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<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Medicare and Continuing Care ? [/INST] Original Medicare is managed by the Federal government and lets people with Medicare go to any doctor, hospital or other health care provider who accepts Medicare. It is a feeforservice plan, meaning that the person with Medicare usually pays a fee for each service. Medicare pays its share of an approved amount up to certain limits, and the person with Medicare pays the rest. People in Original Medicare must choose and join a Medicare Prescription Drug Plan if they want to get Medicare prescription drug coverage. For more information about Original Medicare, visit http://www.medicare.gov for a free copy of "Your Medicare Benefits." (Under "Search Tools," select "Find a Medicare Publication.")</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Medicare and Continuing Care ? [/INST] People who choose Original Medicare may wish to consider Medigap, a type of Medicare supplement insurance. Medigap policies are sold by private insurance companies to fill gaps in Original Medicare Plan coverage, such as outofpocket costs for Medicare coinsurance and deductibles, or for services not covered by Medicare. A Medigap policy only works with Original Medicare. A person who joins a Medicare Advantage Plan generally doesn't need (and can't use) a Medigap policy. For more information about Medigap policies, visit http://www.medicare.gov to view a copy of "Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare." (Under "Search Tools," select "Find a Medicare Publication.") You can also call 1800Medicare (18006334227). TTY users should call 18774862048.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Medicare and Continuing Care ? [/INST] Some people think that Medicare and Medicaid are the same. Actually, they are two different programs. Medicaid is a staterun program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid. If you have questions about Medicaid, you can call your State Medical Assistance (Medicaid) office for more information. Visit http://www.medicare.gov on the web. (Under "Search Tools," select "Find Helpful Phone Numbers and Websites.") Or, call 1800Medicare (18006334227) to get the telephone number. TTY users should call 18774862048.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Medicare and Continuing Care ? [/INST] Home health care is shortterm skilled care at home after hospitalization or for the treatment of an illness or injury. Home health agencies provide home care services, including skilled nursing care, physical therapy, occupational therapy, speech therapy, medical social work, and care by home health aides. Home health services may also include durable medical equipment, such as wheelchairs, hospital beds, oxygen, and walkers, and medical supplies for use at home.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Medicare and Continuing Care ? [/INST] Here are questions to ask when considering a home health agency. Is the agency Medicareapproved? How long has the agency served the community? Does this agency provide the services my relative or friend needs? How are emergencies handled? Is the staff on duty around the clock? How much do services and supplies cost? Will agency staff be in regular contact with the doctor? Is the agency Medicareapproved? How long has the agency served the community? Does this agency provide the services my relative or friend needs? How are emergencies handled? Is the staff on duty around the clock? How much do services and supplies cost? Will agency staff be in regular contact with the doctor? You can use Medicare's "Home Health Compare" tool to compare home health agencies in your area. Visit http://www.medicare.gov. Under "Search Tools," select "Compare Home Health Agencies in Your Area."</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Medicare and Continuing Care ? [/INST] Here are some questions to ask when considering choosing a nursing home. You may want to make surprise visits at different times of the day to verify conditions. Is the nursing home Medicare or Medicaidcertified? Does the nursing home have the level of care needed (such as skilled or custodial care) and is a bed available? Does the nursing home have special services if needed in a separate unit (such as a ventilator or rehabilitation) and is a bed available? Are residents clean, well groomed, and appropriately dressed for the season or time of day? Is the nursing home free from strong, unpleasant odors? Does the nursing home appear to be clean and well kept? Does the nursing home conduct staff background checks? Does the nursing home staff interact warmly and respectfully with home residents? Does the nursing home meet cultural, religious, and language needs? Are the nursing home and the current administrator licensed? Is the nursing home Medicare or Medicaidcertified? Does the nursing home have the level of care needed (such as skilled or custodial care) and is a bed available? Does the nursing home have special services if needed in a separate unit (such as a ventilator or rehabilitation) and is a bed available? Are residents clean, well groomed, and appropriately dressed for the season or time of day? Is the nursing home free from strong, unpleasant odors? Does the nursing home appear to be clean and well kept? Does the nursing home conduct staff background checks? Does the nursing home staff interact warmly and respectfully with home residents? Does the nursing home meet cultural, religious, and language needs? Are the nursing home and the current administrator licensed?</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What to do for Medicare and Continuing Care ? [/INST] Nursing home care can be very expensive. Medicare generally doesn't cover nursing home care. There are many ways people can pay for nursing home care. For example, they can use their own money, they may be able to get help from their state, or they may use longterm care insurance. Nursing home care isn't covered by many types of health insurance. Most people who enter nursing homes begin by paying for their care out of their own pocket. As they use up their resources over a period of time, they may eventually become eligible for Medicaid. Medicaid is a state and Federal program that will pay most nursing home costs for people with limited income and resources. Eligibility varies by state. Medicaid pays for care for about 7 out of every 10 nursing home residents. Medicaid will pay for nursing home care only when provided in a Medicaidcertified facility. For information about Medicaid eligibility, call your state Medical Assistance (Medicaid) Office. If you have questions about Medicaid, you can call your State Medical Assistance (Medicaid) office for more information. Visit http://www.medicare.gov on the web. (Under "Search Tools," select "Find Helpful Phone Numbers and Websites.") Or, call 1800Medicare (18006334227) to get the telephone number. TTY users should call 18774862048.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Medicare and Continuing Care ? [/INST] Medicare does cover skilled nursing care after a 3day qualifying hospital stay. Skilled care is health care given when the person needs skilled nursing or rehabilitation staff to manage, observe, and evaluate his or her care. Care that can be given by nonprofessional staff isn't considered skilled care. Medicare does not cover custodial care or adult day care. For more information on Medicare coverage of skilled nursing facility care, visit http://www.medicare.gov to look at or print a copy of the booklet "Medicare Coverage of Skilled Nursing Facility Care." (Under "Search Tools," select "Find a Medicare Publication.") You can also call 1800Medicare (18006334227) to find out if a free copy can be mailed to you. TTY users should call 18774862048.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Medicare and Continuing Care ? [/INST] Hospice care is a special way of caring for people who are terminally ill (dying) and helping their families cope. Hospice care includes treatment to relieve symptoms and keep the individual comfortable. The goal is to provide endoflife care, not to cure the illness. Medical care, nursing care, social services, drugs for the terminal and related conditions, durable medical equipment, and other types of items and services can be a part of hospice care.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Medicare and Continuing Care ? [/INST] The general number for Medicare is 1800Medicare (18006334227). TTY users should call 18774862048. You can also visit http://www.medicare.gov. The "Medicare & You" handbook is mailed out to all Medicare enrollees in the fall. It includes detailed information about all aspects of Medicare. On the following pages you will find phone numbers, web addresses, and names of publications that provide detailed information about various aspects of Medicare. If a person needs to sign up for Medicare, call Social Security at 18007721213 or go to http://www.ssa.gov to find out more. Your State Health Insurance Assistance Program, or SHIP, gives free health insurance counseling and guidance to people with Medicare or to family and friends who have authorization to help someone with Medicare questions. To get the most uptodate SHIP telephone numbers, call 1800Medicare (18006334227) or visit http://www.medicare.gov. (TTY users should call 18774862048.) Under "Search Tools," select "Find Helpful Phone Numbers and Websites." For information about enrolling in Medicare Part A or Part B, visit http://www.medicare.gov and view a copy of "Medicare & You." (Under "Search Tools," select "Find a Medicare Publication.") Or, you can contact your State Health Insurance Assistance Program. For information about Medicare prescription drug coverage, visit http://www.medicare.gov to get a free copy of "Your Guide to Medicare Prescription Drug Coverage." (Under "Search Tools," select "Find a Medicare Publication.") If you have questions about Medicaid, you can call your State Medical Assistance (Medicaid) office for more information. Visit http://www.medicare.gov on the web. (Under "Search Tools," select "Find Helpful Phone Numbers and Websites.") Or, call 1800Medicare (18006334227) to get the telephone number. TTY users should call 18774862048. To find out about Medigap policies, visit http://www.medicare.gov to view a copy of "Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare." (Under "Search Tools," select "Find a Medicare Publication.") You can also call 1800Medicare (18006334227). TTY users should call 18774862048. To find out about PACE (Programs of AllInclusive Care for the Elderly), which provides coverage for lowincome, frail, older adults who get health care in the community, call your State Medical Assistance (Medicaid) office or visit PACE to find out if a person is eligible and if there is a PACE site nearby. Several states have State Pharmacy Assistance Programs (SPAPs) that help people who qualify pay for prescription drugs. To find out about the SPAPs in your state, call 1800Medicare (18006334227). TTY users should call 18774862048. For more information about the Medicare Summary Notice, including a sample MSN and information on how to read it, visit http://www.medicare.gov and select "Medicare Billing." Or call 1800Medicare (18006334227) and say "Billing." TTY users should call 18774862048. For information about appeals, visit http://www.medicare.gov to get a free copy of "Your Medicare Rights and Protections." (Under "Search Tools," select "Find a Medicare Publication.") You can also call 1800Medicare (18006334227) to find out if a free copy can be mailed to you. TTY users should call 18774862048. To find out if a patient is eligible for Medicare's home health care services, call the Regional Home Health Intermediary (RHHI). An RHHI is a private company that contracts with Medicare to pay bills and check on the quality of home health care. To contact an RHHI, or get local telephone numbers for your State Hospice Organization, call 1800Medicare (18006334227) or visit http://www.medicare.gov. TTY users should 18774862048. To compare home health agencies in your area, you can use Medicare's "Home Health Compare" tool. Go to http://www.medicare.gov and under "Search Tools," select "Compare Home Health Agencies in Your Area." For more information on Medicare coverage of skilled nursing facility care, visit http://www.medicare.gov to look at or print a copy of the booklet "Medicare Coverage of Skilled Nursing Facility Care." (Under "Search Tools," select "Find a Medicare Publication.")</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Osteoporosis ? [/INST] A Bone Disease Osteoporosis is a disease that thins and weakens the bones to the point that they become fragile and break easily. Women and men with osteoporosis most often break bones in the hip, spine, and wrist, but any bone can be affected. You can't "catch" osteoporosis or give it to someone else. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass, placing them at risk for more serious bone loss and fractures. Although osteoporosis can strike at any age, it is most common among older people, especially older women. How Bone Loss Occurs Bone is living tissue. Throughout our lives, the body breaks down old bone and replaces it with new bone. But as people age, more bone is broken down than is replaced. The inside of a bone normally looks like a honeycomb, but when a person has osteoporosis, the spaces inside this honeycomb become larger, reflecting the loss of bone density and strength. (The word "osteoporosis" means "porous bone.") The outside of long bones called the cortex also thins, further weakening the bone. Sometime around the age of 30, bone mass stops increasing, and the goal for bone health is to keep as much bone as possible for as long as you can. In most women, the rate of bone loss increases for several years after menopause, then slows down again, but continues. In men, the bone loss occurs more slowly. But by age 65 or 70, most men and women are losing bone at the same rate. Weak Bones Can Lead to Fractures Osteoporosis is often called "silent" because bone loss occurs without symptoms. People may not know that they have osteoporosis until a sudden strain, bump, or fall causes a bone to break. This can result in a trip to the hospital, surgery, and possibly a longterm disabling condition. Broken bones in your spine are painful and very slow to heal. People with weak bones in their spine gradually lose height and their posture becomes hunched over. Over time a bent spine can make it hard to walk or even sit up. Broken hips are a very serious problem as we age. They greatly increase the risk of death, especially during the year after they break. People who break a hip might not recover for months or even years. Because they often cannot care for themselves, they are more likely to have to live in a nursing home. Prevention and Treatment The good news is that osteoporosis can often be prevented and treated. Healthy lifestyle choices such as proper diet, exercise, and treatment medications can help prevent further bone loss and reduce the risk of fractures.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Osteoporosis? ? [/INST] Risk Factors You Can't Change Some risk factors for osteoporosis cannot be changed. These include Gender. Women are at higher risk for osteoporosis than men. They have smaller bones and lose bone more rapidly than men do because of hormone changes that occur after menopause. Therefore, if you are a woman, you are at higher risk for osteoporosis. Age. Because bones become thinner with age, the older you are, the greater your risk of osteoporosis. Ethnicity. Caucasian and Asian women are at the highest risk for osteoporosis. This is mainly due to differences in bone mass and density compared with other ethnic groups. AfricanAmerican and Hispanic women are also at risk, but less so. Family History. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too. History of Previous Fracture. People who have had a fracture after the age of 50 are at high risk of having another. Gender. Women are at higher risk for osteoporosis than men. They have smaller bones and lose bone more rapidly than men do because of hormone changes that occur after menopause. Therefore, if you are a woman, you are at higher risk for osteoporosis. Age. Because bones become thinner with age, the older you are, the greater your risk of osteoporosis. Ethnicity. Caucasian and Asian women are at the highest risk for osteoporosis. This is mainly due to differences in bone mass and density compared with other ethnic groups. AfricanAmerican and Hispanic women are also at risk, but less so. Family History. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too. History of Previous Fracture. People who have had a fracture after the age of 50 are at high risk of having another. Risk Factors You Can Change There are other risk factors for osteoporosis that can be changed. Poor diet. Getting too little calcium over your lifetime can increase your risk for osteoporosis. Not getting enough vitamin D either from your diet, supplements, or sunlight can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health. Physical inactivity. Not exercising and being inactive or staying in bed for long periods can increase your risk of developing osteoporosis. Like muscles, bones become stronger with exercise. Smoking. Cigarette smokers may absorb less calcium from their diets. In addition, women who smoke have lower levels of estrogen in their bodies. Learn more about smoking and bone health. Poor diet. Getting too little calcium over your lifetime can increase your risk for osteoporosis. Not getting enough vitamin D either from your diet, supplements, or sunlight can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health. Physical inactivity. Not exercising and being inactive or staying in bed for long periods can increase your risk of developing osteoporosis. Like muscles, bones become stronger with exercise. Smoking. Cigarette smokers may absorb less calcium from their diets. In addition, women who smoke have lower levels of estrogen in their bodies. Learn more about smoking and bone health. Medications. Some commonly used medicines can cause loss of bone mass. These include a type of steroid called glucocorticoids, which are used to control diseases such as arthritis and asthma; some antiseizure drugs; some medicines that treat endometriosis; and some cancer drugs. Using too much thyroid hormone for an underactive thyroid can also be a problem. Talk to your doctor about the medications you are taking and what you can do to protect your bones. Low body weight. Women who are thin and smallboned are at greater risk for osteoporosis. Medications. Some commonly used medicines can cause loss of bone mass. These include a type of steroid called glucocorticoids, which are used to control diseases such as arthritis and asthma; some antiseizure drugs; some medicines that treat endometriosis; and some cancer drugs. Using too much thyroid hormone for an underactive thyroid can also be a problem. Talk to your doctor about the medications you are taking and what you can do to protect your bones. Low body weight. Women who are thin and smallboned are at greater risk for osteoporosis. Use this checklist to find out if you are at risk for weak bones. Many of these risk factors, both ones you can change and ones you cannot change, affect peak bone mass, which is when your bones achieve maximum strength and density. Because high peak bone density can reduce osteoporosis risk later in life, it makes sense to pay more attention to those factors that affect peak bone mass. Learn more about peak bone mass.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Osteoporosis ? [/INST] Fractures A Possible Warning Sign Osteoporosis does not have any symptoms until a fracture occurs. Women and men with osteoporosis most often break bones in the hip, spine, and wrist. But any fracture in an older person could be a warning sign that the bone is weaker than optimal. Some people may be unaware that they have already experienced one or more spine fractures. Height loss of one inch or more may be the first sign that someone has experienced spine fractures due to osteoporosis. Multiple spine fractures can cause a curved spine, stooped posture, back pain, and back fatigue. Women and men who have had a fracture are at high risk of experiencing another one. A fracture over the age of 50 or several fractures before that age may be a warning sign that a person has already developed osteoporosis. People over the age of 50 who have experienced a fracture should talk to their doctor about getting evaluated for osteoporosis. Risk Factors for Fractures The more likely you are to fall, the higher your risk for a fracture. And more severe falls increase your risk for fractures. Factors that increase your risk of falling and of fracturing a bone include decreased muscle strength poor balance impaired eyesight impaired mental abilities certain medications, such as tranquilizers and muscle relaxants hazardous elements in your living environment, such as slippery throw rugs and icy sidewalks. decreased muscle strength poor balance impaired eyesight impaired mental abilities certain medications, such as tranquilizers and muscle relaxants hazardous elements in your living environment, such as slippery throw rugs and icy sidewalks. The angle at which you fall also affects your risk of fracture. Hip Fractures Although low bone mass (or low bone density) plays an important role in determining a person's risk of osteoporosis, it is only one of many risk factors for fractures. Various aspects of bone geometry, such as tallness, hip structure, and thighbone (femur) length, can also affect your chances of breaking a bone if you fall. Increasing age, too much weight loss, a history of fractures since age 50, having an existing spine fracture, and having a mother who fractured her hip all increase the risk of hip fracture regardless of a person's bone density. People with more risk factors have a higher chance of suffering a hip fracture.