assuming no eating disorder).

###Input :Yes, but I don't think it should cause this much weight loss either, as well as the fast loss of muscle.I'll try eating even more as you told me.. even tho I'm still skeptical about it, as me and my brother eat pretty much the same things yet he's alright(skinny but not on the same level as me) ###Output :That's literally the only answer. If you've been evaluated for metabolic disorders, malignancy, etc, the only thing that will make you gain weight is eating more calories.Even moreTo clarify, mid 2,000s is not a lot of food for a teenage boy. If that's an accurate estimate at all, is not surprising you're not gaining weight. You're not eating a lot to start with.Eating the same amount of food won't make you gain weightEating less food won't make you gain weight.You must eat more food.

###Input :If I feel heart flutters about once a day, and cardiology tests come back normal, at what point do I need a medicine to prevent strokes? In other words, when, if ever, would it be time to go on Plavix or Eliquis?(Female, 55, no drugs, overweight, normal blood pressure, normal cholesterol) ###Output :The sensation of flutters versus having atrial flutter / fibrillation is different. Unless you actually were diagnosed with it, you do not need medicine for stroke prevention.

###Input :35F, 145lbs, 511 dont smoke, drink rarely. Generally consider myself healthy, however mid last year I underwent double jaw surgery and have since not taken part in any form of exercise and feel very unfit, but I still eat a well balance diet for the most part!After surgery however I lost over 20lbs in around 2 months and then gained it all back in the following 4 I had a hard time psychologically during recovery for a plethora of varied reasons and also unexpectedly became a carer for a relative who developed dementia whilst I was still recovering, this took a toll on mental health and I fell into a bit of a depression, I was prescribed Sertraline 50mg in late September 2022 however my mental health has VASTLY improved, it is my physical health that is bothersome.I also have a history of IBS and GERD (diagnosed over 10 years ago so is my normal but has slowly gotten a little worse over time).I reached out with no urgency to doctors for a health check as my generally sense of physical health felt at an all time low. I wanted to reassess IBS and GERD with focus on regular urgent diarrhoea (occasionally up to 6x a day), and regular nausea. Additionally I find myself easily very short of breath, dizzy and nauseous, and ultimately I feel weak. The disconcerting feeling this brings means I avoid any physical activity (historically I have enjoyed being more active). I noted that my heart rate has been falling lower and lower in the last 8 months since surgery and I am not physically fit at the moment. I feel slow. Maybe I am just getting old I was given a battery of tests and most of my bloods are generally fine, I have some deficiencies eg. Folate (which I queried as I dont drink and enjoy my greens) but was advised that some people are built different and need more vits or nutrients than others and I just need to take supplements I assume this may cause some of my symptoms such as diarrhoea?I also had a 24hr Holter monitor and results came through yesterday. I havent seen them but doc noted 357 counts of bradycardia with lows of 37bpm. Coupled with my nausea and dizziness, I have an urgent referral to cardiology (although that still means in 3 months).However when I read up on Bradycardia, it doesnt seem to be a concerning issue? I dont have the full results but is it only the coupling of my nausea etc that makes it more concerning. Unsure if relevant, but despite low heart rate I often have slightly high blood pressure.Tldr: is bradycardia with nausea and dizziness worthy of urgent cardiology referral? Can heart issues cause additional symptoms such as regular diarrhoea?Also not sure if relevant, but I had a persistent rash and redness and deep itch in left breast for last 2 months, ultrasound shows I have lots of benign cysts and a fibroadenoma, they (radiologist and consultant) seemed unconcerned but did biopsy due to my age and I will get results soon, the lack of concern from consultant means I have little concern also (my mother has fibroadenomas that have never caused any issues), but thought I would add everything that ails me! Ha! In case there is some magical connection to it all.Thanks! ###Output :What is your normal heart rate? Was it sinus bradycardia? How long were these episodes in duration?. Also would be helpful to know any medications other than the SSRI and whether you have sleep apnea, have had Lyme or chagas disease or are hypothyroid.To he honest I would also be surprised if it is sinus bradycardia that it is causing your symptoms rather than vice versa. Nausea and bowel movements are an excellent way to temporarily lower your heart rate. Most often it is just a normal variant, and if it is sinus bradycardia almost never requires a pacemaker. Wouldnt get too overwrought.The downside is i there is no magical connection here to any issue other than maybe being a symptom of nausea, which isnt that magical.

###Input :Thanks for response! I take no other medication, however I did take antibiotics and omeprazole briefly post surgery last year. I cannot see the detailed results, ###Output :okay then what i said above i guess.

###Input :I have zero other health issue than those noted in my post, when I was very young I had migraines and I have always had dodgy joints (again Im getting older and runs in the family) and that is about it.I have never had any ailments you noted. When first diagnosed with IBS I was given lansoprazole in case I had an ulcer. But generally I have been in good health most of my life and taken little medication. Its just a bit cloudy all at once now I have reached my mid 30s Blood tests historically are fine only regular things to note: I consistently have high bilirubin in liver blood tests but as the rest are fine this is usually noted as Gilberts syndrome? And again, not an issue. Cholesterol is teetering on high side but still currently in normal range. High but normal MCV in last few blood tests (~100)Im more concerned that I am not in need of an urgent referral and wasting time? But secondarily would like to know why I feel so rotten, and if it could relate to heart at all? It would be great if I could actually see the results and notes - I should call and ask for them and see if they will share! ###Output :I suspect that this is not cardiac related and it is incidental. But with your symptom of dizziness and bradycardia and your GP's concern followup is prudent and not a waste of time. "urgent" and "three months" don't seem to belong together.You certainly have symptomatic gastrointestinal disease, diagnosed IBS but some of the symptoms sounds like gastroparesis. I would continue to followup with gastroenterology for workup and treatment.

###Input :Hey guys,Today I had a pulmonary function test performed and results are mostly normal, which I expected. The only abnormal result is my FEF25-75%. The final value was 2.04, 64% of the expected reference value.I didn't have a bronchio dilator test performed due to palpitations, which I take beta-blockers for. Still being studied in cardiology.I didn't expect much to come out of this, because my GP suspects it might be exercise induced asthma. I wasn't feeling particularly bad when I had the test performed either.I experience chest tightness, wheezing, sob, air-way burning feeling and it hurts when I try to take a deep breathe. If I talk too much or laugh, I also get chest pain and cough.I have been prescribed Atrovent/Ipratropium bromide and it's so far the only thing that has helped me. It has taken me from barely being able to walk 40-50min, to walking 40-90min (usually 40-60) depending on the day without collapsing. ###Output :The FEF25-75 is the forced expiratory flow throughout the middle of your expiration. When we fully exhale our lungs are left with some air leftover (called residual volume, or RV on your PFT). This RV is there because as we exhale our small airways close down as the intrathoracic pressure rises above the intra-bronchiolar pressure -- it's a normal part of expiration. A lower FEF25-75 is thought to reflect early small airway closure, which could be a component of asthma (as asthma affects small airways).You'll notice I use a bunch of hedgy language (lots of "could" and "thought to"). PFT guidelines recommend against using FEF25-75 to diagnose or treat anything. The data just isn't very strong. The American Thoracic Society recommends not even putting the FEF25-75 on the PFT report. All that said, the FEF25-75 isn't entirely worthless, it just has to be interpreted with caution. If you have the right symptoms, a reduced FEF25-75, and a positive clinical response to bronchodilators it can be very reasonable to suspect asthma.If you have a great response to the inhaler, great, there's your answer. If not, it would be a reasonable time to seek an evaluation by a pulmonologist. Your goal should be feeling normal. All-too-often asthmatics will talk about having daily symptoms, which is a real shame. They either need more aggressive treatment or a different diagnosis altogether.

###Input :23F, 51 and 115 pounds, Asian. depression, anxiety, ptsd, adhd, taking 20mg adderall, 57.5mg paroxetine, 50mg welbutrin. i drank weekly in college but since ive left, i barely have. no weed either.I crashed my car a while back into a pole, but I have no idea how it happened - my memory is blank from me just driving on the road to me being in front of a pole, where i tried to break before i crashed. i dont know why theres a gap in the memory, but my pcp is suggesting i may have passed out or have had absence seizures, but she feels its neurological and not cardiological which is why Im seeing a neurologist in a week. i am just wondering if there are any ideas of what it could be / if i have any disorder. i know i didnt fall asleep as i have a pretty routine sleep schedule, but i just want any ideas of what could have happened to soothe my nerves. the car crash left me with a broken ankle and a friction burn, but nothing else. thank you in advance. ###Output :You need to be evaluated for potential seizures - that's why you're scheduled to see a neurologist. If nothing found there, probably worth getting some kind of cardiac workup.

###Input :Age: 28Sex: Non-binary/Female (she/they with a uterus)Height: 59Weight: 145Race: White/EuropeanDuration of complaint: N/A, 3-weeksLocation: New England USAAny existing relevant medical issues: Depression and anxietyCurrent medications: Wellbutrin (daily 150mg), Xanax (as needed, usually ~0.25mg/month)Hi Docs,This is a question about my spouse (she/they) in their late 20s and physically healthy. She has a panic disorder thats especially bad in medical settingse.g., took 0.5mg Xanax before their recent echocardiogram, but was still hyperventilating and crying throughout.Three weeks ago she was having some chest tightness, which we thought was from a workout we did the prior day, but wanted to go to urgent care just in case. Urgent care gave her an EKG (her first one), which had an inverted T wave in one lead (EditI think it was actually in two leads, EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally.). Along with the tachycardia (which always happens in medical offices, but goes back down to ~70bpm after) and they sent us (in our car, not ambulance) to the ER.ER did blood panel CBC/diff, some hormones, D-dimer in case clot, etc, all looked normal except for neutrophils at 82% (reference 48-76), then checked for fluid in the heart cavity with an ultrasound. ER wasnt concerned and sent us home with a cardiology f/u.Cardiology NP was worried about potential inflammation (e.g. myocarditis, as Ive heard has been a more common than usual in young women lately from covid, which we dont think weve had yet) so did an echo and a few more blood tests, including a sediment test, all of which looked normal.No chest pain or tightness or swelling other complaints since the ER incident.I dont have the full EKG, but herere the values they released to us from one lead:PR interval: 123ms QRS: 78ms QT: 318ms QTC: 443ms P Axis: 65 degrees R Axis: 69 degrees T Axis: -4 axis (was -36 at previous visit)Cardiology NP is concerned about the inverted T wave and wanted a cardiac MRI after the echocardiogram, but to me the T wave seems like an unconcerning variation in the absence of other symptoms. If I was the patient Id be fine with the MRI but, given how psychologically difficult an MRI would be for my spouse, Im not sure its necessary and want to encourage her to talk to her primary care doctor about her options.Based on the (of course incomplete) picture Im giving here, does my interpretation sound reasonable, or am I missing something?Thank you! ###Output :Inverted T-waves in V1 and V2 are normal.

###Input :Thank you! Yeah I just went back into the ER notes to check. It looks like it was two leads, not sure which ones (Thinking back, I think they circled the top right cornerlead 4?)From the ER Chart: EKG reveals sinus tachycardia at a rate of 117, T wave inversions inferiorly and laterally. ###Output :Would need to be able to see the EKG to tell more info.Are they still having symptoms?Could provide more info with: Troponin lab value D dimer lab Echo report

###Input :Thanks for the responseAh, that makes sensebummer that they dont provide the full EKG, I shouldve taken a picture. Ill update this post if I somehow get it.Theyre not having any symptoms anymore, aside from the anxiety.Troponin is <6 ng/L. D-dimer is <270 ng/mL.Echo summary: The left ventricular cavity size and wall thickness are normal. Left ventricular systolic function is normal. There are no segmental left ventricular wall motion abnormalities noted. The estimated ejection fraction is 60% The right ventricular size is normal. The right ventricular systolic function is normal. Normal valve structure and function.Reason for exam: eval in ED with CP x 4 days, EKG showed TWI inferolateral leads, trop <6, Dimer wnl, no history of Covid. Persistent tachycardia. Abnormal EKG Palpitations ###Output :Thank you. So labs and the echo are normal. TWI is not an indication for cardiac MRI. TWI in inferolateral leads can even be due to things like lead misplacement.I think it would be in your partners best interest to ask the ordering NP how the cardiac MRI would impact their care. If it's positive for myocarditis, what will they do to treat it? (The answer is probably nothing). If it is negative for myocarditis, what will they do to treat it? (Also nothing) Secondly, it could be in their best interest to discuss this test and their care with a physician.Gotta give you a disclaimer: My assessment and recommendations are based on the information provided and I have not seen the EKG, taken a history from the patient, or performed a physical exam. I don't want to sow mistrust and am not attempting to disagree with other medical personnel, since the ordering NP has performed all of these assessments.

###Input :40M, 5'10", 210 lbs, Caucasian, California.5mg Bisoprolol for arrhythmia, 160mg fenofibrate for high trigs, 300mg gapapentin for chronic thoracic spinal painHello. I'll try to keep this as short as possible as I know you're all busy.TL:DR - https://imgur.com/a/m5lprmBWondering if anyone can offer an opinion on this ECG from my implanted loop recorder. The loop recorder was inserted 1.5 years ago to investigate a an episode of sustained arrhythmia + syncope. I have a history of AVRT (ablated in 2006, possibly WPW, but that wasn't made fully clear to me). It seems something didn't go quite right during the ablation and the AVRT was eliminated but I developed frequent PVCs that were not present before the procedure. I have some documented NSVT from holter monitors and 30 day loop recorders over the past 10 years.My loop recorder seems to not be programmed to detect much of anything on its own. I think I would have to literally be in v-fib for it to automatically flag an event for review. After about a year of it literally capturing nothing despite having symptoms, I requested a patient trigger device that I can use to force the device to record and upload an event. Since I have started using the trigger, I have been able to capture several episodes such as this: https://imgur.com/a/m5lprmBWhen I look at this, my untrained sees a salvo of PVCs, which I guess technically defines NSVT. I have asked my doctor for an opinion on these events and every time his response is basically "Doesn't look like anything to me".What he doesn't seem to understand or appreciate is I find these episodes to be physically very uncomfortable and honestly, highly distressing, like hand over heart, feeling like I'm going to die sort of vibes. I admit that's probably a bit dramatic and an overreaction, but my cardiac history and long road to a diagnosis has trained me to think this way. Additionally, I am dealing with Kaiser Permanente in California and unfortunately, they have a rather abysmal reputation for cardiology and electrophysiology is basically non-existent.I realize there's people out there that have PVCs and other palpitations and barely notice them, but for some reason when I experience them, its like I'm getting punched in the chest.My hope is that someone out there can give me a reason why I should NOT be worried about these events. My doctor seems to be very, very, unconcerned by them, and maybe he's right to think that, but an explanation would be nice and if there's a way to be less frightened by these episodes, I think that should be considered therapeutic and part of the plan for care in this situation.Thanks for reading. ###Output :So first things first I dont see clear P waves and you seem to be slightly irregular. Do you have a history of AFib? Secondly the beats that you point out are wide but also irregular. This makes it less likely that they are PVCs/NSVT and more likely to be AFib with aberrant conduction if you have AFib to begin with. Since you have AVRT and have had ablation, its not unusual to have some aberrancy when the rate changes since you have an abnormal electrical conduction system thats also been burned. While this isnt life threatening in any way, increasing your bisoprolol dose would probably help keep the rates better controlled and decrease your symptoms. You can also get a cardioversion/ablation if you are actually in AFib

###Input :No history of AFib.I think the lack of visible p waves may have more to do with how the ecg is rendered with this recorder (very small), plus this is a screenshot of the report's summary, so maybe the actual report renders the morphology with better detail (I don't ever have access to that). For comparison, I have a 6 lead Kardia ecg device that is much clearer and shows clear p waves.This isn't the first time I've gotten a recommendation to increase the bisoprolol dosage but im a bit concerned about the long term side effects of that. I've already been on it for over a decade and I'm 40 now. However, after this recent episode, I think it's probably best for my sanity.Follow-up question. Does your opinion change knowing that I have never been diagnosed with afib, despite several doctors reviewing my strips in the past? ###Output :I think the answer no matter what is to increase bisoprolol.

###Input :Now I am off them in the past few weeks I have noticed mild chest pain and fluid retention in my legs. I have always carried weight in my legs but recently I have been needing to pee quickly after lying down at night. I can speed the process up by lying on the ground and putting my legs up against the wall to let it drain down them. I always get a lot of fluid when I pee when I do this, lots more that I should do. I know fluid retention can be dangerous with heart problems and Im getting quite concerned. I have a GP phone appointment next Friday but Im concerned Im not pushing for the right things fast enough.I also suffer from what I have always assumed was IBSI have been tested for Celiac, thyroid problems, absorption levels and all the standard things you would be tested for on the NHSI know that the heart problems could be caused by the low levels in my blood, but what is causing my levels to be low in the first place. Im really worried and really at a loss. Thanks ###Output :The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication.

###Input :The history isnt convincing for anything heart failure related causing your fluid retention.What is far more likely is that its a side effect of your contraceptive pill. Fluid retention is listed as a common or very common side effect of your particular medication. ###Output :Often, but not always. Your physiology changes over time so sometimes you may start to see side effects that you previously didnt.

###Input :Cross from /AskCardiologyDetails to previously deleted post, dad had heart attack but refuses medical adviceI previously posted and deleted due to lack of details. My dad (56M) had a cardiac event two weeks ago that he refused to explain. Yesterday he invited me to dinner to explain his situation. He looks TERRIBLE, he is gray with the blackest bags under his eyes. He explained he was working out and suddenly had SVT bad enough to where he lost feeling in his body, his left arm turned blue and he collapsed (didnt lose consciousness) and couldnt get up for a couple hours. As a nurse, he 100% believes he had a heart attack. He stated he has been feeling ill for 6 months, had this event, and has not felt normal since. His cholesterol and triglycerides are insanely high and he knows he has hereditary atherosclerosis. He is very anti-doctor/pharmaceutical and is relying on a diet of nitrous oxide-rich foods and Willow bark to clear is arteries of plaque. He looks like a corpse and Im afraid he will die soon without medical attention. If he did have a heart attack, whats his outlook without treatment?Edit: he is not on any medications, works out twice a day, his father had triple bypass at 70. ###Output :Ok man, I'll be pretty straightforward - lack of attention to this could kill your father.The thing you worry about after a heart attack is that part of the heart muscle doesn't work well. You can get heart failure pretty easily when one wall of the heart isn't contracting. If he looks bad to you, keep gently encouraging him to get checked out. Use words like "I'm worried about you" and "I don't want to lose you." Don't push. Encourage and focus on your concern for him.It isn't clear it was a heart attack, but something bad happened. An arrhythmia, exacerbation of undiagnosed heart failure, a heart attack, some other vascular event are all on the table and need proper testing to sort out.

###Input :hanks for your response, I did ask that he see a doctor but he is very stubborn and just accepts if its my time then oh well. So Im not expecting much here unfortunately. ###Output :Ugh. Im sorry. So hard to watch a parent do that. Be persistent. Enlist other family members. Avoidant behavior is very common. Especially for healthcare workers.

###Input :Im 34, female, 5 ft. And currently depending on the day between 209 and 223 lbs ( its weird, Ill get to that.)Day 1 Normal bp: 90/60. Weight 184 pounds 5/29/21.So back in June, I was working in a facility housing homeless individuals. During my shift, I smelled what I thought it was an electrical fire or fumes coming through or exhaust system. I discovered that folks were either cooking or smoking methamphetamine in the facility, but couldnt do more then create an incident report and narrow down where this happened.I coughed a bit, Had a headache, went outside to clear my head. Didnt think anything of it. By the end of my shift It felt weird to breathe. Like I was stuffed up. Within 48 hours I was wheezing coughing and very fatigued. COVID negative. Started azithromycin and prednisone 7 day taper.By day 4 post incident I could feel It wasnt helping. Went to the hospital. 02 was in the high 70s, I was coughing so hard. Confused. BP elevated for me 120/70s. Admitted for 4 days. 3 COVID tests (2 pcr, 1 rapid) negative. No fever this whole time. Nothing came up in sputum tests or blood work other than what they explained as inflammation.According to docs notes: patient was admitted to the hospital originally for suspicious of pneumonia based on the chest x-ray reading. In speaking to the patient, her symptom is more consistent with a asthma/COPD attack and lack the usual signs symptoms of infectious pneumonia including fever, productive cough, leukocytosis, and known sick contact. Instead, her symptom was brought about by inhaling smoke at her workplace. Patient has a history of childhood asthma for which she managed at home with rescue inhaler, patient did not have any asthma issues as an adult until exposure at her work.Therefore, after admission, she was treated for an asthma/COPD exacerbation. Antibiotics initiated on admission ( levaquin, azithromycin)to a more appropriate diagnosis. She responded well to bronchodilators, nebulizer, and oral steroid. So I finish the azithromycin, prednisone and have duoneb, and albuterol to help.CT scan showed glass opacities, right side of lungs was worse. 5th PCR test negative for COVID.06/13-I go back to the doctor 6/13. I feel worse. They tell me to give it time.06/24- return to work on light duty. No more than 4 hours a day of walking.07/03-7/23- doctors are still saying give it time. My lungs sound clear. I quit my job with the county to work from home.07/29- go into urgent care because I feel like I cant breathe. Exacerbation of symptoms. They talk about referral to pulmonologist but nothing yet. More prednisone dosepak7/30-8/15- using flutter, spirometer, albuterol and duoneb still as directed. Flutter/ spirometer every hour. Albuterol every 8 hours.Hospital admission 8/16-8/21 doctors notes*Called by nursing due to worsening hypoxia. Patient was admitted for presumed asthma exacerbation with high suspicion for COVID-19 infection. She was initially on room air with SPO2 of 90%. Since her admission, her oxygen needs has been gradually increasing. She is currently on 15 LPM oxygen mask with SPO2 95%. She is becoming more tachypneic with respiratory rate up to 36.Due to lactic acidosis of 3.9 on presentation, patient was started on normal saline at 125 mL/h. She was also started on dexamethasone for presumed asthma exacerbation with possible COVID-19 infection. She is on albuterol MDI inhaler every 4 hours and every 2 hours as needed.Vital signs: Temperature 98.7, pulse of 107, respiratory rate 36, blood pressure 114/74, SPO2 95% on oxymask.On physical exam, patient is alert and oriented. She shows signs of mild respiratory distress with increased work of breathing and tachypnea. She has decreased breath sounds with mild crackles expiratory right greater than the left. No active wheezing.Laboratory studies show white count of 18.3, hemoglobin 14.7, platelets 277. Chemistry panel within normal limits with potassium of 3.9. Magnesium low at 1.7. Lactic acid improving to 2.2 from 3.9. Procalcitonin less than 0.05. D-dimer 0.41.CTA with PE protocol per my review shows no filling defects consistent with pulmonary embolism. There are mild diffuse patchy interstitial bilaterally concerning for COVID-19 infection versus asthma related pneumonitis. No pleural effusions or focal consolidations.Acute hypoxemic respiratory failureLactic acidosisHigh suspicion for COVID-19 infection. Progressive worsening with administration of IV fluids. Improving lactic acid.Plan: -Discontinue IV fluids. -Furosemide 40 mg IV once. -Continue dexamethasone 6 mg by mouth daily for 10 days. -Continue albuterol scheduled and as needed. -Magnesium sulfate 4 g IV once to assist with treatment of possible asthma exacerbation. -Check ABG. -Continue levofloxacin. -Follow-up COVID-19 testing results. Continue precautions for now. -Escalate to high flow oxygen to decrease work of breathing.Patient is critically ill. The patient continues to have: Acute hypoxemic respiratory failure the vital organ system that is affected is the: Respiratory system If untreated there is a high chance of deterioration into: Respiratory failure, cardiac arrest, and eventually death. The critical care that I am providing today is: I performed an extensive data review and discussed care with patient. I have stopped IV fluids and started diuresis with furosemide 40 mg IV. I started magnesium sulfate IV for treatment of presumed asthma exacerbation. I have escalated oxygen needs to high flow oxygen.I get discharged from this hospital stay with 2L oxygen constantly. I get to see my doctor for follow up 9/8. They tell me again to get better first. Then well look at respiratory therapy and pulmonologist and physical therapy long term. I talk to them about my weight gain and my puffy face. They say its common with steroids. I can self monitor for oxygen use.9/17 develop vertigo, confusion, nausea and vomiting. Diagnosed with colitis. COVID negative. Urgent care visit. No longer on oxygen but still exhausted.9/25- diagnosis sinusitis, vertigo from left ear infection. Lungs clear. COVID negative10/5- vertigo doesnt go away. Given meclizine. COVID negative10/17- patient noted to have slightly elevated blood pressure likely circumstantial secondary to presenting complaint (152/90). Referred to primary care physician for further evaluation.Medical Decision Making: CT temporal bones show some fluid within the left mastoid. Slight elevation of white count. Patient also has an abnormal dilatation of the right lateral ventricle on CT of her head. This is concerning in light of her ongoing nausea vomiting and vertigo over the last several weeks. Discussed with pharmacy and placed on antibiotics to cover for possible mastoiditis and discussed with hospitalist for admission for further evaluation and treatment of this ongoing vertigo and abnormal CT head. Admitted in guarded condition.10/17- COVID positive. Test results received after discharge. 10/18. 10/21 tests negative for COVIDWeight gain from June to October 21 is from 184 pounds to 222.October 27- pcp follow up after quarantine. Currently 231 pounds. BP is 148/86.Doc notes History of Pneumonia, RecurrentRecurrent pneumonias with recurrent hospitalizations Exposure to methamphetamine at work at shelter - ended up with ground glass opacities on imaging. Tested multiple times for covid, negative at that time. Has had persistent fatigue, lightheadedness, loss of energy Positive for Covid 10 days agoWeight GainGained 30 pounds since September. Has had recurrent doses of steroids with recent infections. Orthopnea Has had decreased appetite and is not eating much at all. When she does eat a lot, feels need to vomit.HypoxiaDesaturations throughout hospitalizations, was discharged on home oxygen which she was able to wean down, but does still have hypoxia when she sleeps and exertion. Concerned for sleep apnea.VertigoRecurrent episodes of vertigo especially after recent illnesses Reports that she is occasionally awoken by vertigo and hot flash symptoms. Repeat evaluations for the same - does have history of CP, recent finding of R ventricle enlargement on MRI. Some benefit with Meclizine, but has had abnormal associated symptoms including confusion, word finding difficulty. Continued to say istory of pneumonia, recurrent Suspicion for initial covid infection with negative test causing initial ground glass opacities As these are consistent with many other etiologies and she has significant other symptoms (fatigue, weight gain, hair loss, vertigo with normal TSH) will consider other etiologies ANA, RF, anti-CCP for evaluationWeight gain TSH normal in the past, so has never reflexed to T4 and T3 - will measure these Autoimmune evaluation as elsewhereHypoxia Pulmonology evaluation,possible covid long-hauler symptoms, possible other causes of groundglass opacities Sleep study and general PFTsCurrently taking : Claritin albuterol Flonase every day. Meclizine as needed. I think they help.I KNOW THIS IS A LOT. I m sorry thank you for even reading this but I wanted to be thorough.How can I advocate for myself further? What can I ask about? Any additional testing you would suggest? I dont feel like a person anymore. If I eat, clean my kitchen and walk the kids to school it takes everything I have. ###Output :This is a hell of a history. From the right ventricular dilatation, hypoxia, and continued GGOs on CT scan Id say that the cause is probably the lungs. The pulmonologist is going to be your best friend here. PFTs are going to be helpful

