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<s> [INST] I saw two white worms while cleaning my 7-month-old baby's umbilical cord. What should I do?Hi! I'm worried about my child. Yesterday i clean his umbilical cord and i got two white worms. There is no wound in his umbilical cord. He is 7 months old. What should i do? Please response. Thank you![/INST]Hi, You will need to address this issue as soon as possible, because it might worsen and the child may develop new symptoms. First, please tell me if you have ever noticed urine, stools, pus or blood oozing out of the umbilicus, any time? For the worm infestation, Please ensure that pets and domestic animals are separated from the baby’s surroundings. The baby will require an Ultrasound examination of the abdomen to see if there is any infestations of the internal organs. Watch out for fits, blank staring and unresponsive-ness in the baby. It will be advisable to take the baby to the pediatrician for a thorough evaluation. Please revert back to inform the progress of the baby’s condition. </s>

<s> [INST] How to start teaching a nonverbal child with Down syndrome through online sessions?Hi! I'm a SPED teacher and currently, I'm about to teach a non-verbal child with down syndrome. I would like to ask where to start. I don't know where and how to start teaching the child, most especially that today, we do online sessions. Also, it's my first time to handle a non-verbal child. Hoping that you can answer my query. Thank you.[/INST]</s>

<s> [INST] I have muscle spasms in my cheeks due to Paroxetine. How long will it last?When I started paroxetine(paxil) 20 mg for GAD, I had three side effects, two of which were common, difficulty sleeping and a lack of appetite. The two were manageable. As for the third, which was a mild muscle spasms in my cheeks. Feeling like muscle cheeks are sometimes tight then relaxes. This side effect lasted 4 years then disappeared. I think when I started exercising it helped disappearing that. Last year, as per my dr instructions I switched to paroxetine cr 25mg cause the paroxetine 20 mg was out of stock. For 3 months everything was perfect, after which I started to take my pill at night. By end of the month, suddenly I started feeling as if the medicine had went out of my body and taking it again. The old side effects of the cheeks muscles spasm are back stronger, adding to it the neck( back and front) muscle contractions non stop and stiffness sometimes due to the continuous contractions. Next month, only cheek spasms(continuous)disappeared completely. Throughout this period, the muscle spasms/contractions(continuous)were covering all the back and front neck muscles at the same time. Since 3 months ago, I began to feel the muscles of the back neck muscles getting smooth and slight improvement in the contractions. They are getting mild and slow. Also feeling like cracking sound in my back neck muscles maybe due to stifness. Moreover, the spasms in the muscles is now getting isolated. Sometimes back sometimes front neck not anymore all area at the same time. I would like to clarify to you that there are no defects or abnormal movements such as tics or jerking movements in my neck. Muscle spasms or contractions are not visual. Only me who can feel them. Things are improving slowly. It is annoying but I don't want to change meds cause I had very disaster experience with the previous ones. From your experience, how long will those spasms lasts?in case I don't want to change meds, what to do to reduce more and more ?any meds or supplements could be taken with the seroxat?[/INST]</s>

<s> [INST] I had three anxiety attacks last night because of ringing sound in my ears. Please help.Good day My situation started yesterday after taking a shower yesterday. I climbed out of the shower and noticed I had this high pitched ringing sound in my ears. This sound is really causing me to panic ; last night I has 3 anxiety attacks because of it and I took 50mg Sressam tablet but it did not work. I still have the ringing in my ears today and I've taken another stressam about 1 and a half hours ago but it's not seeming to work. I'm afraid I might have an anxiety attack again tonight because of it. I've recently been placed on Acnetret for my Ance (7 days ago) but my Dr told me to stop it for a few days because I have been experiencing extreme back pain which I am still experiencing right now. I have been off the tablets for about 2 or 3 days and I dont know If this could be causing the high pitch (silence sort of noise) in my ears. Its causing extreme anxiety and unfortunately all Dr's rooms are closed right now. Age: 15 Male 176 cm 164.8 kg[/INST]Hello First of all, please know that ringing sensation is very common and prevalent. There are many suspected causes for ringing sensation in the ear. The most common ones being - wax impinging on the ear-drum, sudden, loud noise, moving into a quiet room from a noisy environment and so on. You say it started after a bath. Even water, soap, hair follicles within your ear, when come in contact with the ear-drum can cause such ringing sensation, although for a short duration. This might have even attracted your attention to a symptom which might have been there even before, but was not noticeable. Sometimes, the medications you are on also can cause this ringing sensation. To be honest, there are lots of causes but no sure way of evaluating it. So, my suggestion - try diverting your thoughts away from this and try concentrating on some other work. When your thoughts are deeply immersed in something else, you will realise that you can hear the ringing sensation only if you think about it. You can also listen to music with ear-phones, with the volume of your device between 30-60% to get your mind off it. But please don’t do this all day. Give a gap of atleast an hour after listening for about 30 minutes. Also, it will probably not bother you when you are involved in a conversation with somebody, keeping your mind off it. All said, there are certain rare causes also, which require systematic treatment, but I wouldn’t want you to worry about them right away. This symptom of yours has started all of a sudden and in all probability might disappear spontaneously as well. Do not get anxious reading about all the causes of ringing sensation on the Internet as it is bound to frighten you. Try the above methods and tell me after 24 hours if there was any improvement at all. </s>

<s> [INST] I have heel pain if I walk without shoes. Why?Hi, i am patient of hyperthyroid. My weight was 52kg cause of hyperthyroism, but i start my medicine from 1 and half years before and recovering from thyroid, and now my weight is increased to 73kg and that why i am facing heel pain but with sport shoe i can walking exercises but without shoe i feel heel pain and i feel difficultie for walk,and in the morning when i wake up, its very difficut for heel to walk so help me for my heel pain and is it ok to walking exercise?[/INST]Dear, Sending Love and healing energy from here! Looking into your problem ,one of the reason you have yourself mention that weight increased and had heel pain . You have said you were having hyperthyroidism and after medication you got recovered. Those patient having hyper also tend to go into hypo too. Since you were hyper and after medication your level decreased might be normal and with meditation it must have gone below the normal . In hypothyroidism, you may be gaining weight.You may fail to lose weight despite ramping up exercise and reducing calories. Neuropathy: Low levels of thyroid hormone can result in nerve damage, called neuropathy characterized by tingling and numbness in the extremities. A painful foot condition known as plantar fasciitis may also develop in your feet, caused by edema (fluid buildup) around the nerves. So i recommend you to do X ray of foot to see any bony spur . Check thyoid level TFT Precursor 1)Use Silicon Heel pad in your shoe to support your heel ,it helps reduces friction . I will follow up and plan treatment after those reports. Thank you </s>

<s> [INST] What does abutment of the nerve root mean?Hi doctor,I am just wondering what is abutting and abutment of the nerve root means in a back issue. Please explain. What treatment is required for annular bulging and tear?[/INST]Hi. I have gone through your query with diligence and would like you to know that I am here to help you. For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist </s>

<s> [INST] Will Nano-Leo give permanent solution for erection problem?Hello doctor, I am 48 years old. I am experiencing weak erection and difficulty in sustaining the same. This condition was observed 10 years back. Also, there is premature ejaculation. Other physical ailments that I have are, I am suffering from hypertension and taking Amlopres-L (Amlodipine and Lisinopril) for the last 10 years, high cholesterol and triglycerides. My cholesterol level is 225 and triglyceride is 200 for the last 12 years. I used to do frequent masturbation in early age. I do have erection during morning hours many times, particularly after sound sleep or if I had long walk previous day. I am having Sildenafil 25 mg or 5 mg Cialis, which is effective enough. But, I wish to get rid of tablet support and live natural way. I consulted urologist today and he prescribed me Nano-Leo capsules and Modula 5 mg for 10 days. I wish to have your second opinion on this. Please guide.[/INST]Hi. For further doubts consult a sexologist online --> https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Every time I eat spicy food, I poop blood. Why?Hi doctor, I am a 26 year old male. I am 5 feet and 9 inches tall and weigh 255 pounds. When I eat spicy food, I poop blood. Sometimes when I have constipation as well, I poop a little bit of blood. I am really scared that I have colon cancer. I do have diarrhea often. I do not have a family history of colon cancer. I got blood tests done last night. Please find my reports attached.[/INST]Hello. I have gone through your information and test reports (attachment removed to protect patient identity). So, in view of that, there are a couple of things that I can opine upon: Hope that helps. For more information consult a general surgeon online --> https://icliniq.com./ask-a-doctor-online/general-surgeon </s>

<s> [INST] Will Kalarchikai cure multiple ovarian cysts in PCOD?Hello doctor, I have multiple small cysts in both ovaries (PCOS). Our family friend suggested me to consume Kalarchikai medicine, powdered mixed with pepper and honey to have it for one mandalam (48 days). I have completed nearly 44 days by consuming one small ball of the mixture every morning and before two weeks I got my periods. Then I had checked whether the cysts were dissolved by having an abdomen scan. But still, small multiple follicules have been seen in it with both ovaries enlarged. Kindly suggest me what I can do further. I got married before one and a half years and I am much worried about my pregnancy. I have gallstones as well.[/INST]Hello. I just read your query. See Kalarachi Kai choornam is helpful in amenorrhea. As far as small cysts are concerned they are unmatured eggs which failed to induce menstrual cycle previously, as a result, they got collected in the ovary and they will remain in the ovary. Now, you have got your periods you can start trying for conception. But I advise you to do it under the supervision of a nearby gynecologist because egg size is important while conception and that you can know by ovulation study. Ovulation study is performed under the supervision of a gynecologist. For gall stones, surgical intervention is required generally. Medicine is not of much help. </s>

<s> [INST] I masturbate only by rubbing the tip of the penis. Is it a wrong way?Hi doctor, During masturbation I just rub the tip of the penis and not the entire penis. Is it a wrong way of doing? I do not get excited during sex and unable to ejaculate. Only, rubbing the tip of the penis gives me excitement. Also, two weeks ago, I have undergone circumcision as my foreskin did not retract. Before circumcision too, I have the same problem. Please help.[/INST]Hi. For further doubts consult a sexologist online -->https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Why am I having body pain and muscle weakness after delivery?Hello doctor, Pain started in my back after 2 months of delivery but now it is all over the body majorly at right side. Currently, having depression medication for the past six months and my doctor adviced me to consult a neurologist as physical pain and muscle weakness is not going away.[/INST]Hello. I read carefully your question and reviewed your X-ray report. Your X-ray shows a normal vertebral column, just muscle spasm (attachment removed to protect patient identity). Coming to this point, I would recommend performing regular physical activity to help reinforce your back muscles and help relieve the muscle spasm. I would also recommend taking a muscle relaxant (Flexeril) to help reduce the muscle spasm. If this does not help, I would suggest considering also fibromyalgia as a possible cause underlying the muscle pain. It is also necessary checking vitamin D plasma levels and magnesium plasma levels for possible deficiency. Another treatment option to consider would be Gabapentine or Doluxetine. </s>

<s> [INST] Which medication can be taken to cure the white spot on tonsil?Hello doctor,I have 1 white spot on my right tonsil, I do not have any fever. What medicine can I take?[/INST]Hi. It is commom to have white spots over the enlarged tonsils. Unless the tonsil is inflammed or it is troubling you, it is not required for you to take any antibiotics or painkillers. You can follow the advice given below: 1. Salt water gargles atleast 8 to 10 times a day for 1 month. 2. Avoid oily spicy and cold food/beverages. 3. Keep sipping on boiled warm water every 3 hours. Tonsils have some crevices on it what we call as crypts, food particles can often get lodged in those crypts which often appear to be white spots. If there is excessive accumulation, over time they can get calcified to form stones what we call as tonsilloliths. All precautionary measures have to be followed as much as possible to prevent infection of the tonsils. </s>

<s> [INST] What causes redness in the eyes?Hello doctor, I have redness in the eyes for 3 days already after moving the eyes very quickly from side to side for a long period of time. The eyes are sore to move. Please tell me what it is.[/INST]Hello. Kindly attach the image of your eye for further diagnosis. </s>