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Osteoporosis ? [/INST] Who Should Be Tested? The United States Preventive Service Task Force recommends that women aged 65 and older be screened (tested) for osteoporosis, as well as women aged 60 and older who are at increased risk for an osteoporosisrelated fracture. However, the decision of whether or not to have a bone density test is best made between a patient and his or her physician. Medicare will usually cover the cost of a bone density test, and a follow up test every 2 years, for female beneficiaries. It also will cover screening and follow up of any male Medicare recipients who have significant risk factors for osteoporosis. When To Talk With a Doctor Consider talking to your doctor about being evaluated for osteoporosis if you are a man or woman over age 50 or a postmenopausal woman and you break a bone you are a woman age 65 or older you are a woman younger than 65 and at high risk for fractures you have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause you have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss you have a chronic illness or are taking a medication that is known to cause bone loss you have anorexia nervosa or a history of this eating disorder. you are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty. you are a man or woman over age 50 or a postmenopausal woman and you break a bone you are a woman age 65 or older you are a woman younger than 65 and at high risk for fractures you have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause you have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss you have a chronic illness or are taking a medication that is known to cause bone loss you have anorexia nervosa or a history of this eating disorder. you are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty. Diagnosing Osteoporosis Diagnosing osteoporosis involves several steps, starting with a physical exam and a careful medical history, blood and urine tests, and possibly a bone mineral density assessment. When recording information about your medical history, your doctor will ask questions to find out whether you have risk factors for osteoporosis and fractures. The doctor may ask about any fractures you have had your lifestyle (including diet, exercise habits, and whether you smoke) current or past health problems medications that could contribute to low bone mass and increased fracture risk your family history of osteoporosis and other diseases for women, your menstrual history. any fractures you have had your lifestyle (including diet, exercise habits, and whether you smoke) current or past health problems medications that could contribute to low bone mass and increased fracture risk your family history of osteoporosis and other diseases for women, your menstrual history. The doctor will also do a physical exam that should include checking for loss of height and changes in posture and may include checking your balance and gait (the way you walk). Bone Density Tests The test used to diagnose osteoporosis is called a bone density test. This test is a measure of how strong or dense your bones are and can help your doctor predict your risk for having a fracture. Bone density tests are painless, safe, and require no preparation on your part. Bone density tests compare your bone density to the bones of an average healthy young adult. The test result, known as a Tscore, tells you how strong your bones are, whether you have osteoporosis or osteopenia (low bone mass that is not low enough to be diagnosed as osteoporosis), and your risk for having a fracture. Some bone density tests measure the strength of the hip, spine, and/or wrist, which are the bones that break most often in people with osteoporosis. Other tests measure bone in the heel or hand. Although no bone density test is 100 percent accurate, it is the single most important diagnostic test to predict whether a person will have a fracture in the future. The most widely recognized bone density test is a central DXA (dualenergy xray absorptiometry) scan of the hip and spine. This test shows if you have normal bone density, low bone mass, or osteoporosis. It is also used to monitor bone density changes as a person ages or in response to treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Osteoporosis ? [/INST] Who Treats Osteoporosis? Although there is no cure for osteoporosis, it can be treated. If your doctor does not specialize in osteoporosis, he or she can refer you to a specialist. There is not one type of doctor who cares for people with osteoporosis. Many family doctors have been learning about osteoporosis and can treat people who have it. Endocrinologists, rheumatologists, geriatricians, and internists are just a few of the specialists who can provide care to people with osteoporosis. Here is how to find an appropriate health care professional to treat osteoporosis. The Goal of Treatment The goal of treatment is to prevent fractures. A balanced diet rich in calcium, adequate vitamin D, a regular exercise program, and fall prevention are all important for maintaining bone health. Medications Several medications are approved by the Food and Drug Administration for the treatment of osteoporosis. Since all medications have side effects, it is important to talk to your doctor about which medication is right for you. Bisphosphonates. Several bisphosphonates are approved for the prevention or treatment of osteoporosis. These medications reduce the activity of cells that cause bone loss. Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly. Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly. A few people have muscle, bone, or joint pain while using these medicines. A few people have muscle, bone, or joint pain while using these medicines. Side effects of intravenous bisphosphonates may include flulike symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, deterioration of the jawbone or an unusual type of broken bone in the femur (thigh bone) has occurred in people taking bisphosphonates. Side effects of intravenous bisphosphonates may include flulike symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, deterioration of the jawbone or an unusual type of broken bone in the femur (thigh bone) has occurred in people taking bisphosphonates. The Food and Drug Administration recommends that health care professionals consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly for patients who have been on bisphosphonates for longer than 5 years. The Food and Drug Administration recommends that health care professionals consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly for patients who have been on bisphosphonates for longer than 5 years. Parathyroid hormone. A form of human parathyroid hormone (PTH) is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Use of the drug for more than 2 years is not recommended. RANK ligand (RANKL) inhibitor. A RANK ligand (RANKL) inhibitor is approved for postmenopausal women with osteoporosis who are at high risk for fracture Estrogen agonists/antagonists. An estrogen agonist/ antagonist (also called a selective estrogen receptor modulator or SERM) is approved for the prevention and treatment of osteoporosis in postmenopausal women. SERMs are not estrogens, but they have estrogenlike effects on some tissues and estrogenblocking effects on other tissues. Calcitonin. Calcitonin is approved for the treatment of osteoporosis in women who are at least 5 years beyond menopause. Calcitonin is a hormone involved in calcium regulation and bone metabolism. Estrogen and Hormone Therapy. Estrogen is approved for the treatment of menopausal symptoms and osteoporosis in women after menopause. Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first. Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Osteoporosis ? [/INST] Scientists are pursuing a wide range of basic and clinical studies on osteoporosis. Significant advances in preventing and treating osteoporosis continue to be made. Such advances are the direct result of research focused on determining the causes and consequences of bone loss at the cellular and tissue levels assessing risk factors developing new strategies to maintain and even enhance bone density and reduce fracture risk exploring the roles of such factors as genetics, hormones, calcium, vitamin D, drugs, and exercise on bone mass. determining the causes and consequences of bone loss at the cellular and tissue levels assessing risk factors developing new strategies to maintain and even enhance bone density and reduce fracture risk exploring the roles of such factors as genetics, hormones, calcium, vitamin D, drugs, and exercise on bone mass. Get more information about ongoing research on osteoporosis from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) at NIH.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Osteoporosis ? [/INST] Osteoporosis is a disease that thins and weakens the bones to the point that they break easily. Women and men with osteoporosis most often break bones in the hip, spine, and wrist, but osteoporosis can be the cause of bone fractures anywhere.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Osteoporosis? ? [/INST] Some risk factors for osteoporosis cannot be changed. These include Gender. Women are at higher risk for osteoporosis than men. They have smaller bones and lose bone more rapidly than men do because of hormone changes that occur after menopause. Therefore, if you are a woman, you are at higher risk for osteoporosis. Age. Because bones become thinner with age, the older you are, the greater your risk of osteoporosis. Ethnicity. Caucasian and Asian women are at the highest risk for osteoporosis. This is mainly due to differences in bone mass and density compared with other ethnic groups. AfricanAmerican and Hispanic women are also at risk, but less so. Family History. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too. History of Previous Fracture. People who have had a fracture after the age of 50 are at high risk of having another. Gender. Women are at higher risk for osteoporosis than men. They have smaller bones and lose bone more rapidly than men do because of hormone changes that occur after menopause. Therefore, if you are a woman, you are at higher risk for osteoporosis. Age. Because bones become thinner with age, the older you are, the greater your risk of osteoporosis. Ethnicity. Caucasian and Asian women are at the highest risk for osteoporosis. This is mainly due to differences in bone mass and density compared with other ethnic groups. AfricanAmerican and Hispanic women are also at risk, but less so. Family History. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too. History of Previous Fracture. People who have had a fracture after the age of 50 are at high risk of having another.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Osteoporosis? ? [/INST] Here are risk factors for osteoporosis that you can control. Poor diet. Getting too little calcium over your lifetime can increase your risk for osteoporosis. Not getting enough vitamin D either from your diet, supplements, or sunlight can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health. Physical inactivity. Not exercising and being inactive or staying in bed for long periods can increase your risk of developing osteoporosis. Like muscles, bones become stronger with exercise. Smoking. Cigarette smokers may absorb less calcium from their diets. In addition, women who smoke have lower levels of estrogen in their bodies. Learn more about smoking and bone health. Medications. Some commonly used medicines can cause loss of bone mass. These include a type of steroid called glucocorticoids, which are used to control diseases such as arthritis and asthma; some antiseizure drugs; some medicines that treat endometriosis; and some cancer drugs. Using too much thyroid hormone for an underactive thyroid can also be a problem. Talk to your doctor about the medications you are taking and what you can do to protect your bones. Low body weight. Women who are thin and smallboned are at greater risk for osteoporosis. Poor diet. Getting too little calcium over your lifetime can increase your risk for osteoporosis. Not getting enough vitamin D either from your diet, supplements, or sunlight can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health. Physical inactivity. Not exercising and being inactive or staying in bed for long periods can increase your risk of developing osteoporosis. Like muscles, bones become stronger with exercise. Smoking. Cigarette smokers may absorb less calcium from their diets. In addition, women who smoke have lower levels of estrogen in their bodies. Learn more about smoking and bone health. Medications. Some commonly used medicines can cause loss of bone mass. These include a type of steroid called glucocorticoids, which are used to control diseases such as arthritis and asthma; some antiseizure drugs; some medicines that treat endometriosis; and some cancer drugs. Using too much thyroid hormone for an underactive thyroid can also be a problem. Talk to your doctor about the medications you are taking and what you can do to protect your bones. Low body weight. Women who are thin and smallboned are at greater risk for osteoporosis.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Osteoporosis? ? [/INST] If you have any of these red flags, you could be at high risk for weak bones. Talk to your doctor, nurse, pharmacist, or other health care professional. Do any of these apply to you? ____ Im older than 65. ____ Ive broken a bone after age 50. ____ My close relative has osteoporosis or has broken a bone. ____ My health is fair or poor. ____ I smoke. ____ I am underweight for my height. ____ I started menopause before age 45. ____ Ive never gotten enough calcium. ____ I have more than two drinks of alcohol several times a week. ____ I have poor vision, even with glasses. ____ I sometimes fall. ____ Im not active. ____ I have one of these medical conditions: Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic hepatic or renal disease Hyperparathyroidism Vitamin D deficiency Cushings disease Multiple sclerosis Rheumatoid arthritis ____ Im older than 65. ____ Ive broken a bone after age 50. ____ My close relative has osteoporosis or has broken a bone. ____ My health is fair or poor. ____ I smoke. ____ I am underweight for my height. ____ I started menopause before age 45. ____ Ive never gotten enough calcium. ____ I have more than two drinks of alcohol several times a week. ____ I have poor vision, even with glasses. ____ I sometimes fall. ____ Im not active. ____ I have one of these medical conditions: Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic hepatic or renal disease Hyperparathyroidism Vitamin D deficiency Cushings disease Multiple sclerosis Rheumatoid arthritis Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic hepatic or renal disease Hyperparathyroidism Vitamin D deficiency Cushings disease Multiple sclerosis Rheumatoid arthritis Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic hepatic or renal disease Hyperparathyroidism Vitamin D deficiency Cushings disease Multiple sclerosis Rheumatoid arthritis ____ I take one of these medicines: Oral glucocorticoids (steroids) Cancer treatments (radiation, chemotherapy) Thyroid medicine Antiepileptic medications Gonadal hormone suppression Immunosuppressive agents ____ I take one of these medicines: Oral glucocorticoids (steroids) Cancer treatments (radiation, chemotherapy) Thyroid medicine Antiepileptic medications Gonadal hormone suppression Immunosuppressive agents Oral glucocorticoids (steroids) Cancer treatments (radiation, chemotherapy) Thyroid medicine Antiepileptic medications Gonadal hormone suppression Immunosuppressive agents Oral glucocorticoids (steroids) Cancer treatments (radiation, chemotherapy) Thyroid medicine Antiepileptic medications Gonadal hormone suppression Immunosuppressive agents</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Osteoporosis? ? [/INST] Women have smaller bones, and they lose bone more rapidly than men because of hormone changes that occur after menopause. Therefore, women are at higher risk for osteoporosis.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to prevent Osteoporosis ? [/INST] Preventing falls is a special concern for men and women with osteoporosis. Falls can increase the likelihood of fracturing a bone in the hip, wrist, spine, or other part of the skeleton. In addition to the environmental factors listed below, falls can also be caused by impaired vision or balance, chronic diseases that affect mental or physical functioning, and certain medications, such as sedatives and antidepressants. It is also important that individuals with osteoporosis be aware of any physical changes that affect their balance or gait, and that they discuss these changes with their health care provider. Here are some tips to help eliminate the environmental factors that lead to falls. Outdoors: Use a cane or walker for added stability. Wear rubbersoled shoes for traction. Walk on grass when sidewalks are slippery. In winter, carry salt or kitty litter to sprinkle on slippery sidewalks. Be careful on highly polished floors that become slick and dangerous when wet. Use plastic or carpet runners when possible. Use a cane or walker for added stability. Wear rubbersoled shoes for traction. Walk on grass when sidewalks are slippery. In winter, carry salt or kitty litter to sprinkle on slippery sidewalks. Be careful on highly polished floors that become slick and dangerous when wet. Use plastic or carpet runners when possible. Indoors: Keep rooms free of clutter, especially on floors. Keep floor surfaces smooth but not slippery. Wear supportive, lowheeled shoes even at home. Avoid walking in socks, stockings, or slippers. Be sure carpets and area rugs have skidproof backing or are tacked to the floor. Be sure stairwells are well lit and that stairs have handrails on both sides. Install grab bars on bathroom walls near tub, shower, and toilet. Use a rubber bath mat in shower or tub. Keep a flashlight with fresh batteries beside your bed. If using a step stool for hardtoreach areas, use a sturdy one with a handrail and wide steps. Add ceiling fixtures to rooms lit by lamps. Consider purchasing a cordless phone so that you dont have to rush to answer the phone when it rings, or so that you can call for help if you do fall. Keep rooms free of clutter, especially on floors. Keep floor surfaces smooth but not slippery. Wear supportive, lowheeled shoes even at home. Avoid walking in socks, stockings, or slippers. Be sure carpets and area rugs have skidproof backing or are tacked to the floor. Be sure stairwells are well lit and that stairs have handrails on both sides. Install grab bars on bathroom walls near tub, shower, and toilet. Use a rubber bath mat in shower or tub. Keep a flashlight with fresh batteries beside your bed. If using a step stool for hardtoreach areas, use a sturdy one with a handrail and wide steps. Add ceiling fixtures to rooms lit by lamps. Consider purchasing a cordless phone so that you dont have to rush to answer the phone when it rings, or so that you can call for help if you do fall. Learn more about devices that can help prevent falls in older adults.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Osteoporosis? ? [/INST] The more likely you are to fall, the higher your risk for a fracture. And more severe falls increase your risk for fractures. Factors that increase your risk of falling and of fracturing a bone include decreased muscle strength poor balance impaired eyesight impaired mental abilities certain medications, such as tranquilizers and muscle relaxants hazardous elements in your living environment, such as slippery throw rugs and icy sidewalks. decreased muscle strength poor balance impaired eyesight impaired mental abilities certain medications, such as tranquilizers and muscle relaxants hazardous elements in your living environment, such as slippery throw rugs and icy sidewalks.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Osteoporosis ? [/INST] If you have osteoporosis, ask your doctor which activities are safe for you. If you have low bone mass, experts recommend that you protect your spine by avoiding exercises or activities that flex, bend, or twist it. Furthermore, you should avoid highimpact exercise to lower the risk of breaking a bone. You also might want to consult with an exercise specialist to learn the proper progression of activity, how to stretch and strengthen muscles safely, and how to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty. Be sure to ask if he or she is familiar with the special needs of people with osteoporosis. If you have health problemssuch as heart trouble, high blood pressure, diabetes, or obesityor if you aren't used to energetic activity, check with your doctor before you begin a regular exercise program.