###Input :Ruptured calcaneofibular ligament and ?fracture of the anterior process of the calcaneus I am a little unsure of where that exactly is on the ankle after looking at multiple diagrams, doctors werent helpful enough in explaining it.- backstory if youre interested:Ill try and keep this short, history of ankle injuries in the past, never quite this bad on that ankle (other one has had reconstructive surgery).I am a 24yo Female who works in emergency as a critical care RN.Rolled the ankle after stepping on a hockey ball 2.5 weeks ago. First 3 days was horrendous, then the pain settled and all I needed was Panadol once a day.XR on day 1 said no fractures. Went home and played another game of hockey a week later (with some pain after of course).US at week 1 said fully ruptured ligament and small ossicle 2.8mm indicating a possible fracture. Recommended CT.CT at 2 weeks showed possible cortical fracture at anterior process of calcaneus.Now Ive had ligament damage in the past, on the other ankle, and this feels relatively minor in comparison.Im being told by an orthopaedic surgeon that I need to be in a moon boot. I am ambulating fine on flat ground with rigid strapping tape on to replace the broken ligament.Its relatively painless to poke around the ankle area. Im not sure I even understand exactly where this supposed fracture is.Im worried by going in a boot when Im coping so well, will hinder my recovery and extend the time itll take me to get back to sport.I can attach some paperwork in the comments.Whats your opinions? Is it possible theres no fracture? ###Output :Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.The anterior process of the calcaneus is deep inside the foot, and thus fractures do not always produce tenderness, as you cannot palpate it directly. I assume that when you say "no bone pain", this is what you are talking about.Fractures of the anterior process can be occult, not seen on plain x-ray due to the overlap of bones in the area, and sometimes CT or MRI are needed to confirm.I am a little surprised at you posting here, as you are a registered nurse who has access to emergency physicians and have already seen an orthopedic specialist for consultation. The opinion of your orthopedic specialist is that you have a fracture, and the treatment recommended is immobilization. No one who has neither examined you nor had access to your imaging studies will be able to give you better advice.The rationale behind immobilization of such fractures is simple: the foot has many bones that articulate (touch and move) with each other. Broken bones that do not heal well will cause permanent pain and debility due to interruption of the way the bones can move in relation to each other.If you want a second opinion, then see another foot specialist, bring them all of the imaging tests on DVD (reports are of limited use in these situations).

###Input :Height: 1.8m (5' 11")Weight: 64kg (141lbs)Race: CaucasianLocation: Seattle, WA, USA (German born, Berlin)Vices: occasional vaping with very weak nicotine content, no drinking, no illicit drugs, chronic pain patient (fentanyl patches, 50 microgram)Current physical conditions: pituitary macroadenoma, adrenal cortext carcinoma, and a ton of implants and artificial bones. I cannot afford treatment for either and my insurance, medicaid, will not pay for removal of either or even treatments since my treatment is HCG, which comes from only fertility clinic pharmacies, and medicaid doesn't cover and fertility treatments for menCurrent mental health conditions: PTSD, bipolar, BPD, ADHD, generalized anxiety, and recently depression. All are treated quite effectivelyMedications (total daily doses): 50microgram fentanyl patches, 6mg prazosin, 12mg tizanadine, 7.5mg mirtazipine, 2700mg gabapentin, 2mg clonidine, up to 150mg hydroxyzine, 80mg Latuda, 200mg Lamotrigine, 40mg viibryd, 10mg melatonin, 8mg ondansetronEmergency Usage Only Medications: Hospital only: 100mg dex, 20mg morphine, 4mg lorazepam all IV for cluster headaches; Personal use: 50mg IM dex for cluster headaches, epi-pen for food allergiesWARNING: This will be long. I deeply apologise, but I feel like I need to be very specific and include context to get an accurate answer, if one even exists.----------------------------------------------CONTEXT:I want to start this off by saying I don't particularly believe in homeopathy, certain Eastern medicine, religion (I'm agnostic, borderline atheist), or the paranormal. I do many things for work, taking whatever pays me, but I have spent the majority of my career as a data architect in medical research. I believe in what can be proven, but I also acknowledge we can't prove absolutely everything to be true or false and that the sciences are ever changing and ever growing. I would also note that my life have been a very challenging one and I seem to have the single worst luck of anyone I've ever personally met. I've been very stressed and it has gotten significantly worse of late, though I've been told that I'm handling it quite well. Of course, I also acknowledge that there's plenty of people who've lived much worse lives. I'm not trying to play the victim or be arrogant.----------------------------------------------IMPORTANT LEAD IN:I went to bed last night around 23:00. I woke up an hour or so later to the sounds of small booms outside the front of my house. I initially thought I'd imagined it, but I rolled over and say all 3 of my cats with their faces pressed against the window screen, ears perked up. The sounds actually happened. A few moments later, I heard out smartlock on the front door unlock followed by the door opening and closing. Aside from internal doors, the front door is the only "normal" door to the house. the others are sliding doors that were all locked and barred and sound completely different when opened and closed. My roommate was asleep in his room and had been for hours. Nobody else lives here. Once again, I thought I imagined it, but the cats had all left my room and run downstairs to the door, which is what they do when someone comes over or gets home from work, errands, or whatever. I then head a set of male and female voices coming from downstairs. I grabbed a replica Master Sword (from The Legend of Zelda game series my roommate gave me a few years back) and went to my roommate. I tried to wake him up repeatedly, but he just mumbled something inaudible and rolled away over and over. So I went downstairs quietly. I spent 15-20 minutes walking around the house, following the voices, but never found anything. One of my cats, Needles, kept running off towards the voices then coming back to yell at me to follow him to them, which is what he does whenever someone comes home and I don't instantly go see them, but I never could find them. He's an utter attention whore. After that, I gave up and went back upstairs. Within 5 minutes I heard the door open and close again and the voices stopped. I don't have the greatest hearing in the world and never got close enough to make out what they were saying. I checked my Nest doorbell camera and at no point did anyone walk past the door. It is always recording and saved online for 5 days and, with the way it's positioned, it couldn't possibly fail to see someone come in or leave. I checked my smart lock app to see how it was unlocked and it said it was unlocked using a key by a user named "error". To clarify, the account's username that opened it was not literally "error", but rather that the app produced an error trying to identify the user. There are no physical keys to our house. It's entirely electronic and only myself and my roommate have the access codes.I have no explanation for what happened. I was wide awake for it all. The cats saw it. My smartlock confirms it. It definitely happened.----------------------------------------------THE REAL ISSUE:After that all happened I went back to sleep. It generally takes me hours to fall asleep, however that's not what happened last night. I always fall asleep with the TV on for noise, but turned down. South Park is what I had on last night and throughout the course of the night, I could clearly identify the voices and episodes as they came and went, even during the "dreams" I'm about to talk about, but NOT during the dream at the end of my story. That's a VERY important thing to note. After maybe 30 minute I felt like I was asleep, but I wasn't. I could feel my sheets, feel my head and arms on the pillow, move around, and feel my cat against my leg. That said, I started "dreaming" as if I was asleep. I'd note now that I've only ever had 1 lucid dream before and it was right after my long-term secret fiance had left me. It was stressful cause I simply came home to an empty house one day. I hadn't heard a word from him all day and all that was left was a quit-claim, signed and notarized, leaving the house entirely to me and taking his name off it and a hand-written note saying "I'll always love you. I'm sorry". Never heard from him again. He was my world even though he wouldn't allow anyone to know we were together cause he desperately wanted to be "straight". I cried myself to sleep for quite literally years, though over time it became a silent cry. I've been told the stress caused the lucid dream. I have countless wonderful stories about him, but he did give me me a strong case of PTSD, which I already had to deal with from an extremely abusive father.Back to the story now. During this "dream" I found myself on a cement platform in a park with a table and two chairs in front of me, underneath a pavilion. There were lots of oak trees, azaleas, and camellias, like a park would look like where I grew up in New Orleans. A cup of my favourite tea was waiting for me. An middle-to-late aged woman was sitting at the table in a white pants-suit. She had blue eyes and gray hair. She introduced herself as "death" and asked me to sit and chat with her for a while. She discussed my life with me and asked me many questions. She knew things about me that I didn't even realize myself. My memory of it is hazy, however. The "dream" lasted 30-45 minutes. During the "dream" I was able to freely move my "sleeping" physical body. Movement would cause a strange type of interference with the dream that I cannot really describe, but as soon as I stopped moving it went back to being incredibly vivid. At one point I sat up entirely, walked to my desk, and scooped up one of my other cats, and brought him back to bed and wrapped my arms around him. I felt entirely real. I had fully control over my body and words through the entire "dream". At some point in the dream she asked me to stop moving around cause it made her "presence" more difficult and she insisted I trust her that it was real. Over the next 7 hours I had 7 more nearly identical "dreams". Each dream was roughly the same, but the scenery and other person changed. Each "person" I talked to presented themselves as some kind of aspect of life. The ones I remember were: Death, Joy, Lust, Love, Pain, and Plague. I'm struggling to recalled specifics about the conversations, but they all insisted it was real and that I was safe. Each discussion was different and revolved around the aspect of life they claimed to be.I woke up completely after that and was confused, scared, and for some reason, relieved. It felt like everything was going to be ok. I've only experienced that feeling one other time. In December 2016, I was run over, intentionally, by a woman in an SUV while I was crossing the road on my motorcycle. She ran her light with the goal of killing me cause she was enraged by the pride flag sticker on the back of my motorcycle. It's a long story that I've shared many times, but this is already long so I'll skip most of it. The force of the impact sent me flying 30 feet and I slammed into an oak tree and the majority of my body was either broken of entirely shattered and I damn well knew it. In relatively short order, I grew cold from my chest and it spread throughout my body and I knew what was happening. I was about to die. I suddenly felt this massive calming wave overtake me and felt like nothing could ever be wrong and everything is ok. I blacked out shortly later and when I woke up again, I was looking at EMTs and a nurse who'd been attempting to revive me. I had been dead for around 5 minutes and had been kept alive by the person who was driving behind me and just so happened to be an ER nurse heading to work at the hospital less than a mile away.Back to the story again, I was awake for around an hour after all those experiences and ended up falling back asleep. This time, however, I had a regular dream, technically a nightmare, which is normal for me. I suffer from night terrors that are truly horrible and take 6mg of prazosin at night to prevent them. I still get them from time to time, but the overwhelming majority of my dreams are standard issue nightmares. I rarely have any positive dreams.As a reminder, I'd mentioned earlier that I had South Park on throughout the night. During the bizarre "dreams", I could hear the voices and episode as they came and went and even laughed at a particularly funny scene and told the "aspect" I was currently talking to about it when it happened. In my last dream of the night, the standard-issue nightmare, I could NOT hear the TV, could NOT control my body, and was completely asleep. I'm not sure what that means overall, but I feel like it's a VERY important detail.----------------------------------------------THE QUESTION:Quite simply, what in the absolute hell happened to me last night?! I don't know what to make of any of it. As I said, I'm not spiritual or religious in any way, but this is causing extreme level of conflict and concern within me. Furthermore, I've been around a lot of dying people, I live with a doctor and dated him for the last 6 years (we broke up a few months back, but still live together), I've dated other doctors, I spend a ton of time at doc appointments and in hospitals, and I myself work as a data architect in medical research most of the time. I'm very aware that when people are nearing the end of their lives, most (60%, if I remember right) will hallucinate loved ones, angels, or even demons, and have long conversations with them over and over. In my experience, and to best of my knowledge, this usually happens within a few days preceding their death, but can happen as far as a few months in advance. Is that what I just experienced? I certainly have serious conditions, but I'm otherwise perfectly healthy. Other than my migraines, cluster headaches, and chronic pain I feel perfectly fine. I've had the migraines and clusters since I was a kid and the chronic pain since I was run over and nearly murdered. Nothing new has come up. I have been much more depressed and anxious about life lately as I've had awful dating experiences, am struggling horribly to land a new job, and the end of my lease is coming up soon and I will have nowhere to live, but I feel like I'm handling it well.I'm exceptionally worried about what happened last night. I want to see a doctor about it, but I have absolutely no clue who I'd go to. I know there's "doctors" who study dream analysis, but I talked to my ex about it, the doctor I live with, and we both feel like that's psuedo-science and doesn't carry any real validity. Because I'm currently laid off, aren't receiving unemployment, and am only earning money by doing freelance and contract work, I have to use medicaid for insurance. There's no available therapists or psychiatrists I can go to cause I can't afford their cash rates and the ones who accept medicaid are seriously booked up and have multi-year long wait lists. I'm on all of the wait lists, but I'm definitely not gonna hear back anytime soon. I can't afford cancer treatments either and medicaid won't pay for them.My mother insists all of it was a dream and I didn't wake up at any point through all of this. That's 100% false. I damn well know when I was awake and what I experienced. I have proof from the cats seeing and hearing what I did and the history on my door lock. I talked to a friend studying psych and he suggested I could be schizophrenic, but he's not a doctor or even a therapist and I was diagnosed as schizo year ago and treated for it, which worked, but when I moved to WA and found a much better psychiatrist, she vehemently disagreed, changed me to my current diagnosis and changed my medications which work far better, so I'm inclined to believe she was right. My psychiatrist in Louisiana was not on good terms with the board and was wildly aggressive with diagnosis and treatment for all her patients. Her results were remarkable, but her methods were HIGHLY questionable and she was quick to prescribe controlled meds. She had me on lorazepam and adderall while I was also on 50mg of Percoset daily from my neurologist. I absolutely never had any problems, complications, or side effects because of this and it was actually extremely helpful in helping me hold down a job and be a functional adult, but it's generally not appropriate to do. I desperately need my ADHD treated to hold down a job, but the state of WA will not allow you to be on more than 1 controlled medication at a time. I understand, but it makes life extremely difficult for me and I think it's completely unfair to make me choose between living in intense pain or being able to focus for more than 5 minutes at a time. Writing this post has taken me over 3 hours cause I keep walking away and doing other things.Anyway, any advice would be amazing. thank you for reading and I'm sorry for the length.TL;DRHad a series of "dreams" last night that didn't work like any dream I've ever had where I could freely move my physical body, which upset the "people" I was talking to in the "dreams". During the series of "dreams" I met personified aspects of life itself, like love, death, regret, plague, etc that held conversations with me about my life. A while after the series of "dreams" ended, I ended up going back to sleep and having a normal nightmare where I couldn't control my sleeping, physical body and things were normal. Now I'm wondering if that's my version of dying people hallucinating loved ones and I don't know what to do or what kind of doctor to see about it.That said, please, PLEASE read the full post. There's way more to this and the TLDR makes me sound like a lunatic. I spend a lot of time carefully writing it up and explaining everything, like the insanely critical context the TLDR is missing, please read it. ###Output :Sounds like lucid dreams. I dont want to Monday morning quarterback your doctors but thats a dizzying (literally) array of psychoactive medications you have all mixing together that probably played some role too.

###Input :Hi docs! Im currently in the neurology critical care unit with an aunt (78F) who was flown from our local hospital to this one. We knew that it was a smaller bleed, but not much else. Im the one that will be asking questions on behalf of her children (who are with me) so that we can fully understand whats going on. What are the questions that I should ask in order to get the most explanation all around? ###Output :I'm so sorry your family is going through this. I'm board-certified in both emergency medicine as well as critical care. Going to need a little more information in order to help tailor the appropriate questions to ask. What information have you received so far about your aunt's current situation, and what is her current condition (e.g. is she on a ventilator, acting appropriately, etc.)? Have the docs given any updates on her prognosis and/or next steps, medically?

###Input :Thank you so much. No information other than that she was resting and that the bleed was small. They said that they would try their best, but wouldnt guarantee anything. Thats all the doctor told her son. :/ ###Output :Well, that's certainly not very helpful or enlightening at all :/ Idk your aunt's medical history, how the bleed occurred, or what intervention's her medical team has already performed so far. However, it's reassuring that the bleed is reportedly small. Important things that would be good to ask would be:-What interventions have been performed so far, and why? Also, which interventions/procedures can be expected in the future? -How severe is the bleed, and what deficits can be expected following recovery vs. what are the chances of a full recovery (note, they likely won't commit to a specific answer to this question, because there's no good way to predict patient outcome, but notifies the care team that you're actively involved in the patient's care and want to be kept in the loop)? -What does the recovery time/process look like if/when her bleed improves? -Are there any additional co-complications going on? -is there any specialized care that is going to be required following recovery? -How often can we expect patient updates from the doc in the future? -Does the providing physician have any specific concerns of their own that we should be aware of?Additionally, it's probably worth asking what support is provided by the hospital that's available for friends/family of the patient. If you have any additional information to share, please post here so that specific questions can be appropriately addressed.

###Input :I chose his CRNP because I was having chest pains and I already knew that I was hypertensive. I'm an advanced EMT and although my scope is nowhere near a CRNP, I can still diagnose myself for what is critical and what is not.This woman is under half of my age. I'm not comfortable with someone fresh out of medical school. She told me that I had to go to the ER. I paid $140 for an office visit for her to tell me that I had to go to the ER, after taking my blood pressure. I already knew that I was hypertensive and they told me over the phone to come in to get some kind of high blood pressure medicine.I told her that and she told me that I needed an EKG and a CBC workup. She told me they could do that at on-site, but without insurance, it would run me around $1,400... and it had to be paid, NOW. Words fail me here. All of this could have been told to me on the phone.I told her that I couldn't afford that out of pocket. She told me that I was going to be sent home... without any medicine. I said, "Let's review here... It's such an emergency that I have to go to the ER or pay for tests now, but you can send me home without medicince???" Unbelievable. I left, had to pay my $140, and went home with no medicine. I got home, at square one again, and was $140 poorer.The social worker called me later that day and she was also an EMT. I told her what I just typed. She emailed the doctor and a few hours later, I was prescribed some amlodipine that could be picked up immediately at my pharmacy.I received better care from a social worker that I paid nothing, than from a CRNP that I had to pay for... amazing. The CRNP obviously didn't even go to the doctor for consult. ###Output :I'm not comfortable with someone fresh out of medical school.NPs do not go to medical school. They are knowledgeable and can treat common illnesses, but they are not medical doctors.Are you located in the US? Do you not have insurance?

###Input :What kind of school do they go to, then? I assumed that they went to some kind of medical school, since their scope is higher than a registered nurse.I am in the US and I just got insurance. ###Output :What exactly is your question? Any given decision to see an MD vs an APP is a balance of complexity and access.

###Input :31F, went to the ER due to stomach pain and uncontrollable shivering. She was admitted to the ICU and had extremely low blood sugar, hypothermia, hyperkalemia, blood in the stool, gram positive cocci in pairs and chains, anemia, and she had been previously diagnosed with endometriosis. They found cysts in the liver, hypodensity in the left side of the brain and have been taking several tests. ER gave her 3 blood transfusions for the anemia and she now has a swollen back, legs, hands, and feet. She is still anemic even after the 3 blood transfusions. She has undergone multiple MRI, ultrasounds, CAT scans, and blood works but they aren't sure what is causing everything.Her vitals at admission were:K 5.9Hgb 5.5Glucose 17Temp 94.5WBC 5700She started antibiotics yesterday morning and her second ecg was normal. She was taking oxycodone for pain but is now on morphine and lidocaine. Doctors said that she had a reaction to her 3rd blood transfusion and her heart rate went up and blood pressure went down. She is now on medication for that. She has not been allowed any food or water today after the reaction. An MRI found that she has lesions in her brain but the nuero surgery consultant said they were not going to do any procedure.Has anyone had experience with something similar and what was the diagnosis? ###Output :While I have lots of experience with patients like her, I dont think theres much that can be said over the internet to help. She has a severe critical illness with what sounds like septic shock. The best people to answer your questions is the team of doctor taking care of your sister.

###Input :Im 30 years old and after a very long and defeating search for a doctor willing to listen, I was finally diagnosed with Nutcracker Syndrome. I have surgery in 1 month, but I am in debilitating pain. Im a critical care nurse of 8 years and no stranger to the difficulties with pain management faced and felt by both physicians and patients. What I was baffled by was the extreme amount of gaslighting I faced as I tried to get this syndrome ruled in/out. Ive fought for months to NOT end up in this position (stuck in pain) by advocating for myself yet listening to each physicians advice, and trying to be a good patient and human being.I was in pain management but left the clinic because the doctor wasnt willing to work with me in any way. I was given Meloxicam, Gabapentin, and one 5mg Norco per day. Only the Norco would do much of anything. I had an appointment set up with a new clinic before I left, but its not till Dec. 12th and my pain has gotten MUCH worse even in the last week. I will also still have to wait the 2 weeks to actually get any medication (as far as i understand).My surgeon cannot prescribe me anything, and I see a PCP who uses holistic and traditional medicene (basically started me on tons of supplements) and really seemed to help me, its pricey but worth it as they are also more available. BUT, they cannot prescribe pain medication as they are a cash pay direct care practice. Ive called other pain clinics and they cant get me in until even later dates, Ive texted every doctor Ive worked with and their leads have fallen through. Meanwhile, the pain is so horrible I can hardly eat or move, and getting worse by the day. I went to the ED out of desperation a couple days ago and the doctor was kind and gave me 14 Norco 5s which help the pain a bit for about 2-3 hours. But I desperately need something stronger and more permanent (obviously).As far as options, My surgeon suggested going back to the ER for more pain meds (which was weird) or my PCP though he knows they cant prescribe those meds. The ER doctor suggested a new PCP which Im considering but Ive had good support with my current one and feel they are far more accessible, especially considering something new happens each week it seems like (strep B UTIs, hypothyroidism, gallbladder and liver issues, you name it). Plus idk if anyone would feel comfortable writing me opiates on a new patient visit.Is it even worth trying a new PCP? Would it be pointless to keep both my current PCP and see a new traditional PCP that could help with pain ? Or should I switch altogether? When my current pain meds run out I WILL have to go back to the ED because it gets that bad and Im no wimp. Its a solid 7-8/10 WITH the Norco on board. Would a second ED physician even consider writing Another script?Should I try and speak to the actual doctor I will be seeing Dec 12 about my hopeless situation or insist that the nurse tell him about it?Im really at a loss, Im in Indiana so medical marijuana isnt an option. I would appreciate any advice, leads, anything. I feel like Ive been failed for a year straight, and I was hoping I would be taken more seriously as someone whose also in healthcare, but its sadly not been the case. TIA ###Output :I'm sorry OP, this is awful. Not familiar with the health care system where you live and why your PCP can't prescribe opioids, but can you see them for help navigating how to have this addressed? I agree it looks bad if you start seeing a new PCP or go back to ED but perhaps letters from your current PCP explaining the situation would be helpful?