<s> [INST] My mother gets chest pain that vanishes on medication. What is her problem?Hello doctor, My mother is having severe chest pain and this has been the case every year during this period. She has consulted a lot many doctors and she took all the prescriptions as per them every year then it goes away only to reappear again during the next year. She is also being upset due to this pain. All antibiotics were given for gastric problems as said by various doctors. All the testing reports seem to be normal but the root cause of the problem is not identified (all doctors are just saying this to be some gastric problem). She is currently Pantoprazole DSR, Ferhub XT, and Clonamelt 0.5 mg.[/INST]Hi. You need to understand first of all that every chest pain should be taken as heart problems until proved otherwise. So if previously ECG (electrocardiography) has been done, you should get it done again. If the cardiac part is clear, I would say that she probably has perimenopausal symptoms. At her age hormone changes occur so chest heaviness, feeling of nervousness, and hot flushes can happen. I have treated my patients with such symptoms with the help of anxiolytic drugs. Get her cardiac evaluation, if normal discuss with your doctor to prescribe this medicine to her for a few weeks and see the results. I am very hopeful that it would work. </s>

<s> [INST] How bad will kidney get affected due to chronic alcoholism?Hello doctor, My serum creatinine is 1.17 and I am taking blood pressure and diabetes tablets. Do I need to worry about my kidneys as I drink alcohol on a daily basis?[/INST]Hi. Reviewing your presentation and details of your test attached (attachment removed to protect patient identity). History of hypertension and diabetes are important factors for chronic kidney disease which if not properly controlled can affect your kidney function in the long term. The BP and sugar levels are well controlled with your medications so it is really important to keep on regular medications. The second point of course the diet which adversely affects your kidney function are maintaining a healthy diet, low fat, low carb, and high fiber diet and a good state of hydration taking about 2.5 liters of water is must to keep your kidneys healthy. Reduce caffeinated and fizzy drinks. Drinking alcohol can badly affect your liver and kidney functions. I recommend you to reduce your intake of alcohol to occasionally and better to avoid it. Regular check on blood pressure and sugar on a weekly basis and give your feedback to your following doctor. And you can do a kidney function test to see creatinine level every six months. If you do regular exercise it will add benefit generally and to your kidneys. So far as you are doing well and keep the follow up there should be no issues. I hope this helps. </s>

<s> [INST] I have loss of smell for the past 2 years with frequent cold and sneezing. Please help.Hello doctor, I have lost my smell. I have consulted many ENT doctors for the past two years but could not resolve the problem. I also have a frequent cold with sneezing. Particularly in the morning, severe sneezing occurs. Please help.[/INST]Hello. The possible causes for loss of smell are 1. Rhinitis. 2. Sinusitis. 3. Ethmoidal polyps. 4. Neurodegenerative diseases. 5. Vitamin B12, and Folic acid deficiency. 6. Tumor of the CNS (central nervous system). 7. Trauma. But in your case possible the cause is sinusitis with or without polyp. Rhinitis and sinusitis may lead to congestion and edema of mucosa, and also nerve endings may give rise to anosmia. 1. So use salt water gargling thrice a day for five days. 2. Use water vapor inhalation thrice a day for five days. 3. Use decongestants like Phenylephrine (tablet Lecope-AD) and anti-histamines to decrease congestion. 4. Avoid cool drinks and ice creams. 5. Use Otrivin nasal spray twice a day for five days. 6. Use tablet Amoxicillin and Clavulanic acid 625 mg twice a day for five days. If symptoms are not improved please get done x-ray paranasal sinuses and nasal endoscopy then we come to know the cause. So review with above reports or consult with your ENT specialist he will examine and treat you accordingly. </s>

<s> [INST] I have bad GERD with epigastric pain, erythema and atrophy of antrum. Please suggest solution.Hello doctor, I am a 27-year-old female. I had a history of on and off acid reflux for a few years. Last month, I had a bad episode of GERD and was prescribed Pantoprazole for a month. It got better and I stopped taking Pantoprazole, but I still have epigastric pain on and off. I had an upper endoscopy last week where the findings were all normal except for erythema atrophy of antrum. No more obvious acid reflux signs though. But epigastric pain still comes and goes. I was prescribed Hyoscyamine, but not sure why. What does erythema atrophy of antrum mean and why do you think I was prescribed Hyoscyamine? I have not had biopsy results from endoscopy yet, but I am hoping and praying for the best.[/INST]Hello. Your symptoms likely from your stomach. Atrophy and erythema mean there is inflammation, might be from a bacterial infection (helicobacter), which we have to wait for the biopsy result then to be treated with triple therapy. Hyoscyamine drug for intestinal cramps, help alleviating pain from cramps, also decrease the acidity in the stomach. To be honest, we rarely use it for stomach, PPI (proton pump inhibitors) like Pantoprazole usually are better with stomach inflammation, and decreasing its acidity. For now, we have to avoid smoking, drinking, and spicy food the could irritate the stomach more. Avoid eating before sleep at least three to four hours. Wait for the biopsy. Another thing, if pain persists, I recommend to repeat the ultrasound, we need to see what is going on with your gallbladder. </s>

<s> [INST] Few days after breakage of condoms, I have sticky penis and inflammation of foreskin. Why?Hello doctor, I had a condom tear while having sex. Two weeks later, I developed symptoms of pain and slight swelling in my right testicle, lower abdominal pain, and foreskin inflammation. Thinking it to be chlamydia, I took 1g single dose of Azithromycin. It provided me some relief but two weeks later the same symptoms arose. Further, my foreskin and penile glans have now become sticky to touch, like a stick note, although it is not moist. I had also developed rashes on my inner thigh. I consulted a doctor who prescribed me T Bact for my sticky and slightly swollen foreskin, Betnovate N for my rashes in my inner thighs, and put me on a seven-day course of Amoxicillin 500 mg for three days. I am on day 5 of this course and my symptoms seem to have eased up significantly, but I fear a relapse could occur like last time. I have minimal abdominal pain now, and my testicles only feel a little uncomfortable from time to time. Further, the stickiness of my penile glans and foreskin has not subsided much, which worries me a lot. I would like to know what is causing this stickiness of foreskin and penis? The swelling of foreskin seems to have reduced somewhat. I am sending you the latest photos as well. Please advise me on what should be my next step.[/INST]Hi. I understand your worry about the swelling of the foreskin you covered with antibiotics with a single dose of Azithromycin and later with one week of Amoxicillin. If there is sexually transmitted disease it might come back for mainly two reasons. Firstly, incomplete treatment and insensitive antibiotics as you did not have a culture result, and secondly, not treating the sexual partner. Therefore, after completing the Amoxicillin no need for more antibiotics hopefully the foreskin swelling resolves. You will need STD (sexually transmitted disease) screening for you and your partner needs a vaginal swab. If you got pain like burning sensation while passing urine or swelling or urethral discharge then you will need to do urethral swab culture as well. The swelling of the foreskin and sticky discharge might have been caused by sexually transmitted disease as the condom was torn we do not have culture results as you started antibiotics before a culture of your urethra was sent. It is great that with Amoxicillin you are getting better. My suggestion is to complete the Amoxicillin course. Then to do the sexually transmitted diseases tests (STD screening) which is chlamydia testing by swab taken from urethra, gonorrhea testing, syphilis tests, trichomonas tests, human papillomavirus (HPV), herpes test, hepatitis B surface antigen test, hepatitis C test, HIV antibody and HIV antigen blood test for you and your partner. Those investigations will help diagnose and prevent future recurrence. No need for any more medications for now apart from the Amoxicillin you are currently on I would be pleased to follow you after tests result to inform for further treatment if required. Urethral swab for partner and STD screen for both and urethral swab of the patient in case symptomatic. STD (sexually transmitted disease). </s>

<s> [INST] I am unable to conceive with normal cycle. Please prescribe fertility medication.Hi doctor, I have been trying for the last one year to conceive baby, but no result. I would like to take medication to boost my fertility. Need a doctor's prescription for the fertility medication. There are no other issues regarding the period cycle or health.[/INST]Hello. Fertility medications cannot be prescribed without a thorough evaluation. This involves finding the exact cause of not being able to conceive whether it is female factors or the male factor. Among the female factor, ovulatory dysfunction is the most common cause. Also, tubal factors like tubal block can also cause difficulty in conceiving and thus need evaluation. I see that your previous cycles have been regular but this time you had a delayed cycle which is the first time you observed this. Delayed cycles indicate ovulatory dysfunction, which could be due to hormonal disturbance of thyroid or Prolactin Hormone, or due to a lifestyle condition like PCOS (polycystic ovary syndrome). Also, I see you are overweight for your height. I would like to know many more details about your issues, like if you have any acne issues or any unwanted facial hair growth. Was there any recent weight gain? What is the average coital frequency in a week? Do you have any vaginal discharge and frequent lower abdominal pain? Have you had tuberculosis or any other chronic medical conditions in the past? Have your husband got a semen analysis done, what is his age, and what does he do? As it is the third day of your periods today, you can get the below mentioned medical tests done and consult a fertility expert with reports for further evaluation and management. Treatment would depend on the underlying causes. In 10-20% of cases, there may not be any attributable causes. It is called unexplained infertility. In such cases, also your fertility expert may suggest assisted reproductive techniques to increase the chances of pregnancy. I hope this helps. Hemogram. Lipid profile. LFT (liver function test), RFT (renal function test). 75 g glucose tolerance test (fasting, 1 hour, 2 hour). HbA1c (glycated hemoglobin) levels. Serum calcium, Vitamin D and B12 levels. Serum fasting and Post prandial. Insulin levels. Serum FSH (follicle-stimulating hormone), LH (leutinizing hormone), free testosterone, Estradiol, Prolactin levels, thyroid profile (T3, T4, TSH, Anti TPO) on second and third day of the next menstrual period. Ultrasound abdomen and pelvis, husband semen analysis. Endometrial sampling and tubal evaluation by HSG (hysterosalpingography). Tablet Folic Acid 5 mg daily once until you conceive. Reduce weight. Maintain menstrual cycles diary. Regular excercises at least 1 hour daily. Dietary modifications. </s>

<s> [INST] I have a painful boil in my innner thigh with discharge and leaving a hole behind. What should I do?Hello doctor, I had a boil in my inner thigh for a week now. It started as a pimple then progressed to a painful bump. Two days ago, it started to drain. I have been applying warm compression and Betadine on it. The swelling and pain decreased however, the wound worries me as it now looks like I have got a hole in my thigh. What will I do?[/INST]Hi. I can understand your concern. According to your statement, you have been suffering from a boil in the inner thigh for a week. It was started as a pimple then progressed to a painful bump. According to your picture (attachment removed to protect patient identity), your boil may become infected. So for your boil, you can take Cefixime 400 mg (twice daily) with Clindamycin 300 mg (twice daily) and apply locally topical Mupirocin or Bacitracin ointment on your affected area. You can take Vitamin C supplements for quick healing and you should undergo some investigations like CBC (complete blood count), RBS (random blood sugar), etc. </s>

<s> [INST] What does abutment of the nerve root mean?Hi doctor,I am just wondering what is abutting and abutment of the nerve root means in a back issue. Please explain. What treatment is required for annular bulging and tear?[/INST]Hi. I have gone through your query with diligence and would like you to know that I am here to help you. For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist </s>

<s> [INST] Will Nano-Leo give permanent solution for erection problem?Hello doctor, I am 48 years old. I am experiencing weak erection and difficulty in sustaining the same. This condition was observed 10 years back. Also, there is premature ejaculation. Other physical ailments that I have are, I am suffering from hypertension and taking Amlopres-L (Amlodipine and Lisinopril) for the last 10 years, high cholesterol and triglycerides. My cholesterol level is 225 and triglyceride is 200 for the last 12 years. I used to do frequent masturbation in early age. I do have erection during morning hours many times, particularly after sound sleep or if I had long walk previous day. I am having Sildenafil 25 mg or 5 mg Cialis, which is effective enough. But, I wish to get rid of tablet support and live natural way. I consulted urologist today and he prescribed me Nano-Leo capsules and Modula 5 mg for 10 days. I wish to have your second opinion on this. Please guide.[/INST]Hi. For further doubts consult a sexologist online --> https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Every time I eat spicy food, I poop blood. Why?Hi doctor, I am a 26 year old male. I am 5 feet and 9 inches tall and weigh 255 pounds. When I eat spicy food, I poop blood. Sometimes when I have constipation as well, I poop a little bit of blood. I am really scared that I have colon cancer. I do have diarrhea often. I do not have a family history of colon cancer. I got blood tests done last night. Please find my reports attached.[/INST]Hello. I have gone through your information and test reports (attachment removed to protect patient identity). So, in view of that, there are a couple of things that I can opine upon: Hope that helps. For more information consult a general surgeon online --> https://icliniq.com./ask-a-doctor-online/general-surgeon </s>