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Osteoporosis ? [/INST] Osteoporosis does not have any symptoms until a fracture occurs. Some people may be unaware that they have already experienced one or more spine fractures. Height loss of one inch or more may be the first sign that someone has experienced spinal fractures due to osteoporosis. People who have experienced a fracture are at high risk of having another one. A fracture over the age of 50 or several fractures before that age may be a warning sign that a person has already developed osteoporosis. Any fracture in an older person should be followed up for suspicion of osteoporosis.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Osteoporosis ? [/INST] Consider talking to your doctor about being evaluated for osteoporosis if you are a man or woman over age 50 or a postmenopausal woman and you break a bone you are a woman age 65 or older you are a woman younger than 65 and at high risk for fractures you have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause you have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss you have a chronic illness or are taking a medication that is known to cause bone loss you have anorexia nervosa or a history of this eating disorder. you are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty. you are a man or woman over age 50 or a postmenopausal woman and you break a bone you are a woman age 65 or older you are a woman younger than 65 and at high risk for fractures you have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause you have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss you have a chronic illness or are taking a medication that is known to cause bone loss you have anorexia nervosa or a history of this eating disorder. you are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty. Here is how to find an appropriate health care professional to treat osteoporosis.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Osteoporosis ? [/INST] Diagnosing osteoporosis involves several steps, starting with a physical exam and a careful medical history, blood and urine tests, and possibly a bone mineral density assessment. When recording information about your medical history, your doctor will ask questions to find out whether you have risk factors for osteoporosis and fractures. The doctor may ask about any fractures you have had your lifestyle (including diet, exercise habits, and whether you smoke) current or past health problems medications that could contribute to low bone mass and increased fracture risk your family history of osteoporosis and other diseases for women, your menstrual history. any fractures you have had your lifestyle (including diet, exercise habits, and whether you smoke) current or past health problems medications that could contribute to low bone mass and increased fracture risk your family history of osteoporosis and other diseases for women, your menstrual history.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Osteoporosis ? [/INST] A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, your doctor may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk. Nutrition. The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. All of these nutrients are needed in balanced proportion. In particular, calcium and vitamin D are needed for strong bones and for your heart, muscles, and nerves to function properly. Exercise. Exercise is an important component of an osteoporosis prevention and treatment program. Exercise not only improves your bone health, but it increases muscle strength, coordination, and balance, and leads to better overall health. Although exercise is good for someone with osteoporosis, it should not put any sudden or excessive strain on your bones. As extra insurance against fractures, your doctor can recommend specific exercises to strengthen and support your back. Therapeutic medications. Several medications are available for the prevention and/or treatment of osteoporosis, including: bisphosphonates; estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMS); calcitonin; parathyroid hormone; estrogen therapy; hormone therapy; and a recently approved RANK ligand (RANKL) inhibitor. (Watch the video to learn how exercise helped a 70yearold woman with osteoporosis. To enlarge the video, click the brackets in the lower righthand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Osteoporosis ? [/INST] Several medications are approved by the Food and Drug Administration for the treatment of osteoporosis. Since all medications have side effects, it is important to talk to your doctor about which medication is right for you. Bisphosphonates. Several bisphosphonates are approved for the prevention or treatment of osteoporosis. These medications reduce the activity of cells that cause bone loss. Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly. Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly. A few people have muscle, bone, or joint pain while using these medicines. A few people have muscle, bone, or joint pain while using these medicines. Side effects of intravenous bisphosphonates may include flulike symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, deterioration of the jawbone or an unusual type of broken bone in the femur (thigh bone) has occurred in people taking bisphosphonates. Side effects of intravenous bisphosphonates may include flulike symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, deterioration of the jawbone or an unusual type of broken bone in the femur (thigh bone) has occurred in people taking bisphosphonates. The Food and Drug Administration recommends that health care professionals consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly for patients who have been on bisphosphonates for longer than 5 years. The Food and Drug Administration recommends that health care professionals consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly for patients who have been on bisphosphonates for longer than 5 years. Parathyroid hormone. A form of human parathyroid hormone (PTH) is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Use of the drug for more than 2 years is not recommended. RANK ligand (RANKL) inhibitor. A RANK ligand (RANKL) inhibitor is approved for postmenopausal women with osteoporosis who are at high risk for fracture Estrogen agonists/antagonists. An estrogen agonist/ antagonist (also called a selective estrogen receptor modulator or SERM) is approved for the prevention and treatment of osteoporosis in postmenopausal women. SERMs are not estrogens, but they have estrogenlike effects on some tissues and estrogenblocking effects on other tissues. Calcitonin. Calcitonin is approved for the treatment of osteoporosis in women who are at least 5 years beyond menopause. Calcitonin is a hormone involved in calcium regulation and bone metabolism. Estrogen and hormone therapy. Estrogen is approved for the treatment of menopausal symptoms and osteoporosis in women after menopause. Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first. Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Osteoporosis ? [/INST] Millions of Americans are able to lead healthy, productive lives while living with osteoporosis. If you have been feeling symptoms of depressionsuch as loss of appetite, hopelessness, feeling useless and helpless, or having thoughts of suicidefor more than 2 weeks, consult a doctor, social worker, or therapist. Medications and counseling are available to fight depression. Learn more about the emotional impact of osteoporosis. Learn more about older adults and depression. (Watch the video to learn more about coping with osteoporosis. To enlarge the video, click the brackets in the lower righthand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parkinson's Disease ? [/INST] A Brain Disorder Parkinson's disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination. It affects about half a million people in the United States although the numbers may be much higher. The average age of onset is 60 years, and the risk of developing Parkinson's goes up with age. Parkinson's disease was first described in 1817 by James Parkinson, a British doctor who published a paper on what he called "the shaking palsy." In this paper, he described the major symptoms of the disease that would later bear his name. Four Main Symptoms Parkinson's disease belongs to a group of neurological conditions called movement disorders. The four main symptoms of Parkinson's are: tremor, or trembling in hands, arms, legs, jaw, or head rigidity, or stiffness of the limbs and trunk bradykinesia, or slowness of movement postural instability, or impaired balance. tremor, or trembling in hands, arms, legs, jaw, or head rigidity, or stiffness of the limbs and trunk bradykinesia, or slowness of movement postural instability, or impaired balance. Parkinson's symptoms usually begin gradually and get worse over time. As the symptoms become more severe, people with the disorder may have difficulty walking, talking, or completing other simple tasks. They also experience nonmotor, or movement, symptoms including mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue. Parkinson's disease not only affects the brain, but the entire body. While the brain involvement is responsible for the core features, other affected locations contribute to the complicated picture of Parkinson's. Parkinson's disease is both chronic, meaning it lasts for a long time, and progressive, meaning its symptoms grow worse over time. It is not contagious. Diagnosis Can Be Difficult About 60,000 Americans are diagnosed with Parkinson's disease each year. However, it's difficult to know exactly how many have it because many people in the early stages of the disease think their symptoms are due to normal aging and do not seek help from a doctor. Also, diagnosis is sometimes difficult because there are no medical tests that can diagnose the disease with certainty and because other conditions may produce symptoms of Parkinson's. For example, people with Parkinson's may sometimes be told by their doctors that they have other disorders, and people with diseases similar to Parkinson's may be incorrectly diagnosed as having Parkinson's. A persons good response to the drug levodopa may support the diagnosis. Levodopa is the main therapy for Parkinsons disease. Who Is at Risk? Both men and women can have Parkinsons disease. However, the disease affects about 50 percent more men than women. While the disease is more common in developed countries, studies also have found an increased risk of Parkinson's disease in people who live in rural areas and in those who work in certain professions, suggesting that environmental factors may play a role in the disorder. Researchers are focusing on additional risk factors for Parkinsons disease. One clear risk factor for Parkinson's is age. The average age of onset is 60 years and the risk rises significantly with advancing age. However, about 5 to 10 percent of people with Parkinson's have "earlyonset" disease which begins before the age of 50. Earlyonset forms of Parkinson's are often inherited, though not always, and some have been linked to specific gene mutations. Juvenile Parkinsonism In very rare cases, parkinsonian symptoms may appear in people before the age of 20. This condition is called juvenile parkinsonism. It is most commonly seen in Japan but has been found in other countries as well. It usually begins with dystonia (sustained muscle contractions causing twisting movements) and bradykinesia (slowness of movement), and the symptoms often improve with levodopa medication. Juvenile parkinsonism often runs in families and is sometimes linked to a mutated gene. Some Cases Are Inherited Evidence suggests that, in some cases, Parkinsons disease may be inherited. An estimated 15 to 25 percent of people with Parkinson's have a known relative with the disease. People with one or more close relatives who have Parkinson's have an increased risk of developing the disease themselves, but the total risk is still just 2 to 5 percent unless the family has a known gene mutation for the disease. A gene mutation is a change or alteration in the DNA or genetic material that makes up a gene. Researchers have discovered several genes that are linked to Parkinson's disease. The first to be identified was alphasynuclein or SNCA. Inherited cases of Parkinsons disease are caused by mutations in the LRRK2, PARK2 or parkin, PARK7 or DJ1, PINK1, or SNCA genes, or by mutations in genes that have not yet been identified.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What causes Parkinson's Disease ? [/INST] A Shortage of Dopamine Parkinson's disease occurs when nerve cells, or neurons, in an area of the brain that controls movement become impaired and/or die. Normally, these neurons produce an important brain chemical known as dopamine, but when the neurons die or become impaired, they produce less dopamine. This shortage of dopamine causes the movement problems of people with Parkinson's. Dopamine is a chemical messenger, or neurotransmitter. Dopamine is responsible for transmitting signals between the substantia nigra and multiple brain regions. The connection between the substantia nigra and the corpus striatum is critical to produce smooth, purposeful movement. Loss of dopamine in this circuit results in abnormal nervefiring patterns within the brain that cause impaired movement. Loss of Norepinephrine People with Parkinson's also have loss of the nerve endings that produce the neurotransmitter norepinephrine. Norepinephrine, which is closely related to dopamine, is the main chemical messenger of the sympathetic nervous system. The sympathetic nervous system controls many automatic functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain several of the nonmovement features of Parkinson's, such as fatigue, irregular blood pressure, decreased gastric motility or movement of food through the digestive tract, and postural hypotension. Postural hypotension is a sudden drop in blood pressure when a person stands up from a sitting or lyingdown position. It may cause dizziness, lightheadedness, and in some cases, loss of balance or fainting. Lewy Bodies in Brain Cells Many brain cells of people with Parkinson's contain Lewy bodies. Lewy bodies are unusual deposits or clumps of the brain protein alphasynuclein, along with other proteins, which are seen upon microscopic examination of the brain. Researchers do not yet know why Lewy bodies form or what role they play in the development of Parkinson's. The clumps may prevent the cell from functioning normally, or they may actually be helpful, perhaps by keeping harmful proteins "locked up" so the cells can function. Genetic Mutations Although some cases of Parkinson's appear to be hereditary, and a few can be traced to specific genetic mutations, most cases are sporadic. Sporadic means the disease occurs randomly and does not seem to run in families. Many researchers now believe that Parkinson's disease results from a combination of genetic and environmental factors. Scientists have identified several genetic mutations associated with Parkinson's including mutations in the alphasynuclein gene. They think that many more genes may be linked to the disorder. Studying the genes responsible for inherited cases of Parkinson's can help researchers understand both inherited and sporadic cases. The same genes and proteins that are altered in inherited cases may also be altered in sporadic cases by environmental toxins or other factors. Researchers also hope that discovering genes will help identify new ways of treating Parkinson's. Environmental Toxins Although researchers increasingly recognize the importance of genetics in Parkinson's disease, most believe environmental exposures increase a person's risk of developing the disease. Even in inherited cases, exposure to toxins or other environmental factors may influence when symptoms of the disease appear or how the disease progresses. There are a number of toxins that can cause parkinsonian symptoms in humans. Researchers are pursuing the question of whether pesticides and other environmental factors not yet identified also may cause Parkinson's disease. Viruses are another possible environmental trigger for Parkinson's. Mitochondria and Free Radicals Research suggests that mitochondria may play a role in the development of Parkinson's disease. Mitochondria are the energyproducing components of the cell and are major sources of free radicals. Free radicals are molecules that damage membranes, proteins, DNA, and other parts of the cell. This damage is called oxidative stress. Changes to brain cells caused by oxidative stress, including free radical damage to DNA, proteins, and fats, have been found in people with Parkinson's. Clinical studies now underway test whether agents thought to improve energy metabolism and decrease oxidative stress slow the progression of Parkinson's disease. Recent evidence suggests that mutations in genes linked to Parkinsons disease result in mitochondrial dysfunction. Buildup of Harmful Proteins Other research suggests that the cell's protein disposal system may fail in people with Parkinson's, causing proteins like alphasynuclein to build up to harmful levels and trigger premature cell death. Additional studies have found that clumps of protein that develop inside brain cells of people with Parkinson's may contribute to the death of nerve cells, or neurons. However, the exact role of the protein deposits remains unknown. These studies also found that inflammation, because of protein accumulation, toxins or other factors, may play a role in the disease. However, the exact role of the protein deposits remains unknown. Researchers are exploring the possibility of vaccine development to decrease or prevent the accumulation of alphasynuclein. While mitochondrial dysfunction, oxidative stress, inflammation, and many other cellular processes may contribute to Parkinson's disease, scientists still do not know what causes cells that produce dopamine to die. Genes Linked to Parkinsons Researchers have discovered several genes that are linked to Parkinson's disease. The first to be identified was alphasynuclein or SNCA . Studies have found that Lewy bodies from people with the sporadic form of Parkinson's contain clumps of alphasynuclein protein. This discovery revealed a possible link between hereditary and sporadic forms of the disease. Other genes linked to Parkinson's include PARK2, PARK7, PINK1, and LRRK2. PARK2, PARK7, and PINK1 cause rare, earlyonset forms of the disease. Mutations in the LRRK2 gene are common in specific populations, including in people with Parkinson's in North Africa. Researchers are continuing to study the normal functions and interactions of these genes in order to find clues about how Parkinson's develops. They also have identified a number of other genes and chromosome regions that may play a role in Parkinson's, but the nature of these links is not yet clear. Whole genome wide association studies, or GWAS, of thousands of people with Parkinson's disease are now underway to find gene variants that allow for an increased risk of developing Parkinson's but are not necessarily causes of this disorder by themselves. A recent international study found that two genes containing mutations known to cause rare hereditary forms of Parkinsons disease are also associated with the more common sporadic form of the disease. This finding came from a GWAS which looked at DNA samples of European people who had Parkinsons disease and from those who did not have the disorder.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Parkinson's Disease ? [/INST] Parkinson's disease does not affect everyone the same way. Symptoms of the disorder and the rate of progression differ among people with the disease. Sometimes people dismiss early symptoms of Parkinson's as the effects of normal aging. There are no medical tests to definitively diagnose the disease, so it can be difficult to diagnose accurately. Early Symptoms Early symptoms of Parkinson's disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly or that their handwriting is slow and looks cramped or small. This very early period may last a long time before the more classic and obvious symptoms appear. Friends or family members may be the first to notice changes in someone with early Parkinson's. They may see that the person's face lacks expression and animation, a condition known as "masked face," or that the person does not move an arm or leg normally. They also may notice that the person seems stiff, unsteady, or unusually slow. As the Disease Progresses As the disease progresses, symptoms may begin to interfere with daily activities. The shaking or tremor may make it difficult to hold utensils steady or read a newspaper. Tremor is usually the symptom that causes people to seek medical help. People with Parkinson's often develop a socalled parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward (called festination), and reduced swinging of the arms. They also may have trouble initiating or continuing movement, which is known as freezing. Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other. Four Primary Symptoms The four primary symptoms of Parkinson's are tremor, rigidity, slowness of movement (bradykinesia), and impaired balance (postural instability). Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. It usually disappears during sleep or improves with a deliberate movement. Rigidity, or a resistance to movement, affects most people with Parkinson's. It becomes obvious when another person tries to move the individual's arm, such as during a neurological examination. The arm will move only in ratchetlike or short, jerky movements known as "cogwheel" rigidity. Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it may make simple tasks somewhat difficult. Activities once performed quickly and easily, such as washing or dressing, may take several hours. Postural instability, or impaired balance, causes people with Parkinson's to fall easily. They also may develop a stooped posture with a bowed head and droopy shoulders. Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. It usually disappears during sleep or improves with a deliberate movement. Rigidity, or a resistance to movement, affects most people with Parkinson's. It becomes obvious when another person tries to move the individual's arm, such as during a neurological examination. The arm will move only in ratchetlike or short, jerky movements known as "cogwheel" rigidity. Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it may make simple tasks somewhat difficult. Activities once performed quickly and easily, such as washing or dressing, may take several hours. Postural instability, or impaired balance, causes people with Parkinson's to fall easily. They also may develop a stooped posture with a bowed head and droopy shoulders. Other Symptoms A number of other symptoms may accompany Parkinson's disease. Some are minor; others are not. Many can be treated with medication or physical therapy. No one can predict which symptoms will affect an individual person, and the intensity of the symptoms varies from person to person. Many people note that prior to experiencing motor problems of stiffness and tremor, they had symptoms of a sleep disorder, constipation, decreased ability to smell, and restless legs. Other symptoms include depression emotional changes difficulty swallowing and chewing speech changes urinary problems or constipation skin problems, sleep problems dementia or other cognitive problems orthostatic hypotension (a sudden drop in blood pressure when standing up from a sitting or lying down position) muscle cramps and dystonia (twisting and repetitive movements) pain fatigue and loss of energy sexual dysfunction. depression emotional changes difficulty swallowing and chewing speech changes urinary problems or constipation skin problems, sleep problems dementia or other cognitive problems orthostatic hypotension (a sudden drop in blood pressure when standing up from a sitting or lying down position) muscle cramps and dystonia (twisting and repetitive movements) pain fatigue and loss of energy sexual dysfunction. A number of disorders can cause symptoms similar to those of Parkinson's disease. People with Parkinson'slike symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson's, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson's. Diagnosis Can Be Difficult There are currently no blood, or laboratory tests to diagnose sporadic Parkinson's disease. Diagnosis is based on a person's medical history and a neurological examination, but the disease can be difficult to diagnose accurately. Early signs and symptoms of Parkinson's may sometimes be dismissed as the effects of normal aging. A doctor may need to observe the person for some time until it is clear that the symptoms are consistently present. Improvement after initiating medication is another important hallmark of Parkinson's disease. Doctors may sometimes request brain scans or laboratory tests to rule out other diseases. However, computed tomography (CT) and magnetic resonance imaging (MRI) brain scans of people with Parkinson's usually appear normal. Recently, the FDA (Food and Drug Administration) has approved an imaging technique called DaTscan, which may help to increase accuracy of the diagnosis of Parkinsons disease. Since many other diseases have similar features but require different treatments, it is very important to make an exact diagnosis as soon as possible to ensure proper treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Parkinson's Disease ? [/INST] Deep Brain Stimulation Deep brain stimulation, or DBS, is a surgical procedure used to treat a variety of disabling disorders. It is most commonly used to treat the debilitating symptoms of Parkinsons disease. Deep brain stimulation uses an electrode surgically implanted into part of the brain. The electrodes are connected by a wire under the skin to a small electrical device called a pulse generator that is implanted in the chest. The pulse generator and electrodes painlessly stimulate the brain in a way that helps to stop many of the symptoms of Parkinson's such as tremor, bradykinesia, and rigidity. DBS is primarily used to stimulate one of three brain regions: the subthalamic nucleus, the globus pallidus, or the thalamus. Researchers are exploring optimal generator settings for DBS, whether DBS of other brain regions will also improve symptoms of Parkinsons disease, and also whether DBS may slow disease progression. Deep brain stimulation usually reduces the need for levodopa and related drugs, which in turn decreases dyskinesias and other side effects. It also helps to relieve onoff fluctuation of symptoms. People who respond well to treatment with levodopa tend to respond well to DBS. Unfortunately, older people who have only a partial response to levodopa may not improve with DBS. Complementary and Supportive Therapies A wide variety of complementary and supportive therapies may be used for Parkinson's disease. Among these therapies are standard physical, occupational, and speech therapies, which help with gait and voice disorders, tremors and rigidity, and decline in mental functions. Other supportive therapies include diet and exercise. Diet At this time there are no specific vitamins, minerals, or other nutrients that have any proven therapeutic value in Parkinson's disease. Some early reports have suggested that dietary supplements might protect against Parkinson's. Also, a preliminary clinical study of a supplement called coenzyme Q10 suggested that large doses of this substance might slow disease progression in people with earlystage Parkinson's. This supplement is now being tested in a large clinical trial. Other studies are being conducted to find out if caffeine, antioxidants, nicotine, and other dietary factors may help prevent or treat the disease. While there is currently no proof that any specific dietary factor is beneficial, a normal, healthy diet can promote overall wellbeing for people with Parkinson's disease, just as it would for anyone else. A high protein meal, however, may limit levodopa's effectiveness because for a time afterwards less levodopa passes through the bloodbrain barrier. Exercise Exercise can help people with Parkinson's improve their mobility and flexibility. It can also improve their emotional wellbeing. Exercise may improve the brain's dopamine production or increase levels of beneficial compounds called neurotrophic factors in the brain. Other Therapies Other complementary therapies include massage therapy, yoga, tai chi, hypnosis, acupuncture, and the Alexander technique, which improves posture and muscle activity. There have been limited studies suggesting mild benefits from some of these therapies, but they do not slow Parkinson's disease and to date there is no convincing evidence that they help. However, this remains an active area of investigation.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Parkinson's Disease ? [/INST] In recent years, research on Parkinson's has advanced to the point that halting the progression of the disease, restoring lost function, and even preventing the disease are all considered realistic goals. While the goal of preventing Parkinson's disease may take years to achieve, researchers are making great progress in understanding and treating it. Genetics Research One of the most exciting areas of Parkinson's research is genetics. Studying the genes responsible for inherited cases can help researchers understand both inherited and sporadic cases of the disease. Identifying gene defects can also help researchers understand how Parkinson's occurs develop animal models that accurately mimic the death of nerve cells in humans identify new approaches to drug therapy improve diagnosis. understand how Parkinson's occurs develop animal models that accurately mimic the death of nerve cells in humans identify new approaches to drug therapy improve diagnosis. Researchers funded by the National Institute of Neurological Disorders and Stroke are gathering information and DNA samples from hundreds of families with members who have Parkinson's and are conducting largescale studies to identify gene variants that are associated with increased risk of developing the disease. They are also comparing gene activity in Parkinson's with gene activity in similar diseases such as progressive supranuclear palsy. In addition to identifying new genes for Parkinson's disease, researchers are trying to learn about the function of genes known to be associated with the disease, and about how gene mutations cause disease. Effects of Environmental Toxins Scientists continue to study environmental toxins such as pesticides and herbicides that can cause Parkinson's symptoms in animals. They have found that exposing rodents to the pesticide rotenone and several other agricultural chemicals can cause cellular and behavioral changes that mimic those seen in Parkinson's. Role of Lewy Bodies Other studies focus on how Lewy bodies form and what role they play in Parkinson's disease. Some studies suggest that Lewy bodies are a byproduct of a breakdown that occurs within nerve cells, while others indicate that Lewy bodies are protective, helping neurons "lock away" abnormal molecules that might otherwise be harmful. Identifying Biomarkers Biomarkers for Parkinson's measurable characteristics that can reveal whether the disease is developing or progressing are another focus of research. Such biomarkers could help doctors detect the disease before symptoms appear and improve diagnosis of the disease. They also would show if medications and other types of therapy have a positive or negative effect on the course of the disease. The National Disorders of Neurological Disorders and Stroke has developed an initiative, the Parkinsons Disease Biomarkers Identification Network (PDBIN), designed specifically to address these questions and to discover and validate biomarkers for Parkinsons disease. Transcranial Therapies Researchers are conducting many studies of new or improved therapies for Parkinson's disease. Studies are testing whether transcranial electrical polarization (TEP) or transcranial magnetic stimulation (TMS) can reduce the symptoms of the disease. In TEP, electrodes placed on the scalp are used to generate an electrical current that modifies signals in the brain's cortex. In TMS, an insulated coil of wire on the scalp is used to generate a brief electrical current. Drug Discovery A variety of new drug treatments for Parkinson's disease are in clinical trials. Several MAOB inhibitors including selegiline, lazabemide, and rasagiline, are being tested to determine if they have neuroprotective effects in people with Parkinsons disease. The National Institute of Neurological Disorders and Stroke has launched a broad effort to find drugs to slow the progression of Parkinson's disease, called NETPD or NIH Exploratory Trials in Parkinson's Disease. The first studies tested several compounds; one of these, creatine, is now being evaluated in a larger clinical trial. The NETPD investigators are testing a highly purified form of creatine, a nutritional supplement, to find out if it slows the decline seen in people with Parkinson's. Creatine is a widely used dietary supplement thought to improve exercise performance. Cellular energy is stored in a chemical bond between creatine and a phosphate. More recently, NETPD has initiated pilot studies to test pioglitazone, a drug that has been shown to stimulate mitochondrial function. Because mitochondrial function may be less active in Parkinsons disease, this drug may protect vulnerable dopamine neurons by boosting mitochondrial function. Cell Implantation Another potential approach to treating Parkinson's disease is to implant cells to replace those lost in the disease. Starting in the 1990s, researchers conducting a controlled clinical trial of fetal tissue implants tried to replace lost dopamineproducing nerve cells with healthy ones from fetal tissue in order to improve movement and the response to medications. While many of the implanted cells survived in the brain and produced dopamine, this therapy was associated with only modest functional improvements, mostly in patients under the age of 60. Some of the people who received the transplants developed disabling dyskinesias that could not be relieved by reducing antiparkinsonian medications. Stem Cells Another type of cell therapy involves stem cells. Some stem cells derived from embryos can develop into any kind of cell in the body, while others, called progenitor cells, are less flexible. Researchers are developing methods to improve the number of dopamineproducing cells that can be grown from embryonic stem cells in culture. Other researchers are also exploring whether stem cells from adult brains might be useful in treating Parkinson's disease. Recent studies suggest that some adult cells from skin can be reprogrammed to an embryoniclike state, resulting in induced pluripotent stem cells (iPSC) that may someday be used for treatment of Parkinsons. In addition, development and characterization of cells from people with sporadic or inherited Parkinsons may reveal information about cellular mechanisms of disease and identify targets for drug development. Gene Therapy A number of early clinical trials are now underway to test whether gene therapy can improve Parkinson's disease. Genes which are found to improve cellular function in models of Parkinson's are inserted into modified viruses. The genetically engineered viruses are then injected into the brains of people with Parkinson's disease. Clinical studies have focused on the therapeutic potential of neurotrophic factors, including GDNF and neurturin, and enzymes that produce dopamine. These trials will test whether the viruses, by lending to the production of the protective gene product, improve symptoms of Parkinson's over time. The National Institute of Neurological Disorders and Stroke also supports the Morris K. Udall Centers of Excellence for Parkinson's Disease Research program . These Centers, located across the USA, study cellular mechanisms underlying Parkinsons disease, identify and characterize diseaseassociated genes, and discover and develop potential therapeutic targets. The Centers' multidisciplinary research environment allows scientists to take advantage of new discoveries in the basic, translational and clinical sciences that could lead to clinical advances for Parkinsons disease.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parkinson's Disease ? [/INST] Parkinson's disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination. It currently affects about half a million people in the United States, although the numbers may be much higher. Parkinson's disease is both chronic, meaning it lasts for a long time, and progressive, meaning its symptoms grow worse over time. It is not contagious.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Parkinson's Disease ? [/INST] Parkinson's belongs to a group of neurological conditions called movement disorders. The four main symptoms of Parkinson's disease are: tremor, or trembling in hands, arms, legs, jaw, or head rigidity, or stiffness of the limbs and trunk bradykinesia, or slowness of movement postural instability, or impaired balance. tremor, or trembling in hands, arms, legs, jaw, or head rigidity, or stiffness of the limbs and trunk bradykinesia, or slowness of movement postural instability, or impaired balance. Other symptoms include depression, emotional changes, difficulty swallowing, speech changes, urinary problems, sleep problems, and dementia and other cognitive problems. Parkinson's symptoms usually begin gradually and get worse over time. As the symptoms become more severe, people with the disorder may have difficulty walking, talking, or completing other simple tasks. They also experience nonmotor, or movement, symptoms including mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue. Parkinson's disease not only affects the brain, but the entire body. While the brain involvement is responsible for the core features, other affected locations contribute to the complicated picture of Parkinson's.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Parkinson's Disease? ? [/INST] About 60,000 Americans are diagnosed with Parkinson's disease each year. The disease strikes about 50 percent more men than women. The average age of onset is 60 years, and the risk of developing the disease increases with age. Parkinson's disease is also more common in developed countries, possibly because of increased exposure to pesticides or other environmental toxins.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What causes Parkinson's Disease ? [/INST] Parkinson's disease occurs when nerve cells, or neurons, in an area of the brain that controls movement die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine, but once the neurons become impaired, they produce less dopamine and eventually die. It is this shortage of dopamine that causes the movement problems of people with Parkinson's.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parkinson's Disease ? [/INST] Dopamine is a brain chemical messenger, or neurotransmitter. It is responsible for transmitting signals between a brain region called the substantia nigra and multiple brain regions. The connection between the substantia nigra and the corpus striatum is critical to produce smooth, purposeful movement. Loss of dopamine results in abnormal nervefiring patterns within the brain that cause impaired movement.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parkinson's Disease ? [/INST] Lewy bodies are unusual deposits or clumps of the brain protein alphasynuclein, along with other proteins, which are seen upon microscopic examination of the brain. Many brain cells of people with Parkinson's disease contain Lewy bodies. Researchers do not yet know why Lewy bodies form or what role they play in the development of Parkinson's disease. The clumps may prevent the cell from functioning normally, or they may actually be helpful, perhaps by keeping harmful proteins "locked up" so that the cells can function.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Parkinson's Disease ? [/INST] There are currently no blood or laboratory tests to diagnose sporadic Parkinson's disease. Diagnosis is based on a person's medical history and a neurological examination, but the disease can be difficult to diagnose accurately. Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases. However, computed tomography (CT) and magnetic resonance imaging (MRI) brain scans of people with Parkinson's usually appear normal. Recently, the FDA (Food and Drug Administration) has approved an imaging technique called DaTscan, which may help to increase accuracy of the diagnosis of Parkinsons disease. Since many other diseases have similar features but require different treatments, it is very important to make an exact diagnosis as soon as possible to ensure proper treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parkinson's Disease ? [/INST] The main therapy for Parkinson's disease is the drug levodopa, also called Ldopa. It is a simple chemical found naturally in plants and animals. Nerve cells use levodopa to make dopamine to replenish the brain's supply. Levodopa helps to reduce tremors and other symptoms of Parkinson's disease during the early stages of the disease. It allows most people with Parkinson's to extend the period of time in which they can lead relatively normal, productive lives.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parkinson's Disease ? [/INST] Carbidopa is a drug that is usually given along with levodopa. It delays the body's conversion of levodopa into dopamine until the levodopa reaches the brain. This prevents or reduces some of the side effects that often accompany levodopa therapy. Carbidopa also reduces the amount of levodopa needed.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Parkinson's Disease ? [/INST] Yes. Other medications available to treat some symptoms and stages of Parkinson's disease include direct dopamine agonists, MAOB inhibitors, COMT inhibitors, an antiviral drug, and anticholinergics. Direct dopamine agonists are drugs that mimic the role of dopamine in the brain. They can be used in the early stages of the disease, or later on to give a more prolonged and steady dopaminergic effect in people who experience "wearing off" or "onoff" effects from taking the drug. Dopamine agonists are generally less effective than levodopa in controlling rigidity and bradykinesia. They can cause confusion in older adults. MAOB inhibitors are another class of drugs that can reduce the symptoms of Parkinson's by causing dopamine to build up in surviving nerve cells. COMT inhibitors prolong the effects of levodopa by preventing the breakdown of dopamine. COMT inhibitors can usually make it possible to reduce a person's dose of levodopa. Amantadine, an old antiviral drug, can help reduce Parkinson's symptoms in the early stages of the disease, and again in later stages to treat dyskinesias. Anticholinergics can help reduce tremors and muscle rigidity.