###Input :Thats a good thought, I have asked them to call the pain management place I have an appointment at the attempt to get me in sooner. I will see if they will do that as well :) Nothing can hurt at this point. And thanks for the validation because honestly, Ive started questioning if its really all that bad (though I know it is).Its crazy what a year of being chronically ill can do to the mind, even someone familiar with the healthcare system (Im in the U.S.). A lot of doctors here would love to be able to help me out but legally cant, or if they can would have to fear for their license (presumably).The ED giving me the small script they did was even kinda going out on a limb. It all comes down to the fact that not many doctors arent familiar with nutcracker syndrome because its rare, and the extreme pain isnt a well known fact about it. So it makes me seem as if Im drug seeking, but one look at my background and its clear theres not history of anything whatsoever.I mean i worked in ICU for 8 years around every narcotic imaginable, and still could be if I wasnt this sick. And I was charge nurse of a high acuity unit. The doctors Ive worked with have helped me alot in this process but their hands are tied on the opiate thing. ###Output :I'm not familiar with the syndrome but it's not hard to look it up. It's very sad that because of the opioid abuse pandemic we've gone so far the other way that people can't get adequate pain relief for appropriate indications.Good luck, and I hope the surgery is effective!

###Input :I had an awful IUD experience, involving vomiting and fainting as a result of the pain level. I would rate my IUD insertion worse than passing a kidney stone or breaking bones. Im not alone with this experience. If you search IUD on TikTok or other female-dominated subreddits, youll see an abundance of women/ teenage girls who have also described the IUD pain as the worst pain in their life. Ive noticed a trend of increased pain particularly among nulliparous women.The Intensity of pain doesnt seem to be acknowledged by many medical providers though, as many patients are told it will be a slight pinch and arent properly informed about the pain involved. As a result, many of us did not properly prepare for the persisting pain by arranging a ride home from the appointment, a day off from work/school, or mental preparation for pain. Many providers both seem to acknowledge that extreme reactions to the insertion are normal, but the pain isnt enough to warrant preparation or pain medicationsI played rugby, basketball, football, and softball. Ive had many broken bones and torn ACLs. Ive also passed kidney stone. The IUD insertion pain was by far worse and longer than any of the aforementioned pain events. If I was offered pain medicine for all those events, why is nothing given for IUD insertions to reduce the associated pain and discomfort? Is there a specific reason?Edit- I should mention Im directing this question to medical professionals in the US.Edit 2- Ill admit I havent looked into any of the studies about this. We had one doctor chime in that studies show that extreme pain is not the norm, but the trend Im seeing in person and across social media appears contradictory to those findings. Would any medical professionals be willing to share the specific studies that are being referenced for care? Im a PhD student in a different area of public health research, but I wouldnt mind doing some critical review of the publications while I have the time. Update: so far I've only found a few relevant articles in my Uni's database. Most are about a decade or older and have really small sample sizes, like n=40 or less. The more recent articles are recognizing the pain of insertion as an issue, but I'm not finding a lot of resources so far. If anyone has a specific research study they reference when learning, I'd be thrilled to look at it.Edit 3 -I started to search for articles. This is the first abstract I found:"Concerns about pain during IUD insertion are a major barrier to use of IUDs among adolescent and young adult patients who may otherwise be interested in this method. Although few studies of pain control options have been conducted in this population, available data suggest that several pharmacologic interventions discussed in this chapter may be beneficial. Pre-procedure naproxen, ketorolac, or tramadol can help to reduce post-procedure discomfort. Paracervical nerve blockage with lidocaine-based anesthetics, topical lidocaine spray, or EMLA cream also appears to reduce pain with IUD insertion. Intravaginal 2% lidocaine gel may reduce pain with tenaculum and speculum placement. This chapter will discuss the complex nature of pain in gynecological procedures, including IUD placement, and the impact of anxiety and fear on pain perception. It will also review clinical guidelines to assist with pain control during procedures and describe evidence-based pharmacological pain control modalities that can be used during IUD procedures." Optimizing IUD Delivery for Adolescents and Young AdultsTho I don't have full access to the text, this abstract is making it apparent that pain management is a valid concern and there are options. Can doctors weigh in more on those options? If it is indeed a recognized problem in the medical community, why aren't these options considered?Update 4: I have 26 peer-reviewed articles to review. Slamming a coffee and Ill get you my quick-and-dirty lit review asap. ###Output :I don't do IUD insertions, but pain management should be discussed and offered.I don't care what the studies say. Sometimes you just need to be a human and empathize with other humans. Medicine is as much an art as it is science.

###Input :Im a 26F, 173lbs, 57 I have SLE Lupus, Ehlers Danlos Syndrome, and Idiopathic inter cranial hydrocephalus.I just had a CT W/O of the brain and neck yesterday. Reason for this was because Ive been having terrible headaches lately. I received a message today stating THIS REPORT CONTAINS FINDINGS THAT MAY BE CRITICAL TO PATIENT CARE.Impressions:Hyperdensity seen in the right frontal along anterior aspect of the right superior frontal sulcus concerning for focus of subarachnoid hemorrhage. Sorry for the all caps I just copied and paste. What does this mean? Thank you for your help ###Output :Physician, Emergency Medicine | ModeratorAgree 100% with /u/sspwnage. Closing this thread as there is no other message that needs to be said other than call 911 or go immediately to the ER (and tell them your CT scan yesterday showed bleeding in the brain). I am a little surprised no physician called to tell you about this which I assume is just an oversight.PhysicianYou need to go to the emergency room ASAP. That CT is showing you are having bleeding in the brain. This is probably the cause of your headaches but they will need to run more tests. Seriously drop what you are doing and go, brain bleeds need to be monitored and seen by a neurosurgeon ASAP.

###Input :Hi there. Female, 20yo with Panic Disorder, GAD, MDD, BPD, the works. Hate it.Anyways, I've had psychiatrists keep me on Prozac 40mg most of my life and it's been the most comfortable. A numbing experience, but it did the job. Years ago, I tried Wellbutrin but at the time I had COVID (which actually amped my anxiety) and thought my anxiety getting worse was due to Wellbutrin, so I was taken off. Back to prozac for 2 more years. Recently, I got off it again and got on Wellbutrin 150mg due to sexual side effects and hoping it'd help my anxiety.It did not. In fact, it made anxiety worse and I've had awful panic attacks, physical symptoms that have been cleared by my GP after tests showed nothing was physically wrong.Talked to the psych, and he said "Ok well I can cross taper you from Wellbutrin slowly back to Prozac.".I swear I keep hearing never to take those together, and even my past psych wanted me to be off prozac completely before getting on Wellbutrin years ago.Note I have horrible health anxiety and dread feeling any negative physical symptoms (to the point I annoy my GP about it) and it's starting to make me feel helpless. I'm constantly bothering people and terrified of dying, and just... Feel like a waste of time to my doctor, a waste of resources to my nearby hospital when a panic attack gets so unbearable it feels like I'm fucking dying, and a bother to my loved ones even though they try to be helpful and reassure me I'm not dying.Last night was possibly the worst panic attack since I've been on Wellbutrin, even worse than Prozac PAs. Basically I was eating soft stick candy, swallowed a whole piece because I have a bad habit of not chewing my food, felt like it was stuck in my throat, tried coughing/throwing it up, began to panic when my throat started feeling weird after trying to force myself to throw up, and panic ensued. Fiance checked, nothing was in my throat and turns out it was probably a phantom feeling in my throat.But anyways, about the medication.So... I've agreed to do a cross taper and lower to 100mg for 2 weeks before adding in Prozac 20mg if I felt ok.Is this ok?Also, secondary question.What do you think of patients who suffer from these things? I'll be completely honest... I genuinely feel like a horrible person for wasting the time of people who help others that really need it.I had gone to an Urgent care when I started experiencing really bad breathlessness and a nurse came in to talk to me, I told them what I was feeling and mentioned it felt worse than most of my panic attacks. She asked me if I had a history of anxiety, answered yes, and she did my vitals and left. Later a doctor came in to check on me, nurse pulled her back outside and I had heard her say "No no, she's having a Panic attack" and their voices became more muffled as they walked away.It just... Kinda confirmed what I was already feeling and connected with other experiences of having gone to hospitals feeling absolutely shitty, with doctors recognizing me and seeming annoyed, or seeing my GP look at me with.. I dunno, not really pity, but something else that just makes me feel like I'm disappointing him, and it's not his fault... It just sort of destroys me, because every time he clears me of any physical illness, he just reminds me to find a suitable therapist and combine it with my medications, despite me knowing and not telling him most therapists around me have a year long waiting list and the ones I tried that DID hear me out... Well, didn't help at all. One I tried recently missed appointments constantly, telling me to wait until next week... for 4 weeks straight. And when I finally saw her, I wanted nothing more than to just spill the beans and vent and try and work through recent trauma with just a really horrible and abusive friendship that I'd managed to cut off, and...She said that before that, we had paperwork to fill out for the next 2 sessions. Not homework or therapy paperwork, mind you, paperwork paperwork.It's just... A helpless feeling. I feel like a bother to most doctors having the anxiety I have. I want to get to a therapy asap to stop having these obsessive thoughts about my health, and in turn, let you guys do what you do best, y'know?I'm really sorry to bother you all here. I guess I want some insight? Validation? Criticism? Confirmation of whether or not it's a huge inconvenience/nuisance for you all? I'm not sure... Any answer on the second half is welcome. Thanks, and again, sorry. ###Output :Physician - PsychiatryProzac and Wellbutrin are very often prescribed in combination and is perfectly safe.You need to chew before you swallow your food. Basic skills of life here. There's a reason we have teeth. Please use them.There's nothing inherently wrong with you seeking medical reassurance when you're anxious about something, but also understand that medical resources are limited and healthcare workers are burnt out and very overworked. If someone comes in for the 4th or 5th time with anxiety symptoms that are similar to the past 4-5 times, it's human nature for the doctors to automatically assume it's anxiety again, which is neither medically urgent nor emergent. It becomes harder and harder for the doctor to justify medical workups when the cause seems very obvious.Having experienced anxiety symptoms for so long and so often, you can learn to recognize when it's anxiety vs something new that would feel different. You can learn how to start taking an active part in recognizing triggers of your anxiety and learning to avoid triggers (i.e. CHEWING your food) or de-escalate your symptoms before they become severe. As a psychiatrist, I'm acutely aware of how difficult is to find a therapist who can take insurance within a reasonable wait list (you should still get on those wait lists, it'll be your turn eventually). In the meantime, you can look into online Cognitive Behavioral Therapy (CBT) courses you can do on your own from home. It's not as effective and personalized as working with your own therapist, but it can get you to start learning the basic skills and concepts and start practicing those skills while you're waiting for a therapist. Therapy will be essential for long-term control of your symptoms. Meds alone will never be enough.

###Input :This is... An incredibly well thought out and insightful comment :')Yeah the chewing the food part was definitely my own fault, even my parents point out I eat way too fast and it's always been a terrible habit to break out of, something in my brain, whenever I try to chew, just says "Stop it, it's food, get it in before it's gone" so I'm genuinely trying to slow down but slip up like yesterday.The medical reassurance thing has sparked up pretty recently and I'll try my best to at least limit the urges to go. The problem is that even though I've had countless panic attacks, something new ALWAYS pops up. A different symptom that just freaks me out every time, jumps up out of nowhere, and automatically is flagged as "This is new. Panic, you're dying." Just when I get used to one symptom, another pops up. Like the breathlessness, which was never really a symptom until recently. Something I noticed after I'd gone to the doctor and got cleared was that trying to tell myself "You're fine, it's new, but nothing is wrong with your lungs and heart, just distract yourself." Tada, as soon as I'm not thinking about it, it goes away, and as soon as I think "Hey, look at that! It went away!" It comes right back because I focus on it, even if it's positive. But at least I got that down, trying to tell myself as long as I'm breathing and not unconscious I don't need to go to a hospital.About the CBT online courses, I had no idea that existed. Usually I'd only take DBT for years and not CBT even though I thought it would help more (but therapists kept saying "well you have BPD so let's focus on DBT" even though... I graduated it.)I usually assumed I NEEDED a person to have CBT therapy with, so is there a specific site you'd recommend? I'm genuinely kinda excited at the prospect of it being online. ###Output :One suggestion I have is for your to start keeping a list of the symptoms you have when you have anxiety/panic, and also checking out descriptions of anxiety symptoms from REPUTABLE medical websites like WebMD, MDConsult, Stanford Health, Massachusetts General Hospital, Johns Hopkins Health, etc, and generate a master list. When you have a new symptom, check it against the master list to see if it's considered a common anxiety symptom, and if it isn't THEN go get a medical workup.You can do a Google search for online CBT classes (be aware these are not usually Free, and if they are, there's usually a catch). Here are a few with good reputations:https://cbtonline.com/https://www.beatingtheblues.co.uk/private-patients/https://cogbtherapy.com/free-online-cbt-workbook (this is free, no catch, but very basic)

###Input :This is amazing. I've never considered a master list and I'll get on that right away. I kinda wanna make a physical and digital one and make them both look nice, so it seems I've got a new art project :DAlso the free online CBT workbook seems best while I look for a CBT therapist or at least get into the therapy waiting list from the psychiatric hospital nearby I get medications from. I apologize for being a little difficult, but here's my question:Concerning symptoms in general, what if it's a new symptom that feels particularly severe or a general symptom from before that feels significantly more severe than usual?Usually I start to panic once let's say... I have dizziness, and suddenly that dizziness morphs into lightheadedness and a feeling faint sensation. Luckily I've been able to tell myself "just lie down, this is probably anxiety" but that was waaaay before, with my health anxiety ramping up again I'm afraid of just freaking out once something comes up and I forget in the moment.Although, I do guess that comes with the territory of learning my symptoms. But like I said, if a symptom is extremely severe, I should probably check with other things like accompaniment of other symptoms that are new and not anxiety related, or if something happened to spark the symptom right? I'm really sorry, I just wanna make sure I know when to panic and when not to, although I realize that's also something I'll need to work on, controlling panic. ###Output :I encourage you to read up on Box Breathing techniques. When someone gets stressed or anxiety, its easy to start hyperventilating, and hyperventilating can induce anxiety symptoms. So learning how to control your breathing can go a long way towards getting anxiety and panic symptoms under control. As soon as you notice that youre feeling anxious, take yourself away from the trigger and go find a quiet private place, preferably dark, and take 5-10 minutes to do the Box Breathing technique. Most anxiety symptoms will go down by doing that and youll be able to better differentiate where youre having anxiety or an actual new concerning symptom.https://www.webmd.com/balance/what-is-box-breathingI also would suggest you find some guided progressive muscle relaxation videos on YouTube and start learning that skill. Its incredibly effective at calming anxiety attacks. If you can successfully complete a whole session, youre probably not going to feel much anxiety afterwards.

###Input :Hey! Im a 33F. 59, 215lbs. Diagnosed with arthritis in my back in 2020. No daily medications normally. ER just started me on prednisone 60mg daily, metaxalone 800mg TID and diclofenac 75mg BID. I have had chronic back pain for years now. I work as a nurse and as you all know the constant pulling and lifting of patients is hard on the back. I did some dumb things as a new grad working short in long term care and ended up with lots of back pain. I went in 2020 to have it evaluated. My NP did an X-ray and it just showed arthritis. She ordered PT but at that time I was working a covid unit and they started mandatory extra shifts and I wasnt able to schedule the PT. About 6 months ago I started having issues where when I would go to stand up my back would catch and Id be stuck bent over for several minutes until it loosened up. I kept saying I was going to schedule an appointment but never did. (I know, I know. ) At work the other night my toes/foot went numb. I ended up going to the ED. They did a CT scan of my lumbar spine and told me I had bulging discs. When the ER NP came in, he told me I had 4 bulging discs in my lumbar spine and he felt they were causing nerve compression which was causing my numbness/tingling. He said I was at risk of herniating and put me on a 10 lb weight restriction until I follow up with primary care for a MRI. (They are a small ED and have no MRI available.) The CT report just came through on MyChart and it says I have bulges at L4-L5 and L5-S1. So am I understanding that that would only be 2 bulging discs? Im thinking my husband and I maybe just misunderstood him when he came in. This is a different side of nursing for me and Im not too sure about the risks and such with disc issues. Is the risk of herniating really high? My job wont put me on light duty because it didnt happen there and they just told me to ask for help with transfers/boosts. I work on a very heavy floor thats not considered ICU but they still call it critical care. Its lots of post ops and amputations. It tends to require a lot of lifting and pulling. Im just feeling really anxious about work and I guess am just looking for reassurance/ guidance. Interestingly enough two days before my foot went numb I was having nerve pain going across my shoulders and radiating down my arms. So Im sure Ive got stuff going on higher up as well. I was able to get a PCP follow up on Wednesday so Im hoping to get more information there.Also- is it common for the numbness tingling to come and go? Im assuming its the meds helping? Because at first it was continuous. Now sometimes it travels up my leg into my thigh but It wont last very long. Maybe an hour or so and then goes away.Sorry for the novel- thank you if youve gotten this far. ###Output :I question everything this ER NP has told you. You're correct, if your report says L4-L5 and L5-S1 that's two discs. Not sure why they said that those disc bulges are causing the pain. It's well known that imaging findings in back pain, particularly minor and common findings of disc degeneration, do not correlate well with back pain. That is to say, imaging findings like yours are not necessarily the pain generator. Was a physical exam done with a lower extremity Neuro exam?

###Input :The NP, MD and nurse never once looked at my foot. I was at work when it started. Im a vascular nurse so I checked pulses and my other nurse friend did a very quick assessment for weakness but it was fine. At the ED they all just kept telling me it was sciatica, which Ive had before but its never made anything go numb. Then once the CT came back they said it was nerve compression from the bulging discs. ###Output :Hopefully your primary care doc will actually do a physical exam.I'd caution you against recommending things based off of what you've seen. That's unsafe, inaccurate and bad practice.

###Input :This post is about my dad, who is about to leave the hospital after a 2 night stay.Age: 55Sex: MHeight: 5'8"Weight: ~180-200Race: whiteDuration of complaint: 5 daysLocation/issue: Esophageal tear, 4 stomach ulcersAny existing relevant medical issues: T2 diabetes, high BP, GERD, alcoholic for ~25-30 years, anxiety, compressed ulnar nerve due to bulging cervical discs - lots of back pain and numbness in armCurrent medications: metformin, no BP meds (had a bad rxn), alprazolam, venlafaxine, there are others I can't remember but they're not super relevant to my concernI'll be brief here, but can answer questions if needed. I don't live near my parents so I'm hearing everything from my mom.Wednesday: Dad isn't feeling great, but that's not uncommon due to the alcoholism-diabetes combo and current back pain. Mom and dad go to the gas station, dad goes to the bathroom, employee informs mom that dad has passed out in the bathroom. They call the ambulance, blood sugar is 54, he's given glucose, and feels better. Refuses to go to hospital, mom takes him home.They walk inside, he feels lightheaded again and vomits multiple times. Mom goes to get a towel and he then passes out and begins to aspirate vomit. Mom sits him up and slaps his back until he can breathe again. Brief comedy break- he says "wow! I feel better!" He goes to the bathroom and is bleeding a lot from his rectum. Refuses again to go to the hospital (he's an ornery fellow, but it's understandable because he doesn't have insurance).Thursday: He goes to his PCP Thursday morning and PCP says he has lost up to 1/3 of his blood and needs to go to the hospital. Dad refuses again. No major events occur the rest of the day.Friday: Dad tells mom he's feeling alright, he eats some food, seems normal. She goes to work. She returns and I'm not sure what exactly happened, but he begins bleeding profusely from the rectum again and goes to the hospital Friday evening.Drs can't identify the source of bleeding and are thinking diverticulitis. He continues to bleed and is given 5 pints of blood over the course of the evening/overnight. They prep him for colonoscopy in the morning. Drs tell mom situation is critical and to be prepared for the worst.Saturday: Dad doesn't respond well to the barium so they do endoscopy through the mouth instead and find an esophageal tear and 4 stomach ulcers. The esophageal tear finally resolves on its own so they didn't do any repair. Rectal bleeding largely subsides but there is still some with every BM. They plan to do a colonoscopy later. Hemoglobin was 9 at intake, now is 7.6. He's on a magnesium drip and gets another pint of blood for a total of 6 pints. Saturday night is not too eventful. Blood pressure is low despite typically high BP.Sunday: Bleeding has mostly subsided. Hemoglobin is still very low. BP still low. GI doctor no longer wants to do colonoscopy and says dad can go home. Floor Dr and nurse think he should stay. Dad is worried about medical bills and claims the hospital is "trying to kill him" so has opted to go home.I have two questions- should he really be going home?? And given he is a physically dependent alcoholic, should he be given alcohol or no? Mom says he was not given alcohol during his stay and did not have any seizures or severe withdrawal symptoms. Last time he had alcohol was probably sometime Friday morning or afternoon. I know quitting alcohol cold turkey is very dangerous so I'm surprised he has been mostly ok in that regard. He's anxious, irritable, and paranoid that the hospital is killing him, but otherwise not terrible. Is he over the hump after 2 days cold turkey? Should my family remove all alcohol from the house and keep him dry? Supervised small doses?I'm surprised he's allowed to discharge himself so soon after nearly dying, when his stats are still bad and his doctors don't even agree. My family hasn't been given much information and don't know how best to take care of him at home. He can be quite the asshole and doesn't listen to anyone (even his doctor) so restricting alcohol or anything else would be difficult.I'd appreciate any advice on home care, what to look out for, and especially what to do about alcohol. For reference his intake varies a lot but sometimes it's as high as a whole 750mL bottle of rum in one day. Supposedly it has been "less" lately due to acid reflux.Edit Sunday Aug 7th: his hemoglobin had gone up, but dropped back to 7.7 and there's a small amount of blood in his stool. So he's still at the hospital for now. ###Output :Glad that he is staying in the hospital.He should strongly consider medications such as naltrexone (oral or intramuscular injections that last for 30 days) or acamprosate which can reduce alcohol cravings. This is the type of medication he should get a prescription for once he is discharged. Once he is home, remove any triggers he might have at home.Wish you and your dad the best

###Input :My son (19M) 6'1" 210lbs who lives approx. 2 hours away at university. No relevant health history besides depression. No routine meds. Doesn't smoke or drink. Yesterday, around 18:00 apparently, he took 50 500mg acetaminophen tablets in a suicide attempt. I was notified at around 02:00 this morning by my ex-wife. I immediately called 911 and notified them of the situation. Ultimately he was taken to the ER a little after 03:00. I have been unable to speak with him due to being Baker Acted. My ex-wife was able to find out that they'd given him something to induce vomiting. My question is roughly 9 hours after ingestion he should definitely be receiving Acetadote, right? I'm not saying that he he isn't, but it wasn't mentioned apparently. It has been quite sometime since I've worked in critical care (RN), but we would have definitely put him on Acetadote. Am I safe in assuming this is the case? Also, in an otherwise healthy young man, what, if any, longterm complications might we be looking at? Thanks in advance for any help. ###Output :No long term complications if he recovers from this, which he should if the timing is correct. There's only 2 ways these go 1) liver failure or 2) complete recovery. He should be early enough in his overdose to be treated.