<s> [INST] Will Kalarchikai cure multiple ovarian cysts in PCOD?Hello doctor, I have multiple small cysts in both ovaries (PCOS). Our family friend suggested me to consume Kalarchikai medicine, powdered mixed with pepper and honey to have it for one mandalam (48 days). I have completed nearly 44 days by consuming one small ball of the mixture every morning and before two weeks I got my periods. Then I had checked whether the cysts were dissolved by having an abdomen scan. But still, small multiple follicules have been seen in it with both ovaries enlarged. Kindly suggest me what I can do further. I got married before one and a half years and I am much worried about my pregnancy. I have gallstones as well.[/INST]Hello. I just read your query. See Kalarachi Kai choornam is helpful in amenorrhea. As far as small cysts are concerned they are unmatured eggs which failed to induce menstrual cycle previously, as a result, they got collected in the ovary and they will remain in the ovary. Now, you have got your periods you can start trying for conception. But I advise you to do it under the supervision of a nearby gynecologist because egg size is important while conception and that you can know by ovulation study. Ovulation study is performed under the supervision of a gynecologist. For gall stones, surgical intervention is required generally. Medicine is not of much help. </s>

<s> [INST] I masturbate only by rubbing the tip of the penis. Is it a wrong way?Hi doctor, During masturbation I just rub the tip of the penis and not the entire penis. Is it a wrong way of doing? I do not get excited during sex and unable to ejaculate. Only, rubbing the tip of the penis gives me excitement. Also, two weeks ago, I have undergone circumcision as my foreskin did not retract. Before circumcision too, I have the same problem. Please help.[/INST]Hi. For further doubts consult a sexologist online -->https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] My breast milk is not ample. Which milk shall I feed my newborn, cow's milk or formula?Hello doctor, My child is one and a half month old. Which milk is better for him, cow's milk or artificial milk (as breast milk is not enough)?[/INST]Hello. Please know that until the baby is 6 months of age, there is nothing better than mother’s milk. If you feel mother’s milk is not enough, there are medications to increase mother’s milk. Has it been tried? How frequent are you breastfeeding? What exactly is the mother’s psychological status (I mean willingness to breastfeed, notions about mother’s physique deteriorating by breastfeeding, not actually able to feed because of other medical conditions, mother being tensed about the happenings in the family or anything that she is really concerned with). Also know that the amount of milk secreted depends on: 1. How frequently the baby is offered breastfeed. 2. How well the baby is sucking. The milk secretion increases according to the baby’s demand. More sucking- more milk. 3. Mother’s diet. 4. The medications that the mother and baby are at present. Kindly give me the above details before you decide to stop breastfeeding completely. If you still want to know the best formula milk, there are many in the market like Cerelac, Lactogen, Nan, etc. Any of them will do. You should know the correct dilutions before feeding. Please know that if a baby is given breast milk for 6 months he/she will have better immunity, better mental abilities, and psychological strength compared to babies fed on formula milk. Please do not start Cow’s milk, or buffalo milk, or pasteurized milk so early. </s>

<s> [INST] Please give some advise to improve my hemoglobin level.Hi doctor, Recently, I had RARP surgery for prostate cancer. My Hb level post surgery fell to 10.8 and I was advised to stay on iron supplement Dexorange Syrup one teaspoon thrice daily after meals. In view of ongoing treatment for erosive gastritis, which is now under control, the Iron supplement was started three months ago. Then, my Hb level has improved to 12.5. I had a CBC, folic acid and iron study and I have enclosed the reports for your reference. I am a vegetarian. Please advise further course of action as I have been advised to stop the Dexorange syrup after three weeks and continue with iron-rich diet. My gastroenterologist is not in favor of long-term usage of Iron supplements. The stomach ulcers due to H.pylori have been treated and stomach lining restored. Currently, I am taking Nexpro 40 mg in the empty stomach and Librax once at night. My CBC report issued an alert for anisocytosis. My amylase level is around 174 U/L, but pancreatitis and bile duct obstruction have been ruled out. I am taking Unienzyme tablet in the morning and night along with one probiotic capsule Vizylac. Please advise if any attention or investigation or treatment required further. Thank you.[/INST]Hi. Based on your query and reports (attachment removed to protect patient identity), my opinion is as follows: Repeat hemoglobin after three months. Add more iron, vitamin B12 and folic acid in your diet. Revert back after three months to a hematologist online.---> https://www.icliniq.com/ask-a-doctor-online/hematologist </s>

<s> [INST] Do I need to take medicine for high cholesterol?Hi doctor, I do not have any health issues. But, my cholesterol level is high at 220. Do I need to take any medicine? Please let me know. I have attached my laboratory reports for your reference.[/INST]Hi. Revert back with the answers to the above questions to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician </s>

<s> [INST] Do I need to get FNB or biopsy to check lymph node enlargement?Hi doctor, I am a 32 year old male. My height is 6 feet and weight is 145 lbs. I am facing a significant unexplained weight loss of more than 45 lbs in four months. My normal weight since high school is 185 to 180 lbs. I am having episodes of significant and frequent drenching night sweats. Also, I have chronic persistent fatigue and occasional non-specific itching. I have a family history of lymphoma with my paternal uncle and maternal cousin. My ultrasound of lymph nodes has two different impressions. The first one was clear bilateral LAD suspicion of neoplastic etiology seen at level 4 and 5. The second opinion was clearly reactive bilateral nodes seen at level 2 and 5. In your opinion, what would be the appropriate course of action? Either FNB or excisional biopsy due to the symptoms and history? Also, if you can interpret films, then I would appreciate your additional opinion. From a differential diagnosis standpoint, what is at the top?[/INST]Hi. Based on your query and attached images (attachment removed to protect patient identity), my opinion is as follows: FNB. For further information consult a hematologist online.---> https://www.icliniq.com/ask-a-doctor-online/hematologist </s>

<s> [INST] My dad's feet are so puffy. Why?Hi doctor, My dad is 83 years old. He keeps coughing up phlegm and sleeping all the time. He is cold and his feet are very swollen. His feet are so puffy and he feels difficult to wear shoes or walk. He weighs about 300 lbs. He is suffering from congestive heart failure. Currently, he is on Lisinopril for blood pressure, Potassium supplement and Furosemide for water retention and Cetirizine for allergy symptoms.[/INST]Hello. For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician </s>

<s> [INST] How to find out the reason for extreme sweating, muscle stiffness and cramp?Hi doctor, I am a 50 year old male. I am living in a harsh, hot climate from my childhood. For the past three years, I have noticed that I get extremely exhausted with sweating. During the said period I get muscle stiffness, cramps and depression. My condition improves a little in days after drinking lots of water to the extent I have to keep my stomach bloating with water. What could be the possible causes for this condition? What medical tests should I get to know the cause? Kindly reply.[/INST]Hello. For better understanding I need more details from you. Revert back with the answers to the above questions to an endocrinologist online --> https://www.icliniq.com/ask-a-doctor-online/endocrinologist </s>

<s> [INST] What are the next treatment options for my brother's condition?Hi doctor, My brother was diagnosed to have ALK positive before two years. He had brain and bone metastasis. He got a brain surgery, WBR and spine radiation. He was on Crizotinib for 10 months and after brain and bone metastasis progression he was on Ceritinib for 5 months. In the latest scan, the disease progression was seen again in bone and also there was a new brain metastasis. Unfortunately, in my country, there is no next generation inhibitor of Ceritinib. What are the options now? Is there any chance to use Crizotinib again? He has some bone fractures also. We are feeling helpless. He is just 35 only. Already, he had WBR twice. What are the next treatment options? When he was on Crizotinib, he felt very active. But, while on Ceritinib, he mostly used to stay on the bed. Kindly suggest some option.[/INST]Hello. I understand your plight. For further information consult a medical oncologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-oncologist </s>

<s> [INST] Does my mom need a surgery for mitral valve leak?Hi doctor, My mom is 46 years old. She recently had her routine physical examinations and they found out her mitral valve could not close fully, but very light degree. The doctor there thinks that she does not need a surgery and he did not mention anything else. So, I really want a second opinion on this. Does she need a surgery? What should she do now to improve her health?[/INST]Hi. Revert back with the reports to a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist </s>

<s> [INST] How to reduce the pain due to ankle sprain?Hi doctor,I have chronic ankle sprains in both the ankles. I have this for maybe a year now. I went to PT and have been doing exercises. But, about a week ago, my ankle began to pop. It is happening once in a while. It really hurts and I have to pause for a couple minutes for the pain to settle. Is this normal? Is there a way for me to prevent or calm this pain? I am taking Zoloft and Ibuprofen when needed. Please help.[/INST]Hi. Hope this message finds you in good health. I have gone through your complaints and understand your concern. For further information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist </s>

<s> [INST] Having PCOS since I was young. Will I be able to conceive naturally?Hi doctor, I am 27 years old. I got married before 1.5 years. I have PCOS since I was young. I remember that I had various types of medication as I did not get my periods regularly in the initial stages. My mother had taken me to many doctors, including ayurveda, homeopathy and allopathy. Before 4 years, my gynecologist prescribed me Ginette 35 and since then, I have been taking this pill. I am now planning for pregnancy and I want to know whether I can just stop taking Ginette 35. Will I be able to conceive naturally? I am also overweight for my height. My height is 5'3" and my weight is 75 kg. I want to have a baby now and want to conceive naturally without any medical treatment. Is that possible?[/INST]Hello. It is good that you continued Ginette 35 (Cyproterone acetate and Ethinyl estradiol) till date. Your menses would have been regular after being placed on Ginette 35 till date as I presume. If you wish to conceive, then you must stop the pills after completing this pack and wait for the withdrawal bleed or menses. From the next cycle, you may try naturally and also follow up ovulation with ultrasound guided follicular monitoring. Sometimes, initial 1 or 2 cycles remain annular after prolonged usage of Ginette 35 and resumes by third cycle. But, that varies from woman to woman. So, you may try conception from next cycle and do follow ovulation. A fresh hormonal profile would be mandatory after a month along with serum fasting insulin levels to check for the insulin resistance as well and present hormonal status. For further information consult a childbirth educator online --> https://www.icliniq.com/ask-a-doctor-online/childbirth-educator </s>

<s> [INST] What does abutment of the nerve root mean?Hi doctor,I am just wondering what is abutting and abutment of the nerve root means in a back issue. Please explain. What treatment is required for annular bulging and tear?[/INST]Hi. I have gone through your query with diligence and would like you to know that I am here to help you. For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist </s>

<s> [INST] Will Nano-Leo give permanent solution for erection problem?Hello doctor, I am 48 years old. I am experiencing weak erection and difficulty in sustaining the same. This condition was observed 10 years back. Also, there is premature ejaculation. Other physical ailments that I have are, I am suffering from hypertension and taking Amlopres-L (Amlodipine and Lisinopril) for the last 10 years, high cholesterol and triglycerides. My cholesterol level is 225 and triglyceride is 200 for the last 12 years. I used to do frequent masturbation in early age. I do have erection during morning hours many times, particularly after sound sleep or if I had long walk previous day. I am having Sildenafil 25 mg or 5 mg Cialis, which is effective enough. But, I wish to get rid of tablet support and live natural way. I consulted urologist today and he prescribed me Nano-Leo capsules and Modula 5 mg for 10 days. I wish to have your second opinion on this. Please guide.[/INST]Hi. For further doubts consult a sexologist online --> https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Every time I eat spicy food, I poop blood. Why?Hi doctor, I am a 26 year old male. I am 5 feet and 9 inches tall and weigh 255 pounds. When I eat spicy food, I poop blood. Sometimes when I have constipation as well, I poop a little bit of blood. I am really scared that I have colon cancer. I do have diarrhea often. I do not have a family history of colon cancer. I got blood tests done last night. Please find my reports attached.[/INST]Hello. I have gone through your information and test reports (attachment removed to protect patient identity). So, in view of that, there are a couple of things that I can opine upon: Hope that helps. For more information consult a general surgeon online --> https://icliniq.com./ask-a-doctor-online/general-surgeon </s>