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Parkinson's Disease ? [/INST] Doctors may prescribe a variety of medications to treat the nonmotor symptoms of Parkinson's disease, such as depression and anxiety. Hallucinations, delusions, and other psychotic symptoms may be caused by some drugs prescribed for Parkinson's. Therefore, reducing or stopping those Parkinson's medications may make these symptoms of psychosis go away. A variety of treatment options, including medications, also are available to treat orthostatic hypotension, the sudden drop in blood pressure that occurs upon standing.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parkinson's Disease ? [/INST] Deep brain stimulation, or DBS, is a surgical procedure used to treat a variety of disabling disorders. It is most commonly used to treat the debilitating symptoms of Parkinsons disease. Deep brain stimulation uses an electrode surgically implanted into part of the brain. The electrodes are connected under the skin to a small electrical device called a pulse generator, implanted in the chest. The generator and electrodes painlessly stimulate the brain to help stop many Parkinson's symptoms such as tremor, bradykinesia, and rigidity. DBS is primarily used to stimulate one of three brain regions: the subthalamic nucleus, the globus pallidus, or the thalamus. Researchers are exploring optimal generator settings for DBS, whether DBS of other brain regions will also improve symptoms of Parkinsons disease, and also whether DBS may slow disease progression. Deep brain stimulation usually reduces the need for levodopa and related drugs, which in turn decreases dyskinesias and other side effects. It also helps to relieve "onoff" fluctuation of symptoms. People who respond well to treatment with levodopa, even if only for a short period, tend to respond well to DBS.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Parkinson's Disease ? [/INST] Genetics is one of the most exciting areas of Parkinson's disease research. Studying the genes responsible for inherited cases can help researchers understand both inherited and sporadic cases of the disease. Sporadic means the disease occurs randomly and does not seem to run in families. Identifying gene defects can also help researchers understand how the disease occurs develop animal models that accurately mimic the death of nerve cells in human Parkinson's disease identify new drug targets improve diagnosis. understand how the disease occurs develop animal models that accurately mimic the death of nerve cells in human Parkinson's disease identify new drug targets improve diagnosis.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parkinson's Disease ? [/INST] The Parkinsons Disease Biomarkers Identification Network, or PDBIN, is an initiative developed by the National Institute of Neurological Disorders and Stroke to discover and validate biomarkers for Parkinsons disease. Biomarkers are measurable characteristics that can reveal whether the disease is developing or progressing. Biomarkers could help doctors detect Parkinsons disease before symptoms appear and improve diagnosis of the disorder.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parkinson's Disease ? [/INST] The National Institute of Neurological Disorders and Stroke (NINDS) has launched a broad effort called NIH Exploratory Trials in Parkinson's Disease, or NETPD, to find drugs to slow the progression of Parkinson's disease. The first studies tested several compounds. One of these, a nutritional supplement called creatine, is now being evaluated in a larger clinical trial to find out if it slows the clinical decline seen in people with Parkinson's disease. For more information on NETPD trials visit: http://parkinsontrial.ninds.org.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Breast Cancer ? [/INST] How Tumors Form The body is made up of many types of cells. Normally, cells grow, divide and produce more cells as needed to keep the body healthy. Sometimes, however, the process goes wrong. Cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous. Breast cancer occurs when malignant tumors form in the breast tissue. Who Gets Breast Cancer? Breast cancer is one of the most common cancers in American women. It is most common among women between the ages of 4585. (Watch the video to learn more about breast cancer survival rates. To enlarge the videos appearing on this page, click the brackets in the lower righthand corner of the video screen. To reduce the videos, press the Escape (Esc) button on your keyboard.) Men can get breast cancer too, although they account for only 1 percent of all reported cases. Read more about breast cancer in men. When Breast Cancer Spreads When cancer grows in breast tissue and spreads outside the breast, cancer cells are often found in the lymph nodes under the arm. If the cancer has reached these nodes, it means that cancer cells may have spread, or metastasized, to other parts of the body. When cancer spreads from its original location in the breast to another part of the body such as the brain, it is called metastatic breast cancer, not brain cancer. Doctors sometimes call this "distant" disease. Learn about different kinds of breast cancer. Breast Cancer is Not Contagious Breast cancer is not contagious. A woman cannot "catch" breast cancer from other women who have the disease. Also, breast cancer is not caused by an injury to the breast. Most women who develop breast cancer do not have any known risk factors or a history of the disease in their families. Treating and Surviving Breast Cancer Today, more women are surviving breast cancer than ever before. Nearly three million women are breast cancer survivors. (Watch the video to hear a woman discuss surviving breast cancer.) There are several ways to treat breast cancer, but all treatments work best when the disease is found early. As a matter of fact, when it is caught in its earliest stage, 98.5 percent of women with the disease are alive five years later. Every day researchers are working to find new and better ways to detect and treat cancer. Many studies of new approaches for women with breast cancer are under way. With early detection, and prompt and appropriate treatment, the outlook for women with breast cancer can be positive. To learn more about what happens after treatment, see Surviving Cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Breast Cancer? ? [/INST] Some women develop breast cancer and others do not, and the risk factors for the disease vary. Breast cancer may affect younger women, but threefourths of all breast cancers occur in women between the ages of 45 to 85. In Situ and Invasive Breast Cancer Researchers often talk about breast cancer in two ways: in situ and invasive. In situ refers to cancer that has not spread beyond its site of origin. Invasive applies to cancer that has spread to the tissue around it. This chart shows what the approximate chances are of a woman getting invasive breast cancer in her lifetime. Risk Factors Risk factors are conditions or agents that increase a person's chances of getting a disease. Here are the most common risk factors for breast cancer. Older age. The risk of breast cancer in a 70 year old woman is about 10 times that of a 30 year old woman, but risk decreases after age 85. Older age. The risk of breast cancer in a 70 year old woman is about 10 times that of a 30 year old woman, but risk decreases after age 85. Personal and family history. A personal history of breast cancer or breast cancer among one or more of your close relatives, such as a sister, mother, or daughter. Personal and family history. A personal history of breast cancer or breast cancer among one or more of your close relatives, such as a sister, mother, or daughter. Estrogen levels in the body. High estrogen levels over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. Estrogen levels in the body. High estrogen levels over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. Never being pregnant or having your first child in your mid30s or later. Never being pregnant or having your first child in your mid30s or later. Early menstruation. Having your first menstrual period before age 12. Early menstruation. Having your first menstrual period before age 12. Breast density. Women with very dense breasts have a higher risk of breast cancer than women with low or normal breast density. Breast density. Women with very dense breasts have a higher risk of breast cancer than women with low or normal breast density. Combination hormone replacement therapy/Hormone therapy. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy. (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT can increase the risk of breast cancer. Combination hormone replacement therapy/Hormone therapy. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy. (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT can increase the risk of breast cancer. Exposure to radiation. Radiation therapy to the chest for the treatment of cancer can increase the risk of breast cancer, starting 10 years after treatment. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast. Exposure to radiation. Radiation therapy to the chest for the treatment of cancer can increase the risk of breast cancer, starting 10 years after treatment. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast. Obesity. Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy. Obesity. Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy. Alcohol. Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. Alcohol. Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. Gaining weight after menopause, especially after natural menopause and/or after age 60. Gaining weight after menopause, especially after natural menopause and/or after age 60. Race. White women are at greater risk than black women. However, black women diagnosed with breast cancer are more likely to die of the disease. Race. White women are at greater risk than black women. However, black women diagnosed with breast cancer are more likely to die of the disease. Inherited gene changes. Women who have inherited certain changes in the genes named BRCA1 and BRCA2 have a higher risk of breast cancer, ovarian cancer and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Men who have inherited certain changes in the BRCA2 gene have a higher risk of breast, prostate and pancreatic cancers, and lymphoma. Inherited gene changes. Women who have inherited certain changes in the genes named BRCA1 and BRCA2 have a higher risk of breast cancer, ovarian cancer and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Men who have inherited certain changes in the BRCA2 gene have a higher risk of breast, prostate and pancreatic cancers, and lymphoma. Five percent to 10 percent of all breast cancers are thought to be inherited. Get information about the BRCA1 and BRCA2 genetic mutations and testing for them. Warning Signs When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for. You can help safeguard your health by learning the following warning signs of breast cancer. a lump or thickening in or near the breast or in the underarm area a change in the size or shape of the breast a dimple or puckering in the skin of the breast a nipple turned inward into the breast fluid, other than breast milk, from the nipple, especially if it's bloody scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple) dimples in the breast that look like the skin of an orange. a lump or thickening in or near the breast or in the underarm area a change in the size or shape of the breast a dimple or puckering in the skin of the breast a nipple turned inward into the breast fluid, other than breast milk, from the nipple, especially if it's bloody scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple) dimples in the breast that look like the skin of an orange. Don't Ignore Symptoms You should see your doctor about any symptoms like these. Most often, they are not cancer, but it's important to check with the doctor so that any problems can be diagnosed and treated as early as possible. Some women believe that as they age, health problems are due to "growing older." Because of this myth, many illnesses go undiagnosed and untreated. Don't ignore your symptoms because you think they are not important or because you believe they are normal for your age. Talk to your doctor.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Breast Cancer? ? [/INST] What Is Cancer Prevention? Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer. When studying ways to prevent cancer, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor. Anything that decreases your chance of developing cancer is called a cancer protective factor. Risk Factors Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer. Different ways to prevent cancer are being studied, including changing lifestyle or eating habits avoiding things known to cause cancer taking medicine to treat a precancerous condition or to keep cancer from starting. changing lifestyle or eating habits avoiding things known to cause cancer taking medicine to treat a precancerous condition or to keep cancer from starting. (For more on risk factors, see the chapter on "Risk Factors.") Here are protective factors for breast cancer. Less Exposure to Estrogen Decreasing the length of time a woman's breast tissue is exposed to estrogen may help lower her risk of developing breast cancer. Exposure to estrogen is reduced in the following ways. Early pregnancy. Estrogen levels are lower during pregnancy. Women who have a fullterm pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35. Breastfeeding. Estrogen levels may remain lower while a woman is breastfeeding. Women who breastfed have a lower risk of breast cancer than women who have had children but did not breastfeed. Surgical removal of the ovaries. The ovaries make estrogen. The amount of estrogen made by the body can be greatly reduced by removing one or both ovaries. Also, drugs may be taken to lower the amount of estrogen made by the ovaries. Late menstruation. Menstrual periods that start at age 14 or older decreases the number of years the breast tissue is exposed to estrogen. Early menopause. The fewer years a woman menstruates, the shorter the time her breast tissue is exposed to estrogen. Early pregnancy. Estrogen levels are lower during pregnancy. Women who have a fullterm pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35. Breastfeeding. Estrogen levels may remain lower while a woman is breastfeeding. Women who breastfed have a lower risk of breast cancer than women who have had children but did not breastfeed. Surgical removal of the ovaries. The ovaries make estrogen. The amount of estrogen made by the body can be greatly reduced by removing one or both ovaries. Also, drugs may be taken to lower the amount of estrogen made by the ovaries. Late menstruation. Menstrual periods that start at age 14 or older decreases the number of years the breast tissue is exposed to estrogen. Early menopause. The fewer years a woman menstruates, the shorter the time her breast tissue is exposed to estrogen. Exercise Women who exercise four or more hours a week have a lower risk of breast cancer. The effect of exercise on breast cancer risk may be greatest in premenopausal women who have normal or low body weight. Learn more about the benefits of exercise for older adults. For exercises tailored to older adults, visit Go4Life, the exercise and physical activity campaign from the National Institute on Aging (NIA) at NIH. Estrogenonly Hormone Therapy After Hysterectomy Hormone therapy with estrogen only may be given to women who have had a hysterectomy. In these women, estrogenonly therapy after menopause may decrease the risk of breast cancer. There is an increased risk of stroke and heart and blood vessel disease in postmenopausal women who take estrogen after a hysterectomy. Learn about menopausal hormone therapy and cancer. Selective Estrogen Receptor Modulators (SERMs) Tamoxifen and raloxifene belong to the family of drugs called selective estrogen receptor modulators (SERMs). SERMs act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues. Treatment with tamoxifen or raloxifene lowers the risk of breast cancer in postmenopausal women. Tamoxifen also lowers the risk of breast cancer in highrisk premenopausal women. With either drug, the reduced risk lasts for several years after treatment is stopped. Lower rates of broken bones have been noted in patients taking raloxifene. Prophylactic Mastectomy Some women who have a high risk of breast cancer may choose to have a prophylactic mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is much lower in these women and most feel less anxious about their risk of breast cancer. However, it is very important to have cancer risk assessment and counseling about the different ways to prevent breast cancer before making this decision. Learn more about surgery to reduce the risk of breast cancer. Prophylactic Oophorectomy Premenopausal women who have a high risk of breast cancer due to certain changes in the BRCA1 and BRCA2 genes may choose to have a prophylactic oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. Prophylactic oophorectomy also lowers the risk of breast cancer in normal premenopausal women and in women with an increased risk of breast cancer due to radiation to the chest. However, it is very important to have cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the symptoms of menopause to begin. These include hot flashes, trouble sleeping, anxiety, and depression. Longterm effects include decreased sex drive, vaginal dryness, and decreased bone density. Unclear As Risk Factors It is not clear whether the following affect the risk of breast cancer. Oral contraceptives. Taking oral contraceptives ("the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. Some oral contraceptives contain estrogen. Progestinonly contraceptives that are injected or implanted do not appear to increase the risk of breast cancer. Environment. Studies have not proven that being exposed to certain substances in the environment, such as chemicals, increases the risk of breast cancer. Oral contraceptives. Taking oral contraceptives ("the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. Some oral contraceptives contain estrogen. Progestinonly contraceptives that are injected or implanted do not appear to increase the risk of breast cancer. Environment. Studies have not proven that being exposed to certain substances in the environment, such as chemicals, increases the risk of breast cancer. For More Information Clinical trials are taking place in many parts of the country. Information about clinical trials can be found at http://www.cancer.gov/clinicaltrials on the website of the National Cancer Institute (NCI). Check NCI's list of cancer clinical trials for breast cancer prevention trials that are now accepting patients.