###Input :My sister (30, Hispanic, 5'3", about 250 lbs) has several medical conditions and a long history of undiagnosed neurological symptoms.Two or three years ago, she started having numbness and weakness in her hands and feet and sometimes arms and legs that got much worse in the heat. She was having a couple of other symptoms at the time (can't remember, but I think one was having trouble seeing out of one eye) that made us wonder if she might need to be screened for M.S., but she didn't have insurance at the time and it resolved after a couple of months, so she never got it checked.Last year in June, she started having multiple grand mal and absence seizures per day, including episodes of stat ep, and an EEG confirmed temporal lobe epilepsy. She also had periods of disorientation with no obvious seizure activity. She tried several medications and they finally settled on max dose Depakote. She has not had a seizure in six months that she knows of.Two or three months ago she suddenly developed the inability to tell if her bladder was full and she also had sudden full releases of her bladder. This has been improved with medication.On June 8th, she went to the ER for a severe headache. She was diagnosed with cervicogenic headache caused by muscle spasms in her back and neck (new onset).On June 29th, the ER gave her a steroid injection (for asthma) in the front of her left thigh and her thigh immediately went numb. It remained numb until this past Monday, when she developed severe pain in her thigh with difficulty walking and bearing weight on that leg. There was no redness, swelling, or other obvious indication of infection or blood clot. Her PCP said it was likely femoral nerve entrapment as a result of the injection and that it would likely resolve over time.Last night (Thursday), just before 5 pm, she had a sudden onset of left sided numbness in her face, neck, left arm, and left leg. She could no longer feel the nerve pain in her thigh at all. She also had blurry vision in both eyes. The paramedics noticed slurred speech, word finding problems, and facial droop. She was able to make it to the stretcher with help. By the time that she got the ER (level 2 stroke center), her entire left side was paralyzed and she had zero sensation on that side. Whenever she tried to lift her left leg, visible muscle spasms were present in her thigh. She also could not feel her pubic region at all and had great difficulty urinating. At no point did she have a headache. She said she had no lapse in memory and does not believe she had a seizure (her SO was with her also). Her blood pressure and blood glucose were normal. Head CT and MRI did not show signs of either a hemorrhagic or ischemic stroke. After a couple of hours, she showed slight improvement - able to slightly lift her affected arm and leg, although she still has no sensation. The facial droop and slurred speech had mostly resolved, but she was still having word finding problems. She was told it was likely a TIA caused by her Nexplanon and that it would be completely resolved by morning. They said if it wasn't a TIA, it could either be an unusual presentation of a seizure or a psychiatric condition (she has depression, anxiety, PTSD, and ADHD, all controlled). She was admitted to the step down unit for observation. They said they could not give her any of her medications until the hospitalist approved them.This morning (Friday) my sister had recurrence of the left sided numbness and could no longer move her arm and leg. The hospitalist was surprised to find that the symptoms had not resolved. The hospitalist said it was likely not a TIA and that they would be looking for other causes, like M.S. The symptoms slowly began to improve again, then the numbness returned along with the paralysis. This has improved slightly again. She had a repeat head MRI and CT, an echo, and a carotid ultrasound, all normal. She was assessed by speech therapy (normal) and PT/OT, who found severe deficiencies and recommended inpatient rehab. At no point throughout the day was she given any of her regular medications, including her Depakote, which is critical for her. The nurse didn't answer any of her call lights all day, and she sat in her own urine for hours, tried desperately to hold her bowels because he was so irritated every time she called that she was afraid to use her call light.Her case worker informed her that both local inpatient rehabilitation centers denied her admission because she didn't meet the criteria based on the neurologist's diagnosis (which we had not yet been updated on). Finally the neurologist came and did a super quick assessment. My sister could lift her left arm about three inches off the bed and her left leg about two inches, and still had almost no sensation. She still could not walk or bear weight at all. The neurologist said that they had ruled out all emergent causes and that it was probably a manifestation of conversion disorder and that it would go away in a few weeks. She will be discharged tomorrow and given a referral for home health.After the neurologist left, my sister started crying. She felt dismissed and judged and crazy and she started wondering if she was faking the whole thing. I reassured her that what she was feeling was real and that I believed her 100%. I called the patient advocate, but they were gone for the weekend. I contacted the house supervisor and requested either a different neurologist or a transfer to another hospital. She said she would talk to the neurologist to see what he was thinking. After they talked, they basically denied both requests, as well as a request for inpatient rehab or PT, and said she would still be discharged tomorrow.There are stairs that lead up to her mobile home. Her SO is not strong enough to assist her with the at home care she needs until home health comes through and she will clearly need significant around the clock care. She will not be adequately cared for at home.I'm not sure if we should just do the best we can until she can contact her regular neurologist on Monday (there is no after hours emergency line), or if we should check her out tonight and take her to an academic hospital for a second opinion and further testing. Our closest major cities are Shreveport, LA (1 hr), Little Rock, AR (2.5 hr), and Dallas, TX (2.75 hr). Any advice would be extremely helpful.This is what I know about her medical history:Hard of hearing Temporal lobe epilepsy (June 2021), last known seizure 6 months ago Cervicogenic headache due to neck/back spasms (June 8) Asthma Unstable SVT (frequent episodes for awhile, but no episodes in a few years) Fibromyalgia Left leg - possible femoral nerve entrapment (June 29) Rectal abscess surgery (Feb 8) ADHD Depression Anxiety PTSD Chronic/frequent laryngitis? (sore throat, loss of voice, and fever every two to four weeks for at least a year, not diagnosed) Upper back pain/vomiting when eating (April) Severe sleep apnea - hasn't received CPAP machine yet Urinary incontinence Non-alcoholic fatty liver disease Chronic rib pain - both sides, since teenager Enlarged spleen (Dec 2020) Hypertension Hyperlipidemia COVID (2020) PCOS Acid refluxThese are the medications I'm aware of:Ozempic (for weight loss) Metformin (for weight loss) Cymbalta Depakote Albuterol Gabapentin Oxybutynin Indomethacin Trelegy Singulair NexplanonShe rarely drinks alcohol - causes back and shoulder pain. She does not smoke cigarettes. She has her medical marijuana card for epilepsy, but rarely used it until this week, when she began smoking frequently to try to control the leg pain.Please let me know if you have any questions. ###Output :I hate to be that physician but in the absence of any actual findings on multiple MRI, ECHOs, Carotid US, sometimes conversion disorder may be more likely than a rare esoteric disease. That being said, what led you away from conversion disorder?

###Input :Thank you for responding. I thought that required a pretty significant stressor. The only thing that's come up in the past couple of weeks is the nerve injury. Nothing else has really been stressful lately and her mental health has been under control. The altered mental status and muscle spasms left me with the injection that it is medical in nature. Also her history of neurological issues presenting over the past three years. I was thinking Todd Paralysis or MS might be more likely. They didn't do a spinal MRI, a spinal tap, or nerve conduction studies. Not sure if it was necessary or not. ###Output :Conversion disorder does not require a significant stressor to be present, although significant is a relative term in itself. That being said, an extensive work-up would include MRIs with/without contrast of brain, cervical spine, thoracic spine, lumbar spine +/- lumbar puncture. If this has all been done and negative, it is more likely conversion then a obscure neurological disease although the latter in itself is difficult to rule out.

###Input :Given the timeline Ive described, would it be reasonable to assume the relationship between Covid and these complications?Would it be reasonable to assume the relationship between MI and demand ischemia?Interestingly, the transfer hospital did not initiate treatment for COVID-19. Could this have changed the trajectory of the case? ###Output :Sounds like the likely timeline is COVID infection --> demand ischemia, MI. Given the situation, it sounds like the transfer hospital and receiving hospital appropriately triaged the issues and treated the most life-threatening issue (the acute MI) first.This patient had a lot of risk factors for getting very sick with any infection, not just COVID. Going without clopidogrel likely also helped precipitate the MI, though no one will be able to say to what extent.I don't think that initiating COVID treatment at time of presentation would have made much difference.

###Input :Hello all... I am a white 33yr old male, 5'9 180lbs no meds taken currently. This is the second time I have had cellulitis in two months. I was wondering if sea moss was beneficial in any way to help the healing process as well as make it faster it's extremely painful and I have it on both of my feet in lower legs I'm afraid to go to the hospital because of the area that I live in they are too quick to judge and stereotype you and I have extreme anxiety going to the hospital so is there anything that I can do to get this healed and taken care of as quickly as possible please any and all comments ideas and suggestions are welcome and will not be criticized or Taken the wrong way ###Output :If on both legs not likely to be cellulitis.Please include one of preferably more of the pictures in your post as an imgur.com or imbb.com link. It makes it easier to help with something when it can be examined visually.

###Input :My dad (52M, no prior health issues except mildly high blood pressure, on a blood pressure med) is currently hospitalized for a pneumothorax after an injury. He broke several ribs, and one of them pierced his lung. The pneumothorax was small, so we assumed hed heal fine on his own, but yesterday he had to be transferred to the critical care unit because he had developed AFib in his sleep. Once his heart rate was stabilized, they put in a chest tube, because X-rays showed air and fluid. Hes been draining a lot of blood and fluids from the tube.They arent sure if the AFib was caused by the collapsed lung, but he has no history of irregular heartbeat or heart problems. Is this common after a pneumothorax? ###Output :Essentially, anyone can develop atrial fibrillation at any time for numerous reasons including you and I. That being said, the stressors on his body could have induced a state conducive to this, or it is possible that these are 2 separate problems that happen to occur around the same time, ie a person with a stroke who also has a UTI. One would not have necessarily induced the other in this case.

###Input :Please take the time to read this. I am extremely sick and not sure if I am going to survive much longer.31M. 5'8"; 125LB; Caucasian; trouble breathing/abdominal pressure; 7 year duration; condition undiagnosed - separate diagnosis of reactive hypoglycemia; current medication (Acarbose 50mg every meal); ZERO drugs/drinking/smoking/vaping/caffeine;My name is Jason Otto. I've been so sick for so long I don't care about online anonymity anymore. Here's a pic of me to prove I'm not making this up:https://ibb.co/1vHzn3xI am extremely messed up. I have been unable to work for the last 8 years and savings have nearly run out. I am now homeless (living out of my car). I have traveled the United States in search of help and I am currently at Harvard. I thought I would get help here but it's more of the same: condescending doctors who take very little time to even talk to the patient and figure out what's wrong. I don't know where else to turn.I am currently looking for a doctor that gives a shit about his/her patients. I'm looking with someone with integrity. I am willing to travel anywhere in the country and can be there within 24 hours. Most dismiss me after the usual 20 minute appointment and tell me nothing else can be done. There is no brainstorming, no critical thinking, no followup, nothing. I don't think that these people understand how serious this situation is. I cannot work, I can barely get out of bed (now my car-seat) in the morning, my cognition is in the toilet and I am unable to function in daily life. I am a vegetable.My problems began in April 2013. I had been having gastritis for a good 6 months and was treated unsuccessfully by several GI docs and their PPIs and H2 blockers. Out of desperation, I went to a chiropractor at the recommendation of a friend. He said he sees all sorts of weird stuff and he will ACTUALLY LISTEN TO YOU. Sold.I see this guy and he thinks my gastritis is due to a hiatal hernia. I now know that this can be seen on an xray and that he was completely full of shit, but I was desperate so just told him to "fix me please". Desperation breeds bad decision making, and without family support I didn't think twice about it.He said he could manipulate it back into place and laid me down on the table, stuck his fingers in exceptionally hard, deep into my abdomen, just under my ribs, about an inch below my xiphoid process, and pushed in and pulled down toward my naval very forcefully.I feel like he moved something out of place.Since then I have had trouble breathing, eating, and feel like I'm constantly being hit in the stomach. I feel like the life is being sucked out of me. It's hard for me to move, it's hard for me to think, refreshing sleep is next to impossible, and I feel like I'm stuck in overdrive all the time because I am so uncomfortable that I cannot calm down. Something feels out of place in my abdomen, almost like it was shifted downward, and no one can seem to tell me what it is or how to treat it.I've had CTs, MRIs, xrays, and many other tests. GI has been ruled out with extensive testing (EGD, barium swallow studies, gastric emptying scans, etc.) It feels like it is outside of my GI tract, almost as if my liver has been displaced. When you go to a doctor and say you are having problems in the epigastric area, you are referred to a GI. GI has been ruled out, and there is nothing wrong. It feels like it's some sort of organ or something else that has been forcefully moved. I feel like I'm in hell in my own body.I struggle to focus because I feel the need to constantly lay down. It's like being hit in the stomach and needing to sit there for a moment to just relax and catch your breath, but the feeling is constant and never goes away. This has crippled me and I cannot do simple things like reading books.If anyone has any idea on what this could be, or has any recommendation on where to go or who to see, PLEASE let me know. I'm someone who always repays the favor, and if you can point me in the right direction or help me in any way, I will more than make it up to you.I used to be a somebody, and now I'm rotting away in my vehicle. I've lost 40 pounds because the thought of food makes me sick, and I cannot find relief.Thank you.-MAlso, THERE IS NO PAIN. I need to make that clear. It's pressure/tension that is constant and I do not feel pain with this at all.I also feel a beating heartbeat in the area, like my heart is pushing against it. The heartbeat is pronounced.Here is a link to an image I uploaded showing the area (under xiphoid process, near liver and diaphragm): https://ibb.co/ByrJ4xSScan list:CT chest, abdomen; MRI chest, pelvis, abdomen; xray chest, pelvis, abdomen; Abdominal ultrasound; Echo, stress test; Tons of blood workEGD; Barium Swallow Study; Colonoscopy; Gastric Emptying Scan; Capsule Endoscopy; Pillcam ###Output :This is now getting filled with bad advice and advertising. I think good suggestions that will come up have come up, and the discussion is over.

###Input :Since you're already in the neighborhood, have you tried this group? https://undiagnosed.hms.harvard.edu/ ###Output :UDN is a good thought, and I think worth looking into. I hope this suggestion gets upvoted more. They have great success stories and are run by great people. It also illustrates that "I am at Harvard for medical care" can mean a bunch of different hospitals, clinics, and doctors, who all have varying expertise and areas of focus.However, a couple things to point out:It's a research study, so not the same as "having a doctor." You also need a study recommendation letter from a health care provider."We cannot accept all applicants." Eligible participants "have at least one objective finding." I honestly don't know how they define that, e.g. is weight loss objective enough?"After all of the necessary information is received... it typically takes 6-8 weeks... to decide whether to accept...."They have about 12 clinical sites across the US, not just Boston.Not trying to dissuade OP. If it were me, I would absolutely be looking at UDN. Let them decide whether you're eligible or not. I'm just trying to provide perspective about what to expect.

###Input :Thanks!It does seem structural but I'm having a hard time getting anyone to believe me. Most docs don't even want to hear my history of how this happened. They're on auto-pilot and seem to just want to know what the symptoms are.I'll look into sympathetic nerve damage. ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification.

###Input :Thanks I added that to my list of things to look into and will be following up with someone on Monday to hopefully evaluate it. I have a list of everything that everyone on here has said and I'm going to bring it to the attention of the next doctor I find. ###Output :To be honest I wonder if you had some traumatic injury to the celiac plexus. This sounds like a neuropathic pain secondary to the chiropractic manipulation. This is a very unusual story you give, so I can't say I have a strong hunch what is going on, but this seems like a reasonable thought. I'm sorry you've ended up in this predicament. You may consider seeing a pain specialist for discussion about a very particular procedure of a type of nerve block.

###Input :I've been thinking the same, and am trying to find out how to know for sure. I'm told that x-rays show the diaphragm, as well as CT scans, but nothing is ever mentioned. I've had an ultrasound of the abdomen as well which I was told would show something if there was a problem, but nothing is coming up. ###Output :Just so you know, x-rays show the diaphragm so-so, but not great. CT would certainly show more detail. Earlier you stated a hiatal hernia "can be seen on an xray," which is true in the sense that an obvious one would show up, but not all would show up.Likewise, an ultrasound of the abdomen could in theory show some diaphragm abnormalities, but that's not often what the sonographer and radiologist will be looking at most closely.

###Input :t that's not often what the sonographer and radioloThank you.I have had a lot of imaging, including CTs, over the past several years. Do you think a second opinion from a radiologist would be a good idea? Usually you get an order from a doctor and the radiologist does and reads the scan, but are there options for people who just want a radiologist to look over old testing? Can I pay someone to look at old tests? ###Output :In general, radiologists definitely look at old scans, and that could be considered a second opinion. This pretty much means the patient has to bring the images on CDs.However, when this happens, it involves a "front line" non-radiology doctor (medicine, ortho, neuro, etc.) who sees the patient and usually is ordering a new scan and wants to know how today's MRI of the hip compares to the 2015 scan from Far Across The Country Clinic, LLC. Rarely the front line doc might have old scans only and just want his/her local radiologist to take a look as a courtesy.I have never run across exactly the 2nd part of what you're suggesting: patient directly sees/pays a radiologist to review stuff (with no front line doc involved). This probably exists somewhere in the world, but it has a sort of "boutique" feel to it.

###Input :Hi Docs & Medical Community -Coming to you all hear with some saddening news. It's been approximatley six weeks since my partner "attempted" suicide via hanging, and I have had extremely limited information on his current condition due to a variety of factors. These include being a non family-member, and his remaining family being very difficult to work with, less than caring of his current condition, and not being the ideal parents. The background for these are for another subreddit, but I'm happy to divulge any information if you all need more. I will try to be as analytical and non-emotional as I can in this post, as I'm only attempting to gather information from those directly involved in the field, as opposed to my resources of compiling random pages on the internet. Hope you all can help, and if you need any information please ping me.For security reasons, this is a throwaway, but I will be checking the post on my main account routinely and can log back in to answer any questions you all may have. Thank you very much for your help.I made an original post on r/TrueOffMyChest yesterday, that you can find here. It may have some information that may be relevant, although focuses more on my emotional state and less on the actual medical facts.---Patient Information: USA, 25M, 6'0", 192, White, Attempted Suicide Via Hanging - Hypoxic Brain Injury. No exisiting medical issues - daily workouts w/ weightlifting and cardio, very diet and food aware. Current medications include 20mg daily Wellbutrin, started 2-3wks before event happened. Prior to Wellbutrin, 20mg of Prozac daily. Casual smoker (vape-nicotine) and regular alcohol intake (2-3 drinks/mo). No recreational drugs. Past history of mild depression and anxiety, routine therapy. Zero previous suicide attempts or thoughts at self-harm.---The last several weeks have been quite stressful and devastating as you can imagine. There's a lot more to the information-specific side of the story, but the long story short is an abusive, neglectful, and incredibly religious mother, who has cut off her son. She is unwilling to call the hospital for daily updates, and obviously they can't release any information to myself or his friends, as we're not family. We have been able to get some limited information through friends of friends - my partner was a graduate school student in biology, and has many friends who know some individuals who work at the specific hospital he's at and were able to nail down some information. With the exception of yesterday's update, in which my partner's best friend drove to the hospital and used one of his friends there to squeeze some actual information (I'm not sure that's legal, but we are totally in the dark and the only person who has information will not share for her own greed), we know nothing concrete.The information yesterday was helpful in a way. For my full emotions, I can't say I'm any better, but from a purely medical standpoint I'd like some help deciphering it. Again, I understand this is a sticky situation involving HIPPA and legality, so want to be clear that I am not advocating for any unethical or illegal reporting standards. I fully understand the rationale and logistics behind HIPPA and it's protection laws. I hope, from a personal perspective, you all can see how we had to do what we did in order just to learn SOMETHING. I am not a judgemental person, but his mother is subjectively awful for her behavior in the past and now, withholding information and not even picking up half of the hospitals calls regarding updates about her own son. We just have to work with what we have.The reason I bring this up at all is due to the fact I want to stress the 'concrete' nature of the status update yesterday - while all of our other updates have had questionting validity due to them being passed through multiple sets of ears and open to interpetation, this one came directly from the source. Anyways, I will attempt to construe a timeline below:Mid-Feburary: Initial incident occured. I discovered my partner hanging by a constructed noose in his bedroom. While I don't know how long he was cut from oxygen, I know that it was >4min and <11min. If it was closer to 4, I'd assume he'd be awake by now. If it was closer to 11, I figured he may be confirmed brain dead and/or medically dead at this point.I called 911 and began CPR immediatley. 911 was quick response, and from call time to arrival was no more than 3-4 minutes. In this 3-4 minute period, I opened his airway and performed CPR while simeltaneously on the phone. I did not detect a pulse nor breathing, and once the EMTs arrived, they relocated me into another room for comfort & questioning while attending to him in the field. They shocked his heart back from AFIB, and I do not remember them confirming if they restarted his pulse.Late-Feburary: 13 days after event. I have no information. I am called by my attorney (who I called to be safe and attempt to find out more info) to see if he knows anyone who can get any contact update. I have contacted his mother by now who has expressed her disgust for her son and says he is an "unforgiveable sinner" and wishes not to be contacted by me anymore. When my attorney calls, he gives me no information other than "no brain activity." I immediatley assume brain death, and am disheartened (to say the least) at this news. I assume at this point that it is irreversible and he will not wake up.Early-March: Limbo period of no information update. My attorney can only guarentee me that he will have any information if she dies - in which case I will be informed.Through grapvine comprised of partner's close friends, limited information is listed that he has been transferred to a highly-rated neurosurgery hospital, and has been moved from "Critical" to "Critical-Stable". His body is improving, but no update on his brain status and activity. No one knows who authorized the transfer, or if it was done by the State or a hospital administration decision. His mother does not answer my request for comment. Brain activity has gone from "no brain activity" to "little to no brain activity" if that makes a difference - it did not to me, at least not at the time.Late-March/Present: Partner's best friend made the state-crossing drive to his current hospital, which as of yesterday, he is still at and not reported medically dead. Source-based information was relayed as follows: Still in "Critical-Stable" condition, with significant brainstem activity. They would not say if it was a persistent or permanent vegetative state, rather they listed it as a "medically-induced coma to allow the brain to heal." They implied that they COULD wake him up if he wanted, but they were holding off to see if he would have a better response. I'm unclear on what that means. They could not give him an exact date on when he was moved from one "level" of inactivity or trauma to the other, so I cannot confirm that. They said his OFFICIAL condition was "Stable, but Unresponsive" which could mean a number of things. I am optimistic that they have taken away the notion of a sudden brain death, but am trying not to a) get my hopes up, and b) speculate on anything that was not explicitly confirmed.In addition to those updates, they said his vitals were normal, and he had sleep/wake cycles, but no voluntary response to stimulation. Whether this is due to a brain injury or the medically-induced coma or some combination of the two is unknown. While he is still on a ventilator, it was reported that it is no longer breathing FOR him, simply assisting him in his breath. His heart was put on bypass, but is pumping on it's own at the moment. This is the last update I have.---So, here we are. This is a lot of words. I want to state - I don't know how to feel. I'm not writing this post for someone to sit here and tell me it's going to be okay. I know, logically, there is a very small percent change (<5%, if not smaller) of him ever waking up, and a fraction of that small chance of him being "normal" in the sense that he was.My intention with this post is to try and get some real life experience from those who have seen something similar or have an area of expertise in this field. I've read a LOT of things on the internet, some of which make sense, some of which don't, and some of which conflict each other.IF YOU HAVE ANY ADDITIONAL QUESTIONS OR NEED ANY MORE INFORMATION, PLEASE LET ME KNOW. WILL UPDATE AS SOON AS I CAN.---I'm not religious, but ask all of you to send some good thoughts his way. You never know. I know that there are a thousand possibilities of varying severity through this outcome. I'm hoping it's the one that he's happy with. ###Output :Thats a very sad and difficult situation, Im so sorry.Im not sure we can help a lot with all this second hand information.The fact that he has a wake/sleep rhythm and triggers the ventilator means that hes not brain dead. The first fact means hes probably moving to (at least) a persistent vegetative state.The chances that he recovers without important disability are slim. Its very hard to predict if this remains in the range of persistent vegetative state or if more consciousness will recover. A next step would be if meaningful communication would be possible.An MRI, EEG and the results of a neurological exam will help inform prognosis, but there still will be significant uncertainty.

###Input :Age 40 Sex MHeight 6'1 Weight 190 Race W Duration of complaint Week Location Left index Any existing relevant medical issues PsA Current medications Biologic Include a photo if relevantLast weekend when planting a very large agave/century plant, I got three spines in my left index finger. Two I got out (but they hurt for days after -irritant/poisonous?). The third I felt a stick but didn't see a mark and couldn't find anything to remove. All week the finger has been warm, red, stiff, and a bit swollen. No change in a week, though now the first joint is a bit painful when pushing on it. I've got PSA, so used to having stiff hands, but this is a little different.I've held a very bright flashlight to it and cannot see any foreign body under the skin.For sure had DTAP 8yrs ago when my first was born. Not sure since.Go to the GP? Let it ride? If the doc, do they just throw oral antibiotics at it, or is there something more effective? ###Output :Missing critical elements of history and no images. You may have an infection and you should seek care. Infections in the hand can be serious.

###Input :29F, 5'2, 80 something lbs, end stage liver failure etc.This one might be long, but I appreciate any kind of advice or input. I'm concerned my sister has been kind of pushed to the side since COVID19 and she's currently in critical, critical condition despite having been discharged. My family is confused on what to do, how to help her, especially since she's been denied a liver transplant. But anyways, here it goes:On March 5th my sister was found collapsed on her bathroom floor, she was completely yellow. Her boyfriend rushed her to the ER, where he was told to call family (us) because she wouldn't make it. From there she was transferred to a larger hospital, placed in surgical ICU and had a team immediately on her case. At this point her liver was failing, and she had an infection but they didn't know the source nor the bacteria causing it. She couldn't breathe on her own etc. Over the next week they threw all the antibiotics at her hoping something would stick, put a tube in her stomach to drain fluid that had built up around her bladder, put her on 24/7 dialysis since her kidneys began to fail, so many tests ran, I unfortunately can't recall all the details right now but if there are any specific questions I can likely answer.It was very touch and go for a while but her fever had gone away despite never finding out the source of infection. She was tolerating the dialysis and the last day I saw her she looked like she was doing a little bit better. Then COVID-19 hit my state and we were no longer allowed to visit her. Phone updates from the RN told us she was doing better, but they never had any specific information on what specific doctor's were saying, questions we had just weren't getting answered and my sister was unable to tell us what was going on. Within one week, we were told she was well enough to go down to general, despite previously being told she would go down to regular ICU first, and be in the hospital for at the very least a total of 6 weeks. She could breathe (not very well) on her own at this point and could communicate, so the hospital was no longer relaying information to us despite her not being in good enough condition to actually understand what was going on and couldn't remember what doctor's were saying to her. The next day we get a call that she's getting a port placed for out patient dialysis, and she was discharged that same day.We knew she wouldn't be 100% obviously but thought she would be better than she is. She comes home and can't walk, can't breathe very well at all, is completely yellow, is in constant pain and honestly looks like she won't be able to make it much longer. We don't know if she can survive with this liver, she was denied a transplant (whole 'nother story) and despite getting outpatient dialysis she looks worse and worse. She was told she was getting a home care nurse, they aren't coming now. She was supposed to originally be getting PT, they won't come out anymore (honestly don't think she's at that point now anyways). I'm trying to facilitate the care she needs and I'm trying to get her appointments set up but all doctors are only doing video call (completely understand). I'm just so scattered right now and have no idea why she was discharged. Should I take her back? Will they even be able to do anything? I don't understand and I'm just looking for any kind of advice I can get.Edit: The liver failure was precipitated by alcohol abuse and exasperated by the sepsis from her bladder infection. The last we had heard from the transplant team was that she was considered a good candidate (after 3 interviews) despite the alcohol abuse. We got a letter in the mail yesterday stating the denial. I am not trying to negate from the alcohol abuse, that was the reason her liver failed. Just that she also had a lot else going on that led to the condition she is in. ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification.