<s> [INST] Will Kalarchikai cure multiple ovarian cysts in PCOD?Hello doctor, I have multiple small cysts in both ovaries (PCOS). Our family friend suggested me to consume Kalarchikai medicine, powdered mixed with pepper and honey to have it for one mandalam (48 days). I have completed nearly 44 days by consuming one small ball of the mixture every morning and before two weeks I got my periods. Then I had checked whether the cysts were dissolved by having an abdomen scan. But still, small multiple follicules have been seen in it with both ovaries enlarged. Kindly suggest me what I can do further. I got married before one and a half years and I am much worried about my pregnancy. I have gallstones as well.[/INST]Hello. I just read your query. See Kalarachi Kai choornam is helpful in amenorrhea. As far as small cysts are concerned they are unmatured eggs which failed to induce menstrual cycle previously, as a result, they got collected in the ovary and they will remain in the ovary. Now, you have got your periods you can start trying for conception. But I advise you to do it under the supervision of a nearby gynecologist because egg size is important while conception and that you can know by ovulation study. Ovulation study is performed under the supervision of a gynecologist. For gall stones, surgical intervention is required generally. Medicine is not of much help. </s>

<s> [INST] I masturbate only by rubbing the tip of the penis. Is it a wrong way?Hi doctor, During masturbation I just rub the tip of the penis and not the entire penis. Is it a wrong way of doing? I do not get excited during sex and unable to ejaculate. Only, rubbing the tip of the penis gives me excitement. Also, two weeks ago, I have undergone circumcision as my foreskin did not retract. Before circumcision too, I have the same problem. Please help.[/INST]Hi. For further doubts consult a sexologist online -->https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Had outside food and suffering from vomiting and diarrhea. Please help.Hi doctor, I am suffering from severe vomiting and diarrhea. I vomited 5 times in the last 6 hours and visited the toilet for about 30 to 35 times. Yesterday, I had outside food such as burger, pizza, chips, bread, etc. Please help.[/INST]Hi. I have gone through your query with diligence and would like you to know that I am here to help you. For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician </s>

<s> [INST] Why is my hCG value too low?Hi doctor, My last LMP was 17th. As my periods delayed seven days, I had a pregnancy test. The beta HCG value was 355.30 mIU/mL. Why the value is too low than the normal range? Is this something to worry?[/INST]Hi. For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist </s>

<s> [INST] What is delaying my pregnancy?Hi doctor, I am trying to get conceive. We have tried two times, but no positive result. I have thyroid but it is normal now. My age is 26 and weight is 78 kg. I am a little overweight for my height. What is the problem. Please help me.[/INST]Hi. Revert back with the report to an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist   </s>

<s> [INST] How to know the reason for spotting and painful bleeding?Hi doctor, Last week, I had bleeding and pain because of the cyst on my ovary. Now, the pain started to ease and I have been spotting and bleeding for one week. I just want to know if this is normal. If so, then how long will it bleed?[/INST]Hi. I hope you are feeling better now with regard to the pain. For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist </s>

<s> [INST] After taking I-pill, my period is irregular. Why?Hi doctor, My regular period comes 24th of every month. I had taken I-pill on the 15 of last month and after that my period came on 24th. Again, I took I-pill on 28th and got period on 5th of this month. Now, again, I am bleeding in a gap of 10 days. Please advise whether it is normal or something serious. Please help me.[/INST]Hello. After taking the second I-pill, the withdrawal bleed started on 5th, which again marked the onset of a fresh cycle. So, the next bleeding could have been due to an early ovulation and possibly an ovulation bleed. Also, sometimes intermenstrual bleeding is common to experience if I-pill is frequently used. Please do not use I-pill often as it has progesterone side effects. Presently, if the bleeding has stopped, then nothing to worry and just observe your cycle. Your next cycle may be delayed by a week or so. So, you need to stay informed. For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist </s>

<s> [INST] USG at 16 weeks showed separation of amnion and chorion. What to do?Hi doctor, My wife is pregnant now. Her first pregnancy was completely normal. Now, at 13 weeks she had major bleeding and that took us to the ER. US showed movement and heartbeat.  Since then, she has continued to bleed with dark brown clots and occasional red blood. She had 16 week US and it showed that there is a separation of amnion and chorion. Also, there is a large floating pocket probable hematoma. This is worrying me. Now, she has fever and severe lower back pain. What to do?[/INST]Hi. First, let me say that I am sorry for your wife's trouble in this pregnancy. For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist </s>

<s> [INST] Does high cholesterol medicine have any side effects?Hi doctor, My cholesterol and triglyceride levels are elevated. But, they were the same in my previous checkup reports too. I am a bit reluctant to take medication because of the side effects. My father has both cardiac and diabetic issues. I am doing exercise regularly and my intake of sugar is also under control. I do not smoke, but drink 3 pegs only on Saturdays. Can you please let me know why my cholesterol levels are still high? Is it too high to take medicines? Is there any side effect with the medicines? What precaution do I need to take in my lifestyle? I know that the long-term elevated levels of cholesterol is risky. Please help me.[/INST]Hi. Your vitamin D levels, thyroid levels and HbA1c are quite good. Regarding your high cholesterol, it may be due to hereditary and food related. You have a high risk of coronary artery disease as you have a positive family history and high cholesterol. If you have any severe muscle pain report to a physician. It is a rare side effect theoretically. Consult your doctor, discuss with him or her and take the medicine with consent. For further information consult a general medicine physician online -->https://www.icliniq.com/ask-a-doctor-online/general-medicine-physician </s>

<s> [INST] How to control continuous abnormal vaginal bleeding?Hi doctor, My wife is 45 years old. Since last month, she has had continuous abnormal vaginal bleeding. She has been prescribed by doctor Deviry 10 mg twice a day. Even after one week of medication, no improvement has been seen. Please help.[/INST]Hi. I totally understand your situation. For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist </s>

<s> [INST] What causes dark and foul smelling urine?Hello doctor, I have had every STD screen known to man and kidney function tests, my urine is foul smelling and dark. This has been an ongoing issue for a year and it has started to affect my life. I have tried everything. Antibiotics, hydration, douche, apple cider vinegar, AZO pills, yeast infection drugs, UTI drugs.[/INST]Hello. Foul smelling and dark urine is indicative of cystitis with highly concentrated urine. If there is no blood or hematuria then renal pathology is unlikely or calculus. You need to take at least 3 to 4 liters of water daily and foul smell is often vaginal and not in urine. You may be suffering from bacterial vaginosis causing a foul smell. Avoid using soaps in the genital region while bathing, use vaginal alkaline washes. </s>

<s> [INST] Other than chest x-ray, what test should be done for cough?Hi doctor, I have attached an x-ray report of my 1 year old baby girl. The report was ill-defined haziness seen in the right perhilar and para-cardiac regions - pneumonitis. What does it mean? She has cough since last five days. My mom is suffering from active tuberculosis. So, x-ray was suggested and the consulting doctor is out of town for the next two days. What should be done next?[/INST]Hello. I understand your concern. 1. Mantoux test. 2. Complete blood count. 3. Gastric aspirate for AFB (acid fast bacilli). An antibiotic should be given for seven days. Revert back with the answers to the above questions to a paediatrician online.---> https://www.icliniq.com/ask-a-doctor-online/paediatrician </s>

<s> [INST] What does abutment of the nerve root mean?Hi doctor,I am just wondering what is abutting and abutment of the nerve root means in a back issue. Please explain. What treatment is required for annular bulging and tear?[/INST]Hi. I have gone through your query with diligence and would like you to know that I am here to help you. For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist </s>

<s> [INST] Will Nano-Leo give permanent solution for erection problem?Hello doctor, I am 48 years old. I am experiencing weak erection and difficulty in sustaining the same. This condition was observed 10 years back. Also, there is premature ejaculation. Other physical ailments that I have are, I am suffering from hypertension and taking Amlopres-L (Amlodipine and Lisinopril) for the last 10 years, high cholesterol and triglycerides. My cholesterol level is 225 and triglyceride is 200 for the last 12 years. I used to do frequent masturbation in early age. I do have erection during morning hours many times, particularly after sound sleep or if I had long walk previous day. I am having Sildenafil 25 mg or 5 mg Cialis, which is effective enough. But, I wish to get rid of tablet support and live natural way. I consulted urologist today and he prescribed me Nano-Leo capsules and Modula 5 mg for 10 days. I wish to have your second opinion on this. Please guide.[/INST]Hi. For further doubts consult a sexologist online --> https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Every time I eat spicy food, I poop blood. Why?Hi doctor, I am a 26 year old male. I am 5 feet and 9 inches tall and weigh 255 pounds. When I eat spicy food, I poop blood. Sometimes when I have constipation as well, I poop a little bit of blood. I am really scared that I have colon cancer. I do have diarrhea often. I do not have a family history of colon cancer. I got blood tests done last night. Please find my reports attached.[/INST]Hello. I have gone through your information and test reports (attachment removed to protect patient identity). So, in view of that, there are a couple of things that I can opine upon: Hope that helps. For more information consult a general surgeon online --> https://icliniq.com./ask-a-doctor-online/general-surgeon </s>

<s> [INST] Will Kalarchikai cure multiple ovarian cysts in PCOD?Hello doctor, I have multiple small cysts in both ovaries (PCOS). Our family friend suggested me to consume Kalarchikai medicine, powdered mixed with pepper and honey to have it for one mandalam (48 days). I have completed nearly 44 days by consuming one small ball of the mixture every morning and before two weeks I got my periods. Then I had checked whether the cysts were dissolved by having an abdomen scan. But still, small multiple follicules have been seen in it with both ovaries enlarged. Kindly suggest me what I can do further. I got married before one and a half years and I am much worried about my pregnancy. I have gallstones as well.[/INST]Hello. I just read your query. See Kalarachi Kai choornam is helpful in amenorrhea. As far as small cysts are concerned they are unmatured eggs which failed to induce menstrual cycle previously, as a result, they got collected in the ovary and they will remain in the ovary. Now, you have got your periods you can start trying for conception. But I advise you to do it under the supervision of a nearby gynecologist because egg size is important while conception and that you can know by ovulation study. Ovulation study is performed under the supervision of a gynecologist. For gall stones, surgical intervention is required generally. Medicine is not of much help. </s>

<s> [INST] I masturbate only by rubbing the tip of the penis. Is it a wrong way?Hi doctor, During masturbation I just rub the tip of the penis and not the entire penis. Is it a wrong way of doing? I do not get excited during sex and unable to ejaculate. Only, rubbing the tip of the penis gives me excitement. Also, two weeks ago, I have undergone circumcision as my foreskin did not retract. Before circumcision too, I have the same problem. Please help.[/INST]Hi. For further doubts consult a sexologist online -->https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Please give some advise to regain the strength of my knees.Hi doctor, I am 18 years old. I have a little problem that effects my daily hobbies. I play basketball and play in such a way that I am constantly running and jumping at maximum effort each time. When I was a little bit younger, I had a pretty bad case of Osgood-Schlatter disease. It was from constant running and jumping because I have always wanted to jump high ever since I was like 8. Now the problem is, I cannot jump and run without starting to hurt or mainly feeling very low on explosiveness. I stretch very well and I exercise my legs very often. I just wanted to know if there was any advice to regaining the strength back in my knees.[/INST]Hello. Strenuous activities. X-ray would be helpful if not improved with conservative management. Infrapatellar bursitis. Avoid jumping and running when acute pain is present. Revert back after two weeks to an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist </s>