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Breast Cancer ? [/INST] Most cancers in their early, most treatable stages do not cause any symptoms. That is why it's important to have regular tests to check for cancer long before you might notice anything wrong. Detecting Breast Cancer Through Screening When breast cancer is found early, it is more likely to be treated successfully. Checking for cancer in a person who does not have any symptoms is called screening. Screening tests for breast cancer include, among others, clinical breast exams and mammograms. Recent studies have shown that ultrasound and MRI's may also be useful complementary screening tools, particularly in women with mammograms that are not definitive. During a clinical breast exam, the doctor or other health care professional checks the breasts and underarms for lumps or other changes that could be a sign of breast cancer. A mammogram is a special xray of the breast that often can detect cancers that are too small for a woman or her doctor to feel. (Watch the video to learn more about digital mammography and dense breasts. To enlarge the video, click the brackets in the lower righthand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Who Should Have a Mammography? Several studies show that mammography screening has reduced the number of deaths from breast cancer. However, some other studies have not shown a clear benefit from mammography. Scientists are continuing to examine the level of benefit that mammography can produce. The U.S. Preventive Services Task Force (USPSTF) recommends a screening mammography for women 5074 years every two years. Learn more about the USPSTF mammography recommendations here. Between 5 and 10 percent of mammogram results are abnormal and require more testing. Most of these followup tests confirm that no cancer was present. Worried about the cost of a mammogram? Learn about free and lowcost screenings. (Centers for Disease Control and Prevention) How Biopsies are Performed If needed, the most common followup test a doctor will recommend is called a biopsy. This is a procedure where a small amount of fluid or tissue is removed from the breast to make a diagnosis. A doctor might perform fine needle aspiration, a needle or core biopsy, or a surgical biopsy. With fine needle aspiration, doctors numb the area and use a thin needle to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not need to be checked out by a lab. For a needle biopsy, sometimes called a core biopsy, doctors use a needle to remove tissue from an area that looks suspicious on a mammogram but cannot be felt. This tissue goes to a lab where a pathologist examines it to see if any of the cells are cancerous. In a surgical biopsy, a surgeon removes a sample of a lump or suspicious area. Sometimes it is necessary to remove the entire lump or suspicious area, plus an area of healthy tissue around the edges. The tissue then goes to a lab where a pathologist examines it under a microscope to check for cancer cells. With fine needle aspiration, doctors numb the area and use a thin needle to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not need to be checked out by a lab. For a needle biopsy, sometimes called a core biopsy, doctors use a needle to remove tissue from an area that looks suspicious on a mammogram but cannot be felt. This tissue goes to a lab where a pathologist examines it to see if any of the cells are cancerous. In a surgical biopsy, a surgeon removes a sample of a lump or suspicious area. Sometimes it is necessary to remove the entire lump or suspicious area, plus an area of healthy tissue around the edges. The tissue then goes to a lab where a pathologist examines it under a microscope to check for cancer cells. Another type of surgical biopsy that removes less breast tissue is called an imageguided needle breast biopsy, or stereotactic biopsy. Eighty percent of U.S. women who have a surgical breast biopsy do not have cancer. However, women who have breast biopsies are at higher risk of developing breast cancer than women who have never had a breast biopsy. Other Detection Methods Magnetic resonance imaging, or MRI, and ultrasound are two other techniques which, as supplements to standard mammography, might help detect breast cancer with greater accuracy. Genetic Detection The most comprehensive study to date of gene mutations in breast cancer, published in September 2012, confirmed that there are four primary subtypes of breast cancer, each with its own biology. The four groups are called intrinsic subtypes of breast cancer and include HER2enriched (HER2E), Luminal A (LumA), Luminal B (LumB) and Basallike. The outlook for survival is different for each of these subtypes of breast cancer. Researchers found that one subtype, Basallike breast cancer, shares many genetic features with a form of ovarian cancer, and that both may respond similarly to drugs that reduce tumor growth or target DNA repair. The authors hope that discovery of these mutations will be an important step in the effort to improve therapies for breast cancer. For the time being, there are no genetic tests that are commercially available based solely on these findings. Soon, however, knowing extensively which breast cancer gene mutations a woman has should help guide precision treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] There are many treatment options for women with breast cancer. The choice of treatment depends on your age and general health, the stage of the cancer, whether or not it has spread beyond the breast, and other factors. If tests show that you have cancer, you should talk with your doctor and make treatment decisions as soon as possible. Studies show that early treatment leads to better outcomes. Working With a Team of Specialists People with cancer often are treated by a team of specialists. The team will keep the primary doctor informed about the patient's progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others. Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it. (Watch the video about this breast cancer survivor's treatment. To enlarge the video, click the brackets in the lower righthand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Clinical Trials for Breast Cancer Some breast cancer patients take part in studies of new treatments. These studies, called clinical trials, are designed to find out whether a new treatment is both safe and effective. Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. Women with breast cancer who are interested in taking part in a clinical trial should talk to their doctor. The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. See a list of the current clinical trials on breast cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] There are a number of treatments for breast cancer, but the ones women choose most often alone or in combination are surgery, hormone therapy, radiation therapy, and chemotherapy. What Standard Treatments Do Here is what the standard cancer treatments are designed to do. Surgery takes out the cancer and some surrounding tissue. Hormone therapy keeps cancer cells from getting most of the hormones they need to survive and grow. Radiation therapy uses highenergy beams to kill cancer cells and shrink tumors and some surrounding tissue. Chemotherapy uses anticancer drugs to kill most cancer cells. Surgery takes out the cancer and some surrounding tissue. Hormone therapy keeps cancer cells from getting most of the hormones they need to survive and grow. Radiation therapy uses highenergy beams to kill cancer cells and shrink tumors and some surrounding tissue. Chemotherapy uses anticancer drugs to kill most cancer cells. Treatment for breast cancer may involve local or whole body therapy. Doctors use local therapies, such as surgery or radiation, to remove or destroy breast cancer in a specific area. Whole body, or systemic, treatments like chemotherapy, hormonal, or biological therapies are used to destroy or control cancer throughout the body. Some patients have both kinds of treatment. Treating EarlyStage Breast Cancer If you have earlystage breast cancer, one common treatment available to you is a lumpectomy combined with radiation therapy. A lumpectomy is surgery that preserves a woman's breast. In a lumpectomy, the surgeon removes only the tumor and a small amount of the surrounding tissue. The survival rate for a woman who has this therapy plus radiation is similar to that for a woman who chooses a radical mastectomy, which is complete removal of a breast. If Cancer Has Spread Locally If you have breast cancer that has spread locally just to other parts of the breast your treatment may involve a combination of chemotherapy and surgery. Doctors usually first shrink the tumor with chemotherapy and then remove it through surgery. Shrinking the tumor before surgery may allow a woman to avoid a mastectomy and keep her breast. In the past, doctors would remove a lot of lymph nodes near breast tumors to see if the cancer had spread. Some doctors also use a method called sentinel node biopsy. Using a dye or radioactive tracer, surgeons locate the first or sentinel lymph node closest to the tumor, and remove only that node to see if the cancer has spread. If Cancer Has Spread Beyond the Breast If the breast cancer has spread to other parts of the body, such as the lung or bone, you might receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. Radiation therapy may also be useful to control tumors in other parts of the body. Get more information about treatment options for breast cancer and for recurrent breast cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Breast Cancer ? [/INST] New Technologies Several new technologies offer hope for making future treatment easier for women with breast cancer. Using a special tool, doctors can today insert a miniature camera through the nipple and into a milk duct in the breast to examine the area for cancer. Using a special tool, doctors can today insert a miniature camera through the nipple and into a milk duct in the breast to examine the area for cancer. Researchers are testing another technique to help women who have undergone weeks of conventional radiation therapy. Using a small catheter a tube with a balloon tip doctors can deliver tiny radioactive beads to a place on the breast where cancer tissue has been removed. This can reduce the therapy time to a matter of days. Researchers are testing another technique to help women who have undergone weeks of conventional radiation therapy. Using a small catheter a tube with a balloon tip doctors can deliver tiny radioactive beads to a place on the breast where cancer tissue has been removed. This can reduce the therapy time to a matter of days. New Drug Combination Therapies New drug therapies and combination therapies continue to evolve. A mix of drugs may increase the length of time you will live or the length of time you will live without cancer. It may someday prove useful for some women with localized breast cancer after they have had surgery. A mix of drugs may increase the length of time you will live or the length of time you will live without cancer. It may someday prove useful for some women with localized breast cancer after they have had surgery. New research shows women with earlystage breast cancer who took the drug letrozole, an aromatase inhibitor, after they completed five years of tamoxifen therapy significantly reduced their risk of breast cancer recurrence. New research shows women with earlystage breast cancer who took the drug letrozole, an aromatase inhibitor, after they completed five years of tamoxifen therapy significantly reduced their risk of breast cancer recurrence. Treating HER2Positive Breast Cancer Herceptin is a drug commonly used to treat women who have a certain type of breast cancer. This drug slows or stops the growth of cancer cells by blocking HER2, a protein found on the surface of some types of breast cancer cells. Approximately 20 to 25 percent of breast cancers produce too much HER2. These "HER2 positive" tumors tend to grow faster and are generally more likely to return than tumors that do not overproduce HER2. Results from clinical trials show that those patients with earlystage HER2 positive breast cancer who received Herceptin in combination with chemotherapy had a 52 percent decrease in risk in the cancer returning compared with patients who received chemotherapy treatment alone. Cancer treatments like chemotherapy can be systemic, meaning they affect whole tissues, organs, or the entire body. Herceptin, however, was the first drug used to target only a specific molecule involved in breast cancer. Another drug, Tykerb, was approved by the U.S. Food and Drug Administration for use for treatment of HER2positive breast cancer. Because of the availability of these two drugs, an international trial called ALTTO was designed to determine if one drug is more effective, safer, and if taking the drugs separately, in tandem order, or together is better. Unfortunately, the results, released in 2014, showed that taking two HER2targeted agents together was no better than taking one alone in improving survival. The TAILORx Trial In an attempt to further specialize breast cancer treatment, The Trial Assigning Individualized Options for Treatment, or TAILORx, enrolled 10,000 women to examine whether appropriate treatment can be assigned based on genes that are frequently associated with risk of recurrence of breast cancer. The goal of TAILORx is important because the majority of women with earlystage breast cancer are advised to receive chemotherapy in addition to radiation and hormonal therapy, yet research has not demonstrated that chemotherapy benefits all of them equally. TAILORx seeks to examine many of a woman's genes simultaneously and use this information in choosing a treatment course, thus sparing women unnecessary treatment if chemotherapy is not likely to be of substantial benefit to them.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Breast Cancer ? [/INST] The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy. Sometimes, however, the process goes wrong. Cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Breast Cancer ? [/INST] Breast cancer occurs when a malignant tumor forms in the breast tissue. The cancer can be found in the breast itself or in the ducts and lymph nodes that surround the breast.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Breast Cancer ? [/INST] When cancer spreads from its original location in the breast to another part of the body such as the brain, it is called metastatic breast cancer, not brain cancer. Doctors sometimes call this "distant" disease.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Breast Cancer? ? [/INST] Did You Know: Breast Cancer Statistics? Breast cancer is one of the most common cancers in American women. It is most common among women between the ages of 4585. Today, more women are surviving breast cancer than ever before. Over two million women are breast cancer survivors. (Watch the video to learn more about breast cancer survival rates. To enlarge the video, click the brackets in the lower righthand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Men can get breast cancer too, although they account for only one percent of all reported cases. Read more about breast cancer in men.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Breast Cancer ? [/INST] When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for. You can help safeguard your health by learning the following warning signs of breast cancer. a lump or thickening in or near the breast or in the underarm area a change in the size or shape of the breast a dimple or puckering in the skin of the breast a nipple turned inward into the breast fluid, other than breast milk, from the nipple, especially if it's bloody scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple) dimples in the breast that look like the skin of an orange. a lump or thickening in or near the breast or in the underarm area a change in the size or shape of the breast a dimple or puckering in the skin of the breast a nipple turned inward into the breast fluid, other than breast milk, from the nipple, especially if it's bloody scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple) dimples in the breast that look like the skin of an orange. Don't Ignore Symptoms You should see your doctor about any symptoms like these. Most often, they are not cancer, but it's important to check with the doctor so that any problems can be diagnosed and treated as early as possible. Some women believe that as they age, health problems are due to "growing older." Because of this myth, many illnesses go undiagnosed and untreated. Don't ignore your symptoms because you think they are not important or because you believe they are normal for your age. Talk to your doctor.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Breast Cancer ? [/INST] One definition of cure is being alive and free of breast cancer for 5 years. If the cancer is found early, a woman's chances of survival are better. In fact, nearly 98 percent of women who discover their breast cancer when it is near the site of origin and still small in size are alive 5 years later. However, women whose cancer is diagnosed at a late stage, after it has spread to other parts of the body, have only a 23.3 percent chance of surviving 5 years. To learn more about what happens after treatment, see Surviving Cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Breast Cancer? ? [/INST] Risk factors are conditions or agents that increase a person's chances of getting a disease. Here are the most common risk factors for breast cancer. Personal and family history. A personal history of breast cancer or breast cancer among one or more of your close relatives, such as a sister, mother, or daughter. Estrogen levels in the body. High estrogen levels over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. Never being pregnant or having your first child in your mid30s or later. Early menstruation. Having your first menstrual period before age 12. Breast density. Women with very dense breasts have a higher risk of breast cancer than women with low or normal breast density. Combination hormone replacement therapy/Hormone therapy. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy. (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT can increase the risk of breast cancer. Exposure to radiation. Radiation therapy to the chest for the treatment of cancer can increase the risk of breast cancer, starting 10 years after treatment. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast. Obesity. Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy. Alcohol. Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. Gaining weight after menopause, especially after natural menopause and/or after age 60. Race. White women are at greater risk than black women. However, black women diagnosed with breast cancer are more likely to die of the disease. Inherited gene changes. Women who have inherited certain changes in the genes named BRCA1 and BRCA2 have a higher risk of breast cancer, ovarian cancer and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Men who have inherited certain changes in the BRCA2 gene have a higher risk of breast, prostate and pancreatic cancers, and lymphoma. Five percent to 10 percent of all breast cancers are thought to be inherited. Personal and family history. A personal history of breast cancer or breast cancer among one or more of your close relatives, such as a sister, mother, or daughter. Estrogen levels in the body. High estrogen levels over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. Never being pregnant or having your first child in your mid30s or later. Early menstruation. Having your first menstrual period before age 12. Breast density. Women with very dense breasts have a higher risk of breast cancer than women with low or normal breast density. Combination hormone replacement therapy/Hormone therapy. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy. (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT can increase the risk of breast cancer. Exposure to radiation. Radiation therapy to the chest for the treatment of cancer can increase the risk of breast cancer, starting 10 years after treatment. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast. Obesity. Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy. Alcohol. Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. Gaining weight after menopause, especially after natural menopause and/or after age 60. Race. White women are at greater risk than black women. However, black women diagnosed with breast cancer are more likely to die of the disease. Inherited gene changes. Women who have inherited certain changes in the genes named BRCA1 and BRCA2 have a higher risk of breast cancer, ovarian cancer and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Men who have inherited certain changes in the BRCA2 gene have a higher risk of breast, prostate and pancreatic cancers, and lymphoma. Five percent to 10 percent of all breast cancers are thought to be inherited. Get information about the BRCA1 and BRCA2 genetic mutations and testing for them. This chart shows what the approximate chances are of a woman getting invasive breast cancer in her lifetime.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to prevent Breast Cancer ? [/INST] When studying ways to prevent breast cancer, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor. Anything that decreases your chance of developing cancer is called a cancer protective factor. Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer. Different ways to prevent cancer are being studied, including changing lifestyle or eating habits avoiding things known to cause cancer taking medicine to treat a precancerous condition or to keep cancer from starting. changing lifestyle or eating habits avoiding things known to cause cancer taking medicine to treat a precancerous condition or to keep cancer from starting.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Breast Cancer ? [/INST] When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for. You can help safeguard your health by learning the following warning signs of breast cancer. a lump or thickening in or near the breast or in the underarm area a change in the size or shape of the breast ridges or pitting of the breast; the skin looks like the skin of an orange a change in the way the skin of the breast, areola, or nipple looks or feels; for example, it may be warm, swollen, red, or scaly nipple discharge or tenderness, or the nipple is pulled back or inverted into the breast. a lump or thickening in or near the breast or in the underarm area a change in the size or shape of the breast ridges or pitting of the breast; the skin looks like the skin of an orange a change in the way the skin of the breast, areola, or nipple looks or feels; for example, it may be warm, swollen, red, or scaly nipple discharge or tenderness, or the nipple is pulled back or inverted into the breast. You should see your doctor about any symptoms like these. Most often, they are not cancer, but it's important to check with the doctor so that any problems can be diagnosed and treated as early as possible.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Breast Cancer ? [/INST] A mammogram can often detect breast changes in women who have no signs of breast cancer. Often, it can find a breast lump before it can be felt. If the results indicate that cancer might be present, your doctor will advise you to have a followup test called a biopsy.