###Input :Ineligible? Its probably the alcohol. Transplant has very strict regulations. I cant believe any transplant team would say shes a good candidate if she lost her liver due to alcohol abuse. Just like with cigarette smokers. You have to quit and show at least 6 months to a year smoke free before you can even get on the list. Its a long process.I had to wait five years after my stomach cancer to get my transplant. So I did my best to follow my diet and restrictions set forth by my nephrologist and dialysis center.Im only speculating, about your situation. Im sorry if any of this sounds harsh.It took 3 years of waiting on the list and finally as my health took a turn for the worse, my ex donated his kidney to me 15 months ago.If she will not comply with the program, theres no reason to transplant a healthy organ in a person who wont stop those destructive behaviors. The restrictions/rules are there for a reason. I had So many moments of pure anger, crying, frustration and hopelessness. But thats normal considering the situation.I AGREE, she needs to be hospitalized. Her dialysis center should be advocating for her. Find out who is the social worker for her clinic and contact them ASAP.Also, did you know that for a liver - you can donate just a portion - it doesnt need to be the entire organ for a successful transplant. You (family) could still get tested while you work with the transplant team to make her eligible.My mom has cirrhosis of the liver & she too was ineligible because she was a heavy smoker and soda drinker. She wouldnt quit. Shes outlived all the doctors predictions. But shes suffered tremendously. I finally got her and my dad to quit about five years ago. Shes still too afraid to have transplant, shes set in her ways. So everyday is sheer hell at this point. Im terrified for her with COVID-19. One person has already died at her assisted facility living.Heres my take on part of the reason she was worse after she came home is most likely the dialysis. Its a new thing for her body. It has to adjust to it slowly over the next few months. Depends on how bad she is. It wrecks havoc on your body. You can have extreme lethargy, dizziness, headaches, nausea and cramping.She has End Stage Liver Disease. She is living with terminal illness. The only real thing besides humor & my kids that helped me cope was educating myself. About my disease, dialysis etc.I am so sorry this is happening. Wishing you both the best in the future to come. ###Output :It's hard to tell you what's happening or what to do without more detailed info, although I completely understand that you do not have this information, and this is all exacerbated by the current isolation requirements. If I were you I would be focused on finding someone to talk to who can explain things better to you or her medical power of attorney (which, by the way she should definitely have at this point). Does she have a follow-up appointment with a liver doctor within the next week?What medical problems did your sister have prior to March 5th when she was found down in the bathroom? Do you understand what is the primary source of her liver failure? Most common things are alcohol abuse, hepatitis C, or toxicity from a Tylenol overdose... others have what's called "cryptogenic" liver disease which means "it's a mystery" but these cases usually don't present as rapidly and dramatically. Sometimes even young healthy patients just have really bad luck and get a bad viral hepatitis that leads to fulminant hepatic failure in a very short time span.Reasons for being denied a spot on the transplant list generally fall into one of three categories: 1 - not sick enough yet, 2 - too sick or has other serious other problems that mean even with a transplanted liver she would not survive long enough to benefit from the very scarce resource of a liver donation, and 3 - not eligible due to history of current or recent alcohol or drug abuse.From what you describe it sounds like she was reasonably healthy and has had a sudden dramatic decline in her health which included an ICU stay with multi-organ failure (liver, kidneys). Then at some point she had somewhat "stabilized" enough, although remained in overall poor health due to her illness. At this point she was discharged home with home health, outpatient dialysis, and PT for rehab, but given the current worldwide situation those services are not being very reliable. Pain, weakness, and some shortness of breath are honestly part of her disease and may not (by themselves) warrant re-admission to a hospital... depends on the severity and whether there is any intervention that could be done in a hospital setting to improve her. Perhaps she should have been discharged to a skilled nursing facility, but these have specific requirements which she may not have met. I can speculate all day but without detailed information it is hard to give good answers.I'm sorry for what you and your family are going through - both the fear of your sister's declining health as well as the uncertainty and confusion you are dealing with. I know it must be very frustrating. Like I said above, the most important thing is getting more info. And if she truly is getting sicker and looking worse at home them take her back to the hospital ER. They may or may not readmit her, but at least she would be evaluated and you'd have a chance to talk with someone about her situation.

###Input :Thank you so much for this thoughtful reply, I'll try to clarify on some of the things you mentioned. I'll try to be as concise as possible.The cause for the liver failure is alcohol abuse, unfortunately.2 weeks prior to March 5th I saw my sister and she looked healthy. She had been complaining about UTI pain and she told me she saw a doctor and got antibiotics, I told her she needed to go back if she's in pain still since it could spread to her kidneys and she said she would. She never did either of those things, so that bladder infection I'm sure, is a result of a long standing infection. She didn't look jaundice two weeks prior, she has always been a drinker, however until this happened unfortunately I don't think anyone (in the family) knew just how bad it got. Apparently she was drinking very very heavily the week/2 weeks prior to collapsing. We didn't hear much from her the week prior to the hospital, her boyfriend told us she was trying to kick alcohol and wasn't feeling well. I honestly can't tell you exactly how things got to the point that they did, as she was living with her boyfriend at the time. I certainly have my own questions as to why it took her collapsing on the floor yellow as you wouldn't believe for him to get her to the hospital... But that's another story and something I'm trying to think about right now.I'm guessing her reason for not getting a spot on the transplant list is either due to your #2 or #3. We were assured when they first started speaking to us that alcoholics are eligible for liver transplants if they feel they are a good candidate, and they thought she was. We went through 3 separate interviews. We just got the news she was denied via letter in the mail just yesterday.She has a follow-up appointment via video call with a liver doctor on Wednesday.I've talked to my mom today about how we need to set up a POA. We didn't think she was going to make it while she was in the hospital/when we could still visit, so while my mom was acting as her advocate, nothing legal has been set up yet. I agree, that needs to be done asap.I forgot a couple things in my original post about how she was considered to have sepsis due to the infection, and she had aspiration pneumonia. Not sure if that's relevant at this point. I'm just taking with my mom rn were trying to make sure we're including as much info as we can remember.Your summary sounds very much on point, and that's kind of where I'm at. Do we take her to the ER? Do we wait until her video call on Wednesday? I can't figure out why she was discharged, and I don't feel like we were armed with enough information about her current condition before she was discharged and were confused on what to expect, what were working with, etc. She's currently in a lot of pain, she's not very alert today, she does have dialysis tomorrow. I'm just so confused lol.Thank you for your help, I'm trying to prepare for what my next move is going to be, everything has been so confusing having COVID19 thrown ontop of all of this. I do feel like this lack of communication wouldn't have happened before all of this, and it's just been confusing trying to figure it all out. She came back to us very very sick, and I just have so many questions. ###Output :Sorry that you and your sister are in this situation, but for this extra information and the long standing alcohol dependency/usage, it sounds like she was denied on that basis. Yes, there are circumstances that can alcoholics can get listed but transplants are reserved for candidates that can make use of their own life and the life of the person whose liver is being transplanted. In other words, it isn't just her life that they are considering. The decision to offer or deny someone a transplant is not a light decision, it involves a whole committee that looks at all aspects of the patient being considered. They look at the usual age, sex and medical history, but also socioencomic history, psychiatric, social structure and support. They usually require a certain number of months of sobriety and vigorous compliance to AA, follow-ups, medications, etc before they can seriously consider any candidate as there is nothing worse than transplanting someone, and that person end up going back to old habits, get lost to follow-up and wasting a healthy transplant that could have gone to someone else. However, just because she was denied now, does not mean she cannot become eligible later.Long standing alcohol consumption can lead to eventual liver failure, and any binges on top of that can throw someone into fulminant hepatic failure and the resultant complications, which sounds like the situation your sister is going through.Unfortunately, she is very, very, very sick and her condition is unlikely to improve dramatically, and she will have more setbacks along the way or she may have an abrupt decline, even while waiting for a transplant. Failed livers have a very high chance of more bad things happening, even with the best therapies and intent. If she is not doing well, such as she is having increased confusion, or unable to be aroused, fevers, gastrointestinal bleeding, I would bring her back to the ER where they evaluated her for transplant (the large hospital, sounds like an academic hospital), if you can. If she cannot make it to the hospital where the transplant evaluation is possible, the closest ER will do, they can stabilize her and decide what to do once she is stable.Hoping for the best! Let us know if you have any more questions.

###Input :Not the OP but have seen plenty of cases of 'young' alcoholics with severe or fulminant liver failure. I've also seen plenty of much older alcoholics who don't develop any of the usually associated diseases. It's a bit unpredictable but generally someone who develops severe disease at a young age will have been drinking a very significant amount over a sustained period of time. And some people are particularly vulnerable to disease unfortunately. ###Output :The degree of liver damage related to alcohol can definitely vary person to person, and probably has a genetic component to it. Just like some people can smoke their whole life and not get lung cancer, some people can drink and not develop cirrhosis (I don't recommend anyone try this). Those cases are the exception to the rule. Smoking and alcohol generally have a dose dependent insult to the respective organs.But definitely have seen early 20s in full liver failure and die, related to alcohol. Some might argue that the developing liver during childhood are more prone to alcohol-related damage.Wow you and your family are really having a terrible month. You seem very calm and reasoned despite the fear and chaos going on. In any family facing these kinds of ordeals it is always very helpful to have someone like you who can rationally absorb information and help others understand.Things that you should "go to the ER now" for would be an altered mental status to the point of near unconsciousness even when you try and speak to her, unbearable pain that is worsening, fevers, significant breathing difficulty (a very rapid respiratory rate like 30+ times per minute or otherwise looks like she is "getting tired" of breathing), a rapid expansion of her swollen belly, or if she cannot do simple tasks of daily living like drinking water or using the restroom on her own. If she is not quite that bad I think it is likely safe to take her to dialysis tomorrow. The dialysis nurses will have a keen eye for patients who are too sick to be at the outpatient center, if they don't seem particularly concerned about her and she tolerates dialysis well then I think she can go back home and await the hepatology appointment / video call on Wednesday. Hopefully you will have much more information after that and can then come up with a plan for the future.Patients with alcoholic liver disease do indeed received transplants all the time. Just because she was not a candidate once does not necessarily mean she never will be. For liver failure caused by alcohol or drug abuse, most donor networks will require abstinence for some period of time (usually several months at a minimum)... but it also sounds like she needs quite a bit of "medical optimization" before she would be well enough to undergo a liver transplant anyway. She needs to recuperate and heal from her infection more and keep taking all the liver failure medications they prescribe. They may also be waiting for her kidneys to hopefully recover some. Hopefully in another week or two she is feeling a bit better and stronger... once she is able to she should strongly consider some kind of addiction recovery program (there are many free ones as well as ones covered by most insurance companies).My very best to her and your family.

###Input :Father, white male, 73 Approx 170, 58 Date of onset 2015My father is currently in a nursing home with the diagnosis of dementia. What is odd about this is that the dementia was sudden onset. The first thing that happened was that my father had an episode they called syncope in December of 2015. He fell down and according to my mother he appeared to seize up. My father is a poor historian since all this and my mother as well so I have to relay this as my memory serves and as she told me so some pieces are missing and some things may be confused.After the syncope episode he did go to the hospital. I am not sure what treatment he started at that time. I believe he had a work up for stroke and seizures and it was negative. In the subsequent months/years my father began to become obsessed with checking his blood pressure. BP readings were not abnormal at this time but he was convinced something was wrong with him. In the medical records it was documented that my father stated something is wrong. That was the last time my father was ever somewhat normal. He lost interest in his usual interests. He appeared quiet and withdrawn. I believe at this time he was taking medication for high blood pressure, prostate medication, cholesterols meds, and Zoloft.My father deteriorated badly enough that he was especially confused one night. My mother and I were concerned enough to take him to the ER. He had severe hyponatremia. I believe his sodium was in the critical range. He had a long hospital course. I believe the hospital corrected the hyponatremia carefully and slowly and I do not find fault with them over this. During the hospital stay my dads heart went bradycardic and he coded. He had to receive a pace maker.After they corrected the sodium my dad never came out of the confusion. He underwent so many work ups to see why he was experiencing the confusion. All the scans, PET scan, blood tests were negative for anything that would explain the confusion.My dad came home with the pacemaker and remained confused. He remained with a flat affect. Loss of interest in hobbies. Diagnosed with dementia at this point. The doctors couldnt explain why a sudden onset of dementia but said this wasnt the usual presentation.Sometime after this my dad had an episode of status epilepticus and went to the hospital. He was placed on a seizure medication at this time. I dont know which one but I can tell you that after he began seizure treatment his personality returned. He improved somewhat.After this he began to deteriorate to the point of not being able to use the restroom in his own. He started wearing diapers. He became bedridden. My mother decided to place him in a nursing home. He recognizes family but isnt oriented to time and space. I do know he began mirtazapine around this time. I was hopeful this would improve his condition if it were not truly dementia. I believe its been about a year since and my dad remains confused. Hes still wheelchair bound.I read promising studies regarding mirtazipine but as time goes on Im not hopeful he doesnt have dementia. Im posting this in hopes anyone can provide any insight over my dads case. My hopes are that he had pseudo dementia.Ill add that all of his care was provided by the VA. We never accused them of any wrong doing. His primary care doctor and neurologist no longer work at the hospital. They asked us repeatedly if my dad was an alcoholic. We would ask why he seemingly developed dementia overnight and they would ask us if he were an alcoholic. My dad was a heavy drinker at times but we didnt feel like alcohol contributed to anything so said no. I know from working in GI that if someone is an alcoholic its hard to hide from a proper work up. Its possible my dad drank more than I knew and its possible that he truly did have dementia but hid it. I guess my question is does this sound like true dementia? Is there anything else that can be ruled out? ###Output :You say sudden, but it sounds like this has been slowly progressive now for almost 6 years, not overnight. That's a fairly typical course for Alzheimer's disease, with initial loss of memory, later urinary incontinence and more global confusion, and later loss of mobility and total impairment. Pseudodementia has particular findings on assessment that indicate for or against; one element is depression. Your father has been on antidepressants, but it's not really clear, at least to me, what depressive symptoms he has had other apathy and loss of affect.But other things don't fit. Neither pseudodementia nor Alzheimer's dementia present with seizures. Severe hyponatremia can, but that would need a workup and cause. Sometimes the cause is brain injury causing syndrome of inappropriate antidiuretic hormone (SIADH), which lowers sodium, which can cause seizures, but it's still not obvious why the first episode of syncope. Eventually severe bradycardia requiring a pacemaker, but not initially?Timing and type of head imaging makes a difference. With the the triad of dementia, incontinence, and now loss of mobility, has there been any discussion of normal pressure hydrocephalus? It would usually be picked up, or at least suspicion identified on CT at some point, but it partially fits and should at least have been ruled out.

###Input :Based on the history you give I would be very surprised if he had not had imaging of his head either CT or MRI and this would certainly have identified if normal pressure hydrocephalus was the cause of his symptoms and this is important to rule out as if identified early it is treatable.It does actually sound pretty good for a history of dementia and I was unclear from your history whether he had in fact had a stroke as this can sometimes lead to a form of dementia known as vascular dementia which is common but presents slightly differently to the more common Alzheimers dementia. In vascular dementia the progression of symptoms tends to be step wise with sudden deteriorations followed by a plateauing of symptoms and then further sudden decline. In Alzheimers the decline tends to be more of a slow and subtle deterioration. You can actually develop seizures with Alzheimers disease which can develop relatively early in the disease but they can be treated with anti epileptics.Dementia cannot explain the hyponatraemia though; however from the history there are 2 common causes for hyponatraemia. Firstly your father was being treated for hypertension and quite a few of the medications used to treat high blood pressure can cause hyponatraemia. This increases if people are on multiple agents to reduce blood pressure and diuretics tend to be the worst but ACEi and ARBs also cause it. Secondly there seems to be some suggestion of alcohol use and at times you say your father was a heavy drinker. Alcohol particularly if drinking over recommended safe limits can also cause hyponatraemia as well as seizures. It is also a risk factor for developing Alzheimers disease and can actually cause a rarer form of dementia known as wernicke-korsakoff syndrome; although from the description you give I suspect this is unlikely to be the cause. ###Output :Its not uncommon for people to say what youre saying, which is they are shocked at how rapidly a person can deteriorate. I hear it all. The. Time. And its totally understandable.The reality is he was slowly deteriorating before that episode, and you didnt notice it. People with early dementia are good st hiding it. We as doctors get used to picking up on the small signs but family doesnt always realize it. Ask them to recall something very specific, and they cant. But they keep light happy conversation very well. And they always seem happy and they say things are going well. In reality they dont remember much.Then something happens. They get sick with whatever and family is shocked at how it becomes full blown dementia. This is classic presentation for a UTI in the elderly. Something that little can make them completely confused.I suspect that was going on for him. You said he had a heart attack, his brain may have not gotten enough oxygen for a short but also, and that can cause permanent damage. You touched on sodium, Im sure you know correcting that has potential downsides as well.Regardless of what caused it, it is what it is now. Outside of it being one of his medications causing it, I suspect theres nothing you can do. Theres some medications they use to treat it, Im not familiar with them.Sorry youre dealing with this. Its hard to watch someone slowly slip away. Make sure youre taking care of yourself, a therapist can help often. And reading up on how to deal with dementia patients is helpful also, theres lots of small things to do that make both of your time together better

###Input :What are permanent treatments for sleep apnea? Due to the fact that obstructive sleep apnea is the result of anatomical characteristics, the question of a permanent cure is complicated to answer. You can definitely do a home sleep apnea test to be sure if you have it or not. Ongoing, sleep apnea may be treated by a CPAP machine or an oral appliance. A CPAP is worn nightly and works by opening up the airway with air pressure. CPAP is effective for the treatment of sleep apnea, but many patients find it difficult or impossible to tolerate. Continuous Positive Airway Pressure machines are machines in which doctors give the nasal mask to the patients that provides continuous air pressure, which opens the blockage in the passage that was causing obstructive sleep apnea. As a result, the patients can easily breathe, and they dont feel any breathing sensation or apnea. Due to this, the patient sleeps well with no snoring, and they wake up fresh in the morning. So this treatment is a very important treatment; however, patients first dont understand this, but once they start using it, they start noticing some changes. They feel active because earlier the sleep, which was not complete or used to be in fragments, you were waking up in between, and you were not aware of it, but now that sleep is complete, the patients feel much better. In addition, if people say that they will ignore it and say they dont need these machines, they will bring complications. Because if you are short of breath and there is less oxygen supply of blood to the organs of the body. There is the possibility of having a heart attack very much; if one has diabetes, then it may get uncontrolled; if someone has BP, then it may get uncontrolled, there is a chance of stroke. Also, the other life-threatening disease may get fatal because of obstructive sleep apnea. So it is very important to identify obstructive sleep apnea, get it diagnosed, get treatment, and, if needed, use a CPAP machine, which is very important for your life. So if you do these things along with lifestyle modification like early dinner. Few exercises can be done, such as walking, working on weight reduction and looking at your health benefits to reduce the use of CPAP machines. In this video, our SimpliHealth expert, Dr. Preeti Sharma Senior consultant Pulmonology and Critical Care at Apollo clinic Chandigarh explains the diagnosis and treatment of obstructive sleep apnea. https://www.youtube.com/watch?v=-GhgspGvrQY ###Output :There isn't a permanent treatment for OSA. There are many treatments for OSA with various indications and various treatment success. CPAP is the most widely applicable with the most consistently positive outcomes. Oral appliances can improve symptoms and in some people normalize their overnight obstructive events, but doesn't have as good long term outcomes as CPAP. Some people may benefit from a surgery where their jaw is moved forward, but it only applies to certain people when their jaw is set very posteriorly. There are also hypoglossal nerve stimulators, but are effective in only certain instances of OSA in which the airway closes in a certain pattern.

###Input :My son is 5 weeks old, I am not sure of his height right now but he weighs 9lbs 4oz. his medical history is complex and I believe it is valuable information so I will start with that..When my son was exactly 1 week old we went to his first pediatrician appointment, they noticed he was looking a bit yellow so they did a bilirubin test the levels came back critically high (21). We were immediately brought back to the hospital and they started him on bili lights however they never tested his bilirubin before we discharged from the hospital I had him at, so we truly dont know how long his levels were that bad. We are RH incompatible so I am certain thats probably what caused the really high biliWhile hospitalized for the bilirubin, we quickly noticed our son was having problems breathing. He was holding his breath for pretty long periods of time. A nurse told us at one point that his respiration rate was only 14.. he was having desaturations and bradycardia with this so he was quickly life flighted to a hospital that was better equipped for this situation. Our son spent 1 night in the NICU and then 9 days in the special care unit. It took him EXACTLY 48 hours to have another breathing episode at this hospital. He was life flighted at 10 pm and then 48 hours later at exactly 10 pm he started having issues again. They did a 1 hour EEG and told us there was nothing substantial And that they didnt find it necessary to do a 24 hour EEG. they decided to try Pepcid 0.2mg because they started to think this was reflux related. At the same time they started the Pepcid he stopped having these breathing episodes. They did not run any further testing and just stated that he was having reflux and was holding his breath because of the acid coming up.My son is now 5 weeks old. We were home for less than 2 weeks and we are now hospitalized again. On Wednesday around 3:30pm our son had what looked to be seizures. His eyes were looking to the left, they were sort of vibrating rhythmically in small side to side movements (not across the entire eye. They stayed looking to the left but kind of vibrated??), and he was unresponsive. We snapped in his face and tapped on him, talked to him and everything and he just was not responsive. He ended up doing this 3 times back to back. Each episode would last about 30 seconds with a 1-3 minute break between each of them. We took a video of it and showed it to our pediatrician who immediately told us with certainty that our son was having seizures. He was admitted to the hospital that night.. they did blood work and did find his electrolytes slightly out of normal ranges, however just a few hours later when they repeated the labs he was back to a healthy range and I was told that couldve happened because of the IV fluids he was on..Once again, our pediatrician made the call to send him out to a better equipped hospital. They sent him to a childrens mercy he was there for 24 hours on an EEG which they did not find anything on.. they told me hes not having seizures and that this movement is normal Im sorry but I truly dont think this is normal. Ive never seen a baby do this and our pediatrician found it alarming enough to send him out to childrens.. our pediatrician has 30 years of experience. Hes a smart guyChildrens mercy discharged us with no answers. We begged them to run more tests or consult with a neonatologist and they refused we left that hospital and went to another one in the area that is well known for their high quality PICU & NICU. we went in and showed them the video.. the nurologist that watched the video said he also does not think this is seizures, however he doesnt think its normal.. right now the plan is to do an MRI tomorrow. In the past he has only had CT scans done, but nothing was found on them..I am absolutely desperate. Our kid is being life flighted twice in his first month of life, and hes spent nearly half of his life in the hospital at this point something is wrong, and no one knows what direction to point us in I asked about the eye movement possibly being related to a balance issue or an issue with his ears and they told me no.. Ive asked if reflux could cause it and theyve told me no Ive asked what could cause it and they give me broad answers I need a direction to go with this. Neurologists dont seem to be finding anything. Could this be a cardiac problem?? Does anyone have any advice on what to ask for if the MRI Comes back normal? Our son needs help. He is miserable. He doesnt sleep, hes not eating very well he gets hungry every two hours and I dont even think hes getting enough milk because he falls asleep every time hes eating and wakes up so upset because hes starving he doesnt let me put him down. I am not being dramatic when I say I have to hold him all day and all night. He will not sleep unless someone is holding him, and usually that someone has to be me. I need help something is wrong and I cant keep doing this. I dont have the energy in me to keep fighting with these doctors.. please help ###Output :Were seizure like episodes actually captured on EEG? Did he do the weird stuff while the leads were actually on? It's possible to have seizures, but have a normal EEG if you're not actively seizing.However, not all abnormal movements are seizures.

###Input :24F 57, 190lbs Meds: Lexapro, Buspar, Zyxal, Allegra, Pepcid, metoprolol tartrate, NuvaringPMH: postural orthostatic tachycardia syndrome, mast cell activation syndrome, hypermobile Ehler Danlos syndrome, and Celiac diseaseOther background: moved to NYC over the summer, works in cardiac surgery and critical careBefore the past few weeks, I had symptoms well under control with meds and lifestyle.3 weeks ago, I woke up out of the blue with itchy, raised hives all over my entire body. I went to urgent care and got a 5 day run of prednisone and steroid cream. Hives continued to fade and pop up all over. A week later, I went to my allergist. She gave me hydroxyzine to manage itching. A few days before it started, I had gotten my flu shot and COVID booster (Pfizer). She said maybe it was a hypersensitivity reaction to one of the vaccines, and that wouldnt last more than a few weeks. We couldnt come up with another trigger other than maybe environmental due to the apartments heat kicking in or the weather changing to cold.After seeing her, things worsened. The hives have been terrible still. Ive been getting pain, hives, and swelling in my small joints (fingers, wrists, ankles). Today, my face started swelling too. I have no idea if its still a vaccine reaction, a new allergen, or something else. Its getting harder to manage and no new ideas from my drs. Any ideas? ###Output :If you have urticaria, this is acute urticaria. They can both be managed the same way.Finding a "cause" for most urticaria in most patients is not a reasonable expectation. Laboratory and other evaluation is not evidence based. Following the evidence-based treatment approach in Figure 2 will greatly improve most patients: https://onlinelibrary.wiley.com/doi/10.1111/all.13397

###Input :Gender - male Age - 54 Weight - 165lbs Height - 5'11So my father has been a heavy alcoholic and smoker for 40+ years but im concerned about his health. About 15 years ago he went to the doctors to get some tests done and his doctor literally said to him "I don't know how you are standing here in front of me", He also had a blood pressure of over 200 and his blood pressure is still at around that level today.But a few months ago he felt really dizzy to the point where He got a doctor's appointment, Then at the doctor's they did a ECG on his heart and said that he must of had a silent heart attack. They also took his blood pressure and it was 260/180.But my father still drinks and smokes like crazy, He did take tablets to lower blood pressure but he still doesn't care.Seriously, How the hell could he still be alive when he has been living with critical blood pressure of over 200 for at least 15 years? Cause apparently if you have a blood pressure of over 180/120 then you have a 80 percent chance of dying within 1 year.Now I love my father but I think he is a ticking time bomb and im worried ###Output :The body can adapt to a lot of things, seems that your dad is lucky. Not sure what type of advice youre looking for, seems that you know the answers. He should stop drinking and smoking and take his blood pressure medication because youre right, he is a ticking time bomb, he could suffer a brain hemorrhage or a heart attack at any moment, or even start to develop symptoms of lungs, heart and liver conditions.