<s> [INST] Is CABG the only solution for coronary artery disease?Hi doctor, My father is diagnosed with coronary artery disease and triple vessel disease with LM. I have attached the angiogram report for your reference. Is the CABG only solution or partial stenting may work? Or is it fine to give only the medication as there are not much clinical symptoms? His TMT was strongly positive. He is a smoker and also takes alcohol. He is a blood pressure patient and takes Amlopress, Telma and Ecosprin.[/INST]Hi. I have carefully reviewed your health query and feel sorry for your father's health issues. It is a concerning disease process. I never recommend to leave it as such and do nothing much for an advanced coronary artery disease. He has got triple vessel involvement and in such circumstances the best next step is to go for CABG surgery (coronary bypass graft) especially if there is no obvious contraindication. No, partial angioplasty is not a solution to the problem. Although he has no obvious signs or symptoms, but you should know well that the disease inside has progressed much and anytime with or without strenuous physical activity he may get a severe heart attack that can be really dangerous and lethal. I would go with the suggestion of CABG right away. For further information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist </s>

<s> [INST] I am feeling dizzy and extremely hot. What to do?Hello doctor, The following event has happened twice. I start feeling dizzy and extremely hot. I can feel my body heat through my shirt. I feel nauseated and was about to faint. Oddly, today, when I went to the kitchen to check my food in the microwave, I opened the fridge instead. When I tried to cut lettuce, I grabbed a spoon. I am not sure if that was a coincidence. I got anxiety after these incidents. After lying down in front of the air conditioner, I feel better. Also, cigarettes seem to intensify my feeling. Please help.[/INST]Hi. I think the main thing to consider is whether this is something significant related to any cardiac or circulatory problems or whether this is something relatively minor. I would certainly suggest you visit your GP or family doctor. You will need to undergo an ECG (electrocardiogram) of your heart to determine its underlying rhythm. You will need your blood pressure and heart rate checkup, along with your blood sugar level. Given that it has happened recurrently now, your doctor may want to send off some blood tests such as your blood count to check your hemoglobin level to make sure you are not anemic, along with your electrolyte levels to ensure that there are no endocrine abnormalities. ECG, observations (heart rate and BP) and blood glucose. 1.Cardiogenic arrhythmia. 2. Presyncope. 3. Endocrine dysfunction. Cardiac presyncope or faint. Keep well hydrated, eat safely to maintain blood sugar and avoid alcohol, smoking and drugs For further information consult a general practitioner online.---> https://www.icliniq.com/ask-a-doctor-online/general-practitioner </s>

<s> [INST] What treatment would you suggest for my father's shoulder condition?Hi doctor, I am enclosing an MRI report of my father who is 70 years old. I want to know whether an operation is the only available option for his shoulder condition according to the report. If we go for the operation, then what is the success rate? Without an operation, how long will it take to get cure? He takes Telma 40 and Ecosprin 150 V regularly because four years back, he had a paralysis attack.[/INST]Hello. I have gone through the MRI report enclosed by you (attachment removed to protect patient identity). Degenerative condition or post injury. As per clinical examination. For further information consult an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist </s>

<s> [INST] Can you suggest a cream or an ointment for dark circles?Hi doctor, I am a 24 year old male. I have severe hyperpigmentation around eyes. My eyes always feel tired. Also, I have this white mucus in my eyes daily when I wake up. Please help.[/INST]Hello. I can understand your concern. Revert back with the answers to the above question to an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist </s>

<s> [INST] What to do for bleeding piles?Hi doctor, I had my kidney transplant two months ago. Now, I am suffering from piles. Can you suggest me some medicine?[/INST]Hi. Revert back with the answers to the above questions to a nephrologist online -->https://www.icliniq.com/ask-a-doctor-online/nephrologist </s>

<s> [INST] I am under a great stress about my life and feel unworthy with extreme mood changes. Please help.Hello doctor, I am 18 years old. I am under great stress about many areas of life like family, career, and personal satisfaction. I think I am not worthy enough and I do not like the way I look. I think I am ugly and at times I hate myself for who I am. I feel unworthy and do not deserve for what I have been given (good school, facilities, luxury). Also, I have an imaginary friend whom I talk to many times during the day and share my problems with him. I do not feel fine. I experience extreme mood changes from happy to sad.[/INST]Hello, Welcome to icliniq.com. What are your symptoms exactly? If they are of depression, then the treatment with an SSRI (selective serotonin reuptake inhibitor) is ideally given for six months or so. Basically, if you are depressed, you will feel irritable, low, feel like crying, sad, do not wish to eat, have difficulty sleep, there can be anxiety, tiredness, headaches, etc. In bipolar illness, there will be a period of these depressive symptoms and then after a period of normalcy, the reverse happens. That is, you feel unusually happy for no reason, there are episodes of spending money excessively on things which you do not need, or maybe excessive use of alcohol, other illicit drugs, sex, irritable behavior, decreased need for sleep and still feeling fresh, grandiose talks and ideas, many non-goal directed activities, etc. So if you have not had the manic/hypomanic phase, then you probably suffered from major depressive disorder or generalized anxiety disorder. You will need to consult with a psychiatrist and take medicines for the same. It will surely help with your symptoms. </s>

<s> [INST] Please interpret echo taken for lightheadedness, chest pain, and shortness of breath.Hello doctor, A 56-year-old patient went to his physician for evaluation of recurrent episodes of lightheadedness, chest pain, and shortness of breath with exertion. One week earlier, he experienced an episode of syncope while walking up the stairs of his house. Vitals: Heart rate - 116 bpm, BP - 164/102 mmHg. Respiratory rate - 18. Weight - 247 lbs. Laboratory exams: Troponin level - normal, hypercholesterolemia, hypertriglyceridemia. Imaging: Doppler echocardiogram demonstrates a significantly stenotic aortic valve and plaques within the coronary arteries. From the given information, which among his findings show abnormal results? What is the possible diagnosis of the patient? What type of muscle tissue is associated? What type of valve is the aortic valve and cite its function? How does the plaque build-up affect the function of the coronary arteries?[/INST]Hello. Did he lose consciousness while walking upstairs? Is he a diabetic? His cholesterol report seems abnormal, along with hypertension and uncontrolled blood pressure. His color Doppler report showing aortic stenosis. Possible diagnosis is age-related atherosclerosis with severe aortic stenosis with dyslipidemia and hypertension. No muscle tissue involved. The major blood vessel called aorta is narrowed. Aortic valve is a tricuspid semilunar valve that allows oxygenated blood from the left atrium into it. It will supply blood to all parts of the body. Due to age-related atherosclerosis (dyslipidemia and hypertension aggravate it). </s>

<s> [INST] I get blood in stools with constipation, but there is no pain. Please help.Hello doctor, I am 22 years old and I have a problem of blood in the stool for two days. I do not feel pain and any other symptoms but sometimes constipation exist and my long toilet interval is once every two days (most common). Sometimes rarely on every day or three days interval. Are there any home remedies and is it normal?[/INST]Hello. Constipation is very common due to the active lifestyle considering your age and history. The blood in stools can be due to chronic constipation. As it does not pain while you pass stool it confirms constipation. To prevent constipation you should drink more water, considering summer season 3 to 4 liters should be good. Include fiber rich food like oats, corn flakes, and fruits like banana, apple, and watermelon. Try having some of these food for dinner. And if you eat nonvegetarian foods make sure you eat an equal amount of green vegetables with it. On an Indian diet, you can have roti instead of white rice. Following this routine would surely improve your constipation. </s>

<s> [INST] I get stomach cramps with headache, loss of appetite, fever and diarrhea. Please suggest solution.Hello doctor, I am a 27-year-old female. I have severe headaches for the past two days wiht loss appetite, nausea, fever, diarrhea, and stomach cramps. I am taking Paracetamol for my problems. Please help.[/INST]Hi. Let me tell you that the symptoms described by you suggest that you have acute gastroenteritis. I suggest antibiotic Metronidazole 400 mg three times a day for five days and continue Paracetamol for pain and fever management. Avoid taking non-steroidal anti-inflammatory medication like Ibuprofen, Aspirin and Diclofenac. Take plenty of oral rehydration solution with water. Make sure that you get plenty of rest. Stop eating solid foods to let your stomach settle. Avoid dairy products, caffeine, alcohol, and nicotine. Avoid sugary, fatty or highly seasoned foods. I hope this helps. </s>

<s> [INST] What does abutment of the nerve root mean?Hi doctor,I am just wondering what is abutting and abutment of the nerve root means in a back issue. Please explain. What treatment is required for annular bulging and tear?[/INST]Hi. I have gone through your query with diligence and would like you to know that I am here to help you. For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist </s>

<s> [INST] Will Nano-Leo give permanent solution for erection problem?Hello doctor, I am 48 years old. I am experiencing weak erection and difficulty in sustaining the same. This condition was observed 10 years back. Also, there is premature ejaculation. Other physical ailments that I have are, I am suffering from hypertension and taking Amlopres-L (Amlodipine and Lisinopril) for the last 10 years, high cholesterol and triglycerides. My cholesterol level is 225 and triglyceride is 200 for the last 12 years. I used to do frequent masturbation in early age. I do have erection during morning hours many times, particularly after sound sleep or if I had long walk previous day. I am having Sildenafil 25 mg or 5 mg Cialis, which is effective enough. But, I wish to get rid of tablet support and live natural way. I consulted urologist today and he prescribed me Nano-Leo capsules and Modula 5 mg for 10 days. I wish to have your second opinion on this. Please guide.[/INST]Hi. For further doubts consult a sexologist online --> https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Every time I eat spicy food, I poop blood. Why?Hi doctor, I am a 26 year old male. I am 5 feet and 9 inches tall and weigh 255 pounds. When I eat spicy food, I poop blood. Sometimes when I have constipation as well, I poop a little bit of blood. I am really scared that I have colon cancer. I do have diarrhea often. I do not have a family history of colon cancer. I got blood tests done last night. Please find my reports attached.[/INST]Hello. I have gone through your information and test reports (attachment removed to protect patient identity). So, in view of that, there are a couple of things that I can opine upon: Hope that helps. For more information consult a general surgeon online --> https://icliniq.com./ask-a-doctor-online/general-surgeon </s>

<s> [INST] Will Kalarchikai cure multiple ovarian cysts in PCOD?Hello doctor, I have multiple small cysts in both ovaries (PCOS). Our family friend suggested me to consume Kalarchikai medicine, powdered mixed with pepper and honey to have it for one mandalam (48 days). I have completed nearly 44 days by consuming one small ball of the mixture every morning and before two weeks I got my periods. Then I had checked whether the cysts were dissolved by having an abdomen scan. But still, small multiple follicules have been seen in it with both ovaries enlarged. Kindly suggest me what I can do further. I got married before one and a half years and I am much worried about my pregnancy. I have gallstones as well.[/INST]Hello. I just read your query. See Kalarachi Kai choornam is helpful in amenorrhea. As far as small cysts are concerned they are unmatured eggs which failed to induce menstrual cycle previously, as a result, they got collected in the ovary and they will remain in the ovary. Now, you have got your periods you can start trying for conception. But I advise you to do it under the supervision of a nearby gynecologist because egg size is important while conception and that you can know by ovulation study. Ovulation study is performed under the supervision of a gynecologist. For gall stones, surgical intervention is required generally. Medicine is not of much help. </s>