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Breast Cancer? ? [/INST] The risks of breast cancer screening tests include the following. Finding breast cancer may not improve health or help a woman live longer. Screening may not help you if you have fastgrowing breast cancer or if it has already spread to other places in your body. Also, some breast cancers found on a screening mammogram may never cause symptoms or become lifethreatening. Finding these cancers is called overdiagnosis. Finding breast cancer may not improve health or help a woman live longer. Screening may not help you if you have fastgrowing breast cancer or if it has already spread to other places in your body. Also, some breast cancers found on a screening mammogram may never cause symptoms or become lifethreatening. Finding these cancers is called overdiagnosis. Falsenegative test results can occur. Screening test results may appear to be normal even though breast cancer is present. A woman who receives a falsenegative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if she has symptoms. Falsenegative test results can occur. Screening test results may appear to be normal even though breast cancer is present. A woman who receives a falsenegative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if she has symptoms. Falsepositive test results can occur. Screening test results may appear to be abnormal even though no cancer is present. A falsepositive test result (one that shows there is cancer when there really isnt) is usually followed by more tests (such as biopsy), which also have risks. Falsepositive test results can occur. Screening test results may appear to be abnormal even though no cancer is present. A falsepositive test result (one that shows there is cancer when there really isnt) is usually followed by more tests (such as biopsy), which also have risks. Anxiety from additional testing may result from false positive results. In one study, women who had a falsepositive screening mammogram followed by more testing reported feeling anxiety 3 months later, even though cancer was not diagnosed. However, several studies show that women who feel anxiety after falsepositive test results are more likely to schedule regular breast screening exams in the future. Anxiety from additional testing may result from false positive results. In one study, women who had a falsepositive screening mammogram followed by more testing reported feeling anxiety 3 months later, even though cancer was not diagnosed. However, several studies show that women who feel anxiety after falsepositive test results are more likely to schedule regular breast screening exams in the future. Mammograms expose the breast to radiation. Being exposed to radiation is a risk factor for breast cancer. The risk of breast cancer from radiation exposure is higher in women who received radiation before age 30 and at high doses. For women older than 40 years, the benefits of an annual screening mammogram may be greater than the risks from radiation exposure. Mammograms expose the breast to radiation. Being exposed to radiation is a risk factor for breast cancer. The risk of breast cancer from radiation exposure is higher in women who received radiation before age 30 and at high doses. For women older than 40 years, the benefits of an annual screening mammogram may be greater than the risks from radiation exposure. There may be pain or discomfort during a mammogram. During a mammogram, the breast is placed between 2 plates that are pressed together. Pressing the breast helps to get a better xray of the breast. Some women have pain or discomfort during a mammogram. There may be pain or discomfort during a mammogram. During a mammogram, the breast is placed between 2 plates that are pressed together. Pressing the breast helps to get a better xray of the breast. Some women have pain or discomfort during a mammogram. Some women worry about radiation exposure, but the risk of any harm from a mammogram is actually quite small. The doses of radiation used are very low and considered safe. The exact amount of radiation used during a mammogram will depend on several factors. For instance, breasts that are large or dense will require higher doses to get a clear image. Learn more about the risks of breast cancer screening.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] You can seek conventional treatment from a specialized cancer doctor, called an oncologist. The oncologist will usually assemble a team of specialists to guide your therapy. Besides the oncologist, the team may include a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others. Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it. You might also be eligible to enroll in a clinical trial to receive treatment that conventional therapies may not offer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Breast Cancer ? [/INST] Clinical trials are research studies on people to find out whether a new drug or treatment is both safe and effective. New therapies are tested on people only after laboratory and animal studies show promising results. The Food and Drug Administration sets strict rules to make sure that people who agree to be in the studies are treated as safely as possible. Clinical trials are taking place in many parts of the country. Information about clinical trials can be found at http://www.cancer.gov/clinicaltrials on the website of the National Cancer Institute (NCI). Check NCI's list of cancer clinical trials for breast cancer prevention trials that are now accepting patients.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] Once breast cancer has been found, it is staged. Staging means determining how far the cancer has progressed. Through staging, the doctor can tell if the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment. Staging will let the doctor know the size of the tumor and exactly where it is in the breast. if the cancer has spread within the breast. if cancer is present in the lymph nodes under the arm. If cancer is present in other parts of the body. the size of the tumor and exactly where it is in the breast. if the cancer has spread within the breast. if cancer is present in the lymph nodes under the arm. If cancer is present in other parts of the body. Read more details about the stages of breast cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] Standard treatments for breast cancer include surgery that takes out the cancer and some surrounding tissue radiation therapy that uses highenergy beams to kill cancer cells and shrink tumors and some surrounding tissue. chemotherapy that uses anticancer drugs to kill cancer most cells hormone therapy that keeps cancer cells from getting most of the hormones they need to survive and grow. surgery that takes out the cancer and some surrounding tissue radiation therapy that uses highenergy beams to kill cancer cells and shrink tumors and some surrounding tissue. chemotherapy that uses anticancer drugs to kill cancer most cells hormone therapy that keeps cancer cells from getting most of the hormones they need to survive and grow. (Watch the video to learn about one breast cancer survivor's story. To enlarge the video, click the brackets in the lower righthand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Breast Cancer ? [/INST] There are two types of breastconserving surgery lumpectomy and partial mastectomy. Lumpectomy is the removal of the tumor and a small amount of normal tissue around it. A woman who has a lumpectomy almost always has radiation therapy as well. Most surgeons also take out some of the lymph nodes under the arm. Lumpectomy is the removal of the tumor and a small amount of normal tissue around it. A woman who has a lumpectomy almost always has radiation therapy as well. Most surgeons also take out some of the lymph nodes under the arm. Partial or segmental mastectomy is removal of the cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. Often, surgeons remove some of the lymph nodes under the arm. In most cases, radiation therapy follows. Partial or segmental mastectomy is removal of the cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. Often, surgeons remove some of the lymph nodes under the arm. In most cases, radiation therapy follows.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] Even if the surgeon removes all of the cancer that can be seen at the time of surgery, a woman may still receive followup treatment. This may include radiation therapy, chemotherapy, or hormone therapy to try to kill any cancer cells that may be left. Treatment that a patient receives after surgery to increase the chances of a cure is called adjuvant therapy.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] Radiation therapy uses highenergy xrays or other types of radiation to kill cancer cells and shrink tumors. This therapy often follows a lumpectomy, and is sometimes used after mastectomy. During radiation therapy, a machine outside the body sends highenergy beams to kill the cancer cells that may still be present in the affected breast or in nearby lymph nodes. Doctors sometimes use radiation therapy along with chemotherapy, or before or instead of surgery.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] Chemotherapy is the use of drugs to kill cancer cells. A patient may take chemotherapy by mouth in pill form, or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called whole body or systemic treatment if the drug(s) enter the bloodstream, travel through the body, and kill cancer cells throughout the body. Treatment with standard chemotherapy can be as short as two months or as long as two years. Targeted therapies, usually in pill form, have become more common and focus on either a gene or protein abnormality and usually have few adverse sideeffects as they directly affect the abnormality and not other cells or tissues in the body. Sometimes chemotherapy is the only treatment the doctor will recommend. More often, however, chemotherapy is used in addition to surgery, radiation therapy, and/or biological therapy.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] Hormonal therapy keeps cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs that change the way hormones work. Sometimes it includes surgery to remove the ovaries, which make female hormones. Like chemotherapy, hormonal therapy can affect cancer cells throughout the body. Often, women with earlystage breast cancer and those with metastatic breast cancer meaning cancer that has spread to other parts of the body receive hormone therapy in the form of tamoxifen. Hormone therapy with tamoxifen or estrogens can act on cells all over the body. However, it may increase the chance of developing endometrial cancer. If you take tamoxifen, you should have a pelvic examination every year to look for any signs of cancer. A woman should report any vaginal bleeding, other than menstrual bleeding, to her doctor as soon as possible.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Breast Cancer ? [/INST] Certain drugs that have been used successfully in other cancers are now being used to treat some breast cancers. A mix of drugs may increase the length of time you will live, or the length of time you will live without cancer. In addition, certain drugs like Herceptin and Tykerb taken in combination with chemotherapy, can help women with specific genetic breast cancer mutations better than chemotherapy alone.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Heart Failure ? [/INST] In heart failure, the heart cannot pump enough blood to meet the body's needs. In some cases, the heart cannot fill with enough blood. In other cases, the heart can't pump blood to the rest of the body with enough force. Some people have both problems. Heart failure develops over time as the pumping action of the heart gets weaker. It can affect either the right, the left, or both sides of the heart. Heart failure does not mean that the heart has stopped working or is about to stop working. When heart failure affects the left side of the heart, the heart cannot pump enough oxygenrich blood to the rest of the body. When heart failure affects the right side, the heart cannot pump enough blood to the lungs, where it picks up oxygen. The Heart's Pumping Action In normal hearts, blood vessels called veins bring oxygenpoor blood from the body to the right side of the heart. It is then pumped through the pulmonary artery to the lungs, picking up oxygen. From there, the blood returns to the left side of the heart. Then it is pumped through a large artery called the aorta that distributes blood throughout the body. When the heart is weakened by heart failure, blood and fluid can back up into the lungs, and fluid builds up in the feet, ankles, and legs. People with heart failure often experience tiredness and shortness of breath. Heart Failure is Serious Heart failure is a serious and common condition. Scientists estimate that 5 million people in the U.S. have heart failure and that number is growing. It contributes to 300,000 deaths each year. Heart failure is most common in those age 65 and older and it is the number one reason older people are hospitalized. Other Names for Heart Failure Heart failure can also be called congestive heart failure, systolic heart failure, diastolic heart failure, leftsided heart failure, or rightsided heart failure.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What causes Heart Failure ? [/INST] Heart failure is caused by other diseases or conditions that damage the heart muscle such as coronary artery disease (including heart attacks), diabetes, and high blood pressure. Treating these problems can prevent or improve heart failure. Coronary Artery Disease Coronary artery disease is a leading cause of death in men and women. It happens when the arteries that supply blood to the heart become hardened and narrowed. High Blood Pressure High blood pressure is the force of blood pushing against the walls of the arteries. If this pressure rises and stays high over time, it can weaken your heart and lead to plaque buildup, which can then lead to heart failure. Diabetes Diabetes is characterized by having too much glucose, or sugar, in the blood for a long time. This can cause heart problems because high blood glucose can damage parts of the body such as the heart and blood vessels. This damage weakens the heart, often leading to heart failure. Other Diseases Other diseases and conditions also can lead to heart failure, such as Cardiomyopathy (KARdeomiOPahthee), or heart muscle disease. Cardiomyopathy may be present at birth or caused by injury or infection. Heart valve disease. Problems with the heart valves may be present at birth or caused by infection, heart attack, or damage from heart disease. Arrhythmias (ahRITHmeahs), or irregular heartbeats. These heart problems may be present at birth or caused by heart disease or heart defects. Congenital (konJENihtal) heart defects. These problems with the heart's structure are present at birth. Cardiomyopathy (KARdeomiOPahthee), or heart muscle disease. Cardiomyopathy may be present at birth or caused by injury or infection. Heart valve disease. Problems with the heart valves may be present at birth or caused by infection, heart attack, or damage from heart disease. Arrhythmias (ahRITHmeahs), or irregular heartbeats. These heart problems may be present at birth or caused by heart disease or heart defects. Congenital (konJENihtal) heart defects. These problems with the heart's structure are present at birth. Other Factors Other factors also can injure the heart muscle and lead to heart failure. Examples include treatments for cancer, such as radiation and chemotherapy thyroid disorders (having either too much or too little thyroid hormone in the body) alcohol abuse or cocaine and other illegal drug use HIV/AIDS too much vitamin E. treatments for cancer, such as radiation and chemotherapy thyroid disorders (having either too much or too little thyroid hormone in the body) alcohol abuse or cocaine and other illegal drug use HIV/AIDS too much vitamin E. Sleep Apnea Heart damage from obstructive sleep apnea may worsen heart failure. Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Sleep apnea can deprive your heart of oxygen and increase its workload. Treating this sleep disorder might improve heart failure. Who Is at Risk? Heart failure can happen to almost anyone. It is the number one reason for hospitalization for people over age 65. Heart failure is more common in people who are 65 years old or older AfricanAmericans people who are overweight people who have had a heart attack men. people who are 65 years old or older AfricanAmericans people who are overweight people who have had a heart attack men. Aging can weaken the heart muscle. Older people also may have had diseases for many years that led to heart failure. African Americans are more likely to have heart failure than people of other races. They're also more likely to have symptoms at a younger age, have more hospital visits due to heart failure, and die from heart failure. Excess weight puts strain on the heart. Being overweight also increases your risk of heart disease and type 2 diabetes. These diseases can lead to heart failure. A history of a heart attack puts people at greater risk for heart failure. Men have a higher rate of heart failure than women.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Heart Failure? ? [/INST] Preventing Heart Failure There are a number of things you can do to reduce the risk for coronary artery disease and heart failure. These things include keeping your cholesterol levels healthy keeping your blood pressure at a normal level managing diabetes maintaining a healthy weight quitting smoking limiting the amount of alcohol you drink following a heart healthy diet limiting the amount of sodium (salt) you consume getting regular exercise avoiding using illegal drugs. keeping your cholesterol levels healthy keeping your blood pressure at a normal level managing diabetes maintaining a healthy weight quitting smoking limiting the amount of alcohol you drink following a heart healthy diet limiting the amount of sodium (salt) you consume getting regular exercise avoiding using illegal drugs. Keep Your Cholesterol Levels Healthy Keeping your cholesterol levels healthy can help prevent coronary artery disease. Your goal for LDL, or "bad," cholesterol, depends on how many other risk factors you have. Risk factors include being a cigarette smoker having high blood pressure having low HDL cholesterol being 45 or older if you are a man and 55 or older if you are a woman having a close relative who had coronary artery disease at an earlierthanusual age (before age 55 for male relatives and before age 65 for female relatives). being a cigarette smoker having high blood pressure having low HDL cholesterol being 45 or older if you are a man and 55 or older if you are a woman having a close relative who had coronary artery disease at an earlierthanusual age (before age 55 for male relatives and before age 65 for female relatives). Recommended LDL Cholesterol Goals If you don't have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL. If you don't have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL. If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL. The goal for HDL, or "good," cholesterol is above 40 in men and above 50 in women. The goal for triglycerides, another fat in the blood, is below 150. If you don't have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL. If you don't have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL. If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL. The goal for HDL, or "good," cholesterol is above 40 in men and above 50 in women. The goal for triglycerides, another fat in the blood, is below 150. Learn how to control your cholesterol with TLC Therapeutic Lifestyle Changes. Keep Blood Pressure at a Normal Level High blood pressure causes the heart to get larger and work harder, which can then lead to heart failure. You should aim for a blood pressure level of 130/80 or below. Talk to your doctor about ways to lower your blood pressure. Get tips on how to control your blood pressure. Manage Diabetes If you have diabetes, its important to manage it properly. Diabetes is characterized by having too much glucose, or sugar, in the blood for a long time. This can cause heart problems because high blood glucose can damage parts of the body such as the heart and blood vessels. This damage weakens the heart, often leading to heart failure. See ways to manage your diabetes every day. Maintain a Healthy Weight Excess weight puts strain on the heart. Being overweight also increases your risk of heart disease and type 2 diabetes. These diseases can lead to heart failure. See a sensible approach to weight loss. Don't Smoke If you smoke, quit. For free help quitting, call a smoking quit line. See medications to help you quit. Follow a Heart Healthy Diet Hearthealthy foods include those high in fiber, such as oat bran, oatmeal, wholegrain breads and cereals, fruits, and vegetables. You can also maintain a hearthealthy diet by limiting foods that are high in saturated fat, transfat, and cholesterol, such as meats, butter, dairy products with fat, eggs, shortening, lard, and foods with palm oil or coconut oil. For more on healthy eating, see Eating Well As You Get Older. Limit the Amount of Alcohol You Drink In general, healthy men and women over age 65 should not drink more than three drinks a day or a total of seven drinks a week. Learn how alcohol affects you as get older. Limit the Amount of Sodium Sodium contributes to high blood pressure and fluid retention. Older adults should limit their intake of sodium to1,500 milligrams daily (about 2/3 tsp. of salt). See ways to cut back on your salt intake. Get Regular Exericse Studies show that people with heart disease, diabetes, and high blood pressure benefit from regular exercise. In fact, inactive people are nearly twice as likely to develop heart disease as those who are more active. Aim for at least 30 minutes a day of exercise. Check with your doctor before starting any exercise program. For information on exercise and older adults, see Benefits of Exercise or visit Go4Life, the exercise and physical activity campaign for older adults from the National Institute on Aging.