###Input :He's also not vaccinated against covid although I think he caught covid a few months ago because he was pretty Ill (He just couldn't be bothered taking a test tho). He has also never got a vaccine in his life (Apparently) and he was offered to get his covid/flu vaccine but he just doesn't want tohe is a heavy smoker and alcoholic (Does it everyday), He also use to do alot of other drugs back in his early day (I.e coke, ketamin, Ecstasy etc) but even his doctor said to him 15 years ago that he should be dead.Now I know that things such as heart attacks, Strokes etc doesn't seem to run in my family luckily and both of my grandparents (his parents) are still alive, my great grandparents (His grandparents) also lived to thier late 90s so maybe genetics plays a role here but still, I thought him having that silent heart attack a few months ago would of motivated him into getting his shit together but it hasn'tAlso, The doctor's gave him folic acid tablets to treat his blood pressure (Which I don't really understand). He also went for a scan the other day on his heart but they lost his scan results ###Output :Folic acid is known to help reduce the risk of having a stroke. It looks like you cant do much else if your dad doesnt want to help himself a bit. Genetics might be doing their part here, theres really no way of knowing for sure why he hasnt any other complications, but thats a good thing :)

###Input :(EDIT Below Original Post ) I kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many have responded, thank you again, It really means so much.I been staying with him for 99% of the time in the hospital. I went home for one day out of 35 days.He was having issues all of this year, mostly without not being able to eat. We went to ER early June and test results came back okay (or so we were told)He became really sick and malnourished so we took him to ER again in Sept and they performed a CAT Scan. They found a Mass.Biopsy of the Mass diagnosed it as Stage 4 Lung Cancer and now he's been in the hospital for over 5 weeks.He had a cardiac arrest which lead to him being put on life support but they carried on with doing radiation to treat the mass and shrink itHe has SVC Syndrome, Pleural effusion (chest tube) Gastrointestinal tube present (Possibly getting a G-J) , HCC Lung Cancer and AFIB ( Atrial Flutter)Medications: (TBE) He's been/are onFor Pain: Morphine , fentanyl , Versed,Blood Thinners: Heparin, Zerelto, LovenoxBlood Pressures: Levophed, MidodrineDiuretics: Lasiks (oral)Lasiks (IV) 10mg to 20mg back to 10mg.Spironolactone (current)I really don't know what to do. They want us to tour LTAC facilities and we're scheduled to meet Palliative Care later on today..Chemo is an option but he might be too weak to do so..Idk if we should transfer hospitals to get second opinions or what.there isn't much I can do besides this. Being supportive and smiling.. Reaching out to people for help/opinions...This feeling of uselessness is overwhelming..EDITED (Additional information): Thank you for all the replies and upvotes... It means a ton. He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing a lot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment. He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk several times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility. They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathing on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay. He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's a lot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest. I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all. https://i.imgur.com/rea1isQ.png ###Output :Sorry to hear.(HCC stands for hepatocellular carcinoma, a kind of liver cancer. It can metastasize to the lung, which can be a cause for confusion. Or perhaps he has a lung cancer and the acronym you were provided isnt quite right. Probably not of much consequence to the following discussion.)If there is talk of LTAC and he is on versed, I am guessing he is still requiring mechanical ventilation?One cannot be precise without seeing all the data but the typical prognosis with this general picture is very poor. If someone is ill enough to die while in the hospital while receiving optimal care, the odds of complete recovery after resuscitation are low (in the neighborhood of 10%). In those who go to LTAC on a chronic ventilator, only a minority ever come off the vent (~30%), and there is a high short-term mortality in these patients even when stage IV cancer isnt in the mix. Stage IV cancer of any kind, with very very rare exception (some testicular cancer, etc), is not curable.Meeting with palliative care seems like a very good next step. If they do not suggest it themselves, I would ask for a family meeting with the palliative care docs, ICU docs, oncology and radiation oncology docs all in the room together. This is often the best way to get a complete picture of the current medical issues.If he is not currently able to make decisions for himself, as I suspect from information provided he is not, the main question for you and your family is: what is the minimum quality of life he would accept? Some would say that unless current therapies have a good chance of returning them to independent living with intact cognition, they would not want to be maintained alive by machines or treatments. Some would say that if they can think but require complete assistance, that would be enough. Some would say even being maintained in a state in which they have no awareness of the outside world is acceptable.The main question for his doctors is: what are the chances his current treatments will get him to that minimum qualify of life, whatever it is for him? If the treatments and supports offered have little chance of returning him to a state he would find acceptable, then one could view his current therapies as prolonging a state of suffering.Sorry again for what your family is going through.

###Input :Very well said.I want add that if you look at the data for people who go to LTAC and are successfully liberated from the ventilator, and are alive and independent at 1 year... It's somewhere between 5-10 percent. It's a long road to get there, even without metastatic cancer.Something I'd like to add about the quality of life comment that I think is important to share with family members... Everyone has a quality of life minimum that they would accept. It's our jobs to tell the people we love what that minimum is while we are alive and healthy so that our love ones know what our wishes are. If (when) something happens to us, it's up to our love ones to state the decision we've previously made. There's always going to be emotions during this tough time, but guilt or regret should not be one of them.In Healthcare we commonly refer to the surrogate or next of kin as the "decision maker", but really the decision maker is always the patient. The surrogate is the party that speaks for the patient when they are unable to and brings the patients desires to light. ###Output :HCC stands for hepatocellular carcinomaIn EPIC, a lot of diagnoses in the problem list are labeled with (HCC) after their name, like "Acute heart failure with reduced ejection fraction (HCC)". I have no idea what it means, but this is probably where OP got it from, and the pt probably doesn't have hepatocellular carcinoma.Edit: Just looked at OP's screenshot and you can see what I was talking about.Yes. Probably means the word salad pointed out by the other poster just before you. Never heard in a clinical context. Reason #649263 that epic sucks.

###Input :HCCs are a method used in coding to show how "sick" a person is. It's used for Medicare reimbursement calculations for payers (insurance), incentive programs, etc. It's part of Risk Adjustment. Heirarchical condition code....or something like that. I can't even remember right now and I'm a certified Risk Adjustment coder. ###Output :Is there any good reason that this stuff is exposed to actual healthcare workers?

###Input :Another aspect to note is that patients who see palliative care earlier have a much better prognosis - longer survival times and higher quality of life scores. ###Output :Pulmonologist here. I am also the medical director of a hospice for the last 15 years. First, I am very sorry for the difficulty that you, your father, and your family are having to deal with. As a physician, and particularly in doing pulmonary/critical care as well as hospice, I have tried to help people through these tough situations for most of my career. Each case is individual and each patient is an individual with their own beliefs and values and dreams.Over the years, I've spoken to many dying patients and their families about their illness, and what I've tried to do is to give them the perspective of a physician in order that they can then use their own values and beliefs within the framework of a physician's perspective...using what we know and applying their own perspective.As a physician, my perspective on your father is that he is dying. Please don't take that as callous...it is not meant that way. Most people think of dying as a moment...and it certainly can be...car wreck, heart attack, massive stroke... those thinks can take a life in the blink of an eye. However, for many, if not most, people...dying is a process. It can be several hours or several weeks...or longer It begins when you know that nothing else can be done for the patient and all you are trying to do is maintain, and despite your best efforts, the trend is that the patient continues to decline. All patient's have good days and they have bad days, but for a dying patient, when you average it out, the trend is that they continue to worsen.It's at this point that I think it's important to find out what kind of death your father really wants. That can sound very brutal to some people...but remember, we're physicians and we experience this life and death everyday, and we see patients who die peacefully and comfortably and we see patient's who die alone and in horrible circumstances. With those experiences in mind and with our practicality, we begin to think about what we would want for ourselves. Ask any physician or nurse friend of yours...chances are they've thought about it a lot...far more than other people. They tend to know exactly how far they're willing to go before they just want comfort.From your post, you've spoken to your Dad about his care:He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.When he says "chance," what does he mean? Chance of a cure?...chance to go back home?...chance to get a little better and be off the ventilator? In other words, you need to know what his goals are. If his goal is cure, there is no chance. If his goal is going home to the way his life had been...there probably is little chance of that either, though there may be a chance to go home...I don't have enough information. But first, find out which of his goals are potentially achievable with his doctors. Once you know what goals are potentially achievable for your father, you and his doctors can talk about what would have to happen to achieve those goals.Eventually...at some point however, because of the nature of our existence, none of those goals will be achievable, and at that point it is reasonable to give your father permission to let go and to seek comfort in the final moments, days, or weeks of his life. I say that because many patients continue to fight because they think that's what they're suppose to do or because they think they'll be letting down their family if they let go. They endure unnecessary suffering because no one has offered them a path of comfort and acceptance or because they made a vow to fight on and they don't want to renege on a promise they made to someone.We all eventually die. Some of us will never know what hit us because it comes too quickly. For those of us who are struck with a terminal illness like cancer, the only benefit is that we may have enough time to get our personal affairs in order and make peace while having some control over the dying process. As a physician, I know how I'd want to die, however, I don't try to push that on any of my patients. There are definitely patients who don't want to do much at all and just want to enjoy what life they have left. There are other patients who can't die in peace without trying everything including investigational treatments. I respect them all but as a physician I have to make sure that they are making those decisions knowing all the facts and the possibilities and risks.Start by talking to your father about his goals and discussing those goals with your father and his doctors. Give your father permission to do what he wants whether it's letting go or fighting to his last breath. And make sure that in the end, his comfort and wishes guide what decisions you may have to make in his stead. I hope this helped a bit. As best as I can on a reddit post, I'd like to give you, your father, and your family a big hug and my wishes that you all will be comforted in the days ahead.

###Input :Thank you for the supportive information. I really appreciate the time you took to type this out.He's responsive and understands what's going on. We're able to communicate with him and he does mouth out his concerns. Even tho he hasn't really had significant improvement, He hasn't been getting worse and has been maintaining stability and he's doing alot better than when he was first admitted into the hospital. I've understood for a while that his cancer isn't curable from a medical standpoint and that it's only possible to maintain it through treatment.He's expressed that no matter how small the chance is, he wants to continue fighting. We've had this talk serveral times throughout the years. Even now he expresses this. Which is why I'm trying to explore every realm of possibility.They trached him and He's been on Spontaneous mode (his respirator) for almost a week, and they did take him off the vent for 2-4 hours a day to get him used to breathe on his own. His diaphragm is really weak and he gets really anxious whenever this happens because of how different it feels but his vitals and oxygen levels always seem okay.He says he isn't in any pain, he just gets frustrated & anxious at times but that's understandable. He's just fighting really hard, we all are. We have an amazing support system from friends and family and there's alot of people rooting for him. I just want him to have a 2nd chance at life and be able to live whatever time he has left to the fullest.I have access to some of his records through MyChart but the daily notes that nurses and docs input isn't all there. I wish I had more information to provide you all.https://i.imgur.com/rea1isQ.pngI kinda wrote all of this in a rush this morning after talking to his critical care doctor and surprised to see how many over responded, thank you again, It really means so much. ###Output :I'm sorry you are going through this.Your father is going to die. I'm no oncologist, but this seems like he won't get into a situation where he can be treated with chemo or other targeted therapy (I assume they looked at that through his biopsy).A second option can help informing treatment decisions and with accepting this terrible news, but looking how to make sure your father is comfortable for the coming period seems like a good idea.

###Input :Hi all, I'm looking for some assistance for what my next steps are, as I'm just a grad student and not a medical professional.TLDR: 48/F with late stage liver failure and diabetes. Estimated 3-6 months to live. She suddenly is not lucid after stopping most treatment and starting an SSRI. I want to know if this sounds like encephalopathy, and if it does, can it be caused by these treatments?My mom (48/F/caucasian) is currently in the hospital for late stage liver failure. The current prognosis is that 10% is functioning, which is complicated by her diabetes. Last month she was in the hospital with 20% liver function, and had a second toe removed (the first was amputated in 2019).I brought her back in after my dad called complaining about how she can no longer stand, speak coherently, stop crying, and was in constant pain, which we were told was encephalopathy. Since she was removed from the ICU, a family member has been here for the entirety of visitation hours everyday to help her eat, get to the bathroom, etc, so we have witnessed this whole process. After a week or so of treatment with diuretics, she was lucid, starting walking, ate all of her food plus snacks, etc, though still in pain. She was able to verbalize that.Due to the IV teatments they were giving her, she accumulated 40 lbs of fluids in her legs and and abdomen, which they said couldn't drain due to her hemoglobin levels/blood pressure. It started weeping from her legs as a yellow liquid, and eventually she developed dozens of sores on her leg bandages and the legs swelled to 3x their regular size. She was in excruciating pain plus itching, which from what I've read to pretty standard. That all said, she was still able to verbalize this and was lucid.5 days ago, she was told by the hospitalist that there is nothing they can do, and instead of palliative care, she should now be in hospice care. She was incredibly upset by this, but was still lucid. At that time, the palliative care doctor prescribed her an SSRI (not sure which one, they would not tell me) and the hospitalist stopped all other treatment other than blood pressure medicine, insulin before meals, oxycodone upon request, and benedryl for itching upon request.The timeline since then is as follows:Friday, she started receiving the SSRI. She was still lucid, calling people, and complaining of pain.Saturday, she stopped eating, speaking, or drinking anything. She just lays in bed, and if you ask her a question she stares blankly at you. She will nod sometimes to questions. She ate very little, and only when urged to.Sunday, she was about the same. Barely ate and doesn't speak at all.Today, Monday 3/15: she is still the same, and hadn't had any sort of fluid since the previous family member left at 6p the day before and I arrived this morning. She has had no bowel movements in 24 hours. The palliative care representative prescribed ritalin to make her more alert, but it hasn't done anything. We are currently working on transferring her to a hospice care facility.She looks like someone on a heavy dose of oxycodone, but she hasn't had any in days. All she does is stare at us and occasionally eat a piece of candy when prompted. I asked the hospitalist what could cause this so suddenly, but he said there's nothing they can do, as it is not encephalopathy. He referred me to hospice and would give no other information.All of that long background is to say this: this doesn't look like how her encephalopathy manifested before (crying, pain, etc). Is it possible for it show up differently? The only new medication introduced last week was an SSRI, but since she only started it Friday, it seems weird that it would have an immediate effect like that, since I would think that it takes some time for it to get to the liver and metabolize (or not metabolize) and cause a rise in her toxin levels. I have also always been told that it takes weeks for SSRIs to be effective, but I don't know how that changes in cirrhosis patients. If this is not encephalopathy, but what is causing this sudden change?I want to make sure she is receiving proper care, as I'm not able to clean much from her doctors and she is not lucid. Thank you for any guidance on this situation!Here are the papers I read regarding this, in case that is important:2015, Issues in the endstage liver disease patient for which palliative care could be helpful2017, Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicityNote:I don't know her current numbers, as they messed up her labs this morning and apparently don't redo them when that happens. ###Output :I imagine this is one of the toughest times you and your family have ever had to go through. Please don't neglect yourselves whilst looking after your mother and seek appropriate support, particularly psychological, as necessary.I am a psychiatrist, so I will try to answer your query regarding the SSRI. I'm afraid my internal medicine knowledge isn't up to date enough to help with much else here.All SSRIs are hepatically metabolised. They can therefore accumulate over long periods of time, so they must be used cautiously in liver impairment, and SSRIs with long half lives should be avoided. Of the SSRI family, citalopram / escitalopram have the least known effect on hepatic enzymes and are typically the SSRI of choice. Some specialists may prefer paroxetine, due to it having the shortest half life. Whichever is chosen, the general rule is to start low and go slow. I trust your mother's doctors have stuck with this rule. In which case, I suspect there has not been enough time for the new SSRI to accumulate to sufficient levels to be responsible for her acute deterioration, particularly if her deterioration began after just one or two doses.However, even if the SSRI isn't doing any harm, we need to ask ourselves, is it doing her any good? In the state that you have described her to be in, especially since the deterioration, I would struggle to justify continuing the SSRI. At this stage, I would argue the potential harm outweighs the potential benefits. And who knows, I might be wrong about the SSRI not being responsible; if it gets discontinued and your mother starts perking up, then all the better.Sorry to hear about this awful situation, do take care.

###Input :You seem to have knowledge about how SSRIs work, wondering if you'd take a look at my post, possibly had SSRI-related damage happen to me. https://www.reddit.com/r/antidepressants/comments/raqwkk/my_life_has_been_upended_and_i_dont_know_what_to/ ###Output :I'm sorry to hear you and your family are going through this. I agree with her physicians that unfortunately it does sound as though your mother is approaching the end of her life and palliative/hospice type care is appropriate.Given your description, I suspect that her current condition is likely caused by hepatic encephalopathy, where toxins like ammonia build up in the body as they are unable to be processed by the failing liver. The treatment for this is usually medications that promote frequent bowel movements, like lactulose or other laxatives, as the bowel is the only other route by which these toxins can be removed.Hospice care should be focused on your mother's values and what's important to her. If you feel that it would be important to your mother to be more awake and with it during this time, it would be reasonable to ask her physicians whether medications to treat encephalopathy could be restarted. However, the counter argument is that by being more awake, your mother may also be less comfortable, the avoidance of which is another goal of end of life care. It could be that this is why her physicians have felt that holding these medications to promote her being less aware is best for her at this time. This is a conversation you should have with her palliative care doctors and together figure out what is the best way to care for her. Again, I'm very sorry and hope this helps.

###Input :9 weeks ago i got pain on my right side under my rib cage. shortly after that nausea, bloating, and indigestion started. then my bowl movements were unpredictable and of all different types (loose... dark... normal... soft... constipation...) then dry heaving started.i have had a hell of a time getting treatment because im not critical enough during this covid19 crap. through multiple urgent care visits i finally got one to take urine and blood samples. they also got me an ultrasound and a telemed appt with a gastroenterologist.the urine was normal, but i was slightly dehydrated. not surprising given i was so nauseous drinking water was difficult. blood test was also normal except for a slightly low RBC count/low iron. the ultrasound showed no evidence of gallbladder problem, but did reveal some potential (likely benign) tumors in my liver. those apparently are completely incidental, and not urgent to diagnose immediately, but i do need to get a CT scan on them once covid restrictions lighten up.this past weekend vomiting returned for a few hours. i also developed a mild fever, and then chills with low body temp. i was also salivating uncontrollably. i had to chew gum to get the salvation to stop. it was weird af.i can only eat small portions of easy to digest food. like grapes and cream of wheat. complex foods or larger portions usually throw me into severe nausea/belching/etc. I've lost around 6lbs this far.i'm waiting for a h. pylori stool sample test to come back in the next 48hrs. at this point im praying its positive so i can get an answer and some relief.is this normal? 9 weeks feels really long. every time i think im improving it hits me and gets bad again. do i sound like im describing an ulcer? and if so does it seem like the bacterial type? can it really take this long to heal? i called the gastroenterologist and im trying to get a follow up appt soon. i realize this is the internet and is not a substitute for true medical care. im just having lots of anxiety and would love some opinions. 9 weeks of constant nausea starts to fuck with your head.note - I've been on anti nausea and proton pump inhibitors for 4 weeks. i take no other meds including nsaids. there's also no history of cancer/ulcers im my family. im also a middle aged male (early 40s). i have no major health issues, injuries, or surgeries. im an avid fitness freak. seasonal allergies, mild rosacea, and depression are my only real health problems to date.any thoughts appreciated. im in hell. getting help during covid is slow. im miserable and have a hard time living daily life. ###Output :Most people with changes in their stools between constipation and diarrhea have irritable bowel syndrome. There are related conditions like sphincter of Oddi dysfunction or biliary dyskinesia that also cause RUQ pain and can sometimes affect stool consistency.H. pylori would be unusual with your symptoms, but it can present in many different ways. It doesn't typically cause diarrhea or other stool changes (unless it bleeds, but that's usually pretty obvious). Furthermore, if you get a stool test for H. pylori, and it's positive, that doesn't mean it causes your symptoms. Many people are asymptomatic. It really takes an endoscopy that shows significant gastritis or an ulcer to make a clear association between your symptoms and the effect of the bacteria.Your liver findings are probably not related. We see incidental liver lesions on ultrasounds all the time. But sounds like your doctors aren't too worried. I agree a CT down the road is a good idea. These are usually benign things, like hemangiomas, but worth getting a more clear diagnosis for these just in case.Other things to consider with nausea / belching with higher calorie foods is gastroparesis, which is where your stomach doesn't empty properly.I know it will be hard to get much workup now, but that's really the only way to narrow this stuff down. The tests we typically do are things like endoscopy (probably of most importance in your case), gall bladder scans, and gastric emptying scans.

###Input :thanks for this reply. i should have been clearer. i have had "looser stool" than normal at times. but not diarrhea. i don't believe I've had diarrhea even once so far. not sure if that natters or not. my most recent one (sry this is so gross) was small and seemed to be covered in a whitish substance. maybe mucus from excess production in stomach?also thx for the heads up that a positive pylori test doesn't mean that's the cause. frustrating, but good to know nonetheless. ###Output :Loose stools would lean towards IBS as well. But its a pretty nonspecific symptom and doesnt narrow things down a ton. :-(

###Input :There are some parasites that can cause liver cysts and start giving you all sorts if weird symptoms. Did you travel anywhere before symptoms began where you walked barefoot on soil/sand or drank water from a source you dont usually drink from? ###Output :People sure do love parasites around here. Unlikely the explanation for OP.From your comment below:Entamoeba - This causes colitis, which is bloody diarrhea, not alternating stools and RUQ pain like OP describes.Liver flukes - Almost always asymptomatic. But, easy to check for with a stool O&P like you suggest.Cystic echinococcus - OP had a liver ultrasound. CE would show a bunch of cysts, and should be apparent to the radiologist.

###Input :From what I've learned from House MD, it's definitely either sarcoidosis or lupus.Also, you get an upvote for your username. ###Output :TuberculosarcoidolupusCANCER.

###Input :I was reading this tweet thread from Dr. Monica Gandhi about molnupiravirhttps://twitter.com/MonicaGandhi9/status/1415093950000422912Molnupiravir was not developed for SARS-CoV-2- originally thought of as a broad-spectrum antiviral because it is a "nucleoside analogs". We use those a lot in HIV but they basically inhibit the virus from replicating because this compound interrupts the process of copyingwhich led me to this article in Business Insiderhttps://www.bloomberg.com/news/features/2021-03-25/merck-mrk-molnupiravir-pill-could-change-the-fight-against-covidThe first antiviral approved in the U.S. was idoxuridine, a herpes treatment regulators green-lit in 1963, generations after the discovery of antibiotics. Its among a widely used class of drugs called nucleoside analoguessynthetic versions of nucleosides, critical building blocks of DNA and its counterpart, RNA, the messenger molecule that delivers instructions to a cells protein-making factories. Nucleoside analogues prevent viruses from replicating, or from replicating effectively, inside cells.When they do invest, they have much more incentive to focus on chronic diseases than acute ones, which entail inherently shorter treatmentand revenuewindows. If you look at what drugs have been developed against viruses, you have HIV, you have hep C, you have herpes. Those are all chronic infections. That means longer-term therapy,And so here I am, my High School Biology in mind, wondering how if day to day my cells are dividing and so need to replicate DNA, how providing a drug that inhibits replication is safe, especially for chronic diseases where the drug is taken on a daily basis for well, the long term.For the care and feeding of the automod:I am a 60 year old male, non-smoking, and this question has recurred off and on for a few years now, mostly in by frontal lobe I believe, though friends insist that that is located in my rectum ###Output :Antivirals like acyclovir and similar nucleoside analogues act only on the cellular machinery within viruses, but not the cellular machinery in human cells. You are right that both viruses and human cells replicate DNA, but they do it in a different way. Some antivirals work on viral DNA polymerase, some work on viral reverse transcriptase, and some probably do something else that I don't know about.