<s> [INST] I masturbate only by rubbing the tip of the penis. Is it a wrong way?Hi doctor, During masturbation I just rub the tip of the penis and not the entire penis. Is it a wrong way of doing? I do not get excited during sex and unable to ejaculate. Only, rubbing the tip of the penis gives me excitement. Also, two weeks ago, I have undergone circumcision as my foreskin did not retract. Before circumcision too, I have the same problem. Please help.[/INST]Hi. For further doubts consult a sexologist online -->https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] I have sinusitis with polyp in right maxillary sinus. Please help.Hi doctor, I am a 31-year-old male. I have sinusitis for almost five years. Also, there is polyp formation in the right maxillary sinus. When I inhale to get relief from nasal congestion and it starts irritating with inflammation. Any advice?[/INST]Hi. We have to first ascertain as to why sinusitis has occurred in the first place. Usually, in most cases, the primary cause is a seasonal or year around allergic problem that is there. Just to make you understand I have tried to explain things in a simple way below. Exposure to dust (or any irritative substance that your body is hypersensitive to) will initially initiate reflexes such as sneezing to remove the offending agent out but if this fails, mucosal cells in you nose start to hyperfunction producing loads of mucus to trap dust (owing to its sticky nature), this mucus has no where to go other than either being blown out of due to mucociliary activity gets pushed into the throat, thereby entering into a new zone. The throat initially reacts by activating cough impulses to push out the mucus, but if that fails, a local inflammation around the throat starts which often leads to symptoms such as feeling of a lump in the throat and repeated feeling to clear the throat. As far as your nose is concerned, due to long standing inflammation, the mucosa starts to get edematous and ends up forming a polyp. I know the problem is there since a long five years, but I am not sure if you have followed any specific treatment chart which is usually recommended before we consider any patient for surgery. This treatment chart is custom made according to your symptoms and does follow the guidelines to treat both allergy with sinusitis. The following things can be considered. 1. Wear an n95 mask at all times, do not allow any dust or irritative substance from entering into your nose. This is the most important thing you should be following failing which, no treatment will bring any relief. 2. Tablet Sinarest (Paracetamol + Phenylephrine hydrochloride + Chlorpheniramine maleate) one tablet twice daily after food 12 hours apart for 15 days. 3. Tablet Allegra M (Fexofenadine and Montelukast) one tablet twice daily after food 12 hours apart for 15 days. 4. Tablet Zerodol TH (Aceclofenac and Thiocolchicoside) 4mg (or its equivalent) one tablet twice daily after food for five days. 5. Tablet Clarithromycin 500 mg one tablet twice daily after food. 6. Duonase nasal spray (or its equivalent) two puffs two times a day in both nostrils for three months (do not inhale while you spray the drug). 7. Tablet Mucomix 600 mg (Acetylcysteine) one tablet twice daily for 1 week. 8. Tablet Wysolone (Prednisolone) 10 mg one tablet after breakfast for 10 days. 9. Steam inhalations 3 to 4 times a day. 10. Saltwater gargles at 8 to 10 times a day for one month. 11. Do not smoke or consume alcohol as it slows down mucociliary clearance mechanisms. All precautionary measures have to be followed strictly for maximum relief, otherwise, medications would not be useful on the long term. Surgery can be considered (if above medications and precautionary measures do not give any relief), but there is a catch to it. The symptoms might come back sometimes even on a higher scale after a brief relief following surgery if the precautionary measures post surgery are not followed. Ideally speaking in a nutshell, I again emphasis on preventing any irritative substance from entering the nose and throat, thereby triggering an allergic cascade of events and reproducing the symptoms you have mentioned above. As far as the polyp is concerned, in very few cases the polyp resolves on its own with medications and often the patient requires a surgery called functional endoscopic sinus surgery where the sinus openings are widened and the polyps are removed. You will have to get a CT scan done to see the extent of the polyp, current condition of the other sinuses and anatomical variations in the nose which could have been contributing to the polyp. I hope this helps. </s>

<s> [INST] My bilirubin level keeps on increasing with negative hepatitis test. What is my problem?Hello doctor, I have jaundice. My biliurubin was 7.5 three weeks ago. I went to the doctor for jaundice. Weekly blood tests as of three weeks show bilirubin has been increasing. Hep test shows I do not have hepatitis. Ultrasound says no tumor bile duct coverage or stones. I took a CT scan and the results show there is no obstruction and pancreas is normal. In other words my body parts are normal. In two weeks, I will see a gastroenterologist. What do you think I have? I will probably have more blood tests this Monday to check bilirubin levels. I am currently on Hydroxyzine HCl.[/INST]Hello. Well, your US (ultrasound) and CT (computed tomography) scan are normal which is kind of satisfying to me. Of course you suppose to have more blood tests to confirm the origin of this jaundice. Hepatitis, although common, but they are not the only one to cause liver problem there are many other causes such as nonhepatotrophic virus infections as herpes virus, Ebstein Barr virus, cytomegalovirus. Non-viral causes are Wilson hemochromatosis, alpha-1 trypsin deficiency. The causes of predominantly raised bilirubin (jaundice) with normal CT scan suggest microscopic primary sclerosing cholangitis, primary biliary cholangitis benign and progressive familial intrahepatic cholestasis. The hepatologist will start from blood tests first and at times can be recommended liver biopsy if the blood test does not serve the purpose. It is possible that you have one of the above or not any of the above. The reason is it is always important to have a clinical history then targeted blood tests and examinations before a hepatologist is able to give you one word specific diagnosis. Deranged liver function tests. Deranged liver function tests. After establishing a diagnosis. Follow up if want to provide more information and discuss the right approach to each and everyone of above disorders. </s>

<s> [INST] Can periods cause loose stools?Hello doctor, Loose stools that are yellowish in color. Only minor abdominal cramping that feels like a period cramp (due to having period for the past two days). Taking oral contraceptive. Abdominal cramping is not continous. Only been occuring for 24 hours.[/INST]Hello. I need to know whether the loose stools are really having organic cause or just secondary to functional changes occuring with time of periods. Loose stools are said when stool volume is more than 200 ml in a day, semisolid to liquid in consistency. Mild abdominal cramping is common when one approaching menstruation, a condition is called premenstrual syndrome which is common condition with various symptoms, not necessarily related to female genital tract. But accompany with emotional and physiologic changes in to abdomen, skin, body blood circulation. You just make sure, that you take home made well cooked diet. Otherwise no need of any investigation or medicine for now. Take oral rehydration solution ORS in one liter of water, and take 200 ml to 300 ml every time you have loose stools. I could have helped you much if you have provided some more information about that pain and quantity of stools. Well, onset for 24 hours, mild cramping, does not show any alarming symptoms. So do not worry. You can take a gynecologist opinion on this. Take care, have a good day. Nonspecific abdominal cramp and loose stools? Food poisoning? Premenstrual syndrome? Follow up with gynecologist </s>

<s> [INST] Kindly explain the management of gallstone.Hi doctor, I have a single gallstone. I am not facing any symptoms but about last week I felt a severe and intense pain in stomach and immediately to back which continues until I had an Decloyran injection. This pain did not spread over the abdomen. When we met the doctor he checked very carefully and said that it was not the pain of gall stone. The doctor asked for an ultrasound and in ultrasound the stone was in its place. No inflammation or fluid accumulation. Gall bladder size was normal. The doctor said that the pain was due to twist of certain veins and is not due to gallstone. I want to ask that whether twisting of vein can cause pain? Is it necessary to do operation? Is there any way to remove single gallstone?[/INST]Hello. So starting from answering your first question. The pain of twisting of veins is an strange term in itself. Why would veins twist around in a healthy young lady with no previous significant medical history. So I do not believe this. Second, the gall bladder is not removed in asymptomatic gall stones. Asymptomatic gall stones are those which do not cause symptoms, and the symptoms of gall stones occur usually when the stone size is 10 mm, if smaller than this, it is unlikely that your pain was gall stone related. Since you did not mention size of gall stones, otherwise it would have been easy to tell you whether it was cause of your pain or not. Other, the pain of gall stones has to be typical in nature; the pain which occur in right upper quadrant of the abdomen (at site of your liver), pain starts suddenly mostly after half hour of meals, peaks within 1 hours, and then starts settling in next 4 to 6 hours. Vomiting and nausea can frequently accompany with this pain. If you have that typical type of pain, then it may be from gall bladder. Your third question. The answer is no. No drug therapy can prevent from formation of stones or dissolution of stone. There are some therapies which are used as in experience, but they are not recommended at all. If gall bladders stones are symptomatic then they has to be removed by doing gall bladder resection via laparoscopy. If not symptomatic, then no need of any drug or surgical therapy. Having said that, elective gall bladder resection is indicated among patients who could not bear the risk of cholecystitis, such as pregnant ladies with size of stones more than 10 mm, or patients with smaller gallbladder stones but having pancreatitis. Stone but without symptoms and presence of gall bladder polyps. These three types of patients can have surgery despite no symptoms. Gall bladder stones Gall bladder stones Follow up to discuss plan of action in your case from now onwards. Ruling out other causes of your abdominal pain, on history and some preliminary investigations. </s>

<s> [INST] Is it possible to get daily headaches due to degenerative disc disease?Hi doctor, My husband is a 38-year-old male who smokes and has degenerative disc disease from several car accidents. No real treatment has been given to him aside from chiropractic visits to reveal tension in his lower back. He does have many stresses with work and home life and is seeing a counsellor due to depression. About a month now, he has experienced daily headaches that would not go away. Often his headaches are accompanied by nausea and vomiting. He has light sensitivity. And I am sure also working on a computer adds to it. Often he feels the headache and it is manageable. But there are times he feels it more. Just the other day he was having what he said was a cluster headache. He is scheduled for a MRI. But I am extremely concerned it is a tumor or something bad. Any thoughts or opinions would be appreciated. Does Degenerative Disc Disease cause daily headaches?[/INST]Hello. Your husband having intermittent headaches which are more looks like migraine then cluster headache from your description. Hence I want to clarify some points. Is that headache is very very severe? Please rate the severity from 0 to 10 where 0 is no headache and 10 is worst headache. Once headache starts it remains for how long? Is there one eye pain, tearing, redness, nasal discharge during headache? Yes, MRI is needed as it is daily headache since 1 month with some odd features. Send me the details of medication currently he is taking including pain relievers. Yes, MRI is normal then it is primary headache like Migriane or Cluster headache and it is curable. Degenerative spinal disease rarely cause headache and in your husband's case it is not the cause. </s>

<s> [INST] I get popping in ears after frequent flight journey. Is this due to infection?Hello doctor, I have flown very often in the last few years. I forgot to wear earplugs and slept on a few flights recently. On the last two trips, I had multiple flights connecting. I noticed my ears did not stop popping after a few days. Since my last flight, my right ear has not cleared up. It used to be at night my ear would pop and get better during the day. Now my right ear has lost hearing, I would estimate about 50% and fluctuates between 50% to 75% during the day. When it is totally silent, I think I hear this tone in my right ear. I do not have headaches and can sleep fine. I have gingivitis and bleeding gums, and no other health issues. I was wondering if my ear is infected or not. I know whatever I have is connected to my frequent flying every two months for the last five years. I always wore earplugs and never had this before but forgot the last trip. Should I take antibiotic drops? I definitely have mucus in my sinus and I am not sneezing or coughing in any major way just and not sure if I am infected or not. Would antibiotic drops help me rule out infection?[/INST]Hello. Simply it is a eustachian tube dysfunction. Ear infection which needs an antibiotic must be accompanied by ear pain. Ear drops do not have any role in the treatment of middle ear infections. I think that you need an anti-edematous and anti-inflammatory like Alphintern tablets or Reparil tablets three times daily for a week plus corticosteroid tablets in the dose of 1 mg for each 1 kg of your body weight daily. For example, if you are 70 kg you need 70 mg of corticosteroid per day for 10 days.The most popular corticosteroid is called Prednisone tablets. Chewing gum will be useful for you. </s>

<s> [INST] I get hives on thighs whenever the climate is hot. How long can I take Claritin?Hello doctor, I am a 17-year-old female. I believe that I have hives on my thighs. I have them for about five to six days and they appear whenever the area gets hot. I was using a blanket last night and the hives got red again but when it is cold, they are not red and appear to be my skin color. I used Hydrocortisone the first three days and it helped, and I was also wearing tight leggings while working all day. The last two days, I have been taking Claritin and it has helped because the area is no longer itchy but the hives and bumps are still there. Should I take Claritin tonight too? How do I get rid of the bumps? I assume that I should not keep on using Claritin since I have used it for two days already.[/INST]Hi, Welcome to icliniq.com. It looks that you are suffering from acute urticaria. This could happen as a result of an allergic reaction to blanket dust or furs in it. There are other causes as well. Is this the first episode? Or you get them frequently? Any history of diabetes or thyroid? Any history of any medicine taken recently for some other issues? Until you reply, you can take Clairtin (Loratidine) dose again. No problem with that. I hope this helps. </s>