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Heart Failure ? [/INST] Common Symptoms The most common symptoms of heart failure include shortness of breath or difficulty breathing, feeling tired, and swelling. Swelling usually occurs in the ankles, feet, legs, and sometimes in the abdomen. Swelling is caused by fluid buildup in the body. The fluid buildup can lead to weight gain as well as a cough. The cough can be worse at night and when lying down. When symptoms first begin, you might feel tired or short of breath after routine physical activities, such as climbing stairs. As heart failure progresses, the symptoms get worse. You may feel tired or short of breath after performing simple activities, like getting dressed.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Heart Failure ? [/INST] Diagnosing Heart Failure There is not one specific test to diagnose heart failure. Because the symptoms are common for other conditions, your doctor will determine if you have heart failure by doing a detailed medical history, an examination, and several tests. The tests will identify whether you have any diseases or conditions that can cause heart failure. They will also rule out any other causes of your symptoms and determine the amount of damage to your heart. During a physical examination, you can expect your doctor to listen to your heart for abnormal sounds and listen to your lungs for a buildup of fluid. Your doctor will also look for swelling in your ankles, feet, legs, abdomen, and in the veins in your neck If your doctor determines that you have signs of heart failure, he or she may order several tests. Diagnostic Tests Tests that are given to determine heart failure include an electrocardiogram (EKG or ECG), a chest xray, and a BNP blood test. An EKG or ECG electrocardiogram measures the rate and regularity of your heartbeat. This test can also show if you have had a heart attack and whether the walls of your heart have thickened. A chest Xray takes a picture of your heart and lungs. It will show whether your heart is enlarged or your lungs have fluid in them, both signs of heart failure. A BNP blood test measures the level of a hormone in your blood called BNP brain natriuretic peptide that increases in heart failure. Once these initial tests have been performed, your doctor may decide to send you to a cardiologist, a specialist in the diagnosis and treatment of heart disease. A cardiologist will perform a physical exam and may order other tests. Other Tests Tests that can identify the cause of heart failure include an echocardiogram, a Holter monitor, and an exercise stress test. An echocardiogram is one of the most useful tests for diagnosing heart failure. This test uses sound waves to create a picture of the heart and shows how well the heart is filling with blood. Your doctor uses this test to determine whether any areas of your heart are damaged. A Holter monitor, which is a small box that is attached to patches placed on your chest. The monitor, which is worn for 24 hours, provides a continuous recording of heart rhythm during normal activity. An exercise stress test captures your EKG and blood pressure before, during, or after exercise to see how your heart responds to exercise. This test tells doctors how your heart responds to activity.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Heart Failure ? [/INST] There is no cure for heart failure, but it can be controlled by treating the underlying conditions that cause it. Treatment for heart failure will depend on the type and stage of heart failure (the severity of the condition). The goals for treatment of all stages of heart failure are to reduce symptoms, treat the cause (such as heart disease, high blood pressure, or diabetes), stop the disease from worsening, and prolong life. Treatments for Heart Failure Treatments for heart failure include lifestyle changes medications specialized care for those who are in the advanced stages. lifestyle changes medications specialized care for those who are in the advanced stages. Treatment for heart failure will reduce the chances that you will have to go to the hospital and make it easier for you to do the things you like to do. It is very important that you follow your treatment plan by keeping doctor appointments, taking medications, and making lifestyle changes.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Heart Failure ? [/INST] In heart failure, the heart cannot pump enough blood through the body. Heart failure develops over time as the pumping action of the heart gets weaker. Heart failure does not mean that the heart has stopped working or is about to stop working. When the heart is weakened by heart failure, blood and fluid can back up into the lungs and fluid builds up in the feet, ankles, and legs. People with heart failure often experience tiredness and shortness of breath.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What causes Heart Failure ? [/INST] Heart failure is caused by other diseases and conditions that damage the heart muscle. It is most commonly caused by coronary artery disease, including heart attack. Diabetes and high blood pressure also contribute to heart failure risk. People who have had a heart attack are at high risk of developing heart failure.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Heart Failure ? [/INST] The most common symptoms of heart failure include shortness of breath or difficulty breathing, feeling tired, and swelling. Swelling is caused by fluid buildup in the body. Fluid buildup can lead to weight gain and frequent urination, as well as coughing.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How many people are affected by Heart Failure ? [/INST] Approximately 5 million people in the United States have heart failure. It contributes to 300,000 deaths each year. It is the number one cause of hospitalizations for people over the age of 65.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Heart Failure? ? [/INST] Heart failure is more common in people who are 65 years old or older AfricanAmericans people who are overweight people who have had a heart attack men. people who are 65 years old or older AfricanAmericans people who are overweight people who have had a heart attack men. Aging can weaken the heart muscle. Older people also may have had diseases for many years that led to heart failure. African Americans are more likely to have heart failure than people of other races. They're also more likely to have symptoms at a younger age, have more hospital visits due to heart failure, and die from heart failure. Excess weight puts strain on the heart. Being overweight also increases your risk of heart disease and type 2 diabetes. These diseases can lead to heart failure. A history of a heart attack puts people at greater risk for heart failure. Men have a higher rate of heart failure than women.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to prevent Heart Failure ? [/INST] Ways to prevent heart failure include keeping your cholesterol and blood pressure levels healthy keeping diabetes in check maintaining a healthy weight quitting smoking following a heart healthy diet limiting the amount of alcohol you drink eating a diet low in salt because salt can cause extra fluid to build up in your body and also contribute to high blood pressure. Older adults should limit their sodium (salt) intake to1500 mg a day (about 2/3 tsp of salt). getting regular exercise. Aim for at least 30 minutes a day of exercise. Check with your doctor before starting any exercise program. For information about exercises that older adults can do safely, see Exercises to Try or visit Go4Life, the exercise and physical activity campaign for older adults from the National Institute on Aging. keeping your cholesterol and blood pressure levels healthy keeping diabetes in check maintaining a healthy weight quitting smoking following a heart healthy diet limiting the amount of alcohol you drink eating a diet low in salt because salt can cause extra fluid to build up in your body and also contribute to high blood pressure. Older adults should limit their sodium (salt) intake to1500 mg a day (about 2/3 tsp of salt). getting regular exercise. Aim for at least 30 minutes a day of exercise. Check with your doctor before starting any exercise program. For information about exercises that older adults can do safely, see Exercises to Try or visit Go4Life, the exercise and physical activity campaign for older adults from the National Institute on Aging.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Heart Failure ? [/INST] Keeping your cholesterol levels healthy can help prevent coronary artery disease. Your goal for LDL, or "bad," cholesterol depends on how many other risk factors you have. Here are recommended LDL cholesterol goals. If you don't have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL. If you don't have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL. If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL. If you don't have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL. If you don't have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL. If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL. The goal for HDL, or "good," cholesterol is above 40 in men and above 50 in women. The goal for triglycerides, another fat in the blood, is below 150.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Heart Failure ? [/INST] There is not one specific test to diagnose heart failure. Because the symptoms are common for other conditions, your doctor will determine if you have heart failure by doing a detailed medical history, an examination, and several tests. During a physical exam, a doctor will listen for abnormal heart sounds and lung sounds that indicate fluid buildup, as well as look for signs of swelling. If there are signs of heart failure, the doctor may order several tests, including: an EKG, or electrocardiogram, to measure the rate and regularity of the heartbeat a chest Xray to evaluate the heart and lungs a BNP blood test to measure the level of a hormone called BNP that increases when heart failure is present. an EKG, or electrocardiogram, to measure the rate and regularity of the heartbeat a chest Xray to evaluate the heart and lungs a BNP blood test to measure the level of a hormone called BNP that increases when heart failure is present.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Heart Failure ? [/INST] Once initial tests have been performed, your doctor may decide to send you to a cardiologist, a specialist in diagnosis and treatment of heart disease. A cardiologist will perform a physical exam and may order other tests. There are several tests that can identify the cause of heart failure. These tests include: An echocardiogram is one of the most useful tests for diagnosing heart failure. This test uses sound waves to create a picture of the heart and shows how well the heart is filling with blood. Your doctor uses this test to determine whether any areas of your heart are damaged. An echocardiogram is one of the most useful tests for diagnosing heart failure. This test uses sound waves to create a picture of the heart and shows how well the heart is filling with blood. Your doctor uses this test to determine whether any areas of your heart are damaged. A Holter monitor, which is a small box that is attached to patches placed on your chest. The monitor, which is worn for 24 hours, provides a continuous recording of heart rhythm during normal activity. A Holter monitor, which is a small box that is attached to patches placed on your chest. The monitor, which is worn for 24 hours, provides a continuous recording of heart rhythm during normal activity. An exercise stress test captures your EKG and blood pressure before, during, or after exercise to see how your heart responds to exercise. This test tells doctors how your heart responds to activity. An exercise stress test captures your EKG and blood pressure before, during, or after exercise to see how your heart responds to exercise. This test tells doctors how your heart responds to activity.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Heart Failure ? [/INST] Treatment for heart failure includes lifestyle changes medications specialized care for those in advanced stages of the disease.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Heart Failure ? [/INST] Lifestyle changes to treat heart failure may include reducing salt and fluid intake following a heart healthy diet adopting a plan to lose weight quitting smoking engaging in physical activity. reducing salt and fluid intake following a heart healthy diet adopting a plan to lose weight quitting smoking engaging in physical activity.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Heart Failure ? [/INST] Many medications are used to manage heart failure. They include diuretics, ACE inhibitors, beta blockers and digoxin. Diuretics are used to reduce fluid buildup. ACE inhibitors work to improve heart failure in many ways, including lowering blood pressure. Beta blockers can also improve heart failure in many ways, including slowing the heart rate. Digoxin affects the hormones that worsen heart failure.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Heart Failure ? [/INST] For severe heart failure, patients may require additional oxygen, a mechanical heart pump, or a heart transplant.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Heart Failure ? [/INST] More detailed information on heart failure is available at http://www.nhlbi.nih.gov/health/dci</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) High Blood Cholesterol ? [/INST] What is Cholesterol? Cholesterol is a waxy, fatlike substance that your liver makes. It is also found in some foods that come from animals. Cholesterol is found in all parts of your body. It plays a vital role in your body. It makes hormones, helps you digest food, and supports the workings of all the cells in your body. But your liver makes all the cholesterol that your body needs to do this. Lipoproteins and Cholesterol Cholesterol circulates in your blood stream. But it's fatty while your blood is watery. Just like oil and water, the two do not mix. As a result, cholesterol travels through your bloodstream in small packages called lipoproteins. The packages are made of fat (lipids) on the inside and proteins on the outside. Two kinds of lipoproteins carry cholesterol through your bloodstream. It's important to have healthy levels of both: lowdensity lipoproteins (LDL) highdensity lipoproteins (HDL). lowdensity lipoproteins (LDL) highdensity lipoproteins (HDL). What Does LDL Cholesterol Do? Lowdensity lipoproteins (LDL) carry cholesterol to all the cells in your body, including the arteries that supply blood to your heart. LDL cholesterol is sometimes called bad cholesterol because it can build up in the walls of your arteries. The higher the level of LDL cholesterol in your blood, the greater your chances of getting heart disease. What Does HDL Cholesterol Do? Highdensity lipoproteins (HDL) carry cholesterol away from the cells in your body. HDL cholesterol is sometimes called good cholesterol because it helps remove cholesterol from your artery walls. The liver then removes the cholesterol from your body. The higher your HDL cholesterol level, the lower your chances of getting heart disease. If Your Blood Cholesterol Is Too High Too much cholesterol in your blood is called high blood cholesterol. It can be serious. It increases your chances of having a heart attack or getting heart disease. When the cholesterol level in your blood is too high, it can build up in the walls of your arteries. This buildup of cholesterol is called plaque. Plaque Buildup Can Lead to Artherosclerosis. Over time, the plaque can build up so much that it narrows your arteries. This is called atherosclerosis, or hardening of the arteries. It can slow down or block the flow of blood to your heart. Artherosclerosis. Over time, the plaque can build up so much that it narrows your arteries. This is called atherosclerosis, or hardening of the arteries. It can slow down or block the flow of blood to your heart. Coronary Heart Disease (CHD). Artherosclerosis can occur in blood vessels anywhere in your body, including the ones that bring blood to your heart, called the coronary arteries. If plaque builds up in these arteries, the blood may not be able to bring enough oxygen to the heart muscle. This is called coronary heart disease (CHD). Coronary Heart Disease (CHD). Artherosclerosis can occur in blood vessels anywhere in your body, including the ones that bring blood to your heart, called the coronary arteries. If plaque builds up in these arteries, the blood may not be able to bring enough oxygen to the heart muscle. This is called coronary heart disease (CHD). Angina. The buildup of plaque can lead to chest pain called angina. Angina is a common symptom of CHD. It happens when the heart does not receive enough oxygenrich blood from the lungs. Angina. The buildup of plaque can lead to chest pain called angina. Angina is a common symptom of CHD. It happens when the heart does not receive enough oxygenrich blood from the lungs. Heart Attack. Some plaques have a thin covering, so they may rupture or break open. A blood clot can then form over the plaque. A clot can block the flow of blood through the artery. This blockage can cause a heart attack. Heart Attack. Some plaques have a thin covering, so they may rupture or break open. A blood clot can then form over the plaque. A clot can block the flow of blood through the artery. This blockage can cause a heart attack. Lowering Cholesterol Can Affect Plaque Lowering your cholesterol level reduces your chances of plaque rupturing and causing a heart attack. It may also slow down, reduce, or even stop plaque from building up. And it reduces your chances of dying from heart disease. High blood cholesterol itself does not cause symptoms, so many people don't know that they have it. It is important to find out what your cholesterol numbers are because if you have high blood cholesterol, lowering it reduces your chances of getting heart disease or having a heart attack.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What causes High Blood Cholesterol ? [/INST] Many things can affect the level of cholesterol in your blood. You can control some of these things but not others. What You Can Control You can control what you eat your weight your activity level. what you eat your weight your activity level. Your Diet Certain foods have several types of fat that raise your cholesterol level. Saturated fat increases your LDL cholesterol level more than anything else in your diet. Saturated fat is found mostly in foods that come from animal sources such as egg yolks, meat, and milk products, including butter, cream and cheese. These foods also contain cholesterol. Saturated fat increases your LDL cholesterol level more than anything else in your diet. Saturated fat is found mostly in foods that come from animal sources such as egg yolks, meat, and milk products, including butter, cream and cheese. These foods also contain cholesterol. Trans fatty acids, or trans fats, also raise your LDL cholesterol level. These mostly come from vegetable oil that has gone through a process called hydrogenation to make it hard. Examples of foods containing trans fats include many convenience foods such as doughnuts, French fries, cookies, cakes and pastries. Trans fatty acids, or trans fats, also raise your LDL cholesterol level. These mostly come from vegetable oil that has gone through a process called hydrogenation to make it hard. Examples of foods containing trans fats include many convenience foods such as doughnuts, French fries, cookies, cakes and pastries. Your Weight Being overweight tends to increase your LDL level lower your HDL level increase your total cholesterol level. increase your LDL level lower your HDL level increase your total cholesterol level. Your Activity Level If you don't exercise regularly, you may gain weight. This could increase your LDL cholesterol level. Regular exercise can help you lose weight and lower your LDL level. It can also help you increase your HDL level. What You Cannot Control You cannot control some things that can affect the level of cholesterol in your blood, including your heredity your age your sex. your heredity your age your sex. High blood cholesterol can run in families. For most people, their cholesterol level is the result of an interaction between their genes and their lifestyles. As we get older, our cholesterol levels rise. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, women's LDL (bad) cholesterol levels tend to increase. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, women's LDL (bad) cholesterol levels tend to increase.</s>