###Input :I 34(F) have been seeing a dermatologist over the course of several years, unfortunately Im in a healthcare system that is hit and miss with varying levels of doctors. Its also a healthcare system with a different first language to mine.I have been diagnosed with rosacea and seborrheic dermatitis. My skin goes from angry inflamed redness to dry and flakey.Initially I was advised to use steroids on the redness inflamed areas and to moisturise 2-3 times a day. To be honest, this doesnt work. Im using steroids weekly. I saw a good dermatologist who prescribed elidel cream which is ok, though it has not really worked well enough to prevent flare ups.Since then I was prescribed skinoren (which burns), told to wear sunscreen with multiple application daily and to start tacrolimus ointment. Avoid stress (Im a mum of 2 very small children and a critical care practitioner, so easier said than done).One dermatologist told me to stop steroids on my face as I had ?lines as a result of long term use. So should I completely stop?I cannot start tetralysal as Im breastfeeding.Are my options limited without oral medication? Will the results be worth me weaning?Im feeling pretty miserable as a woman when I can no longer wear make up without significant flare up and people asking what happened to your face?Advice is conflicting, often superficial and although I understand its chronic, will I ever have good enough skin to feel my normal self again? I only developed this in the past 6-8 years.Obligatory: BMI 20, non smoker, enjoy a glass of wine regularly. No other medical conditions or medication. ###Output :Topical corticosteroids are inappropriate for long-term use. Pimecrolimus is much safer for long-term use and tacrolimus is more potent than pimecrolimus. Many who use azelaic acid use too much quantity and get irritation. Much smaller quantities are appropriate. Adding additional agents such as topical ivermectin and metronidazole may additionally help for rosacea, as could imidazole antifungal agents and similar for seborrheic dermatitis.

###Input :33F, recently diagnosed with PCOS / insulin resistance, high TST, low cortisol.Im at a pretty critical point in getting my hormones fixed and after my appointment today I was notified that if I want to continue seeing the doctor that I see, there is a $100 fee per month to continue under her care. I see her three times a year but they want $1200 to ensure a spot to see her. They were very clear this was not insurance related and would be my responsibility...seems shady?? Hoping some medical professionals can explain it to me if its legitimate since, as it stands, it sounds very questionable. I want to understand. ###Output :A physician can charge out of pocket whatever they want, not shady. Billing insurance is totally separate. This is a concierge model of healthcare that typically gives a patient more reliable access to their doctor (and is typically more expensive than other doctors). I suggest you find a different doctor that fits you situation better.

###Input :26F 56 120 lb No medications Non smoker No known medical issues Migraine symptoms approximately 1x/week for the last 4 weeksSo I did an MRA on Friday afternoon and the technicians gave me the results in a CD without any explanation. I didnt have a chance to speak with my neurologist. My boyfriend, who is a senior neuroscience biomedical engineering PhD student and has seen many brain scans before, immediately pointed out a strange deformity in my MRA. On the saggital view in the top middle of the brain close to the motor area there is a bump. His first thought was subdural meningioma. It was dark in the MRA image so he thinks it may not be a tumor because it isnt highly vascularized. Could it be a chat? Could it be a meningjoma covered by a subdural hematoma?Background - about 4 weeks ago I started having migraine symptoms basically for the first time. Nausea, dizziness, feeling out of breath while exercising even though I am a relatively fit person...and I had 3 episodes of mild throbbing pain on the side of my head. So I went to see a neurologist who recommended a MRA/MRI.He tried to book it before Id be set to go out of the country on holiday for 3 weeks - all the way from US to a beach in Thailand with possibly limited access to medical care. We only booked the MRA because the most urgent goal was to make sure it was not an aneurysm.I had yet another episode today - lots of nausea and feeling sort of dizzy and hard to balance at times. And I have my flight tomorrow early morning ... 30+ hours!The main question here is - how likely would it be for my situation to be dangerous enough that I should not get on a 30+ hour multi-flight trip? Any counter-indications towards flying that I may want to be aware of given my symptoms and this MRA result? The problem is that I cant speak to my neurologist until Monday morning - by then Id already be in Thailand (or sick / critically unwell due to the flight?).Any help would be greatly appreciated!! Im ok with flying as long as I can be reasonably sure that I am not putting myself at risk by doing so. ###Output :Unfortunately, Without the images or report, it would be impossible for anyone to give advice here. Can you call your doctor or the doctor on call before you leave?

###Input :Definitely call the Dr on call now. ###Output :Your symptoms would not match anything you described may or may not be on your MRA images. That being said besides vascular anomalies nothing else can be commented on in an MRA. So seeing dark or light things outside of the vessels does not mean anything, that's what the MRI is for.

###Input :My mom was diagnosed with Diverticulitis/Ischemic colitis on Saturday. I picked up an Rx for her and it said take every 6 hours.Yesterday, I called urgent care to see if taking it every 8 hours was a possibility, as my mother has moderate dementia and it's difficult to get her up in the middle of the night. They said no...has to be 6 hours, but I don't have to wake her up in the middle of the night.This makes no sense to me; if it's not allowed to switch to 8 hours, then it means it's critical to take it every 6...which means I have to wake her.I already have sleep issues, and waking her at 3am every night is going to be a whole ordeal and struggle. Sure, I'd love for her to sleep through the night, but I don't see how they can say I don't have to wake her. It doesn't make sense.I just want to do the right thing. Can someone give me guidance? Thanks!!Edit: I actually called the pharmacy first, before reaching out to the urgent care: they said they could not provide guidance. ###Output :It is rarely necessary to dose flagyl more than every 8-12 hours, this is sufficient for the large majority of indications as it maintains adequate blood levels. I don't typically give it more frequently than this and work in an ICU with very sick patients. Every 8 hours is a reasonable compromise. There is another medicine called augmentin that is used for diverticulitis and is twice a day.The general push recently has been to not use antibiotics for diverticulitis, though with your mother's age it is still appropriate to prescribe these. But in any event wouldn't get overly concerned about the flagyl dosing interval provided she is getting it more often than every 8 to 12 hours.Remember I do not know your mother's specific situation, so this is not meant to supplant the information from your providers, just that without any other details a less frequent dose of flagyl is adequate.

###Input :Thanks so much for this. I called her doctor and we'll see them on Friday. Thanks to your prompting, I asked if they would like to make any changes. They haven't yet...maybe because she already started...? Thanks again!!!This was an urgent care so she probably was not seen by an actual physician. ###Output :I think interrupting the night sleep of an elderly infected woman seems a bit of an odd choice even in the hospital.Give her one dose right when she wakes up, and one dose right when goes to sleep. Then space the others as evenly during the day as possible. (So for example, she goes to sleep at around 21:00 and awakes at 7:00 her doses should be at: 7:00-11:30-16:30-21:00).On the other hand, the active metabolite of metronidazole (flagyl) has a half-life of 9-19 hours. So taking it more than thrice daily is also odd.

###Input :Thank you much. It's 250mg. I called her GI doc to update them and to see if they want to do any changes, and they scheduled to see her on Friday She was seen in an urgent care so probably these were not prescribed by a physician ###Output :Fair enough, in my country every antibiotic has to be run through an MD (we don't really have DOs), so I assumed the same.

###Input :[16M] So 2 days ago i felt pain on my right eyelid, the pain is like bruise, I don't really care about it. The next day the pain wasn't gone, so I checked "Inside" of my eyelid and it's more red than the left side, now i am worried about this. My current hospital only accepts critical/emergency cases so I can't go there for now. What should I do about it? Is it bleeding inside?Edit : Nearby pharmacist says it's an infection/allergy and gave me eyedrop "DexOph", could this help me? ###Output :Ophthalmologist here. The picture isnt great, but it looks pretty normal to me. I wouldnt just use Dexoph without seeing an ophthalmologist. Dexoph is dexamethasone which is a steroid. Unregulated use of steroid eye drops can lead to both premature cataracts and glaucoma.You should go see an ophthalmologist.Edit: can you upload a higher pixel picture of the affected eye along with a picture of the normal eye for comparison?

###Input :Female, 50, 5 5, 215 pounds, never smoked, seizures, chronic stomach issues like abdominal migraine and ileuses, breast cancer.I have lifelong chronic digestive issues, stemming from a major exploratory surgery when I was 5 years old. About 20 years ago, I started having major issues requiring hospitalization with NG tubes and all kinds of other fun stuff because of the adhesions from the 1974 surgery hardening and choking my intestines.Starting in 2006, after many other things failed, doctors treated both the pain and the hyperactive bowels using Dilaudid. Over the past 13 years, my tolerance has increased, through absolutely nothing but closely monitored physician prescriptions and instructions. Through all of these years, I have taken some hefty narcotics for about one week every month, and not at all the other three weeks. I have thanked God a thousand times that I don't appear prone to any type of addiction (Never smoked, drink a couple of times a year, no illegal drugs whatsoever, couldn't care less about gambling, etc. My worst vice is Amazon.)Between this and absorption/metabolic condition, I get extremely little relief from the highest oral dosage that my PCP is comfortable with: 8mg every 6 hours.I'm currently in breast cancer treatment, halfway through Herceptin infusions that are supposed to continue through September. From the very beginning, Herceptin gave me diarrhea, and it has worsened to date to the point that I am in the hospital about one out of every three weeks because such severe diarrhea that I am dehydrated, critically low on magnesium, excruciating cramps because it flares my chronic condition, and you can imagine the rest.Two weeks ago I went to the emergency room with the usual symptoms, was given my now usual dose of two milligrams IV Dilaudid immediately followed by 1 mg every 3 hours for the next 8 days inpatient. Normally, they start tapering off by spreading out doses around day 4 and I am home and much more comfortable by day 8. This time, however, they noticed significant thickening of my colon on a CT scan, so on day six, when the Dilaudid had just calmed my bowels and decreased my pain, they had me do colonoscopy prep, which not surprising brought excruciating pain back with 18 hours of non-stop diarrhea.SO... hospitalist has access to 13 years of hospital records outlining the progression of all of this, has recent records showing mastectomy, Herceptin, labs consistent with six months of diarrhea... yet still harangued me the entire visit, accusing me of being there basically faking it for the Dilaudid. I could never keep him focused enough on my actual issues to get any help from him or get any questions answered because he was so convinced that there was no illness, only addiction. He claimed he read my records. I couldn't get him to call any of my other doctors. I couldn't get him to look at the December prescription bottle the nurses took from my purse and locked up that was still half full. The day of the colonoscopy, for the first time in my life, I told them I was a 9 on a scale of 1 to 10 in pain ... I'm very conservative with those numbers. Asked if I could have just one dose of 2mg of Dilaudid to get me back on track and was denied. Then he started the discharge process that day... with renewed diarrhea every couple of hours and 9 on the pain scale AND no tapering of Dilaudid. Being on Medicare (disability on the first try, approved in 2017 in less than 90 days due to the severity of illness), I threatened to report him because I didn't believe I was ready for discharge, and he told me with hostility that I could stay one more day but then I was out.I was discharged with the same level of diarrhea I went in with, more pain that I went in with, and spent three lovely days in bed crying my way through Dilaudid withdrawal. All caused by a doctor who lectured me for 4 days on the opioid epidemic. I can't imagine how many people would have become addicted in my situation instead of just gutting out the withdrawal.How do I get this to stop? Isn't there any overarching agency or physician type or anything I can do to have it documented once and for all that there has never been an addiction problem and that there is a room full of files documenting the illness and the reason for the medication?I'm seriously considering stopping life-saving breast cancer medication because on top of all of the pain and diarrhea, I can't face another week like the week he put me through. This wasn't my first experience with a doctor so obsessed with this notion, but it was by far the worst.What the hell are people with decades of documentation, debilitating chronic illness, and zero evidence of any addiction at any time supposed to do? ###Output :I read it somewhere in this but you need to 1) go to a pain clinic and 2) have a medication contract that may even cover pain crisisDilaudid isn't a great chronic opiod and ideally you should be switched to methadone or buprenorphine, but again, that's something that should be discussed at the pain clinic.Also, I would reexplore with a GI your hyperactive bowels and see if you can find an alternative to opioids for it's management.

###Input :Awaiting my follow up appointment after questionable minimal supravermian atrophy that was found on my brain MRI last week. Im unable to find valuable information with the phrase supravermian atrophy online. Im hoping someone can shed some light on what a finding like this could possibly be related to. Im too impatient to wait until my follow-up to learn more about it.27F, 5 8, 138 lbs, European ancestry. I work full-time as a critical care RN in a peds ICU. History of gangrenous appendicitis age 5, Guillain barre related to a suspected tick-borne pathogen age 8, asthma (controlled by corticosteroids,) anxiety (relieved with PRN benzos,) vasovagal syncope episodes during ovulation since the age 16. I spent my early childhood on military bases with known toxic contamination (Fort McClellan, Fort Bragg.) I dont do drugs, I drink maybe 1-2 times a month. PALB2 & CHEK2 gene mutations. Dad was diagnosed with stage IV Glioblastoma, age 48. Paternal uncle died of a brain tumor age 3. Paternal aunt had endometrial cancer at 27. Mom has history of substance abuse, Sjogrens, rheumatoid arthritis. Maternal grandpa received a heart transplant (acquired heart disease,) maternal grandma and aunt had ductal cell carcinoma (after menopause.) I was out of work for over a month due to an intermittent fever ranging 99-103. No pathogens detected in my pancultures. Blood work was normal: CBC, BMP, TSH, HIV, Syphilis, B12, Vit-D, thiamine, folate. In the past year Ive had the following symptoms: fatigue (I could sleep 16 hours a day if I was able,) dizziness, occasional double vision, compulsive sighing/feeling out of breath, itchy/burning armpits, twitching throughout my body, headaches (~3/week,) cold hands and feet, high blood pressure, stress and urge incontinence (especially around ovulation,) severe abdominal pain right before a bowel movement, sometimes I pass out from the pain. Ive noticed changes in my speech: fluency, long pauses between words, losing track of sentences. I cant hear people or retain information unless Im staring directly at them, and I have worsening sound sensitivity. My memory has suffered. I will quickly lose new information and have difficulty recalling information on the spot. I find bruises on myself because Im clunky and clumsy.I want to feel young, healthy, and happy. Please help. ###Output :Can you post the full MRI report? I too have trouble understanding what that term means; the vermis is a part of the cerebellum, but the space above it (supravermian) in my experience refers to a space containing CSF, not brain tissue.

###Input :Hi so I (23f) have had a sudden onset of joint pain mostly in my hands and arms. It may have been more gradual than I noticed, but this week has been very brutal! Its like my finger joints are just VERY achey and my elbows are also in pain fairly frequently (mostly when my elbows are bent).I work on a computer all day, but am not a typist. I am usually working on excel spreadsheets doing data analysis which I guess I never thought of as typing as its more of a critical thinking thing as my main task. That being said my hands are on a keyboard for the majority of the day.Now my FIL had surgery for carpal tunnel syndrome last year, and it feels like exactly what he described and I am panicking a bit bc I didnt really think that I was a candidate for having this issue so early on in my life! Is it possible that I have carpal tunnel syndrome? What else could it be?Im just scared of the financial ramifications an issue like this may have (Im broke as shit!! But I do have insurance!), but I obviously want to take care of it ASAP instead of letting it get worse. What should my course of action be/how long should I wait before getting it checked out in person?Thanks in advance for your time!ETA: not sure if this is relevant to this issue, but I am in relatively good health. I am overweight but have lost around 50 pounds since the beginning of the year and am well on my way to a healthy weight. I eat mostly cleanly and walk a lot. I used to be an avid weightlifter but have not gotten back into it after a knee injury in 2018 (big part of how I became overweight... lack of movement & depression from losing my job & other stresses due to my injury). I also was a 4 sport athlete in high school: softball, swimming, track & field (discus & shot put), and volleyball. I dont know if any of this is helpful but if it could be a contributing factor I thought I would mention it. ###Output :Yes, it's possible for you to have carpal tunnel- it just really depends on your level of activity with hands.You aren't locked into surgery. I'd start with getting an ergonomic setup for yourself and taking frequent breaks from typing. I would also look into getting a wrist brace to sleep with at night, and begin using that for a week or two and seeing if you improve. Chances are if you take early action you won't need surgery for quite some time- if ever.

###Input :Wow, that is great news! Will that help with the elbow pain as well? Also do I still need to see a specialist or set something up with my primary care physician? ###Output :It can help with the elbow as well, yes.If you end up seeing a doctor they will tell you what I just did. I'd say hold off and start with what was mentioned unless it progresses significantly or it starts actively impacting your ability to function.

###Input :Hey, for the past year or so I've been smoking socially (about twice a month). I know that death/critical care rates are much higher for smokers, but I haven't smoked in about a month and don't plan to start again so where does that put me? I'm an otherwise healthy, moderately fit 18 year old. I know info isn't available for covid19, so if you know this regarding respiratory infections in general let me know, anything is helpful ###Output :Puts you somewhere between the smokers and the non-smokers, closer to the non-smoker side of things. Good on you for planning not to smoke again. That's about the best thing you can do.

###Input :Age: 30sSex: MaleHeight : 5Ft 8inWeight: 180Race: LatinoDuration of complaint: 5 months+Location: Texas, US. Abdominal pain, blood in stool.Medical Issue: Had recurring blood in stool that increased in intensity and frequency. Saw doctor and prescribed Cipro after which frequency of bowel movements and amount of blood increased. Given prednisone which seemed to increase amount of blood in stool. Had CT scan of abdomen which revealed hepatic mass lesions. Primary care doctor advised and arranged for admission to emergency room for an MRI of the abdomen. ER doctor however reviewed scans from CT and believed they were cysts and wouldn't proceed with MRI. ER doctor emphasized need for colonoscopy first which I have scheduled for 31st, but he worries that is too far away. For reference it took me 6 weeks to get the CT scan. I didn't get a referral/authorization for an MRI from my primary care doctor. ER doctor told me to return on Monday and that I may possibly be scheduled for colonoscopy through their hospital. How critical is all this? I'm worried as I now have to wait the weekend at minimum, but likely will have additional weeks of waiting for paperwork/insurance authorization/scheduling before I can get these procedures. ###Output :You didnt mention any blood test results (e.g. liver function test).Also, did the imaging study not reveal anything in your GI tract?Either way, yes you should undergo a colonoscopy as soon as possible. The results of the colonoscopy will inform further management decisions.If you feel like fainting, or experience any symptoms that you consider to be drastic, go to the ER.Best wishes.

###Input :Sorry in advance for the formatting. My mother is the patient. She is a 62 year old female, 52, ~140 lbs, a caucasian, and she has several issues with chronic pain/osteoporosis/degenerative disc disease/some nerve issues/arthritis that her doctor has prescribed a 12.5 mcg fentanyl patch for that she changes every two or three days. She was on a higher dose when she started using the patches but she did not like the side effects, so her doctor cut the fentanyl dose in half to 12.5 mcg. She is taking lexapro, wellbutrin, a blood pressure medication (I think bystolic), montekulast, and possibly a diuretic (unsure if shes still taking that) daily. As needed, she is prescribed voltaren gel and voltaren pills, Valium, and norco (hydrocodone 10/325). She has some additional health issues that arent relevant to my concerns (high bp, asthma, primary lymphedema, some allergies. Dementia runs in her family, but the people who have had it have all been very sharp until their early 80s.Since she has been on the fentanyl patch for a few months now, my fatherwho is a physician himselfand I (who live with her) have noticed some very concerning things. We all see the same physician, so he knows all of us and our character. I would like to tell the doctor about these concerns using a letter, but Im not sure if Im being too wordy or if I should contact him another way. Please give me your constructive criticism as to how I can effectively communicate with him so these concerns get addressed. Heres what I have written:Dr. Doctor,I am writing out of concern for my mother, [major_bummers mom] (DOB XX/XX/XXXX). I am aware that I have no power regarding my mothers care and no right to her personal health information. However, as a daughter, I have some concerns regarding my mothers current usage of the fentanyl patches you prescribe her. I wanted to reach out to you about them personally because I dont think she has the mental ability to realize how much of a toll these patches have taken on her. I realize not all of these concerns I have about her cognitive ability/memory/ability to preform daily functions could be attributed to her use of the fentanyl patches, but the timing leads me to think it is the cause.My father and I noticed that about two weeks after my mother began using the fentanyl patches, her overall productivity became much less than normal. She is now spending her days sleeping as much as she can (10 hrs per night with a 3-4 hr nap) and gets a significantly less amount of work done compared to before she started using the patches. She says she thinks her pain is under better control with the patch, but her avoidance of physical activity and her daily complaints of increasing or new pains tell me it is not working as well as originally hoped.My mother has seemed to slowly lose her critical thinking skills, her ability to remember things, and speak/think at her normal speed. She was the type of person to remember where everything in the house is, even years after it was put somewhere, but now she has started to lose things such as everyday items, important documents/records, and even her own controlled medications. (She normally hides them so she has to think about where they are before taking a narcotic, but recently she forgot where she put all of her scheduled medications and had my dad and I flipping the house upside down looking for them for about 6 hours. She also separated one fentanyl patch from the others and has been saying she has been unable to find it for days, making me wonder if she actually put two on.) Along with my concerns about her memory is that in the past month and a half or so, she has started remembering things that have never happened/things shes made up in her head and has been unintentionally giving my father and I completely false information, which has caused a lot of frustration within the family. She will become unnecessarily upset with us as she genuinely doesnt realize some of her memories are extremely inaccurate or have never been real. Usually, this results in an argument with her until she either gives up or understands our explanations as to how and why what she remembered couldnt have happened. She often asks the same basic question (such as are you going to work today?) several times per day because she doesnt remember the answer from the first three times shes asked. Her accounts of something that weve both seen are usually inaccurate.On bad days, her speech is sometimes very slowalmost incomprehensibleand my dad and I have to either work on completing her sentences for her or ask her to form a complete thought/statement before speaking. I dont feel like the person Im talking to is my mother and is instead someone that is either mentally handicapped, drunk and drowsy, or demented. She often seems mentally absent or half asleep when I am trying to have a normal conversation with her, even with no distractions.Lastly, my biggest concern is that her ability to react to things has slowed down substantially since she began having a strong opiate in her system on a constant basis. When I have the opportunity, I ask/offer to drive her places because she is a danger to herself and others behind the wheel. She has made a habit of going below the speed limit and stopping at places she has the right-of-way to be a safer driver, in her words. This is a woman that used to love to drive fast cars on racetracks. She has started to slam on the brakes when she approaches a stopping point because she does not slow down in time to stop properly/safely. It seems that her situational awareness has taken a nosedive since she started using the patches. If she were to cause an accident, which she has almost done on many occasions since starting the fentanyl patch, a police officer would absolutely see she is driving while incapacitated/under the influence of a drug.It pains me to see my mother like this and hope you understand my concerns. I am grateful for your time reading this letter and hope you will keep my observations in mind when proceeding with my mothers care. My family and I very much appreciate all that you have done for us. If you need further detail or have any questions, please dont hesitate to give me a call.Sincerely,Major_bummerEdit: added some additional health information and fixed grammar ###Output :Make it shorter and send it. The goal of pain management (in patients without terminal illness) isnt to completely eliminate pain or get people on government disability. Its to get their pain to a level that is tolerable enough for them to main functionality (keep being employed, for example). Sounds like your mom is on too many narcotics. Based on the problems you told me (all musculoskeletal), she probably needs to be tapered off narcotics completely.

###Input :Would a bulleted list be more appropriate for a busy doctor?She has been on narcotics for years as her spine is not in good shape at all (we almost went overseas for better spine surgery technology but couldnt afford it) so I doubt shell get off of the narcotics entirely anytime soon. Shes one of the few patients with enough pain that she qualifies for disability and deserves a relatively strong opiate, but not as strong as fentanyl. I still feel like she was doing better mentally taking more hydrocodone daily instead of using a constantly releasing fentanyl patch. Granted I wasnt in the room when he initially prescribed the fentanyl patches, but it seems like a huge leap to go from 3 hydrocodone per day to fentanyl without trying something like an extended release opiate that isnt as strong as fentanyl + comes with less risks. I know shes tried things like gabapentin and lyrica before but her body didnt like them too much and she reacted to them strongly. ###Output :There is no evidence that opioids work any better than over the counter meds for chronic, non-cancer-related musculoskeletal pain, so your assertion that she deserves a strong opioid is specious at best. Fentanyl is no better or worse than long-acting opioids, it is the dose that is most important. Regardless, her current situation is not acceptable (being zonked all day long) and I would argue that you have an obligation to notify their prescriber.

###Input :Age 16Female110lbs, maybe lessRussiaHello doctors,Our relative was hit by a car. We don't know many details at this time except that she is out of critical condition, but still unconscious.The reason for posting is because it's Russia and for most part, doctors don't really care for their patients, especially if it's a public hospital.Can someone please tell me what are some of the must be done tests, scans, blood work after an accident.Thank you ###Output :It's impossible to know without knowing how exactly they were injured. I would assume that if she is unconscious, they would do some kind of imaging of her brain to make sure there isn't any bleeding in there.

###Input :For example, this morning we had a 63 yo patient that had been sinus tach since her admission a day or two ago. She was alert but not fully oriented during morning rounds. This morning, over the course of an hour, she slowly went from 115 to the 40s. She ended up bradying down and a code was called. There was a short run of vtach right before we started coding her. She ended up regaining spontaneous circulation and was moved from step down to ICU.As far as her history, I barely saw her chart. I know she was suffering from c diff and chest pain. There was critical care protocol for fentanyl and propofol but other than that I have no idea.Is this something related to electrolytes? Cardiac issues? Need more information? Her ekg strips were normal sinus tach prior to the event. Ive also seen this in other patients that were DNR where they just Bradyd to asystole. Any insight is appreciated. ###Output :Definitely need more info. Bradying down essentially just means someone is dying. So for that patient in the ICU I'm gonna assume she has lots of possible reasons to die. Electrolytes absolutely, acid/base yes, hypoxia, hypotension, MI, PE etc etc. The list is literally endless. Brady codes are the most frequent ones I have seen usually.