<s> [INST] I am a 13 year old male. How to assess my present stage of puberty?Hi doctor, I am 13 years old. I have been curious about puberty and height. I am currently 5 feet 6 inches and really insecure about my body and height. I feel very hairy and fair. I have been researching tanner stages of development and I am around tanner stage 4. I have hair around my inner thighs, I can grow a slight mustache in three weeks, I have line of hair from my testicles to my belly button forming. I have little hair around my nipple and some hair on my underarms. I have lots of leg hair and a medium amount of arm hair, my penis is 6.5 inches erect and 4 inches flaccid. I have attached a photo. I wear a shoe size of 11. How tall can I expect to be and how far into puberty really am I? I also have hairy parents.[/INST]Hi. I appreciate your efforts of going into the details about puberty and its effects on the body. You have done quite a bit of research. You only need to understand a few more things. First, not everybody’s body responds the same way to puberty. The genetic makeup has a big influence on it. Your final height depends on your parents’ height, lifestyle diet, physical exercise, and also mildly influenced by the mindset and environmental factors. Generally, boys grow up to 18-20 years of age unless the growth is arrested by early puberty. By your description, your puberty is just setting in, which is normal for the age. Now, your final height will depend on your diet and physical activity. It is possible that you might add another 4-5 inches to your height. </s>

<s> [INST] I have severe rib pain and it hurts more while standing and taking deep breaths. Please help.Hello doctor, I am having severe rib pain since this morning and it hurts when I stand up straight or when I move or lay down. I tried putting a heating pad and ice pack on it and did not do anything. I feel extreme discomfort, cannot take deep breathes, and feel sharp stabbing pain once in a while.[/INST]Hello. There are many conditions where we can get chest pain along with ribs pain. I would like to ask a few questions. Is that pain on costochondral junction which means if you palpate your ribs you can feel there is one gap and then the other rib is started. So pain in that region is costochondritis but the pain is like neurogenic pain sharp and localized (at specific). Does that pain radiates to the tip of shoulder or not? Is the pain associated with other symptoms like palpitation? Had you done exercise one day before and got pain? Meanwhile, I would recommend you start one drug and let us work on your problem. Also, remember anxiety and panic attacks can cause symptoms very similar to angina. These attacks which can occur out of the blue or in response to a stressful event include chest pain along with shortness of breath, palpitations, and dizziness. Take tablet Parafon Forte (Chlorzoxazone) 500 mg per oral three daily after food for three days. This prescription for you helps relax certain muscles in your body and relieve the discomfort caused by acute (short-term), painful muscle, or bone conditions. </s>

<s> [INST] My penis is like an hourglass and bends in a weird way while erect. Is this Peyronie's disease?Hello doctor, I am a 24-year-old male. I have noticed that my penis gets really narrow in the middle like an hourglass and bends in a weird way when half erect or in the process of getting erect. It gets completely normal when fully erect though and there is no pain. This happens once every few days. Should I be worried? I have tried searching online and the closest result is Peyronie's. However, in Peyronie's the erect penis gets the hourglass shape with pain but in my case erections are just fine. Any help would be greatly appreciated as I am quite worried.[/INST]Hi. After reviewing your history, it seems to me Peyronie’s disease but I need pictures (flaccid, partial, and complete erection) from you to confirm it. Presentation is secondary to fibrosis in tunica Albuginea causing curvature of penis on erection to variable degrees. It starts with inflammation and pain but will stabilize and become painless with time over approximately six months. Its causing factors are not exactly known but related to microvascular injury and healing with fibrosis is more common in diabetics and might be secondary to autoimmune diseases. Diagnosis is made purely on clinical grounds by history examination and pictures. Treatment ranges from medications to local injections to surgery which is reserved for significant deformity and curvature. I would be grateful to further diagnose and follow up on you. Please send me pictures to support the diagnosis before I make a strategy for your treatment. Provide pictures. </s>

<s> [INST] What does abutment of the nerve root mean?Hi doctor,I am just wondering what is abutting and abutment of the nerve root means in a back issue. Please explain. What treatment is required for annular bulging and tear?[/INST]Hi. I have gone through your query with diligence and would like you to know that I am here to help you. For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist </s>

<s> [INST] Will Nano-Leo give permanent solution for erection problem?Hello doctor, I am 48 years old. I am experiencing weak erection and difficulty in sustaining the same. This condition was observed 10 years back. Also, there is premature ejaculation. Other physical ailments that I have are, I am suffering from hypertension and taking Amlopres-L (Amlodipine and Lisinopril) for the last 10 years, high cholesterol and triglycerides. My cholesterol level is 225 and triglyceride is 200 for the last 12 years. I used to do frequent masturbation in early age. I do have erection during morning hours many times, particularly after sound sleep or if I had long walk previous day. I am having Sildenafil 25 mg or 5 mg Cialis, which is effective enough. But, I wish to get rid of tablet support and live natural way. I consulted urologist today and he prescribed me Nano-Leo capsules and Modula 5 mg for 10 days. I wish to have your second opinion on this. Please guide.[/INST]Hi. For further doubts consult a sexologist online --> https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Every time I eat spicy food, I poop blood. Why?Hi doctor, I am a 26 year old male. I am 5 feet and 9 inches tall and weigh 255 pounds. When I eat spicy food, I poop blood. Sometimes when I have constipation as well, I poop a little bit of blood. I am really scared that I have colon cancer. I do have diarrhea often. I do not have a family history of colon cancer. I got blood tests done last night. Please find my reports attached.[/INST]Hello. I have gone through your information and test reports (attachment removed to protect patient identity). So, in view of that, there are a couple of things that I can opine upon: Hope that helps. For more information consult a general surgeon online --> https://icliniq.com./ask-a-doctor-online/general-surgeon </s>

<s> [INST] Will Kalarchikai cure multiple ovarian cysts in PCOD?Hello doctor, I have multiple small cysts in both ovaries (PCOS). Our family friend suggested me to consume Kalarchikai medicine, powdered mixed with pepper and honey to have it for one mandalam (48 days). I have completed nearly 44 days by consuming one small ball of the mixture every morning and before two weeks I got my periods. Then I had checked whether the cysts were dissolved by having an abdomen scan. But still, small multiple follicules have been seen in it with both ovaries enlarged. Kindly suggest me what I can do further. I got married before one and a half years and I am much worried about my pregnancy. I have gallstones as well.[/INST]Hello. I just read your query. See Kalarachi Kai choornam is helpful in amenorrhea. As far as small cysts are concerned they are unmatured eggs which failed to induce menstrual cycle previously, as a result, they got collected in the ovary and they will remain in the ovary. Now, you have got your periods you can start trying for conception. But I advise you to do it under the supervision of a nearby gynecologist because egg size is important while conception and that you can know by ovulation study. Ovulation study is performed under the supervision of a gynecologist. For gall stones, surgical intervention is required generally. Medicine is not of much help. </s>

<s> [INST] I masturbate only by rubbing the tip of the penis. Is it a wrong way?Hi doctor, During masturbation I just rub the tip of the penis and not the entire penis. Is it a wrong way of doing? I do not get excited during sex and unable to ejaculate. Only, rubbing the tip of the penis gives me excitement. Also, two weeks ago, I have undergone circumcision as my foreskin did not retract. Before circumcision too, I have the same problem. Please help.[/INST]Hi. For further doubts consult a sexologist online -->https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] My lipid profile is deranged with high triglycerides. Should I start on medication?Hello doctor, I am 34 years old. My lipid profile shows: Total cholesterol 154 mg/dL HDL 26.8 mg/dL LDL 67.9 mg/dL Triglyceride 298 mg/dL FBS is 95mg/dL and RBS 132 mg/dL. Blood pressure 146/82 mmHg. Can I use the cholesterol medicine for triglycerides?[/INST]Hi. I can understand your concern. According to your statement, you have been suffering from back pain and hypertriglyceridemia with low HDL (high density lipoprotein) level. You have a high VLDL (very level density lipoprotein) level too. For your abnormal lipid profile level, you should avoid fatty foods and dairy products. You can take Fenofibrate for your high triglycerides level along with Omega-3 fatty acid for your low HDL level. Continue these medications for abnormal lipid profile and do repeat your lipid profile after three months later. For your back pain, you can take Naproxen with Baclofen, Calcium with vitamin D supplements. So you can continue the medications as follows. Capsule Lofibra (Fenofibrate) 200 mg 0+0+1 (after meal), tablet Naprosyn 500 mg 1+0+1 (after meal) for 10 days, tablet Lioresal (Baclofen) 10 mg 1+0+1 for one month, tablet Carbocal D 400 0+1+0 for two months, capsule Bio Marine, Omega-3, and Fish oil 0+1+0 (continue), tablet Prevacid (Lansoprazole) 30 mg 1+0+0 (before meal) for one month. </s>

<s> [INST] My 40-day-old son has undescended left testis. Will it come down on its own or surgery required?Hello doctor, My 40-day-old son's left testis is undescended. Sonography shows his testis on the upper end of the inguinal canal. Please suggest whether it will come down naturally.[/INST]Hi. According to the report you have sent (attachment removed to protect patient identity), the child has left-sided undescended testis. It is a common practice to wait until the baby is six months old before operating. There is a small chance that the testis might descend on its own by six months. They usually do not descend after six months and also the risk of that testis becoming nonfunctional if waited beyond six months is high. Another thing is, there is a small risk of that testis becoming cancerous if it is not operated within one year. So, your child will need a surgery orchidopexy by about six months of age if it does not descend spontaneously. Follow up at 6 months of age. </s>

<s> [INST] If gallbladder stones are not removed shortly, will it turn cancerous?Hello doctor, My friend is having a gall bladder stone. We consulted few doctors, some are saying the immediate operation is needed otherwise it will be cancerous and some are saying no immediate action is required. She is having pain in her right side of the upper abdomen and also in the middle. I am attaching her ultrasound report. Please tell me about her condition. During this pandemic, we are not able to go outside and consult the doctor.[/INST]Hello. I can understand your concern about symptoms complex and ultrasound findings and whether surgery is the answer to your problem. Well, first of all, I want to clear that you do not have stones in the gallbladder. They are concretions. It is a medical term and they are called microlithiasis (gall bladder stones less than 3 mm in size). So the possibility of developing cholecystitis (gall bladder inflammation) is very low. However, this microlithiasis can cause pancreatitis (inflammation of the pancreas which is a gland sitting over the back of the abdomen). Thirdly, the pain can be secondary to the functional gall bladder problem, where the gall bladder is naturally slow resulting in damping of bile (yellow secretion produced by the liver and stored within gallbladder) and production of small concretions such as in y our case. So I would ask you to get a few blood tests to confirm whether you have pain due to pancreatitis. I also want that you should discuss to me in more detail about your pain, as only proper history can give me a clue towards your problem whether gall bladder inflammation, pancreatitis, or functional gall bladder disorder even before any further testing. Since the ultrasound findings and your symptoms are not correlated very well, there is no point in discussing the role of surgery. But I just want to assure you that you probably need no surgery, so do not worry about it. I suggest you some tests, please get it done, then I would recommend you some lifestyle changes and a medical treatment that can help you resolve your minor stones within the gallbladder. I hope this helps. Pancreatitis. Cholecystitis. Peptic ulcer disease. Functional gallbladder disorder (gallbladder dyskinesia). Complete blood count. Serum amylase and lipase. Liver function tests. TSH (thyroid-stimulating hormone). Start capsule Esomeprazole 40 mg half an hour before meals once daily for now. Follow up after investigation. </s>

<s> [INST] I have elevated lipid profile and low vitamin D. Should I start medicines?Hello doctor, I am 39 years old. Recently I have done some health check ups. The report shows my LDL cholesterol is 140, Triglycerides -165, HDL-30. Should I take any medicine? Or should I start walking or exercise? My vitamin-D level is 20.15. What medicine should I take for my low levels of Vitamin D?[/INST]Hello. I have gone through your reports (attachment removed to protect patient identity). Your lipid profile and liver enzyme ALT are deranged and Vitamin D is low. For low Vitamin D, you should have tablet Uprise D3 (or Calcirol sachet) 60,000 units once a week with milk for eight weeks. After eight weeks, you should have it once a month for the next six months. Now the liver enzyme is deranged likely due to fatty liver, which is related to deranged lipid profile. You should get an ultrasound of liver to confirm it. Now since LDL (low density lipoprotein) is moderately elevated, you may give a try of a healthy lifestyle. So you should have a healthy lifestyle like avoiding fatty, oily, high calorie foods. Avoid fried, fast food, egg yellow, non veg consumption, and avoid excessive oil. Do not reuse the cooking oil once used for frying. Have regular exercises like brisk walking or running according to the capacity for atleast 30 minutes a day. Repeat lipid profile after eight weeks and if there is a response then should continue a healthy lifestyle or else will medications like tablet Atorva (Atorvastatin) 10 mg bedtime once daily for six to eight weeks. I hope this helps. </s>