###Input :I'm trying to understand a current family situation where I believe doctors are being hasty with care.My brother in law, about 30 years old 6ft 250lbs, is currently in the hospital for acute pancreatitis due to alcoholism which stressed the one kidney he had (genetic one kidney). He's currently sedated on vent, dialysis crrt, and insulin drip. He was admitted a week ago after he called an ambulance. With only symptoms being nausea and stomach pain. Since being admitted he was bumped down to 30% oxygen with breathing therapy, 5.0 PEEP, and his vitals and blood work were all in normal ranges for an adult male. Then they lessened his sedation and he was responsive. Hand squeezing and pointing. However other blood work and vitals dipped a bit after he had breathing trouble from bile due to pancreatitis.Additional: I think initial intubation was due to shock/hyperventilation upon admission or lung infection? Doctors have said all organs are viable. Torso MRI showed a good gallbladder, liver, and lungs without liquid. Family told they should not worry about organ donation yet(family match donation to improve health). Organs are not necrotic.I'm not trying to decide if my BIL needs a DNR. That's not my choice to make. I'm just curious how doctors factor offering it or when it's needed.TLDR; So, why would a doctor recommend a DNR for such a young patient that could seemingly recover? When do you consider patients to be at a point of no return? Is it standard to ask any critical patients to sign a DNR? Do Doctors weigh stats before offering or just their judgement?If you were this patient would you ask for a DNR? ###Output :Your BIL is critically unwell and requiring multiple organ support. He has de-facto multi-organ failure because his kidneys are needing dialysis, his blood pressure is being supported by drugs and he is being ventilated for what sounds like ARDS.The DNAR is if these things stop working, so he does not undergo futile CPR. If he recovers and leaves ICU theyll tear that DNAR up (or you can ask them to), but it wont affect the quality of his care to have one in place.Currently -depending on where you are- he isnt a transplant candidate due to the alcohol, as well as being critically ill.

###Input :Absolutely this. DNR is NOT the same thing as comfort care or withdrawing life sustaining treatments. Them asking about a DNR in this case probably means they think he is unlikely to survive or have a good outcome from CPR. But its important for everyone to consider what they would want done if they were to have a catastrophic health event, regardless of their current health.Okay but studies have shown that a DNR can result in lower quality of care, and typically do. In the BIL's case, although he is critical, he is responsive, and has only been in the hospital for a week. He has made significant recoveries like oxygen levels being reduced and other blood work levels being stabilized to healthy amounts.We are being told both organs have capacity to recover or with the kidney some function. They aren't necrotic. Couldn't he still qualify from a family member match willing to donate? Doctors have not moved towards that idea either.I guess my question is- how does a doctor stack the odds like that? Yes, on paper he has three machines doing organ functions. But is there not potential for recovery? If the oxygen intubation progresses with therapy, he could also remove feeding tube. There is also potential for getting pancreatitis managed, and kidney support with regular dialysis treatments or donation.Does a doctor weigh statistics or is it just judgement? And what helps them make that judgement? Because I feel like someone with the potential to recover, who is pretty young, would not be a candidate for a DNR.Now if there was a clearer document that outlined CPR in a worst case scenario then yes I see that. But signing a generic DNR with chances of recovery and treatment options seems very pessimistic. Especially given that BIL has a condition that can cause asphyxia and there have been cases where DNRs do result in vent being removed. ###Output :Simple answer is at the moment none of his organs need replacing- or rather theyre broken in a way a transplant wont fix. An organ isnt like a broken gear, the whole system needs to work for the organ to work.And nobody is taking him off life support prematurely due to a DNAR. Its simply stating if his heart stopped beating that would be the end of treatment. irrespective of age, if he reaches that point he isnt surviving in his current condition.As previously mentioned, if he continues to make progress forwards then theyll tear up the DNAR anyway, but at the moment your BIL is not somebody I would expect to survive chest compressions- it would be another organ not working, without the ability to support it or replace it to ensure survival.

###Input :When you sign a DNR it isnt just a genetic DNR. There are different sections to it. It asks if you are ok being on a vent if needed. It asks if you are ok having a feeding tube if needed.You can be ok with life support, just not CPR if it comes down to it. ###Output :This is a difficult question to answer without knowing the full clinical picture. What is his day to day ventilation settings? Just because he is down to 30% doesn't meet his PEEP is down. How has his spontaneous breathing trials go? What does his CXR show? What do you mean the blood work is great? What are his I/Os? How is his kidney function?

###Input :He's got a feeding tube because he's been sedated. But he's had bowel movements. Constant IV hydration drip but no urine in catheter.They had been doing breathing therapy with him that is when they lowered his sedation and oxygen. He seemed to be doing better with 30% and then bile in the tube then his condition worsened. He's now at 50% again. They have done several torso scans but they haven't given details on the scans diagnostics.That's most of what I have based on what I've been given. They said his kidney and pancreas are not necrotic. He did have an infection in his lungs when he was admitted but they cleared out several days ago. However since he had bile with the intubation he has liquid in the lungs again. ###Output :There's far too many details still being missed here to state that his care is hasty. You have an individual who has one kidney on continuous dialysis while having low blood pressure. He is making no urine at all. For some reason, he was intubated for pancreatitis, so I assume it was because of ARDs. He sounds critically ill.

###Input :To clarify, just because the organs aren't necrotic doesn't mean they are functioning. Also organ donation has nothing to do with DNR. The appropriateness of someone to donate only comes after they have died or are literally about to. In the US people self-declare at the DMV so the organ donation services already know their intent in most cases.He has multisystem organ failure, plus underlying conditions which will make his recovery harder than someone without those (alcoholism, solitary kidney) based on what you have written, so it is absolutely imperative to find out what his wishes might be regarding code status. In the absence of any clear directives from the patient in the past, the family is asked to predict what the patient would choose for themself if they were able to sit in on the discussion and weigh in--basing this off of past comments, how they engaged (or avoided) healthcare interventions on their own, etc.I suggest that his designated healthcare agent and any other family present, have a care conference with the intensivist. This is a time set aside in a nearby conference room, not at the bedside or in the hall. Include one of his nurses if possible, any specialists who can make it (often harder to arrange) and then the unit's social worker/case manager. The purpose is to outline exactly where he is on his trajectory, what the major challenges are, what the expected chances of recovery appear to be at this point, and then a discussion of next steps. Find out more about why the doctor was recommending DNR. Hear what they have to say about this based on their experience. It might be because they don't feel he will likely be resuscitated if they make attempts, therefore, to attempt shocks and compressions would be futile. If they feel it would be futile, then it would represent only harm to the patient and not comfort or cure. I cannot predict what they are thinking so you need to find out, but this has been my experience from working in ICU as an RN and Care Manager.If he cannot be weaned off of the vent shortly, he will need a trach and a PEG (feeding tube in his side). If he stabilizes enough to be discharged from ICU (off of CRRT, off of high vent settings, off of any vasopressors that are stabilizing his BP, only on X number of antibiotics, etc) then he will meet criteria to transfer to a ventilator rehabilitation hospital or LTACH (long term acute care hospital).If this happens, it is a long slog. Is it something he would want? Also, he might not survive it and could have a downturn at any time, heading back to the hospital. Knowing this, is this something the family would predict HE would want? If so, you have your answer. If not, then it is appropriate to consult hospice to make him comfortable. Another service to consult if you have it available is Palliative Care. In many hospitals they are consulted for complex cases like this who are taking a long time to recover. They are particularly helpful to the patient to improve quality of life while recovering, as well as provide support and guidance to family.At the end of this long post, I offer you two things. One-you are in my thoughts. I know how difficult this is and you are on a crash course of learning right now. Two, please use this resource that many families in your position find extremely helpful--patients let us know so often this has helped them in cases like yours: Hard Choices for Loving People booklet ###Output :If this was me I would want a DNR and a DNI signed. More importantly, I would want a MOLST form singed indicating exactly the care that I would want, the care that I don't want, and for how long. That is to say, give me antibiotics for one week and see how I do, if nothing's happening then stop all unnecessary treatments.What I like to see in patients is an end goal. What happens far too often, is patients will sit in an ICU for an extended period of time deconditioning and not getting better, but family does not want to do anything for fear of making the situation worse or feeling like they are murdering a family member by taking away care. Recognize that his pancreas is not well at all. His kidneys are not well at all. His liver is not well at all. Assumedly, his lungs aren't either.Let's say he is extubated. Now we have a burnt pancreas. And kidney. And liver. If you are this young and have liver dysfunction or failure, that's a life of slowly getting sicker and sicker until you can possibly but probably not get a liver transplant in the future. It's painful. If his kidneys are truly shot and he requires dialysis in the future, that's 50 years of spending 3 days a week going to get dialysis and sitting there having your blood cycled over and over for hours, just to go home and not feel well. Then you do it again. Then you do it again. That's a lot of stress for a 30-year-old. A 30-year-old that already has alcoholism. If your pancreas is constantly becoming inflamed, diabetes maybe in the future or at least insulin dependence. A 30-year-old diabetic will have a low quality of life.DNR and DNIs are to preserve a patient's dignity thinking about the long-term consequences to their health and quality of life. The idea that saving people is enough, is not enough. By stating do not resuscitate, You're saying to give a chance, but don't take it farther than he would like given all that has happened, and will happen in the future.The doctor sees this all the time. The doctor sees a family that holds on to hope that everything will be okay because their family member is " a fighter, " but neglects to see that the patient has already fought 25 rounds and has been knocked out three times. And also neglects to see that, if they come out of the fight, they essentially will have an agonizing future for the rest of their life.

###Input :Hello Reddit,My younger brother was 27, Male, maybe 6 foot and 375 pounds, half white/asian, no drugs, no smoking, extremely rarely drinking (like less than once a month).I don't recall what his early symptoms were but I found a virtual chat that said he may of had "uncomplicated cystitis" and had antibiotics prescribed for it. He saw a urologist and eventually had a nephrostomy tube, then had surgery later and was noted with a failed kidney. They were unable to remove it due to his weight and having hemorrhage concerns, at least that was my understanding, and that's it for a his existing medical condition, with an exception.I'm first wondering how he developed this condition to begin with. Would the failed kidney have caused the infection? I wish I had the full records so I could paint a better picture, but ultimately I can only guess that his high blood pressure was a cause, plus having a high stress job.Ever since all this, he had to urinate every like hour and this caused issues with work and sleep. I really don't understand why this kept happening and nothing was given to him for it. Would having a failed kidney cause that? This started back at the end of 2020 and the tube and surgery may have been in Q2/3? I now can't remember what happened first.From that I'm mostly wondering about the reason for frequent urination and if he would have got infected some other way outside of high blood pressure. He almost never leaves the house, and I fear he'd only get sick if a family member came home with something.Fast forward to the bulk of my reason to post. On January 13, 2023 he mentioned some nasal congestion and some body aches. He didn't seem to get better on the 14th so I asked if he wanted to see a doctor and he said not yet. This eventually came with some headaches so we tried to go to an urgent care but the wait times were 3+ hours so we figured try a Teladoc (98point6 for this call) and get an appointment later. He mentions a head ache lasting 4-5 days, dull/sharp pains in waves from front to back, also going behind his eyes. He was taking ibuprofen, and was asked about a fever and he said he wasn't sure but his head seems warmer compared to his body. They basically said to take Afrin and Excedrin and go to urgent care if things don't get better. When he went to take the afrin that night, he blew his nose and had a nose bleed, and per our father he had nose bleeds from time to time, but not that super often.Come January 19 I take him to urgent care and I do have his visit summary. Blood pressure 174/89 (why the fuck didn't anyone talk about this), temporal temperature of 98.1 (maybe the medication lowered it?), pulse 90, respiration 18, oxygen saturation 97. They gave him Toradol and sent him home. I feel like a fucking asshole that I wasn't in there with him, I had to drop him off and attend a work meeting that I should of canceled, and our mother picked him up. This is all very local, like within 15 minute drives.He doesn't seem to get better and on the 22nd he talks about some vision issues so I immediately take him to the nearest ER, which is a satellite and not attached to a large hospital. He goes to a back room almost immediately after checking in - alone, and again I feel like a fucking loser as I should of gone there with him to help explain everything - who knows exactly what he said since he was dealing with headaches. I did come back and talk to one of the nurses, but that didn't seem to change anything they expected.He had the following lab tests done, CBC With Diff, CG4 PANEL POC, Comprehensive Metabolic Panel Poc, PCR Influenza A & B and Covid 19 (POCT). Also had a CT Head W/O Contrast and EKG. Done today was just the CG4 and Comprehensive Metabolic, guess the CBC was still processing? I don't recall any notes on this, and his MyChart is closed.They didn't seem to find anything, even though he had a 171/105 blood pressure, they did ask if he had history and I didn't have a full answer, but said it wouldn't be surprising since the rest of the family has medication for it, but he didn't have a primary care doctor to prescribe it. He had trouble finding one since COVID and it really pisses me off that I didn't help him find one somehow. He also had 100.1 temperature.They gave him .9% NaCl (NS), tylenol, benadryl, toradol and reglan, and sent him home.The next day I don't remember exactly what triggered this, maybe balance, but we took him to the ER attached to the hospital and the doctor almost immediately said he wasn't going home that night, he saw something. They put him in a gown and my brother was shivering mad, and he normally likes it cold. Sometime that night I believe he got a room and had some tests, and they said he had meningitis, and shortly after was uncertain of contagious so the room was adjusted and we had to wear N95 masks and a face shield / gown. This went for maybe 2-3 days, and it bothers me so much because this was the most critical time that I could of had talking to my brother and I minimized my time like a coward and asshole. I believe our mother was there the whole time though.After that 2-3 days it was cleared for bacterial and said likely viral (they never said what he had) and the additional PPE was stopped. I remember he texted me to bring apple juice, yogurt, and fruit cups, which I did, but asked if it was okay because I thought hospitals didn't want outside food. They said it was okay as long as it conformed to a low sodium diet, which those did.During this I know he had a lumbar puncture, which is likely how they found the meningitis, and had a CT/MRI that they said was clear. Then suddenly the next day he developed delirium. He was able to answer our questions and knew who we were, but it was like he was living in a video game or something. He'd also spring up very quickly pulling wires to urinate (and frequently) which caused concerns for the monitoring and fall prevention, since he was a little wobbly and I think bumped his side one day because of the bar being down for the accessibility access for the toilet.The doctors believed the delirium was due to his lowered sodium levels, which could have been to the frequent urination and low sodium diet. He was drinking a ton of Gatorade at home back home, probably around the 16th I was buying him multi-packs as I felt those helped me recover. Eventually they put him on a EEG and because of the frequent getting up and sometimes he'd just try to rip the things off, they restrained him. I wasn't there when it happened but our mom was there and it sounded a little traumatic, like saying "why are you doing this mommy, and then attempting to bite her". Not sure if that's exactly what happened but he was restrained. Either at that point or shortly after he did have a nurse assigned to be next to him 24/7 to monitor, and help him pee as he'd be responsive if he had to go and the nurses asked.During this delirium he'd talk about random stuff, sounded like he was in a game, he couldn't explain where he was, but he was still answering questions. Everyday I visited I'd ask if he knew who I was and he'd start by laughing and saying of course, and I had to be more specific with him and he'd confirm my name and that I'm his brother. During this time we had a family member with him 24/7, but would occasionally talk to him, I know I'd hold his hand and he'd squeeze back, but we'd end up sitting to the side talking to each or reading a book, etc.Finally on the 30th I was coming in to swap out with our father, who said that my brother was a bit quieter today, maybe he was finally getting some much needed sleep as it seemed like he wasn't getting any. I also noticed that he had an oxygen tube under his nose, which wasn't there before. I didn't want to wake him so I didn't do much, and this was the first day I decided to pop up my switch and play some yoshi crafted world, and I kept one ear bud out just in case.I know he had a lumbar puncture done either before I came or just as I came, and an MRI earlier (might have been the previous day, it's becoming a blur now and I hate it) and the neurologist said they see a lesion, and it looked like one of the quadrants of the brain. I honestly can't remember but it felt like a sizable portion. I also looked at the EEG from time to time as I assume they were looking for seizures and I swear I saw alerts on the machine detecting them.This was the first time that I was going to pull the all nighter, and it was normally our mother that would do that and I offered to stay but she wanted to get some rest which I understood. A bit after I was there I noticed they swapped the tube with an oxygen mask, and I regret to this day that I did not look at that monitor better, seeing if oxygen was dropping, etc. There was a nurse there but I don't know how well they were watching, I swear one of the guys before was on his phone most of the time. I remember there was a night shift change, and I don't recall how long after before the most traumatic part happens. I did ask if my brother snored normally to our parents, as I never really heard him sleep and our father said yes, and he should get a sleep study done. It reminded me of our father's sleep apnea when napping on the couch during movie night. I don't remember how long this went on for, but I think they adjusted the bed height or something, don't remember... yet another thing to add to my list of regrets.That night after playing a bit I remember my arms getting tired so I pulled the little side table near me to prop my switch up on so I could just use the remotes, and all of a sudden a bunch of nurses come rushing into the room and one of the nurses checks his neck and says no pulse, then a code blue is called. I am escorted out of the room and just panicking. I don't remember hearing the monitor beeping prior (remember 1 ear bud and I had the volume at like 1 tick), and I don't recall him snoring just before either. For all I know the sensors were faulted and he was out for awhile, I have no idea how immediate it was, or if maybe the table pulled/squeezed the oxygen tube (this all happened in like 10 seconds). I know that his monitor was beeping a lot earlier due to his blood pressure, and I don't know if they gave him medication, but I don't remember that monitor beeping at all that day. Maybe the last nurse silenced it? I don't know. I also don't know how well the nurse was watching. One of the nurses in the morning/afternoon was great and I know she was looking at his face and the monitor with great focus, and I fear the night nurses not so much. I know the nurse that night was from newborns, and just helping out.I don't understand why or how he code blued, how quick it was, or anything, but I know it took them over 20 minutes to bring him back and he was on a ventilator. They did the 24 hour thermal treatment of going cold then normal, and after that for the next few days they'd do an eye test and pain test with no responses. On February 1 they did some test with a dye to see blood movement in the brain and I saw the results that night saying there was little blood flow but not clinically brain dead. I had a spark of hope but knew I wasn't a doctor. The next day we talked to the neurologist and confirmed that he was indeed brain dead and I felt like I lost my brother for the 3rd time in that hospital. Once during delirium, then the cardiac arrest, and now. We had to decide when to pull the life support, and I watched him officially die, for what felt like the 4th time.Having to find the courage to join our father for the funeral arrangements, then the funeral which was a visitation before cremation, then picking up the urn a week later, it's been waves of trauma and it still feels like yesterday a month later. Everyday I've gone home to see my parents, and touch the urn and cry. I don't understand why he's in there and not at our house playing video games with his friends.I don't understand how he got sick to begin with, he moved in with me back in May and I tried to make things as comfortable for him as possible. This was his first winter with me and I think this house is a bit drier than the parents he lived with, but I wouldn't think that'd cause the issue. He almost never leaves, he works from home and plays games. If he caught anything it'd be from me, and I know I got sick at the end of June with COVID and he caught that from me, what a fucking loser I am. I did another trade show in September and got sick, not sure if he got it then, he didn't report time off to work (and he tries to take every time off he can).I don't understand why the teladoc didn't ask other questions, or the urgent care to find anything. Then later the first ER only commented on the high blood pressure, and it wasn't until the second ER that they knew something was up.Why did he get delirium, why did they let sodium levels drop? What was going on with the oxygen? With the monitoring he had, how did they let a cardiac arrest happen?I have so many questions and it pains me knowing that even if I get knew, it doesn't change that my baby brother is gone. We had so many plans this year, such as cooking better for ourselves, working out to lose weight, and most critically spending more time outside of his room to try new things like restaurants and take vacations. The last vacation I had with him was 2007, and he was in Hawaii with the parents in 2008 where I was rejected from going because I didn't have a job after high school.Before his delirium I remember one big ask, which was to get a hug, and that he was ready and wanting to go on adventures with me. I hadn't seen my brother much outside of a quick dinner talk from time to time, and when he moved in I was glad to be bonding with him again, and we didn't even get 1 year. We had so many plans, and the world robbed him of that.During the visitation I played the Halo song "Never Forget". He was a big Halo fan and that song always gave me the feels. I hugged his cold body for that entire song, wishing I could give him more.This is a long post and I apologize, I just needed to write, and I wonder if anyone knows what may have caused things. I fear that my lack of knowledge and experience failed to get him to the ER sooner, but it didn't seem like that even helped, they may have just done the same as they did on the first visit and turned him around.I failed to protect you brother, I am so sorry. This world is just not fair and you deserved so much more. You were the nicest person anyone would of met and you made those around you happier. I miss you so much brother, and I love you even more.I will see you again one day. ###Output :I'm sorry for your loss.Delirium can be caused by many factors including infections, metabolic imbalances, medications, and underlying medical conditions. In your brother's case, the low sodium levels may have played a role, but it is also possible that there were other contributing factors such as an underlying infection or a reaction to medications.His low sodium could be due to frequent urination, or due to his low sodium diet, or it could be due to an underlying medical condition such as adrenal insufficiency or kidney disease.Don't know about the oxygen - but, changes in oxygen levels can occur due to changes in respiratory function, changes in blood pressure, or changes in heart function.The fact that he was on monitoring does not guarantee that a cardiac arrest could not occur. It is possible that the cardiac arrest was due to an underlying medical condition or a sudden event such as an arrhythmia. But, ultimately I don't know.

###Input :Im not sure if this is the appropriate place to post, Ill delete if not.33F, Current diagnoses: anemia, bulging discs, arthritis. Im on slow release iron and vitamin B12 daily and mobic and skelaxin PRN. I see a PCP regularly. Ive always been an anxious person but lately its been significantly worse. I lost my sister at the end of 2021, she was at home recovering from covid and died unexpectedly. It was a very traumatic experience, I watched the paramedics perform CPR on her. Im also a nurse, worked a covid unit the first 2 years of the pandemic. Ive got a lot of negative feelings from that as well, like most hcw. I find myself crying more often than not. I find myself unable to sleep because Im reliving the night my sister died and the days that followed. Its not just when Im asleep though. Itll hit me when Im driving or at the store, just these intrusive memories replaying and I cant make them stop.I work third shift, I come home and stand next to my husband because Im convinced hes not breathing. I have to watch his chest rise and fall several times before I believe hes ok. I panic if he doesnt respond to a text, I almost left work one night because I was freaking out convinced he was dead, he was home with covid and had just fallen asleep.I now work a unit thats not technically critical care but our patients are very sick. (Post op, pressors, a lines ) I often feel so heavy in my chest by the end of the night sometimes until I get home because Im so anxious that I have forgotten something or done something wrong.When I did my physical I did discuss my grief with my PCP but told her I felt like I was ok. I do this thing were I like to say Im ok even though I know Im not. Its getting to a point though its obviously interfering with my life. Im just not sure who to turn to. Ive never sought care for my mental health so I was going to go through my employers EAP but its so overwhelming. Theres therapists, social workers all kinds of options. But theres no psychiatrists available. I dont really know if theres a reason I should be seeking one or if I should just start with a therapist. I think I just feel overwhelmed by all of it and need help in which direction I should go.If youve read all of my ramblings I greatly appreciate it. Any and all advice is welcomed. Thank you all for your time! ###Output :I think you would benefit the most from having both psychological and pharmacological therapy together.It sounds like you're in a different country than mine, and your healthcare system may be slightly different, but I hope this largely applies.I think your first step ought to be going back to your primary care doctor and telling them what you've written here.Your primary care doctor should be able to signpost you towards the appropriate psychological service, who can do their own assessment and determine what type of psychological therapy is best suited for your needs.At the same time, I think you would benefit also from pharmacological therapy, but it's not necessary for you to see a psychiatrist immediately. Your primary care doctor is trained to assess and prescribe treatment for common and uncomplicated psychiatric conditions. If it later becomes clear that your illness is more complex than it first appeared, or if you don't respond to the first or second-line treatments, you could explore getting a referral to see a psychiatrist then.You should also look into seeing your employer's occupational health service, who can, I hope, help support you in your work and make any necessary adjustments. I would strongly recommend discussing your health with them especially if your mental state starts interfering with your ability to work.I hope things start getting easier for you soon.

###Input :What type of medical tests should I ask my doctor to perform to look at underlying medical issues or deficiencies that might be responsible for my hair loss. I have complained in the past and she only looked at iron.Im a 34F who has lost probably 60% of my hair over the past 3 years. I have no history or family members with hair loss. I am east European with light brown, fair hair. However, I have always been complimented with how full, soft, lush my hair is. Hair loss is all over rather than patterned. ###Output :This post has very little information about your general health, no information about your medications, inadequate information about the alopecia distribution, and no quality images of your scalp. Meaningful comment is not appropriate.