<s> [INST] I have troubled gut with gas, constant rumbling in stomach, and frequent burps. Please help.Hello doctor, For the last year or so I have been experiencing a troubled gut, gassy disposition, constant rumbling in the stomach, and frequent burps. Since then I have stopped consuming lactose, heavy foods such as cheese, full-fat milk, and paneer since but my stomach is still unsettled a year on. I have also noticed that over the last three months my skin has been breaking out on the chin, forehead, and cheeks. This coincides with the start of the lockdown where I live. I have never experienced acne or other skin issues before. My diet has remained the same vegetarian, lactose-free, a decent amount of fruits and veggies, next to no sweets, ghee, butter, chapatis, and rice. I do not smoke at all and drink very infrequently. I do not skip meals. I do not take supplements currently, only Cod liver oil capsules for immunity for the last 5-6 years. How do I improve my gut health and does it have anything to do with my sudden skin problems?[/INST]Hi. If your gut is not normal, it will definitely affect your skin. First thing, include a lot of probiotics in your diet. Take two cups of curd daily. Have small frequent meals like two to three hours eat something. Your meal should be breakfast, lunch, and dinner with two intermittent snacks. Include ghee every day in your diet. Add one or two teaspoons ghee with rice along with other accompaniments. Stop the Cod liver capsules completely. Supplements should not be taken for years together. Occasionally if you eat homemade sweets, nothing will happen. You can take it as your weight is very low. For in-between snacks, you can eat fruits, buttermilk (include every day), protein powder in the evening, channa, etc. Always have protein-rich foods in the morning hours and the later meal should be light. Avoid breads, bakery products, processed foods, sodas, rich sweets, junks, etc. Get a complete blood test done. Follow up after a week with your reports. </s>

<s> [INST] I am getting intense pelvic pain between 18-24 days of my cycle. Why?Hello doctor, I am 18 years old. And about five or six times in the past year, I have experienced intense, nauseating pain that I can only guess is ovarian, but I cannot find anything on the internet to really pinpoint it. It alternates sides, lasts for a couple of hours, and is always between days 18-24 of my cycle. This morning it lasted hours, the pain reaching from my left ribs to my pelvis, which felt like a lot of pressure and made it painful to urinate.[/INST]Hello. The pain you have been experiencing is most likely the ovulatory pain, typical to occur in the midcycle when one has regular cycles of 28-30 days, or if you have you menstrual periods of varying dates, you can observe that exactly 14 days prior to the menstrual period. It is called Mitterschmerz syndrome or pain. It is a normal phenomenon and usually mild but rarely it can be severe. As your pain has been severe today, it would be better to get an ultrasound done to rule out any other causes of your pain. If you had mentioned the date of your last menstrual periods, it would have been helpful. You can take antispasmodic medications and see if the pain gets relieved, But if it does not, then it would be better to seek emergency medical help. And I am assuming that chances of pregnancy have been ruled out, if not then please evaluate yourself (just in case if sexually active). I hope this helps. </s>

<s> [INST] My x-ray shows discontinuity in medial tubercle of talus. Please suggest treatment options.Hello doctor, I am 24 years old. Last month, I had a motorcycle accident. I did an x-ray and it is written in the result as: There are bone discontinuity seen in the medial tubercle of the talus of the calcaneus. Such can represent an incomplete linear fracture. No osseous reaction or radiopaque foreign body noted in the projection taken. Boehler angle 42°. What are the best over the counter medicines for my fracture?[/INST]Hello. Looking into your x-ray pictures (attachment removed to protect patient identity) and reading your problem, I got to know about linear undisplaced fracture of the talus. We need to understand the function of the talus bone and its role in the movement of ankle and foot. It is between the leg and the foot so that bodyweight may be transferred from the ankle to the leg, helping to walk while maintaining balance. The bone also helps in the movements of the ankle, and together with the calcaneus facilitates the movements of the foot. It has already been I think more than 15 days have to outcast or do immobilization of foot? It is needed to immobilize the foot and take some medicine. If you have swelling of moderate type then put splint for 10-14 days and convert to cast. Then we need to do check an x-ray around in four weeks and then in six weeks and see the final callus formation and healing. </s>

<s> [INST] My mother is suffering from a mental disorder for 24 years. Can she recover?Respected sir/madam, My mother has been suffering from mental disorder since 24 years (from my birth) . My dad took her to the hospital and undergone treatment also but no use , after up to 2 years prescribed medicine also used . It had been 20 year of not using any medicine and treatment . Since my birth i hadn't my mother's love and care . Now I want to get her treatment . Her condition right now she is healthy , don't remember anyone ,quiet calm , sometimes do whatever we told. Is there any chance to recover ? Please give me some advice as I don't know what to do?[/INST]Hello , I am sorry to hear about your situation. I can imagine how hard it must be for you. In your query you have not mentioned the diagnosis so I can't suggest exactly what needs to be done but I will explain how it works .. The fact that you mentioned that she doesn't remember anyone could be a part of 1. Dementia for which you would require a neurologist , Medications can help to an extent . 2. Psychosis or Depression can have such reactions , you will require a Psychiatrist for this . A complete evaluation is required , the doctor might do a CT/ MRI depending on the symptoms and start treatment accordingly and yes Medications can help to an extent depending on severity of the issue. One way is to get her treated on OPD basis ie at home with followuos with doctor , or you can opt for residential treatment facilities which keep the patient in the facility and there is a holistic approach to treatment where doctor , nurses , therapist , etc works as a team in recovery . I would need more information about symptoms or need to talk to your mother to be able to understand exactly what she is going through . I hope this helps .. Feel free to contact me if you have any questions. take care . </s>

<s> [INST] I have jaw pain because of an impacted wisdom tooth. What should I do?I'm having ache in lower jaw. Last time i visited dentist...i had a root canal same side After a month i started experiencing pain in that jaw sometimes... Doctor said root canal is fine and that i have impacted wisdom tooth after a quick x ray. I am having pain now again in that jaw after 3 months. What should i do? Due to covid 19 I'm not sure i should visit a dentist[/INST]Hello, welcome to iCliniq. This may be the pain from the same reason you had previously. If you have an impacted wisdom tooth, then that can cause you this kind of problem repeatedly. But if you have pain on biting, that may be from the root canal treated tooth. Do you have the xray? Can you send me a picture of the affected area and the xray ? In the meantime, you can rinse mouth with warm saline water 5-7 times daily. If the pain doesn't subside, you can take painkiller... Tab Ibuprofen (400mg) two times daily for 2/3 days (after meal) Please send me the pictures for proper diagnosis and better treatment plan. Thank you for contacting us. </s>

<s> [INST] I have back pain, tiredness, feeling sleepy, and foot inflammation. What could have caused all these?Hello doctor, I have back pain, tiredness, more sleepy feeling, and inflammation on the foot.[/INST]Hi. I can understand your concern. According to your statement, you have been suffering from back pain, tiredness, more sleepy feeling, and inflammation on foot. I have gone through your investigations (attachment removed to protect patient identity) result and found that your Vitamin D3 level is below normal, GGT (gamma-glutamyl transferase) level slightly high, HDL (high dentisy lipoprotein) level below normal, TG (thyroglobulin) and VLDL (very density lipoprotein) level significantly high, TSH (thyroid-stimulating hormone) level normal at the upper limit. Total leucocyte count with lymphocytes count slightly high, eosinophil count are significantly high. So your back pain, tiredness, more sleepy feeling with inflammation of foot may result from vitamin D3 deficiency. Clinical features of vitamin D3 deficiency are repeated infections, tiredness, back pain, depression, bone pain, muscle pain, fatigue, delayed wound healing, feeling sleepy, etc. Again high TG levels may cause abdominal pain, loss of appetite, nausea or vomiting, tiredness, fatigue, etc. Your high eosinophil count indicates that you may suffer from allergies. As your TSH level is normal at a higher limit, so you should repeat the thyroid function test within three months. For your vitamin D3 deficiency, you should need more exposure to sunlight for vitamin D3 synthesis as well as take vitamin D3 enriched foods and supplements. For your high TG level, you should continue Fenofibrate along with Omega-3 fatty acid for low HDL level and repeat your lipid profile test after three months. For your low back pain, you can take Naproxen with Esmoprazole combination with Baclofen and calcium supplements. </s>

<s> [INST] What does abutment of the nerve root mean?Hi doctor,I am just wondering what is abutting and abutment of the nerve root means in a back issue. Please explain. What treatment is required for annular bulging and tear?[/INST]Hi. I have gone through your query with diligence and would like you to know that I am here to help you. For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist </s>

<s> [INST] Will Nano-Leo give permanent solution for erection problem?Hello doctor, I am 48 years old. I am experiencing weak erection and difficulty in sustaining the same. This condition was observed 10 years back. Also, there is premature ejaculation. Other physical ailments that I have are, I am suffering from hypertension and taking Amlopres-L (Amlodipine and Lisinopril) for the last 10 years, high cholesterol and triglycerides. My cholesterol level is 225 and triglyceride is 200 for the last 12 years. I used to do frequent masturbation in early age. I do have erection during morning hours many times, particularly after sound sleep or if I had long walk previous day. I am having Sildenafil 25 mg or 5 mg Cialis, which is effective enough. But, I wish to get rid of tablet support and live natural way. I consulted urologist today and he prescribed me Nano-Leo capsules and Modula 5 mg for 10 days. I wish to have your second opinion on this. Please guide.[/INST]Hi. For further doubts consult a sexologist online --> https://www.icliniq.com/ask-a-doctor-online/sexologist </s>

<s> [INST] Every time I eat spicy food, I poop blood. Why?Hi doctor, I am a 26 year old male. I am 5 feet and 9 inches tall and weigh 255 pounds. When I eat spicy food, I poop blood. Sometimes when I have constipation as well, I poop a little bit of blood. I am really scared that I have colon cancer. I do have diarrhea often. I do not have a family history of colon cancer. I got blood tests done last night. Please find my reports attached.[/INST]Hello. I have gone through your information and test reports (attachment removed to protect patient identity). So, in view of that, there are a couple of things that I can opine upon: Hope that helps. For more information consult a general surgeon online --> https://icliniq.com./ask-a-doctor-online/general-surgeon </s>

<s> [INST] Will Kalarchikai cure multiple ovarian cysts in PCOD?Hello doctor, I have multiple small cysts in both ovaries (PCOS). Our family friend suggested me to consume Kalarchikai medicine, powdered mixed with pepper and honey to have it for one mandalam (48 days). I have completed nearly 44 days by consuming one small ball of the mixture every morning and before two weeks I got my periods. Then I had checked whether the cysts were dissolved by having an abdomen scan. But still, small multiple follicules have been seen in it with both ovaries enlarged. Kindly suggest me what I can do further. I got married before one and a half years and I am much worried about my pregnancy. I have gallstones as well.[/INST]Hello. I just read your query. See Kalarachi Kai choornam is helpful in amenorrhea. As far as small cysts are concerned they are unmatured eggs which failed to induce menstrual cycle previously, as a result, they got collected in the ovary and they will remain in the ovary. Now, you have got your periods you can start trying for conception. But I advise you to do it under the supervision of a nearby gynecologist because egg size is important while conception and that you can know by ovulation study. Ovulation study is performed under the supervision of a gynecologist. For gall stones, surgical intervention is required generally. Medicine is not of much help. </s>

<s> [INST] I masturbate only by rubbing the tip of the penis. Is it a wrong way?Hi doctor, During masturbation I just rub the tip of the penis and not the entire penis. Is it a wrong way of doing? I do not get excited during sex and unable to ejaculate. Only, rubbing the tip of the penis gives me excitement. Also, two weeks ago, I have undergone circumcision as my foreskin did not retract. Before circumcision too, I have the same problem. Please help.[/INST]Hi. For further doubts consult a sexologist online -->https://www.icliniq.com/ask-a-doctor-online/sexologist </s>